Beyond Standardization: A Qualitative Study Using the i-PARIHS Framework and User Profiles to Improve Invasive Arterial Blood Pressure Monitoring Accuracy

Background Invasive arterial blood pressure (IBP) monitoring is vital in critical care, yet its accuracy is frequently compromised in practice. While previous studies have focused on technical comparisons or procedural standardization, a systematic understanding of the multifaceted barriers and facilitators from frontline nurses' perspectives is lacking. Aims To comprehensively explore factors influencing IABP monitoring accuracy through the lens of the i-PARIHS framework and to develop ICU nurse user profiles to inform tailored improvement strategies. Study Design: A descriptive qualitative study. Semi-structured interviews were conducted with 24 ICU nurses from a tertiary hospital in China between June and August 2025. Data analysis followed a two-step approach: directed content analysis guided by the i-PARIHS framework, followed by clustering analysis to construct distinct user profiles. Results Four themes aligned with i-PARIHS were identified: the dual nature of the innovation (value vs. risk), varied recipient competency, contextual barriers (e.g., lack of protocols), and facilitation strategies. Furthermore, three nurse profiles emerged: 1) The Experience-Guarded Expert (highly skilled but reliant on personal experience, cautious about risks), 2) The Seeking-Guidance Practitioner (knows standards but struggles with application, desires clear tools), and 3) The System-Advocating Catalyst (focuses on root causes and systemic solutions). Each profile exhibited unique needs and barriers. Conclusions Improving IABP accuracy requires a move beyond one-size-fits-all approaches. The integration of the i-PARIHS framework with user profiling provides a powerful strategy for developing targeted interventions. Tailoring support to the specific characteristics of different nurse profiles—such as providing decision aids for Practitioners and engaging Catalysts in quality improvement—is essential for enhancing patient safety. Relevance to Clinical Practice: The findings provide nurse managers with a framework for systematically assessing barriers to accurate IBP monitoring. Crucially, the identified user profiles enable a shift from generic training to precision interventions, guiding leaders to tailor support—such as simplified job aids for less confident staff and leadership roles for system-oriented nurses—to address specific needs, thereby enhancing monitoring reliability and patient safety.