Cracking the code to overcoming obstacles in the rectification of nursing quality inspection issues: A qualitative exploration based on CFIR theory

Cracking the code to overcoming obstacles in the rectification of nursing quality inspection issues: A qualitative exploration based on CFIR theory | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cracking the code to overcoming obstacles in the rectification of nursing quality inspection issues: A qualitative exploration based on CFIR theory Qing Wang, Jun Liang, Ya'nan Zhang, Qianfei Li, Cuiling Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8720415/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Nursing quality supervision is a core component in ensuring patient safety and quality improvement. Its effectiveness hinges on the genuine implementation of corrective actions within the "supervision-feedback-rectification-follow-up" closed-loop cycle. However, current rectification efforts often remain at the level of fragmented experience, lacking systematic analysis of the barriers to implementing corrective measures, which hampers sustained improvement. Therefore, systematically identifying the obstacles to the implementation of corrective actions based on a scientific framework is an urgent need to address this dilemma and achieve continuous quality enhancement. Objective To understand nursing staff's attitudes and suggestions regarding the rectification of nursing quality supervision issues, as well as the barriers encountered during implementation, thereby providing a basis for subsequent scientific rectification and effective implementation. Methods A descriptive qualitative study was conducted. An interview guide was developed based on an in-depth understanding of the concepts and dimensions within the CFIR theoretical framework, encompassing 6 question dimensions. Using a structured checklist, 21 issues identified during nursing quality supervision were collated. Through on-site verification, 18 corrective measures were determined to be "unimplemented," involving 17 departments. Subsequently, semi-structured in-depth interviews were conducted with 15 head nurses and 15 staff nurses from departments with unimplemented measures. The interview data were analyzed using thematic analysis, involving coding, categorization, and the final extraction of core themes. Results Three overarching themes were identified: 1) Divergent attitudes among nursing staff towards the rectification of supervision findings; 2) Systemic and multifaceted challenges in implementing rectification measures for nursing quality supervision issues; 3) Recommendations to employ information and intelligent platforms to facilitate the effective implementation of corrective actions. Conclusion This study reveals that the effective implementation of corrective measures is constrained by a combination of factors: divergent attitudes among nursing staff towards rectification, systemic challenges encountered during the implementation process, and the absence of information technology support. Implications for Nursing Management: It is recommended that nursing management practices focus on three key areas: 1) Enhancing communication and guidance to influence behavior through attitudinal shifts; 2) Establishing a structured model for rectifying issues identified in nursing quality supervision to overcome systemic barriers; 3) Advancing the development of information technology platforms to improve the quality and efficiency of the rectification process. Nursing Quality Supervision Problem Rectification Attitude Recommendations Introduction Nursing quality management is a vital component of medical quality management, serving as a crucial safeguard for patient safety and one of the key performance indicators in healthcare administration. Implementing nursing quality control is therefore of significant importance 1 – 3 . The National Health Commission and the National Administration of Traditional Chinese Medicine, in their issued “Action Plan for Comprehensive Improvement of Medical Quality (2023–2025)”, emphasize strengthening foundational quality and safety management, improving the monitoring and feedback of nursing quality, and conducting continuous improvement initiatives based on evidence and clinical needs to enhance the standardization and consistency of nursing care 4 . Nursing quality supervision, as a method involving on-site inspections, collection of nursing quality indicator data, and evaluation of nursing quality 5 , represents one of the important inspection approaches for promptly identifying nursing errors, effectively standardizing clinical nursing practices, improving medical quality, and ensuring healthcare safety 6 , 7 . Rectification, as a critical link in the closed-loop management cycle of "supervision–feedback–rectification–follow-up" for nursing quality, acts as the core pivot from "problem identification" to "improvement realization." Whether rectification measures are effectively implemented directly determines the success of this closed-loop management, constituting the fundamental purpose and objective of nursing quality supervision. Currently, there has been extensive research on the rectification of nursing quality supervision issues. Healthcare institutions commonly employ various approaches, such as optimizing rectification measures through best-evidence summaries 8 , enhancing the implementation effectiveness of measures by improving nurses' sense of responsibility 9 , increasing rectification efficiency by applying information technology platforms 10 , and boosting rectification satisfaction through strengthened supervision 11 , 12 . However, these measures are often either too abstract 13 , disconnected from clinical need 14 , lack feasibility 15 , or only address localized issues 16 , leading to suboptimal rectification outcomes 17 . Some managers utilize management tools such as PDCA 10 , Quality Control Circles (QCC) 18 , and Root Cause Analysis (RCA) 19 for issue rectification, but the focus of the rectification process tends to be on tool application rather than an in-depth analysis of the methods and approaches for ensuring the effective implementation of measures, resulting in limited practical reference value. In previous research, a feedback model for on-site nursing quality supervision issues was developed 20 , which mentioned guidance for improvement but only introduced the perspectives for such guidance without addressing the specifics of how to implement rectification. Essentially, the challenges in nursing quality issue rectification stem from systemic management deficiencies 21 . Therefore, uncovering these systemic shortcomings in the rectification process is key to the effective implementation of corrective measures. The Consolidated Framework for Implementation Research (CFIR) can comprehensively identify barriers from five dimensions: the intervention/innovation, outer setting, inner setting, characteristics of individuals, and the implementation process 22 – 24 . Researchers have successfully applied it to analyze barriers in areas such as dietary management during dialysis 25 , cardiac rehabilitation practices 26 , and oncology nursing 27 , with positive outcomes. In this study, the corrective measures formulated by various departments as localized optimization plans, and their implementation status still falls within the scope of implementation science 28 . Consequently, using the CFIR theoretical framework to comprehensively identify the barriers to inadequate rectification provides a scientific basis for addressing the dilemma of systemic management deficiencies in the rectification process. China implements a three-level nursing quality management system 29 , with head nurses serving as the primary agents of nursing quality management. They play a dual role in both nursing quality supervision and rectification. During the rectification phase, head nurses act as both decision-makers and executors of corrective actions. Some measures require implementation by staff nurses, while others fall under the responsibility of head nurses. The duties of head nurses and staff nurses involve clear division of labor yet require close collaboration, forming a bidirectional, interactive, and mutually supportive rectification community. In summary, based on the CFIR theoretical framework, this study employs qualitative interviews with head nurses and staff nurses to explore nursing personnel's cognitive attitudes and practical experiences regarding the rectification of nursing quality supervision findings. It aims to systematically identify the barrier factors affecting the effective execution of corrective measures, thereby providing a reference for the subsequent scientific construction of a rectification model for issues identified in nursing quality supervision. Research Subjects and Methods A descriptive qualitative research design was employed to gain an in-depth understanding of head nurses' and staff nurses' attitudes and suggestions regarding the rectification of issues identified in nursing quality supervision, as well as the barriers encountered during the implementation of corrective measures. The interviewers were two head nurses who are routinely involved in all stages of nursing quality supervision and rectification. They are colleagues of all interviewees and are proficient in qualitative research methods. This study has been approved by the Ethics Committee of Shanxi Bethune Hospital (Approval No. YXLL-2025-196). All participants provided written informed consent. Research Subjects Purposeful sampling was adopted. Starting in August 2025, the corrective measures submitted by departments that had undergone night rounds in the previous week were retrieved every Thursday from the Nursing Quality Management Information System. Measures that were "actionable through decomposition and results quantifiable" were selected. These measures were then systematically organized using the thematic group discussion method according to a structured checklist 30 . The checklist framework comprised seven fields: "Ward Name - Original Corrective Measure - Observation Item - Observation Target - Observation Method - Evidence Source - Implementation Judgment." The specific procedure was as follows: ① the original corrective measure was broken down into specific, observable actions serving as observation items. ② the key visible elements that can reflect the process and effect of the implementation of the measures can be taken as the observation object. ③ the data collection method for directly obtaining information on the observation items was defined as the observation method. ④ Each item was evaluated against predefined objective evidence serving as the evidence source. ⑤ Two individuals, both holding associate senior professional titles or higher and with over five years of nursing management experience, jointly determined the implementation status. Full implementation was judged as "implemented" and marked "Yes." Non-implementation or partial implementation was judged as "not implemented" and marked "No." In case of disagreement, a third person made the determination to reach a final consensus. From August to September 2025, a total of 112 measures were retrieved. Among them, 21 measures could be organized using the structured observation checklist. Of these, 18 were judged as "not implemented," involving 17 departments. See Table 1 for the structured observation checklist on the implementation of rectification measures. Head nurses and on-duty nurses from the 17 departments whose measures were judged as "No" for implementation became the target population for semi-structured interviews. The sample size was determined by data saturation. A total of 15 head nurses and 15 nurses from 15 departments were selected as research subjects. All 30 interviewees participated fully in the interviews without any withdrawals. The selection of interviewees adhered to the maximum variation sampling strategy 31 . Table 1 Structured Observation Checklist for Implementation of Rectification Measures Department Name Original Corrective Measure Observation Item Observation Target Observation Method Evidence Source Implementation Judgment Traditional Chinese Medicine Dept After retrieving medications, the treatment shift nurse and the responsible nurse perform dual verification of each barcode against the medication information. Once confirmed correct, the barcode is affixed to the medication box. ①Verify medication information; ② Affix barcode Nurses Direct Observation Verification process No Gastrointestinal Surgery Dept When verifying blood collection orders and test tubes, tally the specimen items and quantities requiring dispatch to different laboratory departments and annotate this information on the test tube labels. ① Tally specimen items and quantities for different laboratory departments; ② Annotate the receiving department on test tubes Nurses Direct Observation Verification process No Neurosurgery Dept Blood specimens for urgent testing, blood type specimens, and specimens requiring transfer to other departments should be placed on separate test tube racks with corresponding labels. ① Blood samples sent to different testing departments are arranged on separate test tube racks; ②Label the test tube with the department for submission Nurses Interview Interview content No Reproductive Medicine Center The department conducted mandatory training on the standard protocol for affixing laboratory test labels, with all staff required to pass an assessment. ①Verify the training content ②Testing Outcomes Training materials / Assessment records Document Review Training materials, Assessment records No Geriatrics Dept Standardize physician's orders. Whether the standardized content is reflected in the orders Physician Interview / Document Review Physician's orders No Hepatobiliary and Pancreatic Surgery Dept For patients who are fasting but still require medication, the physician's order should specify "fasting but medication allowed." For patients who are fasting but taking medication, is there a medical order stating 'fasting but not taking medication'? Physician's order sheet Document Review Physician's orders content Yes Hepatobiliary and Pancreatic Surgery