A qualitative examination of changing practice in Canadian neonatal intensive care units.
OBJECTIVE
The goal was to explore the perspectives of health care professionals on factors that influence change to policies, protocols and practices in the Neonatal Intensive Care Unit (NICU) with regard to nosocomial infection and chronic lung disease. Study design An exploratory descriptive design using semi-structured individual and focus group interviews was used. Individual interviews (n=76) and focus group sessions (n=14 with a total of 78 participants) were conducted for a total of 154 health professional participants.


METHODS
Mayring's qualitative content analysis approach was used to analyse the data. All interviews were audio-taped, transcribed and analysed using inductive reasoning. The data were then organized into categories that reflected emerging themes.


RESULTS
Seven categories that influenced practice change were derived from the data including staffing issues, consistency in practice, the approval process, a multidisciplinary approach to care, frequency and consistency of communication, rationale for change and the feedback process. These categories were further delineated into three emerging themes related to human resources, organizational structure and communications. Pettigrew's conceptual framework provided a lens to view the results in relation to the process of change.


CONCLUSIONS
This study has helped to further our understanding of individual and organizational factors that facilitate and hinder changes in clinical practice in the NICU. These factors will be used as a starting point for organizational change to enhance infant outcomes in the NICU.
Stevens
Bonnie
B
Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Lee
Shoo K
SK
Law
Madelyn P
MP
Yamada
Janet
J
D002908:Chronic Disease; D002985:Clinical Protocols; D003142:Communication; D003428:Cross Infection / Q000517:prevention & control; D006280:Health Workforce; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D007407:Interviews as Topic; D008171:Lung Diseases; D009864:Ontario; D009936:Organizational Innovation; D016134:Organizational Policy