Barriers and Facilitators Related to Nasal Injury Among Preterm Neonates in Selected Neonatal Units of a Tertiary Care Centre, North India

Abstract

Introduction Preterm neonates require Non-invasive Respiratory Support (NiRS) because of underdeveloped lungs to administer pressurized oxygen for a long duration. The interface used to deliver NiRS can cause pressure injury at the nasal surface, septum, and bridge. Preterm neonates are more vulnerable to such injuries due to immature skin and septum. It is the responsibility of Health Care Professionals (HCPs) to prevent nasal injury through the implementation of evidence-based practices and innovative techniques to secure nasal interfaces. Objectives (1) To find out the barriers and facilitators related to nasal injury among preterm neonates in selected neonatal units of a Tertiary Care Centre, in North India. (2) To seek the remedial measures suggested by HCPs to prevent nasal injury. Methodology After obtaining permission from the head of the department of neonatology, covert participatory observations related to existing practices were made using an observation checklist. Focused Group Discussions (FGDs) were conducted with HCPs (Nursing Officers-43 and Physicians-10) and audio-recorded. Out of the total of eight FGDs, three were conducted with physicians in a group of 2–4 members and the remaining five with nursing officers in a group of 8–9 members, each of 15–20 min duration. FGD guide was used as a tool to guide the discussion. The qualitative data were analyzed by using Van Manen’s approach. Result The barriers identified were related to supplies, staff, and administration. Supplies include limited hospital supply of RAM cannula, reuse of hard ethylene oxide sterilized RAM cannula, lack of adequate size head caps; staff includes lack of awareness regarding the implications and effect of nasal injury among healthcare professionals, variable documentation of nasal injury; administration: no standard guidelines and lack of regular audits to prevent nasal injury. The facilitator suggested were motivated healthcare professionals. Suggested remedial measures were the availability of appropriate size RAM cannula, stockinette head caps, self-motivation, frequent inspection and early identification of nasal injury, staff education, and standard protocol of measures for nasal injury prevention. Conclusion There are concrete barriers and limited facilitators. There is a need to incorporate the suggested remedial measures to address barriers to preventing nasal injury among preterm neonates.