Implementation of i‑PARIHS-guided pulmonary rehabilitation in patients receiving oxygen by high‑flow nasal cannula

Patients receiving high-flow nasal cannula (HFNC) oxygen therapy often experience dyspnea-related exercise fear, which limits adherence to pulmonary rehabilitation (PR). The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework provides a structured approach to evidence translation, yet its application in HFNC-based PR remains limited. This study evaluated the feasibility and preliminary effectiveness of an i‑PARIHS–guided strategy in reducing dyspnea and exercise fear while improving functional outcomes among patients receiving oxygen by HFNC. A two-cycle implementation project with historical controls was conducted in a tertiary hospital respiratory department, involving forty-five nurses and two cohorts of sixty patients each (one cohort receiving usual care as historical controls and one receiving the intervention). Twenty-two best-evidence publications were synthesized into seven topics and translated into fifteen review indicators across five audit domains—personnel structure, readiness assessment, exercise timing, training content, and education. Interventions included structured PR training, motivational interviewing, goal setting, individualized education, and fixed multidisciplinary teams, implemented over four months. The primary outcomes were dyspnea (mMRC) and six-minute walk distance (6MWD); secondary outcomes were exercise self-efficacy and quality of life (SF-36). At baseline, adherence was below 80% for seven of the fifteen review indicators (implementation outcomes); after implementation, adherence exceeded 90% for all fifteen, with four reaching 100%. Relative to the historical control cohort, significant improvements were observed in dyspnea, 6MWD, self-efficacy, and quality of life (all P < 0.05), and gains were sustained at three-month follow-up. Although the quasi-experimental, historical-control design precludes definitive causal attribution, these findings suggest that i‑PARIHS–guided PR may enhance functional outcomes, reduce exercise fear, and strengthen engagement by patients who are receiving oxygen by HFNC.