Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

In sites where adoption had not taken place, the resistance expected to come from parents was looked at more negatively and more challenging to overcome. Nurses saw themselves as having to 'take the brunt' of the complaints by parents, predicting that they would be put in the difficult position advocating to back the 'old' delivery system on behalf of the family. Despite the broadly expressed concern that parents would 'over treat' their children at home having seen a greater number of puffs being administered in the ED, there was no evidence, experiential or otherwise, to support that concern, and some participants noted that actually the opposite situation occurred occasionally. Early adopter/adopting sites perceived an increase in patient empowerment and confidence, and a decrease in parental anxiety after having been shown how to manage their child's asthma effectively with the MDI/ spacer.