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Barriers and facilitators in implementing intra-abdominal pressure measurement by nurses in paediatric intensive care
ZhiRu Li1, FangYan Lu2, Li Dong3
1Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Insights
Paediatric critical care nurses face knowledge and resource barriers in measuring intra-abdominal pressure. Interventions should focus on education, equipment, and collaboration to improve patient care.
Area of Science:
- Critical Care Medicine
- Nursing Science
- Patient Monitoring
Background:
- Intra-abdominal hypertension is a significant risk factor for mortality in critically ill patients.
- Accurate intra-abdominal pressure monitoring is crucial for early detection and management of intra-abdominal hypertension and abdominal compartment syndrome.
- Paediatric critical care nurses are vital in observing subtle changes in intra-abdominal pressure in critically ill children.
Purpose of the Study:
- To explore paediatric critical care nurses' perspectives on barriers and facilitators to intra-abdominal pressure measurement.
- To identify factors influencing the clinical practice of intra-abdominal pressure monitoring in paediatric intensive care units.
Main Methods:
- A qualitative, exploratory study using semistructured interviews.
- Conducted in a tertiary hospital's paediatric intensive care unit in China.
- Utilized the Theoretical Domains Framework for interview guide development and data analysis.
Main Results:
- Fourteen nurses and nursing managers were interviewed.
- Seven domains identified, including six barrier domains (knowledge, social influences, behavioral regulation, beliefs about consequences, beliefs about capabilities, environmental context/resources) and four facilitator domains (social influences, beliefs about consequences, environmental context/resources, social/professional role/identity).
Conclusions:
- Interventions are needed to support nurses in intra-abdominal pressure measurement.
- Key areas for improvement include knowledge, skills, equipment, interprofessional collaboration, standardized processes, and a supportive environment.
- The Theoretical Domains Framework can guide the design of targeted interventions for standardized intra-abdominal pressure management.
Background:
Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children.
Objectives:
The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement.
Methods:
A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework.
Results:
Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six "barrier" domains and four "facilitator" domains. The six "barrier" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four "facilitator" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity.
Conclusions:
The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.
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