Manias Elizabeth, Aitken Robyn, Dunning Trisha
Associate Professor of Nursing, School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Vic., Australia.
J Clin Nurs. 2005 Sep;14(8):935-44. doi: 10.1111/j.1365-2702.2005.01234.x.
The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.
Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making Design. A descriptive prospective qualitative design was used. Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.
Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.
Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.
Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.
本研究旨在确定毕业护士在药物管理活动中如何使用护理方案。目标如下：检查在药物活动方面对各种护理方案的遵守程度，并确定病房环境如何影响毕业护士使用护理方案管理患者药物。
护理方案有助于新获得资格的护士将新知识融入实践并促进有效的决策制定。设计：采用描述性前瞻性定性设计。方法：十二名在一家大都市教学医院的内科、外科和专科病房参与直接患者护理的毕业护士参与了本研究。在给患者给药的两小时期间，对毕业护士进行参与观察。观察结束后立即对每位护士进行深入访谈，并收集参与护士及其护理患者的人口统计学数据，包括所有开具的药物。还转录了与临床环境中药物管理活动相关的护理方案。
数据中出现了六个主题：护理方案的可用性和使用、给药前仔细核对患者身份、给药前对某些药物进行双重核对、撰写事件报告、遵循特定政策以及确定给药时间。
如果毕业护士认为护理方案不妨碍其他护理活动，他们就会遵守。如果参与者感到被鼓励做出自己的决定，并且涉及纪律处分的可能性降低，他们也更有可能遵循护理方案。
经验丰富的卫生专业人员应鼓励毕业护士遵守药物护理方案，并就药物活动做出临床合理的决策。通过提供同伴支持并以身作则，经验丰富的卫生专业人员还可以向毕业护士展示有效使用护理方案是优质患者护理 的重要组成部分。
