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      Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

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          Abstract

          Objective

          To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US).

          Methods

          Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies.

          Results

          In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) ‘Escalation’ is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward–‘measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use.

          Conclusion(s)

          DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.

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          Most cited references59

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

            Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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              What's in a name? Qualitative description revisited.

              "Whatever Happened to Qualitative Description?" (Sandelowski, 2000) was written to critique the prevailing tendency in qualitative health research to claim the use of methods that were not actually used and to clarify a methodological approach rarely identified as a distinctive method. The article has generated several misconceptions, most notably that qualitative description requires no interpretation of data. At the root of these misconceptions is the persistent challenge of defining qualitative research methods. Qualitative description is a "distributed residual category" (Bowker & Star, 2000). Cambridge, MA: The MIT Press) in the classification of these methods. Its value lies not only in the knowledge its use can produce, but also as a vehicle for presenting and treating research methods as living entities that resist simple classification.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 June 2022
                2022
                : 17
                : 6
                : e0269788
                Affiliations
                [1 ] The University of Queensland, School of Nursing, Midwifery and Social Work, St Lucia, Brisbane, Queensland, Australia
                [2 ] Herston Infectious Diseases Institute (HEiDI), Metro North Hospital and Health Service, Herston, Brisbane, Queensland, Australia
                [3 ] School of Nursing and Midwifery, Griffith University, Nathan, Brisbane, Queensland, Australia
                [4 ] Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
                [5 ] Central Queensland University, Cairns, Queensland, Australia
                [6 ] Nursing and Midwifery Research Centre, Workforce Development and Education Centre, Royal Brisbane and Women’s Hospital, Herston, Brisbane, Queensland, Australia
                [7 ] Health and Wellbeing Service Group, Townsville Hospital and Health Service, Townsville, Queensland, Australia
                [8 ] Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
                [9 ] Sonography Innovation and Research (Sonar) Group, Gold Coast, Queensland, Australia
                [10 ] School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
                [11 ] Centre for Applied Health Economics, Griffith University, Nathan, Brisbane, Australia
                [12 ] Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
                Stanford University School of Medicine, UNITED STATES
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jessica Schults reports grants from Becton Dickinson unrelated to the current project. Claire Rickard: discloses that her current or previous employer has received on her behalf: investigator-initiated research grants from BD-Bard, Cardinal Health and Eloquest; and consultancy payments for lectures or opinion from 3M and BD-Bard; unrelated to current project. Nicole Marsh: reports that her affiliated universities have received on her behalf, speaker fees from 3M, investigator-initiated research grants from Becton Dickinson, Cardinal Health, Eloquest Healthcare and a consultancy payment from Becton Dickinson for clinical feedback related to peripheral intravenous catheter placement and maintenance (unrelated to the current project). Marie Cooke: discloses that her previous employer has received on her behalf: investigator-initiated research grants from BD-Bard unrelated to current project. PC, ES, RP, CB, MF, JK, GK, PS, JB, GK have no conflicts of interest to disclose.

                Author information
                https://orcid.org/0000-0002-5406-9519
                https://orcid.org/0000-0001-5674-1404
                https://orcid.org/0000-0001-8579-445X
                https://orcid.org/0000-0003-1100-4552
                Article
                PONE-D-21-22073
                10.1371/journal.pone.0269788
                9231778
                35749443
                cc9b02d5-f991-43ae-b50c-af89ac6e08ac
                © 2022 Schults et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 July 2021
                : 23 May 2022
                Page count
                Figures: 0, Tables: 3, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000925, national health and medical research council;
                Award ID: APP1180193
                Award Recipient :
                This work was supported by the National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1180193). https://www.nhmrc.gov.au/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                We note that your Data Availability Statement reads: "There are ethical restrictions with the sharing of the data set (Griffith University Human Research Ethics Committee) as data contains potentially sensitive information. Requests for access to de-identified data may be made to research-ethics@ 123456griffith.edu.au or the corresponding author j.schults@ 123456uq.edu.au and progress through the ethics committee.

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