TABLE 2

Qualitative Analysis Themes and Exemplar Quotations

ThemeExemplar Quotation
1. The pathway leads to more efficient care.“Instead of having the nurse wait an hour for you because the kid is on q3 but could totally be stretched but you can’t see them, they’re waiting, they’re just on standby with their Ventolin [salbutamol] waiting to get it, waiting for you to get up there.”
2. Nurses know their patients well and are ideally positioned to implement the pathway, leading to improved patient care.“I think we might be a little bit better because it kind of gives us that bit of more control because we’re there all the time. The patient—if we think they can be pushed up, we can push them up. And so we can always back it back down. So I think the quality of our care might have improved a little bit.”
3. Participants trust the nurses and are confident in their abilities to implement the pathway.“They’ve [nurses] taught me more about the respiratory system then any physician I’ve ever worked with. The nurses and RPNs—I absolutely have 100% trust in them.”
4. Participants (nurses and physicians) perceive that the pathway is leading to shorter LOS and less readmissions.“More timely discharge, that would be the main advantage.”
“I’m not sure exactly why they’d come back, but I just don’t think they’re coming back as much.”
5. The pathway provides nurses with more time to interact with and educate families, which leads to better patient/family-centered care.“I’m teaching the parents more of what to look for and they’re paying … because I’m in there more often, they’re paying a little … maybe closer attention when they’re asking you know ‘are we going to move him up?’ ‘are we doing this?’ ‘what is going on?’ Whereas before you know the doctor would come in only when called.”
“That was good because they [nurses] were more … they are more available than doctors.”
6. Residents and medical students may not gain competence in the treatment of asthma as a result of the pathway.“I would just say to make sure that we get enough exposure to asthma as residents, which often happens with the kids that don’t qualify for the pathway—so like the severe asthmatics or … pneumonia or other kids—but just make sure that we don’t lose that exposure so that you’re still comfortable with asthma in case you get an asthmatic.”
7. Participants need additional education on what the pathway entails to be comfortable with it (especially new or junior staff members).“I did find it a little bit confusing just at first, but it was all laid out in the guidelines when I did go back and take a look through it. It was just about when to call the team, like when switching from nebs to puffers or certain things like that. But then whenever I did go back through the pathway I think I was able to find that information.”
8. Pathway needs to be flexible to meet the patients’ needs.“I think it’s just continuing to make sure there’s enough flexibility to allow for—for everyone exercising their own clinical judgement. I think sometimes the worry with things like pathways and PPOs and that kind of thing is that people will just kind of blindly follow them.”
9. Nurses may be more cautious in implementing the pathway that may lead to no change in LOS until nurses get comfortable with the pathway.“It was scary, like ‘oh my god, if I make the wrong decision!’… So we may end up as nurses leaving them on a step longer than we intend to.”
“And when you do it once or twice, then you make your right decisions and the child goes home a day or so earlier. You realize that you know, it is something that you could do.”
  • LOS, length of stay; PPO, pre-printed order form; q3, every 3 hours; RPN, registered practical nurse.