A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework.

Abstract

Objective: Intraoperative acquired pressure injury (IAPI) is a common perioperative complication in surgical patients, and operating room nurses are the primary implementers of evidence-based IAPI prevention strategies. Although standardized evidence-based guidelines for IAPI prevention exist, their translation into clinical practice remains suboptimal. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to identify barriers and facilitators to implementing these prevention measures, to provide an empirical basis for the clinical translation of evidence-based IAPI prevention interventions.

Methods: A descriptive qualitative research design was adopted. A semi-structured interview guide was developed in strict alignment with the CFIR 2.0 framework. Twelve operating room nurses from a tertiary general hospital in Qinghai Province were recruited via purposive sampling, and face-to-face individual interviews were conducted for data collection. Qualitative content analysis was used to code the data, and core themes were extracted from the full dataset.

Results: With reference to the five core domains of the CFIR framework, 14 key factors influencing the implementation of evidence-based IAPI prevention measures were identified, categorized into 6 barriers and 8 facilitators. The barriers included: mismatch between evidence-based guidelines and operating room clinical realities; insufficient protective supplies; lack of targeted positive incentives; poor interdepartmental communication; uneven prevention competencies among nurses; and experience-dependent practice with lax adherence among some nurses. The facilitators included: multi-channel access to evidence-based information; industry policy support; aligned prevention goals among nurses; accessible professional training and guidance; emphasis and support from department managers; clinical adaptation needs; flexible implementation strategies; and nurses' awareness of self-reflection and improvement.

Conclusion: The clinical implementation of evidence-based IAPI prevention measures in operating rooms is influenced by multilevel factors. The core challenges lie in the mismatch between general evidence-based guidelines and the specialized operating room setting, as well as the absence of positive incentive mechanisms. This study fills a research gap in this field and provides practical evidence for establishing a specialized evidence-based practice system for IAPI prevention.