Dept The department standardizes and provides training on the clamping time for nasogastric tubes after medication administration and key observation points. ① Standardized clamping time; ② Standardized observation points Training materials / Assessment records Document Review Training materials, Assessment records No Digestive System Oncology Dept Emphasize management protocols for hypoglycemic patients during morning meetings and randomly assess nurses' understanding of the standards within the following week. ①Consistency between nurse's response and management protocols; ②Mastering of management protocols content Nurse s Listening / Document Review Nurses' mastery of management protocols No Otorhinolaryngology-Head and Neck Surgery Dept The responsible nurse should arrange the blood collection tubes in an orderly manner before blood sampling. Arrangement of blood collection tubes Nurses Direct Observation Venous blood sampling procedure No Rehabilitation Medicine Dept During the night shift, the team leader handles the doctor's orders. The person who handles medical orders during the night shift Physician's order sheet Document Review Signature on the medical order No Pediatrics Dept For patients with poor peripheral circulation, promptly communicate with the physician regarding the collection of venous blood specimens. Specimen collection for patients with poor peripheral circulation Nurses Inquiry Nurse's response No Urology Dept For patients positive for hepatitis B surface antigen, the responsible nurse should remind the physician to issue isolation orders. Is there the physician's order for isolation for the patient with positive Hepatitis B surface antigen (HBsAg)? Physician's order sheet Document Review Physician's orders No Neurosurgery Dept Create a departmental management protocol for venous blood collection requirements in a text-and-image format, post it at the specimen collection counter, and ensure everyone is aware and implements it. Is there a departmental management protocol for venous blood collection requirements in a text-and-image format posted at the specimen collection counter? Departmental management protocol content Direct Observation Specimen station No Anesthesiology Dept Place the defibrillator in Operating Room 1 together with its self-test/maintenance log sheet Whether the defibrillator and its self-test/maintenance log sheet are placed together Operating Room 1 Direct Observation Placement No Thoracic Surgery Dept During the verification of medical orders, specimens sent to specialized departments should be marked with a red marker pen. Whether specimens for special departments are annotated with a red marker. Nurses Direct Observation Physician's orders verification process Yes Thoracic Surgery Dept After blood collection, carefully verify the department to which the specimens are to be sent, and place blood samples on the specimen counter according to the department in separate areas.. Whether the nurse carefully checks the department to which the specimens are to be sent, and places the specimens on the specimen table according to the department in separate areas. Nurses Direct Observation Nurse's behavior After blood collection No Neurology Dept For special handover information, place clear markers at the patient's bedside. Whether markers for special information are present at the bedside. Nurses Direct Observation Bedside markers No Nephrology Dept During medication education, inform patients of start time, dosage, precautions, and potential adverse reactions. Whether the medication education includes the stated content. Nurses Listening Medication education session No Neurosurgery Dept Implement measures to prevent foot drop in bedridden patients. Whether preventive measures for foot drop are taken for bedridden patients. Patients Direct Observation Patient positioning Yes Orthopedics Dept For post-op patients with limb swelling, document the swelling and post-medication effect evaluation in nursing records. Whether nursing records for such patients document swelling and medication effect evaluation. Nursing record Document Review Recorded content No Gastroenterology Dept Provide one-on-one guidance to nurses in developing nursing care plans. Whether one-on-one guidance was provided. Nurses Inquiry Nurse's response No Research Methodology Interview Outline Based on the concepts and five dimensions of the implementation science CFIR theoretical framework, an initial interview outline was developed and pre-tested. The interview outline was revised based on the results of the pre-testing. The final interview outline is as follows: ① What is your perspective on the rectification work regarding issues identified in nursing quality supervision? Why? Please provide examples. ② During the implementation of rectification measures, what factors related to the measures themselves hindered their execution? Why? Please provide examples. ③ During the implementation of rectification measures, what factors within the department hindered their execution? Why? Please provide examples. ④ During the implementation of rectification measures, what factors outside the department hindered their execution? Why? Please provide examples. ⑤ During the implementation of rectification measures, what aspects of the process were inadequate? Why? Please provide examples. (What measures were taken during the implementation process to promote rectification?) ⑥ What additional opinions and suggestions do you have regarding the rectification of issues identified in nursing quality supervision? The interview guide was specifically designed for this study and is available in Supplementary File 1. Data Collection Methods Prior to the formal interviews, thorough communication was conducted with the participants to explain the purpose, significance, process, and confidentiality policy of the study. Informed consent forms were signed, and general demographic information of the participants was collected. Real names were replaced with identification codes to ensure data anonymity. The interviews were conducted as one-on-one face-to-face sessions in quiet, independent meeting rooms. Conversations were recorded using an iPhone, and subtle changes in the participants' psychological mood, posture, behavior, and facial expressions were observed. Valuable questions were followed up appropriately, and supplementary notes were taken. During the interviews, no leading, suggestive, or evaluative remarks were made. The duration of each interview was determined based on the participant's specific feedback, ranging from 30 to 50 minutes per person, with an average of 40 minutes. Data Analysis Within 24 hours after each interview, two researchers transcribed the audio recordings into text materials using the iPhone Voice Memos application. Combining the key terms noted by the researchers during the interviews and the participants' expressions, tone, eye contact, silence duration, and body language at the time, significant statements were extracted. The interview records of the 15 head nurses were sequentially coded from HN1 to HN15, while those of the 15 nurses were coded from N1 to N15. Separate independent documents were created for each group, and thematic analysis was employed for data analysis. The identified viewpoints were coded; coded viewpoints were then aggregated; similar viewpoints were identified and organized using inductive methods; the organized data were returned to the participants for verification. Each set of data was analyzed independently by at least two researchers to identify themes, which were subsequently revised based on feedback from the participants. A total of 150 meaning units, 45 codes, 11 subthemes, and 3 main themes were identified. Results General Information of Study Subjects A total of 15 head nurses and 15 nurses were interviewed. Their gender, age, educational background, years of management experience, position, and professional title are detailed in Table 2. Number Educational background Professional title Position Years of management experience Number Educational background Professional title Years of experience HN1 Bachelor's degree Associate Chief Nurse Specialty Nurse Manager 5 N1 Bachelor's degree Associate Chief Nurse 18 HN2 Postgraduate degree Supervisor Nurse Ward Head Nurse 2 N2 Bachelor's degree Associate Chief Nurse 20 HN3 Postgraduate degree Supervisor Nurse Ward Head Nurse 1 N3 Bachelor's degree Associate Chief Nurse 25 HN4 Bachelor's degree Supervisor Nurse Specialty Nurse Manager 5 N4 Bachelor's degree Supervisor Nurse 8 HN5 Bachelor's degree Supervisor Nurse Ward Head Nurse 3 N5 Bachelor's degree Senior Nurse 5 HN6 Postgraduate degree Associate Chief Nurse Chief Nursing Officer 13 N6 Postgraduate degree Supervisor Nurse 8 HN7 Bachelor's degree Associate Chief Nurse Specialty Nurse Manager 17 N7 Bachelor's degree Senior Nurse 4 HN8 Bachelor's degree Associate Chief Nurse Chief Nursing Officer 14 N8 Postgraduate degree Supervisor Nurse 3 HN9 Bachelor's degree Associate Chief Nurse Specialty Nurse Manager 16 N9 Bachelor's degree Supervisor Nurse 12 HN10 Bachelor's degree Supervisor Nurse Ward Head Nurse 3 N10 Bachelor's degree Supervisor Nurse 11 HN11 Bachelor's degree Chief Nurse Chief Nursing Officer 20 N11 Bachelor's degree Supervisor Nurse 15 HN12 Bachelor's degree Supervisor Nurse Ward Head Nurse 4 N12 Bachelor's degree Senior Nurse 2 HN13 Postgraduate degree Associate Chief Nurse Specialty Nurse Manager 5 N13 Bachelor's degree Senior Nurse 1 HN14 Postgraduate degree Associate Chief Nurse Specialty Nurse Manager 6 N14 Postgraduate degree Supervisor Nurse 17 HN15 Bachelor's degree Supervisor Nurse Ward Head Nurse 3 N15 Bachelor's degree Supervisor Nurse 16 Key Themes Divergent Attitudes among Nursing Staff Toward the Rectification of Supervision Findings Proactive and Collaborative Attitude Some nursing staff view rectification as an opportunity for improvement. They proactively collaborate to resolve issues and actively implement corrective measures. HN2: "Our department occasionally admits patients with concomitant renal failure. Nurses routinely record frequency of urination on the vital signs sheet. Once, during a night round, feedback was given that 'recording urine output is more accurate than frequency for patients with renal failure.' I found this particular rectification suggestion very meaningful." HN5: "Quality supervision often highlights that 'potassium chloride sustained-release tablets/aspirin enteric-coated tablets cannot be administered via nasogastric tube.' Even though this wasn't an issue in my department, I took the initiative to review the literature to clarify and understand it thoroughly." N8: "The corrective measures developed by the department are all based on actual clinical problems. Addressing them proactively not only enhances my own skills but also makes the work more efficient and convenient." Negative and Resistant Attitude Some nursing staff are resistant to rectification, displaying strong negative emotions that affect their work. HN12: "Every time a problem is identified, I feel immense pressure because the focus isn't really on how to fix it, but on being labeled or categorized." HN8: "Some feedback from supervisors is about non-existent problems. The issues cited are the same every week. If I address them, it feels like admitting to being a repeat offender." N4: "There are too many things to rectify, and the directives often change frequently. I don't want to waste my energy on it." Passive and Compliant Attitude Some nursing staff mechanically complete rectification procedures but refuse to engage in deep thinking or meaningful participation. HN1: "Supervisors always have to document some problems. Making approximate corrections is sufficient; there's no need to be overly meticulous." N7: "Many rectification tasks are about trivial matters that hold little significance and are impossible to eliminate completely." Contingent Selective Attitude Some nursing staff hold varying attitudes, dynamically adjusting their level of engagement based on the perceived benefits and drawbacks of the rectification. HN10-11: "If a new rectification requirement conflicts with our department's current protocols, I'm reluctant to implement it. However, if it's compatible, I'm willing to give it a try." HN3: "If the rectification is genuinely aimed at solving problems, I'll take it seriously. If it's more about asserting authority through nitpicking, I'll just go through the motions." N9: "I pay attention to rectifications mandated by our head nurse. However, many issues raised by supervisors from other departments are not professional in my view, so I don't consider them necessary to address." Systematic and Multi-faceted Challenges in Implementing Nursing Quality Supervision Rectifications Poor Feasibility of the Rectification Measures Themselves Some measures are problematic due to vague descriptions, increased nursing workload, misalignment with patient needs, or contradictions between old and new standards, making them difficult to implement in clinical practice. N6: "Rectification measures often vaguely state 'strengthen training, optimize processes, and reinforce sense of responsibility,' but there's no clarity on how to actually implement them." N5: "To improve nurses' ability in condition observation, the department required night-shift nurses to compile a list of 'ten key details' for critically ill patients and discuss them with the whole team after morning handover. The night shift is already heavily burdened; adding this extra task meant we could only manage a perfunctory effort." N1: "To maintain environmental tidiness, we were required to store urinals on the under-bed storage rack. However, some elderly patients have limited mobility, and placing the urinal bedside when family isn't present allows for easier access and helps prevent falls. Enforcing the rule causes significant resentment among these patients." N2: "The head nurse previously required night-shift nurses to empty and record patient drainage fluid in the morning. Recently, because doctors need to review the drainage during morning rounds, the head nurse changed the rule: night shift no longer empties it; the primary nurse does. So, who records the output volume? Which