Sustainability of high flow in a Peruvian PICU: A qualitative analysis.

AIM: To describe nurse and physician perspectives on enabling factors that promote sustainability of high flow use in resource-limited settings. BACKGROUND: Over 650 000 children died from respiratory infections in 2016 globally. Many deaths could be prevented with access to advanced paediatric respiratory support, but sustainability of technology in resource-limited settings remains challenging. INTRODUCTION: Local providers have expertise related to site-specific barriers to sustainability. Engaging local providers during implementation can identify strategies to promote ongoing technology use beyond initial deployment. METHODS: This qualitative descriptive study was conducted five focus groups with nineteen nurses and seven individual interviews with physicians in a Peruvian paediatric intensive care unit. Data were analysed using a realist thematic approach. RESULTS: Providers described five important factors for high flow sustainability: (i) Applying high flow to a broader patient population, including use outside the paediatric intensive care unit to increase opportunities for practice; (ii) Establishing a multidisciplinary approach to high flow management at all hours; (iii) Willingness of nurses and physicians to adopt standardization; (iv) Ongoing high flow leadership; (v) Transparency of high flow impact, including frequent reporting of clinical outcomes of high flow patients. DISCUSSION: Local providers described strategies to overcome barriers to sustainability of high flow in their clinical setting, many of which are generalizable to implementation projects in other resource-limited settings. CONCLUSION AND POLICY IMPLICATIONS: These findings provide nursing, administrative leaders and policymakers with strategies to promote sustainability of new technology in resource-limited settings, including development of guidelines for appropriate clinical use, change management support, leadership development and clinical outcome reporting procedures. Administrative support and oversight are paramount to foster successful implementation in these settings.

A Nationwide Snapshot of the Predictors of and Barriers to School Garden Success.

OBJECTIVE: To explore the degree and predictors of and barriers to school garden integration (termed success). DESIGN: A 30-item online survey consisting of demographic, garden characteristic, and barrier questions, as well as the School Garden Integration Scale, was conducted in 266 school garden organizations (13 national, 8 regional, and 245 state or local). PARTICIPANTS: A total of 414 school gardeners from 38 states and Puerto Rico. MAIN OUTCOME MEASURES: School garden success using the GREEN Tool. ANALYSIS: Descriptive statistics were used to determine the degree of success of school garden programs and explore barriers. Multiple regression analysis was conducted to determine independent predictors of school garden success. RESULTS: The average score was 37 (range 1-53, of a possible 57 points), indicating moderate success. Operating budget (P < .001), operating time (P < .05), and planting in-ground (P < .01) had a positive significant influence on success score, whereas rural location (P < .01) and lacking community interest (P < .01) had a negative significant influence, controlling for race/ethnicity, region, total garden investment, and Community Need Index score (a proxy for socioeconomic status). CONCLUSIONS AND IMPLICATIONS: Results indicate that success of school garden programs may be more difficult for the schools located in a rural area or in the absence of school or community-at-large interest. This study found that race/ethnicity of students and socioeconomic status are not related to success score, which is promising as other research indicates that successful school gardens may be especially impactful for low-income people of color. Causal research is needed to identify strategies that increase school garden success, with a focus on engaging key stakeholders (administrators, teachers, parents, the community at large, and garden coordinators).