Dejina Thapa is a registered nurse with over 7 years of clinical and academic experience working in different health care settings in Nepal. Nepal. Since 2020, Dejina has been persuing a PhD at Nethersole School of Nursing, The Chinese University of Hong Kong. She is currently working in a project which is focused improving the adherence to ventilator bundle in multisite Nepalese health care settings. She has also involved in various research project and also involved in funded research projects in simulation training for the nurses.
Her expertise and research interests fall within the areas of implementation science, critical care unit and patient safety.
Low- and middle-income countries, like Nepal, have greater rates of ventilator-associated pneumonia than high-income countries. Effective implementation of ventilator bundle is crucial to reduce the occurrence of ventilator-associated pneumonia. So far, no comprehensive assessment of barriers to sustained, successful implementation of hospitals interventions has been conducted in Nepalese healthcare settings. The main aim of the study is to identify the perceived barriers and facilitators of health care professionals to the implementation of the ventilator bundle in a tertiary care centre.
This qualitative study used the semi-structured virtual interview, enrolled twenty-one participants; nurses (n=18) and doctors (n=3) were selected by purposive sampling. The study setting was a general ICU and medical ICU at a tertiary academic hospital. All the interview data were transcribed, coded, using thematic analysis, and analysed using the NVivo software.
Provider-related factors, organisational, environmental, and patient factors were the major identified barriers that could affect the implementation of the ventilator bundle. The major barriers were a high rate of nursing turnover, imbalanced nurse-to-patient ratio, heavy workload, time spent on training new employees, lack of knowledge and skills, especially in novice nurses, and lack of motivation and reward. The key facilitators were timely educational training and workshops, ensuring the availability of strong leadership and champions, and providing adequate support at the organisational level.
The findings of this qualitative study revealed that organisational support is critical to the effective implementation of the guidelines. Building on these facilitators and addressing and measuring these barriers may aid in improving the acceptability and sustainability of the ventilator bundle especially among the nurses.