Häggström Marie, Asplund Kenneth, Kristiansen Lisbeth
Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
Scand J Caring Sci. 2013 Sep;27(3):506-15. doi: 10.1111/j.1471-6712.2012.01063.x. Epub 2012 Aug 14.
The aim of this study was to provide a deeper understanding of the experience of intensive care staff regarding the reduction in the use of medical technology prior to patients' transfer from the ICU.
The goal of ICU transitional care, provided for intensive care patients before, during and after the transfer from the ICU to another care unit, is to ensure minimal disruption and optimal continuity of care for the patient. To smooth this transition, there is a need to prepare for a less technological environment and therefore also a need for a gradual reduction in the use of monitoring equipment.
Group interviews and individual interviews, together with participant observations, were conducted with ICU staff in two hospitals in Sweden. The data were analysed using classic grounded theory.
The main concern was the ICU staff's ambiguity regarding whether and how to reduce the use of medical technology devices. Insecurity about weaning patients from medical equipment combined with a lack of standardized routines made it difficult for staff to reduce the technical support. The core category describes how the ambiguity was solved primarily by 'prioritizing control'. However, this often caused the ICU staff to use advanced technology while the patients were in the ICU until the ward staff arrived, even if this should have been handled otherwise. Why and how the ICU staff used the strategy of 'prioritizing control' is further explained in the categories 'being affected by cultural/contextual aspects', 'searching for guidance and a shared understanding' and 'weighing advantages with more v s less technology'.
It is important to consider ICU staff ambiguity concerning the reduction in technology and to establish strategies for a safe and structured transitional phase with step-down procedures in which technology and monitoring is gradually reduced prior to transfer from ICU.
本研究旨在更深入地了解重症监护室工作人员在患者从重症监护室转出之前减少医疗技术使用方面的经历。
重症监护室过渡护理的目标是在重症监护患者从重症监护室转至另一护理单元之前、期间和之后，确保对患者的护理干扰最小且连续性最佳。为了使这种过渡顺利进行，有必要为技术含量较低的环境做好准备，因此也需要逐步减少监测设备的使用。
对瑞典两家医院的重症监护室工作人员进行了小组访谈、个人访谈以及参与观察。使用经典扎根理论对数据进行分析。
主要问题是重症监护室工作人员对于是否以及如何减少医疗技术设备的使用存在模糊认识。在使患者脱离医疗设备方面缺乏安全感，再加上缺乏标准化程序，使得工作人员难以减少技术支持。核心类别描述了这种模糊性主要是如何通过“优先控制”来解决的。然而，这往往导致重症监护室工作人员在患者在重症监护室期间一直使用先进技术，直到病房工作人员到来，即使本可以采用其他方式处理。在“受文化/背景因素影响”、“寻求指导和达成共识”以及“权衡技术多与少的优势”等类别中，进一步解释了重症监护室工作人员为何以及如何采用“优先控制”策略。
重要的是要考虑重症监护室工作人员在技术减少方面的模糊认识，并制定策略，以便在安全且结构化的过渡阶段采用逐步降低程序，即在从重症监护室转出之前逐步减少技术和监测的使用。