shift is responsible now? It's unclear." Lack of Consensus in Internal Communication and Understanding When formulating rectification measures, some managers rely on experiential decision-making with insufficient nurse participation. Furthermore, during dissemination, there is often a failure to thoroughly explain the rationale and objectives behind the measures, coupled with a lack of systematic training. This results in nurses failing to develop a unified understanding, ultimately hindering effective implementation. HN6: "Most nurses offer suggestions from their own perspective without considering the bigger picture. I usually discuss with key nursing staff to finalize the measures." HN7: "The system-level head nurse often just forwards directives from the nursing department to the group chat without analysis, summarization, or clear decision-making. Individual departments are left unsure how to implement them and often end up delaying." N14: "Every rectification feels like a sudden ambush --- decided today, to be implemented tomorrow, with no clear guidance on how to actually do it." N11: "As a float nurse rotating through different departments, I encounter varying protocols and requirements. Due to the lack of systematic training, I have to rely on fragmented information and my own experience to figure things out. My understanding of many requirements is actually not thorough." Absence of Supportive Conditions for Implementation of Corrective Measures Some interviewees noted that insufficient allocation of basic resources, a poor departmental organizational culture and execution climate, communication and collaboration barriers between doctors and nurses as well as between nurses and patients, and a lack of positive performance evaluation incentives all diminish the internal motivation for implementing rectification measures and undermine sustained improvement. N4: "The head nurse requires sphygmomanometers to be disinfected after each use, but neither disinfection supplies nor backup sphygmomanometers are provided, making it impossible to comply." N8: "Many nurses on the night shift let family members refill tracheostomy humidification bottles themselves. I know it's wrong, but if I don't go along or if I report it to the head nurse, I'll be ostracized by everyone." N10: "The trash bin under the medication cart is always left uncleaned. If the previous shift didn't do it, then I won't either." HN14: "Inpatient self-administered medications need to be managed under formal doctor's orders, but doctors generally don't see it as important. Nurses end up constantly nagging them, which is frustrating." N12-15: "Although the department's quality score is linked to performance pay, the difference it makes is minimal. It has little impact on actual income and doesn't affect performance evaluations or promotions, so there's no need to pay much attention to it." Inadequate Supervision Mechanisms for the Rectification Process The interviews revealed that some departments lack routine supervision during the execution phase, leading to an absence of ongoing monitoring for the implementation of rectification measures. Furthermore, supervision between departments suffers from inconsistencies in standards and understanding, which can easily trigger conflicts and hinder implementation. N9: "After the operating procedure was updated, aside from one training session when it was first released, there has been no follow-up assessment. Over time, everyone reverts to old habits." N3: "With fewer staff on night shifts, many processes get simplified. The lack of effective night-shift quality control turns some issues into 'supervision blind spots'." HN4: "The ENT department requires post-parotidectomy patients to follow a regular diet, just avoiding overly sour or sweet foods. However, during a supervision visit, a supervisor from the Stomatology department insisted on a completely bland diet. Such discrepancies leave nurses confused about what to do." Failure to Institutionalize and Normalize the Management of Rectification Measures Most rectification measures are not solidified into departmental standard operating procedures or protocols. Even when standards are established, they often fail to be integrated into job responsibilities and routine training. Additionally, some departments lack established mechanisms for regular self-inspection and evaluation. These factors cause the enforcement of measures to gradually weaken as external attention wanes, preventing them from becoming internalized as stable work habits. N11: "This year, the department started performing endoscopic thyroid surgeries. Detailed nursing protocols were developed at the time but were never incorporated into the standard nursing routines. New staff aren't aware of them, and they eventually get forgotten." N15: "Although the department clearly states that the treatment nurse is responsible for managing the examination room, this duty is not included in my job description, nor is it covered in routine quality control checks. Performance isn't affected by how well or poorly it's done, so vigilance naturally slips over time." N1: "Departmental training always focuses on new rectification requirements but rarely covers these already established standards with training or assessment. New staff learn by following senior colleagues and can easily pick up old, incorrect habits." N13: "When a rectification measure was first implemented, the head nurse supervised it frequently. Later, the checks stopped, and everyone naturally became less diligent." Recommendations to Apply Information and Intelligent Platforms to Facilitate Effective Implementation of Rectification Measures A Need for Timely Integration of Rectification Measures with Information Systems Following the implementation of rectification measures, the failure to promptly synchronize with the hospital information system resulted in nursing staff still relying on manual recording or informal processes, thereby increasing their workload. HN9: "The hospital is promoting Enhanced Recovery After Surgery (ERAS), requiring patients to fast from clear liquids 2 hours preoperatively. However, the information system cannot accurately synchronize with the operating room schedule. To avoid disputes, nurses can only enforce this strictly for the first scheduled surgery of the day." HN13: "Narcotic and Psychotropic Substances require management under a double-lock cabinet with dual-person verification. Currently, the system only checks that both locks are used but does not verify the identities of the two individuals, allowing for 'sham dual verification.' If the information system could implement fingerprint or facial recognition, this issue would be easily resolved." N7: “ Pain assessment requires evaluating the factors influencing the patient's pain, but this feature is not implemented in the system, leading to potential omissions in the assessment and no record of the results." A Desire for Intelligent Decision Support and Alert Systems Nursing staff expressed a desire for information platforms to provide intelligent alerts and decision support to enhance work efficiency. HN10: "For terminal disinfection after infectious disease cases, if the system could automatically identify such cases and generate a pop-up reminder upon patient discharge, it would significantly reduce incidents of missed terminal disinfection." HN5: "Post-operative patients require focused attention on Deep Vein Thrombosis (DVT) prevention. If the system could automatically assess risk levels based on surgery type and patient immobilization time, and then generate personalized activity and observation plans to remind nurses for implementation, ensuring more effective measure execution." N15: "Many nursing care plans require dynamic adjustments. If the system could intelligently suggest, 'Current nursing problem resolved, consider adjusting goals' or 'New risk identified, please assess,' it would greatly enhance the precision and timeliness of care planning." Discussion The Attitude of Nursing Staff towards Quality Supervision and Rectification Affects the Behavior of Rectification Behavioral science theories and prior research clearly indicate that individual attitudes are a key antecedent variable driving behavioral intentions. For example, the COM-B model identifies "motivation" as a core element for behavior occurrence 32 , while the Theory of Planned Behavior (TPB) emphasizes the direct determining role of "behavioral attitude" on behavioral intention 33 . This study further reveals that nursing staff's intrinsic attitudes towards quality inspection rectification are not monolithic and homogeneous; rather, they exhibit significant diversity, complexity, and dynamism, specifically manifesting in the following four types: First, the Proactive Collaborative Type: Nursing staff view rectification as a developmental opportunity to enhance professional competence and optimize workflows. This aligns highly with the characteristics of nurses described in Hu Meihua et al.'s research 7 as "identifying with and committing to continuous improvement." They can transform external requirements into internal drivers, thereby achieving genuine quality improvement. Second, the Resistant Type: Nursing staff harbor negative emotions due to perceived unfairness or feeling overburdened, which directly hinders action. Third, the Passive Compliant Type: Nursing staff only mechanically complete superficial tasks, lacking the willingness to reflect on the root causes of problems or to explore solutions. This leads to rectification becoming a mere formality, failing to address fundamental issues and creating a vicious cycle of "repeatedly correcting, repeatedly violating." Fourth, Contingent Selective Type: Nursing staff dynamically adjust their level of engagement based on criteria such as whether the rectification measures are compatible with existing workflows and whether they genuinely solve problems. This behavioral pattern highlights that the rationality and effectiveness of the rectification measure themselves are crucial external factors shaping nursing staff's attitudes. These findings indicate that attitudinal differences are a central hub influencing rectification behaviors. Intervention measures aimed solely at changing external behaviors while neglecting the complex internal attitudinal composition of nursing staff are likely to be half-effective. Therefore, management practices must move beyond a "one-size-fits-all" model and adopt differentiated strategies: ①Empower and Recognize the Proactive Collaborators: For example, provide them with more opportunities to participate in decision-making, establish them as role models, offer public recognition, and disseminate their successful experiences, thereby transforming individual strengths into group momentum. ②Address the Resistant Type by Fostering a Fair and Just Feedback Environment: Adhere to an inspection style focused on issues rather than individuals to dissolve their antagonism and rebuild their trust in the rectification process. ③Guide the Passive Compliant Type by Clarifying Value and Simplifying Processes: For instance, when assigning tasks, managers must clearly explain "why it needs to be done" and "what benefits it brings to nurses and patients." Simultaneously, break down complex measures into simple, actionable steps to lower the barrier to execution, and gradually cultivate their sense of responsibility through small, successful experiences. ④Win Over the Contingent Selective Type by Clarifying Meaning and Ensuring Compatibility: For example, when implementing new measures, managers should conduct sufficient pilot studies, use data to demonstrate the relative advantages of the new method compared to the old one clearly, and ensure good compatibility of new measures with existing workflows to earn the active identification and engagement of nursing staff. In summary, attitude determines behavior. Recognizing the diversity of attitudes and implementing differentiated management strategies is the primary step in stimulating the internal drive for rectification at the individual level and promoting the shift in quality improvement from "being told to do" to "I want to do." Building a Scientific Model for Rectifying Issues Identified in Nursing Quality Inspections to Ensure Systematic and Comprehensive Implementation The Consolidated Framework for Implementation Research (CFIR) provides a structured tool for systematically analyzing barriers within complex implementation environments. Its effectiveness has been validated in healthcare quality improvement studies, such as those on dietary management during dialysis 25 and cardiac rehabilitation practices 26 . Based on the CFIR framework, this study further reveals that the difficulties in rectifying issues from nursing quality inspections constitute a multi-dimensional, intertwined systemic problem: First, "Poor Feasibility of the Rectification Measures Themselves" directly corresponds to the "Innovation/Intervention" domain of CFIR, indicating that the relative advantage, complexity, and adaptability of the measures are prerequisites for their acceptance. Second, the "Attitudinal Differences" exhibited by nursing staff profoundly reflect the influence of the "Individual Characteristics" domain, serving as the internal driving force behind their decision to adopt or reject corrective actions. Third, "Lack of Consensus in Internal Communication and Understanding" and "Absence of Supportive Conditions for Implementation" jointly point to the core role of the "Inner Setting" domain, highlighting the critical importance of contextual factors such as organizational culture, resources, communication, and leadership support. Fourth, "Inadequate Supervision Mechanisms During the Rectification Process" is closely linked to the "implementation process" domain, emphasizing that supervision can facilitate nurses' transition from initial "task-oriented" behavioral compliance to habitual, ingrained ways of thinking and acting 34 , thereby addressing the issue of "no one supervising without rectification." Fifth, "Failure to Institutionalize and Standardize the Management of Rectification Measures" relates to the "Outer Setting" domain, suggesting the