+ Neonatal Pain Management : Barriers to and Facilitators of data entry in the Better Outcomes Registry & Network (BORN) Ontario Information System Catherine Larocque, BScN, 1,2 Jessica Reszel, RN, MScN, 2 Sandra Dunn, RN, PhD, 2,3 Denise Harrison, RN, PhD 1,2 1 School of Nursing, University of Ottawa, 2 Children’s Hospital of Eastern Ontario, 3 Better Outcomes Registry & Network (BORN Ontario)
+ Background – Neonatal Pain Effects of pain : Evidence: Blood work causes Breastfeeding (BF), pain, distress, and Skin-to-Skin care physiological (SSC), and sucrose changes reduce pain Epidemiology: Measurement All newborn tool : infants have blood Pain management work for screening data element was Need: in the first days of added to the BIS in Identify life April 2014 barriers and facilitators to capturing new data element
+ New data element Pain Relief Measures During Newborn Screening or Serum Bilirubin [PPC,NICU] New pick list values: • Breastfeeding • Skin to skin • Sucrose • Other • None • Unknown
+ Purpose/Aims To identify the barriers and facilitators to: Data entry of the newborn pain management data 1) element into the BORN information system (BIS), and Implementation of pain treatment during newborn 2) screening. To ensure high quality data is available to identify gaps in practice for subsequent planning of practice improvements
+ Design & Methods Design Descriptive qualitative Sampling and Data Collection Purposive sampling of nurse managers (or their delegates) in the province of Ontario from maternal/newborn hospitals E-mail invitations were sent to potential participants in blocks of 12 Used a semi-structured interview guide Interviews continued until saturation of concepts Data analysis Interviews were transcribed verbatim and conventional content analysis was completed Descriptive statistics to summarize demographic data
+ Participant flowchart Total eligible level I/II maternal N=88 newborn sites in Ontario No site contact N=84 (n=4) Total responses received : n=20 Total completed interviews: n=15
+ Demographics Hospital site demographics 15 (100%) Health #1-4- SW and Central Ontario 5 (33%) Region #5-8- Greater Toronto Area 4 (27%) #9-11- Eastern and SE Ontario 2 (13%) #12-14- Northern Ontario 4 (27%) Level of Care Level I 8 (53%) Level II 7 (47%) Birth Volume 101-500 5 (33%) 501-1000 6 (40%) 1001-2499 1 (7%) 2500-4000 3 (20%)
+ Demographics cont’d Participant demographics 16 (100%) Role Director 4 (25%) Manager 5 (31%) Resource Nurse/Nurse 4 (25%) Educator/Nurse Specialist 2 (13%) Care Facilitator 1 (6%) Results n=15 Participant aware of Yes 11 (73%) new data element? No 4 (27%) Self-reported use of Always 0 any pain management Most of the time/Sometimes 8 (53%) at site Rarely/Never 5 (33%) Unknown 2 (13%)
+ Results Driving BIS data entry and use Pain management practice Practice Change Barriers Facilitators Barriers Facilitators Lack of User- BPGs, Patient awareness & BORN Type of IT Issues Friendly health BFI Guidelines, support staff procedure system Policies status perception Who enters Education Staff Time Documentation Documentation Staff Red Tape the data Initiatives and Data Unit Parent Low birth Issues with Resources management Quality Resources factors advocacy volume element involvement measures Non- Familiarity Parent Lack of Lack of Knowing Staff Type of nursing & policies communication factors the patient attitude Procedure staff Experience Lack of Unit Advantages Traditions education & factors for staff awareness
Participant 009 “ I t’s an element in BORN which means we’ve now included it in our charting, which we should do but it gives you a kick-start right? Well if it’s on BORN we gotta have it in our charting. And once you have it in the charting, then the trigger is there for the staff right? They’re seeing it all the time […]. If every time they’re pulling up their intervention screen they’re seeing this stuff, then they’re gonna remember right? ”
+ Results- BIS entry BIS data entry and use Barriers Facilitators Lack of User- BORN awareness & IT Issues Friendly support staff system perception Who enters Documentation Documentation Time the data Issues with Data Low birth Resources Quality element volume measures Non- Lack of Knowing Staff nursing communication the patient attitude staff
Participant 004 “ I think sometimes the, the front line staff don’t necessarily understand the complete importance of BORN and you know kind of the real reason why it’s done and why it’s so important […]. Because they are doing the actual hands- on work you know that’s their, they’re very task oriented […]. So I think it’s hard sometimes to look at the big picture. ”
+ Results- Pain Management Practice Pain management practice Barriers Facilitators BPGs, Type of Patient health BFI Guidelines, procedure status Policies Staff Red Tape Staff Education Initiatives and Resources Unit factors Parent advocacy management involvement Parent factors Lack of policies Familiarity & Type of Experience Procedure Lack of Tradition education & Advantages for Unit factors awareness staff
+ Results- Model CONTEXT BARRIERS FACILITATORS RESOURCES
+ Implications and Next Steps Disseminate study findings Report distributed to all maternal/newborn hospitals in Ontario which will include strategies to address the identified barriers Disseminate study findings through conference presentations, poster presentations, etc.
+ Acknowledgements All the participants who graciously agreed to participate in our study The Be Sweet to Babies research team Especially: Dr. Denise Harrison Jessica Reszel Amanda Bowman BORN Ontario Especially: Catherine Larocque, BScN Dr. Sandra Dunn, Knowledge Translation clarocque@cheo.on.ca Specialist Canadian Institutes for Health Student Research Assistant Research (CIHR) for Denise Harrison, RN, PhD Chair in Nursing Care of Health professional Student Research Children, Youth and Families Award
+ Important references Qualitative Description Sandelowski, M. (2000). Whatever Happened to Qualitative Description? Research in Nursing & Health, 23, 334-340. doi: 10.1002/1098-240X(2000008)23:4<334::AID- NUR9>3.0.CO;2-G Sandelowsi , M. (2010). What’s in a Name? Qualitative Description Revisited. Research in Nursing & Health, 33, 77-84. doi: 10.1002/nur.20362 Graneheim, U.H. & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and methods to achieve trustworthiness. Nurse Education Today, 24, 105-112. doi: 10.1016/j.nedt.2003.10.001 Hsieh, H.F. & Shannon, S.E. (2005). Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15, 1277-1288. doi: 10.1177/10497323052305276687 Data Saturation Fusch, P.I. & Ness, L.R. (2015). Are We There Yet? Data Saturation in Qualitative Research. The Qualitative Report, 20(9), 1408-1416. Retrieved from: http://www.nova.edu/ssss/QR/QR20/9/fusch1.pdf Mason, M. (2010). Sample Size and Saturation in PhD Studies using Qualitative Interviews. Forum: Qualitative Social Research, 11(3). Retrieved from: http://www.qualitative-research.net/index.php/fqs/article/view/1428
+ Visual coding scheme- themes and subthemes
+ Survey Questions
+ BFI one pager (resource)
+ Sucrose policies
+ CHEO playlist
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