Nurses' Experiences with Implementation of a Postcesarean Birth Opioid-Sparing Protocol.

PURPOSE: Opioid-sparing protocols have significantly reduced opioid use postcesarean birth through maximizing nonpharmacologic and nonopioid pain management tools. This study explored nurses' experiences with an opioid-sparing protocol at a single institution, where inpatient opioid prescribing was reduced by over half. METHOD: Focus groups were used to identify key facilitators and barriers to implementation of the opioid-sparing protocol. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Focus groups were recorded, transcribed, thematically coded, and analyzed for barriers and facilitators using predetermined CFIR domains. RESULTS: Three focus groups of nurses who care for women during postpartum were conducted in March and April 2019. Fourteen nurses participated. They were all women, with an average of 9.3 years (SD = 5.4) of maternity nursing experience. Facilitators of implementation were: 1) high satisfaction with the intervention's efficacy; 2) awareness of opioid harms promoting readiness for opioid-sparing efforts; 3) adequate staffing and the culture of evidence-based practice; and 4) bedside skills in pain management to identify patients' needs. The most significant barrier was a lack of nurse engagement with protocol development and implementation. CLINICAL IMPLICATIONS: An increased partnership among the interprofessional team members through all stages of implementation is necessary for the success and sustainability of best patient care practices.

Gynecological health impact of sexual assault.

We examined the relationship between sexual assault and gynecological health symptoms (e.g., pelvic pain, painful intercourse) in a sample of predominately African American female veterans. Those who had been sexually victimized experienced significantly more frequent gynecological health symptoms than those who had not been assaulted. Multiple forced penetrations, assault by an intimate partner, having weapons used, physical injury, belief that the victim's life was in danger during the assault, and serving in the military at the time of assault increased the likelihood of reporting particular gynecological health symptoms. Screening women in health care settings for a history of violence can link women to resources and treatment for assault-related health symptoms.

Issues facing the dissemination of prevention programs: three decades of research on the adolescent diversion project.

This paper argues that the issues facing effective prevention programs when they embark on dissemination, implementation, and routinization have been largely ignored by the field. Through the example of the Adolescent Diversion Program, these issues are illustrated and discussed. Four sequential longitudinal experimental studies are summarized as a context for the discussion of dissemination issues. In each case, the alternative preventive program is demonstrated to be more effective than traditional approaches. Challenges to widespread implementation of effective prevention programs are then discussed with a call for the field to add such issues to its scientific agenda.