need for higher-level institutional and policy support to ensure the sustainability of rectification efforts, moving beyond "isolated corrective actions" 35 to reduce the negative cycle of "recurrence-rectification-re-recurrence." However, existing research often focuses on single aspects of rectification, such as optimizing individual measures 8 or introducing information technology 10 , lacking holistic intervention targeting the systemic elements mentioned above. Therefore, constructing a scientifically systematic rectification model is crucial. Its core advantages lie in: ①Providing a Comprehensive Roadmap: Offering managers a complete path for rectification and systematically identifying barriers. ② Emphasizing Multi-dimensional Synergy: Taking a holistic, problem-oriented approach rather than focusing on isolated links. ③Prioritizing Contextual Fit: Ensuring rectification efforts are more aligned with clinical realities. ④ Treating Rectification as a "process of implementation" that requires management, ensuring the orderly advancement of improvements. Future research will further explore the specific components and implementation pathways of such a rectification model, aiming to provide clinical practice with a scientific and sustainable solution. Leveraging Informatization and Intelligent Platforms to Provide Technical Empowerment for the Implementation of Rectification Measures With the deepening adoption of the smart healthcare concept, artificial intelligence and information platforms have become key drivers for enhancing healthcare quality and management efficiency. Research indicates that digital and intelligent nursing management systems can effectively optimize quality control processes and achieve real-time data capture and closed-loop management 10 . Furthermore, quality control platforms developed based on databases have significantly improved the precision and timeliness of nursing management 11 . The results of this study further confirm the urgent expectation of clinical nursing staff to solve the rectification dilemma with the help of information technology, and point out the specific direction. Firstly, the desire expressed in this study for "rectification measures to be promptly aligned with the information system" is of core significance. It aims to break down information silos and institutionalize best practices into standardized electronic workflows. This reduces reliance on informal processes and manual documentation, thereby minimizing execution deviations and workload at the source. This aligns with the approach of Shi Hongyi et al. 13 in constructing a structured nursing quality system, as both emphasize the importance of deep integration between information systems and clinical norms. Secondly, the finding of a desire for "systems capable of intelligent decision-making and early warning alerts" represents an advancement from passive rectification to proactive prevention. By using algorithmic models for intelligent assessment and prompts regarding patient risks and operational steps, such systems can not only free nursing staff from cumbersome memorization and checking tasks but also preemptively avoid adverse events, achieving precision nursing. This finding is highly consistent with the future trend of "digital and intelligent" empowerment of nursing quality advocated by Luo Jinkai et al. 10 . In conclusion, this study demonstrates that deeply integrating informatization and intelligent development into the nursing quality rectification system has shifted from an 'option' to a 'necessity'. Future research could focus on developing and validating specific application models and effectiveness of such intelligent platforms, ultimately building a new model for continuous nursing quality improvement characterized by human-machine collaboration, high efficiency, and precision. Summary This study was grounded in the Consolidated Framework for Implementation Research (CFIR) and employed a descriptive qualitative research approach, aiming to systematically identify barriers hindering the implementation of rectification measures for issues identified in nursing quality inspections. The research revealed significant variations in nursing staff's attitudes towards rectification. It further dissected the comprehensive, systemic challenges constraining rectification effectiveness, spanning aspects from measure feasibility and organizational support to supervision mechanisms and institutionalization. Additionally, it highlighted the substantial negative impact of insufficient information system support on rectification efficiency. The management insights derived accordingly provide a crucial foundation for healthcare institutions to address rectification dilemmas and construct a scientific rectification model. However, as a single-center qualitative exploration, the generalizability of these conclusions awaits further verification through future large-sample, multi-center studies. Declarations Disclosure There is no conflict of interest in publishing this article. Ethical Approval This study was approved by the Institutional Review Board of Shanxi Bethune Hospital of China (YXLL-2025-196) and conducted in accordance with the Declaration of Helsinki. All methods were performed in accordance with the recommended guidelines and regulations. The purpose and significance of the study were explained to the participants, and only those who agreed to participate were interviewed after obtaining written informed consent. Clinical trial number Not applicable. Consent for publication Not applicable. Funding Information There is no financially supporting body for this article. Author Contribution All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Acknowledgments Not Applicable. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Chen Y, Zheng J, Wu D, Zhang Y, Lin Y. Application of the PDCA cycle for standardized nursing management in a COVID-19 intensive care unit. Annals Palliat Med. 2020;9(3):1198–205. Pei-Ying KO, Chen-Shie HO, Pei-Hung L. The impact of a multilevel interactive nursing quality control and audit application on nursing quality management. 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Chin J Evidence-Based Med. 2017;17(5):603–6. Yao G, Ye X, Zhao J. Analysis and efects of Emergency Rescue Nursing Records. Chin Med Record. 2019;20(12):14–6. Luo J, Zhang J, Sun M, et al. Construction and Application of an Intelligent Nursing Quality Management System in a Multi-Branch Hospital Setting. Chin Nurs Manage. 2025;25(2):161–6. Xu J, Qian Y, Chen Q, Gu D. Development and application of nursing quality management systembased on Access database. J Nurs Adm. 2023;23(9):700–4. Ding Z. Observation on the Application of Nursing Quality Management Supervision in Nursing Quality Management. Electron J Clin Med Literature. 2020;7(5):189. Shi H, Zhang J, Zhang Y. Clinical Practice of Building a Structured Nursing Quality System through Nursing Information Systems. J Clin Nurs. 2022;21(4):70–2. Shen Y, Wang B, Chen X, et al. Development and Reliability and Validity Testing of the Core Competency Evaluation Questionnaire for Level III Nursing Quality Control Personnel. J Nurs Adm. 2025;25(5):455–60. Yue Y, Niu L, Lv H. Problems and Countermeasures in Nursing Interventions in 100 Nursing Records. J Nursing(China). 2000;27(5):46–7. Song G, Yang S, Jiang L. Causes of Nursing Adverse Events and Corrective Measures. Mod Nurse. 2016;11(2):183–4. Wen X, Yan X, Li K. The Impact of a Nursing Information System Based on Quality Control Tools on the Quality of Orthopedic Surgery Nursing. J Huaihai Med. 2024;42(6):635–9. Gao M. Practice of Quality Control Circles in the Continuous Improvement of Traditional Chinese Medicine Specialty Nursing. J Traditional Chin Med Manage. 2023;31(14):160–2. Wang Q, Ma Y, Ma H, Wang Y. Application of Integrated Root Cause Analysis in Preventing Airway Care Adverse Events in Patients with Tracheostomy after Laryngeal Cancer Surgery. Chin Nurs Res. 2024;38(21):3936–40. Zhang X, Deng Z, Zan H, Du R, Chen J. Construction and Application of On-Site Supervision and Feedback Model for Nursing Quality. Chin Nurs Manage. 2024;24(5):746–50. Zhou C, Lu J, Zhu H, Li Y. Application of Positive Feedback Closed-Loop Management System in Daytime Information Follow-Up System Management. Mod Nurse. 2022;29(8):159–62. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement science: IS. 2009;4:50. Birken SA, Powell BJ, Shea CM, et al. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement science: IS. 2017;12(1):124. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement science: IS. 2022;17(1):75. Lu Q, Liang Y, Li Y, Luo Z, Zhong J, Wu G. Analysis of Barriers to the Clinical Application of the Best Evidence in Dietary Management During Dialysis: Based on CFIR Theory. Intern Med. 2024;19(03):252–6. Ping Y, Qin Q. Analysis of Factors Influencing the Implementation of Hospital-Led Home-Based Cardiac Rehabilitation Programs: Based on the CFIR Theoretical Framework. Health Res. 2023;43(04):421–7. Fu J, Zeng L, Zhan Y, et al. Progress in the Application of Implementation Research Frameworks in Oncology Nursing. Chin Nurs Res. 2026;40(01):155–9. Liu Y, Ma Z, Ma Z. Interpretation of the Components of the New Implementation Research Comprehensive Framework (CFIR 2022). Chin J Evidence-Based Med. 2023;23(6):738–44. Qing Q, Wang J, Huang Y, Huang Y, He J. Construction and validation of a risk prediction model for nursing adverse events in hospitalized patients. Chin Nurs Res. 2024;38(22):4004–8. Liu W, Li Y, Han Q, Lin Y. Construction of a Peer Support Education Program for Nursing Interns Based on Social Learning Theory. J Nursing(China). 2023;30(3):16–9. Flock C, Boekels R, Herrmann A, et al. Final year medical students' expectations for medical education on climate change and planetary health - a qualitative study. Med Educ Online. 2025;30(1):2477670. Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Acceptability, reliability, and validity of a brief measure of capabilities, opportunities, and motivations (COM-B). Br J Health Psychol. 2020;25(3):474–501. Su T, Zhu Y, Wang Z, Xu L, Pang X. Research Progress on the Application of the Theory of Planned Behavior in Oral Health Behaviors. Chin Nurs Res. 2024;38(12):2194–8. Gu Y, Hu Y, Zhou Y, et al. Promoting the Translation of Evidence into Practice (15) Strategies for Sustaining Change. J Nurses Train. 2020;35(21):167–1972. Chen Z, Chen Z, Fang F. Application of Six Sigma Management Model in the Quality Management of Surgical Instruments. Med Equip. 2025;38(8):40–4246. Additional Declarations No competing interests reported. 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Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYDACCRgJZlQwMBgwMLCRouUM8VqgDMY2IrTIz25+9vBrm4U8v3TzsYdf59UlbmdPPvaAocYmmoH97AFsWhjnHDM3ljkjYThzzrF0Y9lth40te56lGzAcS8tt4MlLwKaFWSLBTFqiQoJxw40cM2nJbQfkDIAMCcaGw7kNEjwG2LSwSaR/k5YwkLCHaJlTx2NwI/8bXi08Ejlmkh8qJBJBWiQ/NjCDbGHDq0VCIqdMmuGMRPLMGWlp0gzHwH4xk0gA+qWNJwerFvkZ6dskf7bV2fZLJB+T/FEDDrFnEh9qbHL72c9g1QIOAh5URgIY4Y0dxh+ojAQ8akfBKBgFo2AkAgASNlqtu+PsUwAAAABJRU5ErkJggg==","orcid":"","institution":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaohong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-01-28 12:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8720415/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8720415/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104405640,"identity":"38167003-ba70-46fc-8a38-2a4be4497ba5","added_by":"auto","created_at":"2026-03-11 12:23:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1640240,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8720415/v1/e77ed1b9-c27c-43d7-86a4-f517f67123b0.pdf"},{"id":104312601,"identity":"28142e22-439f-4382-bf43-a64e7ca212a0","added_by":"auto","created_at":"2026-03-10 11:18:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":82401,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8720415/v1/a08bdb5291428ec1e8663841.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cracking the code to overcoming obstacles in the rectification of nursing quality inspection issues: A qualitative exploration based on CFIR theory","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNursing quality management is a vital component of medical quality management, serving as a crucial safeguard for patient safety and one of the key performance indicators in healthcare administration. Implementing nursing quality control is therefore of significant importance\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The National Health Commission and the National Administration of Traditional Chinese Medicine, in their issued \u0026ldquo;Action Plan for Comprehensive Improvement of Medical Quality (2023\u0026ndash;2025)\u0026rdquo;, emphasize strengthening foundational quality and safety management, improving the monitoring and feedback of nursing quality, and conducting continuous improvement initiatives based on evidence and clinical needs to enhance the standardization and consistency of nursing care\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Nursing quality supervision, as a method involving on-site inspections, collection of nursing quality indicator data, and evaluation of nursing quality\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, represents one of the important inspection approaches for promptly identifying nursing errors, effectively standardizing clinical nursing practices, improving medical quality, and ensuring healthcare safety\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Rectification, as a critical link in the closed-loop management cycle of \"supervision\u0026ndash;feedback\u0026ndash;rectification\u0026ndash;follow-up\" for nursing quality, acts as the core pivot from \"problem identification\" to \"improvement realization.\" Whether rectification measures are effectively implemented directly determines the success of this closed-loop management, constituting the fundamental purpose and objective of nursing quality supervision.