Perceptual Reasons for Resistance to Change in the Emergency Department Use of Holding Chambers for Children With Asthma

Katrina F. Hurley, Joan Sargeant, Jack Duffy, Ingrid Sketris, Doug Sinclair, James Ducharme

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

Abstract

Study objective: We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of β-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change. Methods: This was a qualitative study guided by principles of grounded theory. Data were collected through focus groups and individual interviews at 2 sites in eastern Canada: Hospital A, where inhalers and holding chambers are used routinely; and Hospital B, where prevailing practice is the use of nebulization. Participant encounters were transcribed verbatim and analyzed for emerging themes. Results: At Hospital A, 6 physicians and 7 nurses participated in separate focus groups. Four interviews were conducted with physician, nurse, respiratory therapy, and pharmacy leaders. At Hospital B, 4 physicians and 3 nurses participated in focus groups, and 6 leaders were interviewed. Perceptions negatively influencing the adoption of inhalers and holding chambers included increased workload, increased equipment costs, myths about the superiority of nebulization, and interprofessional conflict. Health professionals reported that their most prominent concern about administering medications with inhalers and holding chambers was the time demand. Nurses especially seemed to think this way, tipping the balance in favor of nebulization despite knowledge of evidence to the contrary and affecting physician decisionmaking as well. Professional territorialism appeared to hinder efforts to ameliorate workload issues through the use of respiratory therapists in the ED. Conclusion: Findings from this study could be used to inform a change program to close the gap between evidence and practice with respect to use of inhalers and holding chambers in the ED.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalAnnals of Emergency Medicine
Volume51
Issue number1
DOIs
Publication statusPublished - Jan 2008

Bibliographical note

Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statment. Dr. Sketris holds a chair in drug use management and policy funded by the Canadian Institute of Health Research/Canadian Health Services Research Foundation, cosponsored by the Nova Scotia Health Research Foundation. Dr. Hurley received salary support under this chair as part of the Drug Use Management and Policy Residency. Other project funding was provided by the emergency departments of the 2 hospitals that participated in this study.

ASJC Scopus Subject Areas

  • Emergency Medicine

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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