Dwyer T A, Mosel Williams L, Mummery K
Central Queensland University, Rockhampton, Queensland, Australia.
Rural Remote Health. 2005 Apr-Jun;5(2):322. Epub 2005 Jul 27.
The endorsement of the chain of survival concept and early defibrillation has challenged health professionals to reconsider their beliefs about how they respond to in-hospital resuscitation. In the rural context, where 24 hour coverage is not available nurse-initiated defibrillation is expected. Despite literature and policy change in Australia to allow nurses to initiate defibrillation, there is no current research that uses a systemic theoretical approach to investigate the specific beliefs of nurses and their use of defibrillators. The purpose of this study was to elicit a beginning understanding of the defibrillation beliefs of rural nurses.
This research used focus groups within the framework of the Theory of Planned Behavior to describe the defibrillation beliefs of rural registered nurses. The sites selected for this study were two acute care hospitals in rural Australia (RRMA Classification). Each of these hospitals was in located 'other rural areas' (RRMA Classification) in separate towns and had 25 and 30 beds. The study sample consisted of 10 females and two males. Focus group questions were designed to elicit salient beliefs within the theoretical framework. Three constructs of behavioral, normative and control beliefs guided the development of the question and analysis of the discussions. In accordance with the authors of the theoretical framework, content analysis was used to analyse the data from the study.
Two behavioral beliefs, four control beliefs and four normative belief categories were elicited. Two behavioral beliefs categories emerged from the open-ended question: 'What, if any are the advantages of you being able to use a defibrillator?' Participants were congruent when discussing the advantages of nurses initiating defibrillation. The two categories were 'quicker response times' (15 responses) and 'increased success with resuscitation' (8 responses). Participants were asked to identify any events that might influence their decision to use or not use a defibrillator if there was a cardiac arrest on their ward on that day. The categories of control beliefs elicited were 'rhythm recognition' (22 responses), 'litigation' (15 responses), 'fear of harm to patient or self' (11 responses), and 'roles' (4 responses). To identify the normative referents, participants were asked to identify who would approve or not approve of them being responsible for the use of defibrillators in their clinical area. Four normative beliefs represent 100% of the responses, these were: patients; nurses; doctors; and the nursing registration body, the Queensland Nursing Council.
The central issues for these participating nurses were related to the consequences for the patient, support and confidence with rhythm recognition. Understanding rural nurses beliefs as they pertain to nurse-initiated defibrillation may provide educators with some insight as to what changes are needed to increase nurse-initiated defibrillation.
生存链概念和早期除颤的认可促使医疗专业人员重新审视他们对院内复苏应对方式的信念。在农村地区，由于无法提供24小时覆盖，期望护士能够启动除颤。尽管澳大利亚的文献和政策有所改变，允许护士启动除颤，但目前尚无研究采用系统的理论方法来调查护士的具体信念及其对除颤器的使用情况。本研究的目的是初步了解农村护士对除颤的信念。
本研究在计划行为理论框架内使用焦点小组来描述农村注册护士对除颤的信念。本研究选择的地点是澳大利亚农村地区的两家急症医院（RRMA分类）。这两家医院分别位于不同城镇的“其他农村地区”（RRMA分类），床位分别为25张和30张。研究样本包括10名女性和2名男性。焦点小组问题旨在引出理论框架内的显著信念。行为、规范和控制信念的三个结构指导了问题的制定和讨论的分析。根据理论框架的作者，采用内容分析法对研究数据进行分析。
引出了两个行为信念、四个控制信念和四个规范信念类别。从开放式问题“如果你能够使用除颤器，有哪些优势（如果有的话）？”中出现了两个行为信念类别。在讨论护士启动除颤的优势时，参与者意见一致。这两个类别是“更快的响应时间”（15条回答）和“复苏成功率提高”（8条回答）。参与者被要求确定如果当天病房发生心脏骤停，可能影响他们决定使用或不使用除颤器的任何事件。引出的控制信念类别包括“心律识别”（22条回答）、“诉讼”（15条回答）、“担心对患者或自身造成伤害”（11条回答）和“角色”（4条回答）。为了确定规范参照对象，参与者被要求确定谁会赞成或不赞成他们在临床区域负责使用除颤器。四个规范信念占回答的100%，分别是：患者；护士；医生；以及护理注册机构昆士兰护理理事会。
这些参与研究的护士的核心问题与对患者的后果、心律识别方面的支持和信心有关。了解农村护士与护士启动除颤相关的信念，可能会为教育工作者提供一些关于需要做出哪些改变以增加护士启动除颤的见解。