\u003c/p\u003e \u003cp\u003eCurrently, there has been extensive research on the rectification of nursing quality supervision issues. Healthcare institutions commonly employ various approaches, such as optimizing rectification measures through best-evidence summaries\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, enhancing the implementation effectiveness of measures by improving nurses' sense of responsibility\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, increasing rectification efficiency by applying information technology platforms\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, and boosting rectification satisfaction through strengthened supervision\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, these measures are often either too abstract\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, disconnected from clinical need\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, lack feasibility\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, or only address localized issues\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, leading to suboptimal rectification outcomes\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Some managers utilize management tools such as PDCA\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, Quality Control Circles (QCC)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and Root Cause Analysis (RCA)\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e for issue rectification, but the focus of the rectification process tends to be on tool application rather than an in-depth analysis of the methods and approaches for ensuring the effective implementation of measures, resulting in limited practical reference value. In previous research, a feedback model for on-site nursing quality supervision issues was developed\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, which mentioned guidance for improvement but only introduced the perspectives for such guidance without addressing the specifics of how to implement rectification. Essentially, the challenges in nursing quality issue rectification stem from systemic management deficiencies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Therefore, uncovering these systemic shortcomings in the rectification process is key to the effective implementation of corrective measures.\u003c/p\u003e \u003cp\u003eThe Consolidated Framework for Implementation Research (CFIR) can comprehensively identify barriers from five dimensions: the intervention/innovation, outer setting, inner setting, characteristics of individuals, and the implementation process\u003csup\u003e\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Researchers have successfully applied it to analyze barriers in areas such as dietary management during dialysis\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, cardiac rehabilitation practices\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, and oncology nursing\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, with positive outcomes. In this study, the corrective measures formulated by various departments as localized optimization plans, and their implementation status still falls within the scope of implementation science\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Consequently, using the CFIR theoretical framework to comprehensively identify the barriers to inadequate rectification provides a scientific basis for addressing the dilemma of systemic management deficiencies in the rectification process.\u003c/p\u003e \u003cp\u003eChina implements a three-level nursing quality management system\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, with head nurses serving as the primary agents of nursing quality management. They play a dual role in both nursing quality supervision and rectification. During the rectification phase, head nurses act as both decision-makers and executors of corrective actions. Some measures require implementation by staff nurses, while others fall under the responsibility of head nurses. The duties of head nurses and staff nurses involve clear division of labor yet require close collaboration, forming a bidirectional, interactive, and mutually supportive rectification community. In summary, based on the CFIR theoretical framework, this study employs qualitative interviews with head nurses and staff nurses to explore nursing personnel's cognitive attitudes and practical experiences regarding the rectification of nursing quality supervision findings. It aims to systematically identify the barrier factors affecting the effective execution of corrective measures, thereby providing a reference for the subsequent scientific construction of a rectification model for issues identified in nursing quality supervision.\u003c/p\u003e"},{"header":"Research Subjects and Methods","content":"\u003cp\u003eA descriptive qualitative research design was employed to gain an in-depth understanding of head nurses' and staff nurses' attitudes and suggestions regarding the rectification of issues identified in nursing quality supervision, as well as the barriers encountered during the implementation of corrective measures. The interviewers were two head nurses who are routinely involved in all stages of nursing quality supervision and rectification. They are colleagues of all interviewees and are proficient in qualitative research methods. This study has been approved by the Ethics Committee of Shanxi Bethune Hospital (Approval No. YXLL-2025-196). All participants provided written informed consent.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Subjects\u003c/h2\u003e \u003cp\u003ePurposeful sampling was adopted. Starting in August 2025, the corrective measures submitted by departments that had undergone night rounds in the previous week were retrieved every Thursday from the Nursing Quality Management Information System. Measures that were \"actionable through decomposition and results quantifiable\" were selected. These measures were then systematically organized using the thematic group discussion method according to a structured checklist\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. The checklist framework comprised seven fields: \"Ward Name - Original Corrective Measure - Observation Item - Observation Target - Observation Method - Evidence Source - Implementation Judgment.\" The specific procedure was as follows: ① the original corrective measure was broken down into specific, observable actions serving as observation items. ② the key visible elements that can reflect the process and effect of the implementation of the measures can be taken as the observation object. ③ the data collection method for directly obtaining information on the observation items was defined as the observation method. ④ Each item was evaluated against predefined objective evidence serving as the evidence source. ⑤ Two individuals, both holding associate senior professional titles or higher and with over five years of nursing management experience, jointly determined the implementation status. Full implementation was judged as \"implemented\" and marked \"Yes.\" Non-implementation or partial implementation was judged as \"not implemented\" and marked \"No.\" In case of disagreement, a third person made the determination to reach a final consensus. From August to September 2025, a total of 112 measures were retrieved. Among them, 21 measures could be organized using the structured observation checklist. Of these, 18 were judged as \"not implemented,\" involving 17 departments. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the structured observation checklist on the implementation of rectification measures.\u003c/p\u003e \u003cp\u003eHead nurses and on-duty nurses from the 17 departments whose measures were judged as \"No\" for implementation became the target population for semi-structured interviews. The sample size was determined by data saturation. A total of 15 head nurses and 15 nurses from 15 departments were selected as research subjects. All 30 interviewees participated fully in the interviews without any withdrawals. The selection of interviewees adhered to the maximum variation sampling strategy\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStructured Observation Checklist for Implementation of Rectification Measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal Corrective Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObservation Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObservation Target\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObservation Method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEvidence Source\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImplementation Judgment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional Chinese Medicine Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter retrieving medications, the treatment shift nurse and the responsible nurse perform dual verification of each barcode against the medication information. Once confirmed correct, the barcode is affixed to the medication box.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e①Verify medication information; ② Affix barcode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVerification process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen verifying blood collection orders and test tubes, tally the specimen items and quantities requiring dispatch to different laboratory departments and annotate this information on the test tube labels.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e① Tally specimen items and quantities for different laboratory departments; ② Annotate the receiving department on test tubes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVerification process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurosurgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlood specimens for urgent testing, blood type specimens, and specimens requiring transfer to other departments should be placed on separate test tube racks with corresponding labels.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e① Blood samples sent to different testing departments are arranged on separate test tube racks; ②Label the test tube with the department for submission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInterview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInterview content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReproductive Medicine Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe department conducted mandatory training on the standard protocol for affixing laboratory test labels, with all staff required to pass an assessment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e①Verify the training content ②Testing Outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTraining materials / Assessment records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraining materials, Assessment records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeriatrics Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandardize physician's orders.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether the standardized content is reflected in the orders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInterview / Document Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhysician's orders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatobiliary and Pancreatic Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor patients who are fasting but still require medication, the physician's order should specify \"fasting but medication allowed.\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFor patients who are fasting but taking medication, is there a medical order stating 'fasting but not taking medication'?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysician's order sheet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhysician's orders content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatobiliary and Pancreatic Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe department standardizes and provides training on the clamping time for nasogastric tubes after medication administration and key observation points.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e① Standardized clamping time; ② Standardized observation points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTraining materials / Assessment records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraining materials, Assessment records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigestive System Oncology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmphasize management protocols for hypoglycemic patients during morning meetings and randomly assess nurses' understanding of the standards within the following week.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e①Consistency between nurse's response and management protocols; ②Mastering of management protocols content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurse\u0026nbsp;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eListening / Document Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNurses' mastery of management protocols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtorhinolaryngology-Head and Neck Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe responsible nurse should arrange the blood collection tubes in an orderly manner before blood sampling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArrangement of blood collection tubes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVenous blood sampling procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRehabilitation Medicine Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the night shift, the team leader handles the doctor's orders.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe person who handles medical orders during the night shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysician's order sheet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSignature on the medical order\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatrics Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor patients with poor peripheral circulation, promptly communicate with the physician regarding the collection of venous blood specimens.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecimen collection for patients with poor peripheral circulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInquiry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNurse's response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor patients positive for hepatitis B surface antigen, the responsible nurse should remind the physician to issue isolation orders.