Promoting active labor admission: Early labor lounge implementation barriers and facilitators from the clinician perspective
Promoting active labor admission: Early labor lounge implementation barriers and facilitators from the clinician perspective
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DOI：
10.1111/nuf.12414
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发表时间：
2019-11-19
期刊：
影响因子：
2.4
通讯作者：
Johantgen, Meg
中科院分区：
文献类型：
--
作者：
Breman, Rachel B.;Low, Lisa Kane;Johantgen, Meg
在美国，低风险孕妇的剖腹产率超过了2020年健康人群的推荐比率。一个建议的策略，以减少剖宫产在这一人群是推迟入院，直到积极的劳动力开始。在一家社区医院实施了一项质量改进计划，利用早期分娩休息室（ELL）促进积极分娩的入院。本研究的重点是从临床医生的角度来确定实施ELL的障碍和促进因素。方法访谈进行了有目的的样本的临床医生。访谈记录是公开编码的，主题是归纳确定的。然后，利用实施研究综合框架进行了框架分析。结果25名工作人员参加了培训。在CFIR的四个领域中确定了障碍和促进因素。主持人包括证据的力量和ELL本身，包括它包含的支持妇女在潜在劳动力的工具。实施障碍包括临床医生自我效能感和感知到的ELL使用率低。结论使用CFIR的分析确定了ELL实施的几个障碍和促进因素。个别妇女提出在分诊的背景下，可接受性和自我效能的个别临床医生实施的重要因素。
Background The cesarean birth rate for low-risk pregnant individuals in the United States exceeds the recommended Healthy People 2020 rate. One recommended strategy to reduce cesarean in this population is delaying hospital admission until active labor commences. A quality improvement program was implemented at a community hospital using the early labor lounge (ELL) to promote admission in active labor. This study focuses on identifying the barriers and facilitators from the clinician perspective to implementing the ELL. Methods Interviews were conducted with a purposive sample of clinicians. Interview transcripts were open coded and themes identified inductively. A framework analysis was then conducted using the Consolidated Framework for Implementation Research (CFIR). Results Twenty-five staff members participated. Barriers and facilitators were identified in four of the CFIR domains. Facilitators included the strength of the evidence and the ELL itself, including the tools it contained for supporting women in latent labor. Barriers to implementation included clinician self-efficacy and perceived low usage of the ELL. Conclusion This analysis using, CFIR identified several barriers and facilitators to the implementation of the ELL. The context of the individual woman presenting in triage and the acceptability and self-efficacy of the individual clinicians represented important factors for implementation.