The Alfred Hospital, Melbourne 3181, Australia.
Int J Nurs Stud. 2010 Feb;47(2):154-65. doi: 10.1016/j.ijnurstu.2009.05.021. Epub 2009 Jul 4.
There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes.
This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care.
A qualitative approach was used comprising naturalistic observation and semi-structured interviews.
The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital.
Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed.
The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than individualised patient assessment and management. These interactions were based on nurses' perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints.
While some nurse-patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients' needs in relation to their medications and encourage opportunities for increased patient participation.
文献和医疗环境中越来越强调以患者为中心的护理。有人认为，以患者为中心的药物治疗方法有可能改善患者的体验和结果。
本研究旨在考察在以患者为中心的护理理念下，护士和患者在急症护理环境中进行药物治疗活动时如何相互作用。
采用定性方法，包括自然观察和半结构化访谈。
研究地点为澳大利亚大都市医院具有协作制定的以患者为中心的护理理念的急症病房。
招募了 11 名经验水平各异的护士参与观察和访谈。如果护士在研究病房中从事直接护理患者的工作，包括药物治疗活动，则有资格参与。采用分层抽样技术确保代表了不同年资的护士。在观察期间由参与护士照顾的患者，如果符合以下排除标准，则被招募参加：年龄小于 18 岁、非英语患者和无法给予知情同意的患者。共观察了 25 名患者，其中 16 名同意接受访谈。
该研究的结果深入了解了在以患者为中心的护理为基础的护理理念下护士和患者之间相互作用的性质。研究结果产生了三个主要主题：提供个性化护理、患者参与以及提供以患者为中心的护理的背景障碍。尽管参与的护士重视以患者为中心的方法，并认为他们正在以以患者为中心的方式进行药物治疗活动，但在药物治疗活动期间，一些护士-患者互动是以常规为中心，而不是以个体化患者评估和管理为中心。这些互动基于护士对患者重要的看法，并没有为患者参与提供机会。与以患者为中心的药物治疗方法相关的两个主要背景障碍是多学科沟通和时间限制。
虽然在药物治疗活动期间，一些护士-患者互动符合以患者为中心的护理原则，但研究结果强调了影响这些互动性质的因素，并确定了改善护理实践的机会。为确保将以患者为中心的护理应用于药物治疗活动，护士应持续评估患者对药物治疗的需求，并鼓励增加患者参与的机会。