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs there the physician's order for isolation for the patient with positive Hepatitis B surface antigen (HBsAg)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysician's order sheet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhysician's orders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurosurgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCreate a departmental management protocol for venous blood collection requirements in a text-and-image format, post it at the specimen collection counter, and ensure everyone is aware and implements it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs there a departmental management protocol for venous blood collection requirements in a text-and-image format posted at the specimen collection counter?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepartmental management protocol content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpecimen station\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesiology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlace the defibrillator in Operating Room 1 together with its self-test/maintenance log sheet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether the defibrillator and its self-test/maintenance log sheet are placed together\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOperating Room 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePlacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracic Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the verification of medical orders, specimens sent to specialized departments should be marked with a red marker pen.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether specimens for special departments are annotated with a red marker.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhysician's orders verification process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracic Surgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter blood collection, carefully verify the department to which the specimens are to be sent, and place blood samples on the specimen counter according to the department in separate areas..\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether the nurse carefully checks the department to which the specimens are to be sent, and places the specimens on the specimen table according to the department in separate areas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNurse's behavior After blood collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor special handover information, place clear markers at the patient's bedside.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether markers for special information are present at the bedside.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBedside markers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring medication education, inform patients of start time, dosage, precautions, and potential adverse reactions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether the medication education includes the stated content.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eListening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedication education session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurosurgery Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplement measures to prevent foot drop in bedridden patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether preventive measures for foot drop are taken for bedridden patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDirect Observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient positioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedics Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor post-op patients with limb swelling, document the swelling and post-medication effect evaluation in nursing records.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether nursing records for such patients document swelling and medication effect evaluation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNursing record\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDocument Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecorded content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology Dept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvide one-on-one guidance to nurses in developing nursing care plans.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhether one-on-one guidance was provided.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInquiry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNurse's response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Methodology\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInterview Outline\u003c/h2\u003e \u003cp\u003eBased on the concepts and five dimensions of the implementation science CFIR theoretical framework, an initial interview outline was developed and pre-tested. The interview outline was revised based on the results of the pre-testing. The final interview outline is as follows: ① What is your perspective on the rectification work regarding issues identified in nursing quality supervision? Why? Please provide examples. ② During the implementation of rectification measures, what factors related to the measures themselves hindered their execution? Why? Please provide examples. ③ During the implementation of rectification measures, what factors within the department hindered their execution? Why? Please provide examples. ④ During the implementation of rectification measures, what factors outside the department hindered their execution? Why? Please provide examples. ⑤ During the implementation of rectification measures, what aspects of the process were inadequate? Why? Please provide examples. (What measures were taken during the implementation process to promote rectification?) ⑥ What additional opinions and suggestions do you have regarding the rectification of issues identified in nursing quality supervision? The interview guide was specifically designed for this study and is available in Supplementary File 1.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Methods\u003c/h3\u003e\n\u003cp\u003e Prior to the formal interviews, thorough communication was conducted with the participants to explain the purpose, significance, process, and confidentiality policy of the study. Informed consent forms were signed, and general demographic information of the participants was collected. Real names were replaced with identification codes to ensure data anonymity. The interviews were conducted as one-on-one face-to-face sessions in quiet, independent meeting rooms. Conversations were recorded using an iPhone, and subtle changes in the participants' psychological mood, posture, behavior, and facial expressions were observed. Valuable questions were followed up appropriately, and supplementary notes were taken. During the interviews, no leading, suggestive, or evaluative remarks were made. The duration of each interview was determined based on the participant's specific feedback, ranging from 30 to 50 minutes per person, with an average of 40 minutes.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eWithin 24 hours after each interview, two researchers transcribed the audio recordings into text materials using the iPhone Voice Memos application. Combining the key terms noted by the researchers during the interviews and the participants' expressions, tone, eye contact, silence duration, and body language at the time, significant statements were extracted. The interview records of the 15 head nurses were sequentially coded from HN1 to HN15, while those of the 15 nurses were coded from N1 to N15. Separate independent documents were created for each group, and thematic analysis was employed for data analysis. The identified viewpoints were coded; coded viewpoints were then aggregated; similar viewpoints were identified and organized using inductive methods; the organized data were returned to the participants for verification. Each set of data was analyzed independently by at least two researchers to identify themes, which were subsequently revised based on feedback from the participants. A total of 150 meaning units, 45 codes, 11 subthemes, and 3 main themes were identified.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information of Study Subjects\u003c/h2\u003e \u003cp\u003eA total of 15 head nurses and 15 nurses were interviewed. Their gender, age, educational background, years of management experience, position, and professional title are detailed in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProfessional title\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYears of management experience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eProfessional title\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eYears of experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChief Nursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChief Nursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChief Nursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssociate Chief Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecialty Nurse Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHN15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWard Head Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eKey Themes\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDivergent Attitudes among Nursing Staff Toward the Rectification of Supervision Findings\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eProactive and Collaborative Attitude\u003c/h2\u003e \u003cp\u003eSome nursing staff view rectification as an opportunity for improvement. They proactively collaborate to resolve issues and actively implement corrective measures.\u003c/p\u003e \u003cp\u003eHN2: \u003cem\u003e\"Our department occasionally admits patients with concomitant renal failure. Nurses routinely record frequency of urination on the vital signs sheet. Once, during a night round, feedback was given that 'recording urine output is more accurate than frequency for patients with renal failure.' I found this particular rectification suggestion very meaningful.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN5: \u003cem\u003e\"Quality supervision often highlights that 'potassium chloride sustained-release tablets/aspirin enteric-coated tablets cannot be administered via nasogastric tube.' Even though this wasn't an issue in my department, I took the initiative to review the literature to clarify and understand it thoroughly.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN8: \u003cem\u003e\"The corrective measures developed by the department are all based on actual clinical problems. Addressing them proactively not only enhances my own skills but also makes the work more efficient and convenient.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eNegative and Resistant Attitude\u003c/h2\u003e \u003cp\u003eSome nursing staff are resistant to rectification, displaying strong negative emotions that affect their work.\u003c/p\u003e \u003cp\u003eHN12: \u003cem\u003e\"Every time a problem is identified, I feel immense pressure because the focus isn't really on how to fix it, but on being labeled or categorized.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN8: \u003cem\u003e\"Some feedback from supervisors is about non-existent problems. The issues cited are the same every week. If I address them, it feels like admitting to being a repeat offender.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN4: \u003cem\u003e\"There are too many things to rectify, and the directives often change frequently. I don't want to waste my energy on it.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePassive and Compliant Attitude\u003c/h2\u003e \u003cp\u003eSome nursing staff mechanically complete rectification procedures but refuse to engage in deep thinking or meaningful participation.\u003c/p\u003e \u003cp\u003eHN1: \u003cem\u003e\"Supervisors always have to document some problems. Making approximate corrections is sufficient; there's no need to be overly meticulous.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN7: \u003cem\u003e\"Many rectification tasks are about trivial matters that hold little significance and are impossible to eliminate completely.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eContingent Selective Attitude\u003c/h2\u003e \u003cp\u003eSome nursing staff hold varying attitudes, dynamically adjusting their level of engagement based on the perceived benefits and drawbacks of the rectification.\u003c/p\u003e \u003cp\u003eHN10-11: \u003cem\u003e\"If a new rectification requirement conflicts with our department's current protocols, I'm reluctant to implement it. However, if it's compatible, I'm willing to give it a try.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN3: \u003cem\u003e\"If the rectification is genuinely aimed at solving problems, I'll take it seriously. If it's more about asserting authority through nitpicking, I'll just go through the motions.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN9: \u003cem\u003e\"I pay attention to rectifications mandated by our head nurse. However, many issues raised by supervisors from other departments are not professional in my view, so I don't consider them necessary to address.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSystematic and Multi-faceted Challenges in Implementing Nursing Quality Supervision Rectifications\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003ePoor Feasibility of the Rectification Measures Themselves\u003c/h2\u003e \u003cp\u003eSome measures are problematic due to vague descriptions, increased nursing workload, misalignment with patient needs, or contradictions between old and new standards, making them difficult to implement in clinical practice.\u003c/p\u003e \u003cp\u003eN6: \u003cem\u003e\"Rectification measures often vaguely state 'strengthen training, optimize processes, and reinforce sense of responsibility,' but there's no clarity on how to actually implement them.