Nurses working in district hospitals in Uttarakhand, India, hold distinct shared viewpoints about what helps and what hinders the implementation of the District Residency Program (DRP) and Standard Treatment Workflows (STWs) in pediatric and neonatal services, according to a new study published in BMC Nursing.
The research, led by Juhi Kalra with co-authors including Ashok Kumar Deorari, Rashmi and Pooja Latwal, was published on 22 October 2026 as an open access research article. It set out to explore and reconstruct nurses’ shared perspectives on the perceived barriers and facilitators to rolling out these two programs at district hospitals in the northern Indian state.
Methodologically, the study took an exploratory sequential mixed methods approach. The researchers first conducted five focus group discussions involving 23 participants drawn from district hospitals in Uttarakhand between September 2024 and July 2025. Transcripts from these discussions were iteratively reviewed and thematically analysed to build a Q-set of 38 statements.
Those statements were then ranked by four trained researchers acting as independent observers, using an observer-based Q-sort with an unforced distribution ranging from minus 4, indicating strong disagreement, to plus 4, indicating strong agreement. The Q-sort data were analysed with PQ Method software to identify distinguishing and shared perspectives across three factors.
The first factor, which accounted for 36 percent of the variance with an eigenvalue of 1.55, highlighted the significance of telemedicine and teamwork, with a Q-sort value of 1 and a Z score of 1.02, over the regular review of manpower and equipment, which received a Q-sort value of minus 4 and a Z score of minus 2.24.
The second factor was defined by a single observer-sort and explained 26 percent of the variance with an eigenvalue of 1.12. This viewpoint placed emphasis on technology and teamwork, with a Q-sort value of 0 and a Z score of 0.63, denied that inconsistent training of nurses was a limitation to professional competence, with a Q-sort value of minus 4 and a Z score of minus 3.45, and perceived good interaction between nurses and residents during the District Residency Program.
The third factor, also defined by a single observer-sort, accounted for 26 percent of the variance with an eigenvalue of 0.83 and showed a strong loading on staff shortage, with a Q-sort value of 4 and a Z score of 1.46.
The authors were careful to note the limits of what the study can show. The focus group discussions did not provide a measure of implementation effectiveness, and causal relationships were not established. The findings therefore describe nurses’ perspectives rather than demonstrating the impact of either program.
Even so, the researchers concluded that nurses’ perspectives on the District Residency Program and Standard Treatment Workflows offered insights into organizational factors, including interprofessional collaboration, teamwork, existing workload, digitalization of documentation, and telemedicine. Addressing these contextual factors, they suggested, may strengthen implementation within district hospitals and improve the delivery of secondary-level healthcare.
The study is available as an open access article in BMC Nursing, allowing readers to examine the full Q-methodology analysis and the underlying focus group findings for themselves.
Subject of Research: Nurses' perspectives on the District Residency Program and Standard Treatment Workflows in pediatric and neonatal services at district hospitals in Uttarakhand, India
Article Title: Nurses’ perspectives on district residency program and standard treatment workflow implementation in pediatric care: an observer-based Q study
Article References: Kalra, J., Deorari, A. K., Rashmi, & Latwal, P. (2026). Nurses’ perspectives on district residency program and standard treatment workflow implementation in pediatric care: an observer-based Q study. BMC Nursing. https://doi.org/10.1186/s12912-026-05516-9
Image Credits: AI Generated
DOI: 10.1186/s12912-026-05516-9
Keywords: nurses, district residency program, standard treatment workflows, pediatric care, neonatal services, Q methodology, district hospitals, Uttarakhand, telemedicine, teamwork, staff shortage, mixed methods
News Source: Harold Sullivan. (October 28, 2026). Nurses weigh in on barriers and facilitators to pediatric care programs in district hospitals. Scienmag.