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN5: \u003cem\u003e\"To improve nurses' ability in condition observation, the department required night-shift nurses to compile a list of 'ten key details' for critically ill patients and discuss them with the whole team after morning handover. The night shift is already heavily burdened; adding this extra task meant we could only manage a perfunctory effort.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN1: \u003cem\u003e\"To maintain environmental tidiness, we were required to store urinals on the under-bed storage rack. However, some elderly patients have limited mobility, and placing the urinal bedside when family isn't present allows for easier access and helps prevent falls. Enforcing the rule causes significant resentment among these patients.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN2: \u003cem\u003e\"The head nurse previously required night-shift nurses to empty and record patient drainage fluid in the morning. Recently, because doctors need to review the drainage during morning rounds, the head nurse changed the rule: night shift no longer empties it; the primary nurse does. So, who records the output volume? Which shift is responsible now? It's unclear.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLack of Consensus in Internal Communication and Understanding\u003c/h2\u003e \u003cp\u003eWhen formulating rectification measures, some managers rely on experiential decision-making with insufficient nurse participation. Furthermore, during dissemination, there is often a failure to thoroughly explain the rationale and objectives behind the measures, coupled with a lack of systematic training. This results in nurses failing to develop a unified understanding, ultimately hindering effective implementation.\u003c/p\u003e \u003cp\u003eHN6: \u003cem\u003e\"Most nurses offer suggestions from their own perspective without considering the bigger picture. I usually discuss with key nursing staff to finalize the measures.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN7: \u003cem\u003e\"The system-level head nurse often just forwards directives from the nursing department to the group chat without analysis, summarization, or clear decision-making. Individual departments are left unsure how to implement them and often end up delaying.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN14: \u003cem\u003e\"Every rectification feels like a sudden ambush --- decided today, to be implemented tomorrow, with no clear guidance on how to actually do it.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN11: \u003cem\u003e\"As a float nurse rotating through different departments, I encounter varying protocols and requirements. Due to the lack of systematic training, I have to rely on fragmented information and my own experience to figure things out. My understanding of many requirements is actually not thorough.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAbsence of Supportive Conditions for Implementation of Corrective Measures\u003c/h2\u003e \u003cp\u003eSome interviewees noted that insufficient allocation of basic resources, a poor departmental organizational culture and execution climate, communication and collaboration barriers between doctors and nurses as well as between nurses and patients, and a lack of positive performance evaluation incentives all diminish the internal motivation for implementing rectification measures and undermine sustained improvement.\u003c/p\u003e \u003cp\u003eN4: \u003cem\u003e\"The head nurse requires sphygmomanometers to be disinfected after each use, but neither disinfection supplies nor backup sphygmomanometers are provided, making it impossible to comply.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN8: \u003cem\u003e\"Many nurses on the night shift let family members refill tracheostomy humidification bottles themselves. I know it's wrong, but if I don't go along or if I report it to the head nurse, I'll be ostracized by everyone.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN10: \u003cem\u003e\"The trash bin under the medication cart is always left uncleaned. If the previous shift didn't do it, then I won't either.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN14: \u003cem\u003e\"Inpatient self-administered medications need to be managed under formal doctor's orders, but doctors generally don't see it as important. Nurses end up constantly nagging them, which is frustrating.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN12-15: \u003cem\u003e\"Although the department's quality score is linked to performance pay, the difference it makes is minimal. It has little impact on actual income and doesn't affect performance evaluations or promotions, so there's no need to pay much attention to it.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInadequate Supervision Mechanisms for the Rectification Process\u003c/h2\u003e \u003cp\u003eThe interviews revealed that some departments lack routine supervision during the execution phase, leading to an absence of ongoing monitoring for the implementation of rectification measures. Furthermore, supervision between departments suffers from inconsistencies in standards and understanding, which can easily trigger conflicts and hinder implementation.\u003c/p\u003e \u003cp\u003eN9: \u003cem\u003e\"After the operating procedure was updated, aside from one training session when it was first released, there has been no follow-up assessment. Over time, everyone reverts to old habits.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN3: \u003cem\u003e\"With fewer staff on night shifts, many processes get simplified. The lack of effective night-shift quality control turns some issues into 'supervision blind spots'.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN4: \u003cem\u003e\"The ENT department requires post-parotidectomy patients to follow a regular diet, just avoiding overly sour or sweet foods. However, during a supervision visit, a supervisor from the Stomatology department insisted on a completely bland diet. Such discrepancies leave nurses confused about what to do.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eFailure to Institutionalize and Normalize the Management of Rectification Measures\u003c/h2\u003e \u003cp\u003eMost rectification measures are not solidified into departmental standard operating procedures or protocols. Even when standards are established, they often fail to be integrated into job responsibilities and routine training. Additionally, some departments lack established mechanisms for regular self-inspection and evaluation. These factors cause the enforcement of measures to gradually weaken as external attention wanes, preventing them from becoming internalized as stable work habits.\u003c/p\u003e \u003cp\u003eN11: \u003cem\u003e\"This year, the department started performing endoscopic thyroid surgeries. Detailed nursing protocols were developed at the time but were never incorporated into the standard nursing routines. New staff aren't aware of them, and they eventually get forgotten.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN15: \u003cem\u003e\"Although the department clearly states that the treatment nurse is responsible for managing the examination room, this duty is not included in my job description, nor is it covered in routine quality control checks. Performance isn't affected by how well or poorly it's done, so vigilance naturally slips over time.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN1: \u003cem\u003e\"Departmental training always focuses on new rectification requirements but rarely covers these already established standards with training or assessment. New staff learn by following senior colleagues and can easily pick up old, incorrect habits.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN13: \u003cem\u003e\"When a rectification measure was first implemented, the head nurse supervised it frequently. Later, the checks stopped, and everyone naturally became less diligent.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations to Apply Information and Intelligent Platforms to Facilitate Effective Implementation of Rectification Measures\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eA Need for Timely Integration of Rectification Measures with Information Systems\u003c/h2\u003e \u003cp\u003eFollowing the implementation of rectification measures, the failure to promptly synchronize with the hospital information system resulted in nursing staff still relying on manual recording or informal processes, thereby increasing their workload.\u003c/p\u003e \u003cp\u003eHN9: \u003cem\u003e\"The hospital is promoting Enhanced Recovery After Surgery (ERAS), requiring patients to fast from clear liquids 2 hours preoperatively. However, the information system cannot accurately synchronize with the operating room schedule. To avoid disputes, nurses can only enforce this strictly for the first scheduled surgery of the day.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN13: \u003cem\u003e\"Narcotic and Psychotropic Substances require management under a double-lock cabinet with dual-person verification. Currently, the system only checks that both locks are used but does not verify the identities of the two individuals, allowing for 'sham dual verification.' If the information system could implement fingerprint or facial recognition, this issue would be easily resolved.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN7: \u0026ldquo;\u003cem\u003ePain assessment requires evaluating the factors influencing the patient's pain, but this feature is not implemented in the system, leading to potential omissions in the assessment and no record of the results.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eA Desire for Intelligent Decision Support and Alert Systems\u003c/h2\u003e \u003cp\u003eNursing staff expressed a desire for information platforms to provide intelligent alerts and decision support to enhance work efficiency.\u003c/p\u003e \u003cp\u003eHN10: \u003cem\u003e\"For terminal disinfection after infectious disease cases, if the system could automatically identify such cases and generate a pop-up reminder upon patient discharge, it would significantly reduce incidents of missed terminal disinfection.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHN5: \u003cem\u003e\"Post-operative patients require focused attention on Deep Vein Thrombosis (DVT) prevention. If the system could automatically assess risk levels based on surgery type and patient immobilization time, and then generate personalized activity and observation plans to remind nurses for implementation, ensuring more effective measure execution.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eN15: \u003cem\u003e\"Many nursing care plans require dynamic adjustments. If the system could intelligently suggest, 'Current nursing problem resolved, consider adjusting goals' or 'New risk identified, please assess,' it would greatly enhance the precision and timeliness of care planning.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eThe Attitude of Nursing Staff towards Quality Supervision and Rectification Affects the Behavior of Rectification\u003c/h2\u003e \u003cp\u003eBehavioral science theories and prior research clearly indicate that individual attitudes are a key antecedent variable driving behavioral intentions. For example, the COM-B model identifies \"motivation\" as a core element for behavior occurrence\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, while the Theory of Planned Behavior (TPB) emphasizes the direct determining role of \"behavioral attitude\" on behavioral intention\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. This study further reveals that nursing staff's intrinsic attitudes towards quality inspection rectification are not monolithic and homogeneous; rather, they exhibit significant diversity, complexity, and dynamism, specifically manifesting in the following four types: First, the Proactive Collaborative Type: Nursing staff view rectification as a developmental opportunity to enhance professional competence and optimize workflows. This aligns highly with the characteristics of nurses described in Hu Meihua et al.'s research\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e as \"identifying with and committing to continuous improvement.\" They can transform external requirements into internal drivers, thereby achieving genuine quality improvement. Second, the Resistant Type: Nursing staff harbor negative emotions due to perceived unfairness or feeling overburdened, which directly hinders action. Third, the Passive Compliant Type: Nursing staff only mechanically complete superficial tasks, lacking the willingness to reflect on the root causes of problems or to explore solutions. This leads to rectification becoming a mere formality, failing to address fundamental issues and creating a vicious cycle of \"repeatedly correcting, repeatedly violating.\"\u003c/p\u003e \u003cp\u003eFourth, Contingent Selective Type: Nursing staff dynamically adjust their level of engagement based on criteria such as whether the rectification measures are compatible with existing workflows and whether they genuinely solve problems. This behavioral pattern highlights that the rationality and effectiveness of the rectification measure themselves are crucial external factors shaping nursing staff's attitudes. These findings indicate that attitudinal differences are a central hub influencing rectification behaviors. Intervention measures aimed solely at changing external behaviors while neglecting the complex internal attitudinal composition of nursing staff are likely to be half-effective.\u003c/p\u003e \u003cp\u003eTherefore, management practices must move beyond a \"one-size-fits-all\" model and adopt differentiated strategies: ①Empower and Recognize the Proactive Collaborators: For example, provide them with more opportunities to participate in decision-making, establish them as role models, offer public recognition, and disseminate their successful experiences, thereby transforming individual strengths into group momentum. ②Address the Resistant Type by Fostering a Fair and Just Feedback Environment: Adhere to an inspection style focused on issues rather than individuals to dissolve their antagonism and rebuild their trust in the rectification process. ③Guide the Passive Compliant Type by Clarifying Value and Simplifying Processes: For instance, when assigning tasks, managers must clearly explain \"why it needs to be done\" and \"what benefits it brings to nurses and patients.\" Simultaneously, break down complex measures into simple, actionable steps to lower the barrier to execution, and gradually cultivate their sense of responsibility through small, successful experiences. ④Win Over the Contingent Selective Type by Clarifying Meaning and Ensuring Compatibility: For example, when implementing new measures, managers should conduct sufficient pilot studies, use data to demonstrate the relative advantages of the new method compared to the old one clearly, and ensure good compatibility of new measures with existing workflows to earn the active identification and engagement of nursing staff. In summary, attitude determines behavior. Recognizing the diversity of attitudes and implementing differentiated management strategies is the primary step in stimulating the internal drive for rectification at the individual level and promoting the shift in quality improvement from \"being told to do\" to \"I want to do.\"\u003c/p\u003e \u003cp\u003e \u003cb\u003eBuilding a Scientific Model for Rectifying Issues Identified in Nursing Quality Inspections to Ensure Systematic and Comprehensive Implementation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Consolidated Framework for Implementation Research (CFIR) provides a structured tool for systematically analyzing barriers within complex implementation environments. Its effectiveness has been validated in healthcare quality improvement studies, such as those on dietary management during dialysis\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and cardiac rehabilitation practices\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Based on the CFIR framework, this study further reveals that the difficulties in rectifying issues from nursing quality inspections constitute a multi-dimensional, intertwined systemic problem: First, \"Poor Feasibility of the Rectification Measures Themselves\" directly corresponds to the \"Innovation/Intervention\" domain of CFIR, indicating that the relative advantage, complexity, and adaptability of the measures are prerequisites for their acceptance. Second, the \"Attitudinal Differences\" exhibited by nursing staff profoundly reflect the influence of the \"Individual Characteristics\" domain, serving as the internal driving force behind their decision to adopt or reject corrective actions. Third, \"Lack of Consensus in Internal Communication and Understanding\" and \"Absence of Supportive Conditions for Implementation\" jointly point to the core role of the \"Inner Setting\" domain, highlighting the critical importance of contextual factors such as organizational culture, resources, communication, and leadership support. Fourth, \"Inadequate Supervision Mechanisms During the Rectification Process\" is closely linked to the \"implementation process\" domain, emphasizing that supervision can facilitate nurses' transition from initial \"task-oriented\" behavioral compliance to habitual, ingrained ways of thinking and acting\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, thereby addressing the issue of \"no one supervising without rectification.\" Fifth, \"Failure to Institutionalize and Standardize the Management of Rectification Measures\" relates to the \"Outer Setting\" domain, suggesting the need for higher-level institutional and policy support to ensure the sustainability of rectification efforts, moving beyond \"isolated corrective actions\"\u003csup\u003e35\u003c/sup\u003e to reduce the negative cycle of \"recurrence-rectification-re-recurrence.\" However, existing research often focuses on single aspects of rectification, such as optimizing individual measures\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e or introducing information technology\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, lacking holistic intervention targeting the systemic elements mentioned above.\u003c/p\u003e \u003cp\u003eTherefore, constructing a scientifically systematic rectification model is crucial. Its core advantages lie in: ①Providing a Comprehensive Roadmap: Offering managers a complete path for rectification and systematically identifying barriers. ② Emphasizing Multi-dimensional Synergy: Taking a holistic, problem-oriented approach rather than focusing on isolated links. ③Prioritizing Contextual Fit: Ensuring rectification efforts are more aligned with clinical realities. ④ Treating Rectification as a \"process of implementation\" that requires management, ensuring the orderly advancement of improvements. Future research will further explore the specific components and implementation pathways of such a rectification model, aiming to provide clinical practice with a scientific and sustainable solution.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eLeveraging Informatization and Intelligent Platforms to Provide Technical Empowerment for the Implementation of Rectification Measures\u003c/h2\u003e \u003cp\u003eWith the deepening adoption of the smart healthcare concept, artificial intelligence and information platforms have become key drivers for enhancing healthcare quality and management efficiency. Research indicates that digital and intelligent nursing management systems can effectively optimize quality control processes and achieve real-time data capture and closed-loop management\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Furthermore, quality control platforms developed based on databases have significantly improved the precision and timeliness of nursing management\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The results of this study further confirm the urgent expectation of clinical nursing staff to solve the rectification dilemma with the help of information technology, and point out the specific direction. Firstly, the desire expressed in this study for \"rectification measures to be promptly aligned with the information system\" is of core significance. It aims to break down information silos and institutionalize best practices into standardized electronic workflows. This reduces reliance on informal processes and manual documentation, thereby minimizing execution deviations and workload at the source. This aligns with the approach of Shi Hongyi et al.\u003csup\u003e13\u003c/sup\u003e in constructing a structured nursing quality system, as both emphasize the importance of deep integration between information systems and clinical norms. Secondly, the finding of a desire for \"systems capable of intelligent decision-making and early warning alerts\" represents an advancement from passive rectification to proactive prevention. By using algorithmic models for intelligent assessment and prompts regarding patient risks and operational steps, such systems can not only free nursing staff from cumbersome memorization and checking tasks but also preemptively avoid adverse events, achieving precision nursing. This finding is highly consistent with the future trend of \"digital and intelligent\" empowerment of nursing quality advocated by Luo Jinkai et al.\u003csup\u003e10\u003c/sup\u003e. In conclusion, this study demonstrates that deeply integrating informatization and intelligent development into the nursing quality rectification system has shifted from an 'option' to a 'necessity'. Future research could focus on developing and validating specific application models and effectiveness of such intelligent platforms, ultimately building a new model for continuous nursing quality improvement characterized by human-machine collaboration, high efficiency, and precision.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSummary\u003c/h2\u003e \u003cp\u003eThis study was grounded in the Consolidated Framework for Implementation Research (CFIR) and employed a descriptive qualitative research approach, aiming to systematically identify barriers hindering the implementation of rectification measures for issues identified in nursing quality inspections. The research revealed significant variations in nursing staff's attitudes towards rectification. It further dissected the comprehensive, systemic challenges constraining rectification effectiveness, spanning aspects from measure feasibility and organizational support to supervision mechanisms and institutionalization. Additionally, it highlighted the substantial negative impact of insufficient information system support on rectification efficiency. The management insights derived accordingly provide a crucial foundation for healthcare institutions to address rectification dilemmas and construct a scientific rectification model. However, as a single-center qualitative exploration, the generalizability of these conclusions awaits further verification through future large-sample, multi-center studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDisclosure\u003c/h2\u003e \u003cp\u003eThere is no conflict of interest in publishing this article.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e This study was approved by the Institutional Review Board of Shanxi Bethune Hospital of China (YXLL-2025-196) and conducted in accordance with the Declaration of Helsinki. All methods were performed in accordance with the recommended guidelines and regulations. The purpose and significance of the study were explained to the participants, and only those who agreed to participate were interviewed after obtaining written informed consent.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eThere is no financially supporting body for this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eNot Applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen Y, Zheng J, Wu D, Zhang Y, Lin Y. 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Med Equip. 2025;38(8):40\u0026ndash;4246.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nursing Quality Supervision, Problem Rectification, Attitude, Recommendations","lastPublishedDoi":"10.21203/rs.3.rs-8720415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8720415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNursing quality supervision is a core component in ensuring patient safety and quality improvement. Its effectiveness hinges on the genuine implementation of corrective actions within the \"supervision-feedback-rectification-follow-up\" closed-loop cycle. However, current rectification efforts often remain at the level of fragmented experience, lacking systematic analysis of the barriers to implementing corrective measures, which hampers sustained improvement. Therefore, systematically identifying the obstacles to the implementation of corrective actions based on a scientific framework is an urgent need to address this dilemma and achieve continuous quality enhancement.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo understand nursing staff's attitudes and suggestions regarding the rectification of nursing quality supervision issues, as well as the barriers encountered during implementation, thereby providing a basis for subsequent scientific rectification and effective implementation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive qualitative study was conducted. An interview guide was developed based on an in-depth understanding of the concepts and dimensions within the CFIR theoretical framework, encompassing 6 question dimensions. Using a structured checklist, 21 issues identified during nursing quality supervision were collated. Through on-site verification, 18 corrective measures were determined to be \"unimplemented,\" involving 17 departments. Subsequently, semi-structured in-depth interviews were conducted with 15 head nurses and 15 staff nurses from departments with unimplemented measures. The interview data were analyzed using thematic analysis, involving coding, categorization, and the final extraction of core themes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree overarching themes were identified: 1) Divergent attitudes among nursing staff towards the rectification of supervision findings; 2) Systemic and multifaceted challenges in implementing rectification measures for nursing quality supervision issues; 3) Recommendations to employ information and intelligent platforms to facilitate the effective implementation of corrective actions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study reveals that the effective implementation of corrective measures is constrained by a combination of factors: divergent attitudes among nursing staff towards rectification, systemic challenges encountered during the implementation process, and the absence of information technology support.\u003c/p\u003e\u003ch2\u003eImplications for Nursing Management:\u003c/h2\u003e \u003cp\u003eIt is recommended that nursing management practices focus on three key areas: 1) Enhancing communication and guidance to influence behavior through attitudinal shifts; 2) Establishing a structured model for rectifying issues identified in nursing quality supervision to overcome systemic barriers; 3) Advancing the development of information technology platforms to improve the quality and efficiency of the rectification process.\u003c/p\u003e","manuscriptTitle":"Cracking the code to overcoming obstacles in the rectification of nursing quality inspection issues: A qualitative exploration based on CFIR theory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 11:18:27","doi":"10.21203/rs.3.rs-8720415/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-05T10:38:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T07:58:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T14:26:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-09T10:17:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-09T09:43:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00205a0a-0ac2-4c4b-b298-213901beb613","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T11:18:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 11:18:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8720415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8720415","identity":"rs-8720415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}