Sharma Anjali, Norton Laura, Gage Sandra, Ren Bixiang, Quesnell Amanda, Zimmanck Kim, Toth Heather, Weisgerber Michael
Medical College of Wisconsin, Milwaukee, Wisconsin;
Hosp Pediatr. 2014 Jan;4(1):1-5. doi: 10.1542/hpeds.2013-0055.
The objectives of this study were to: (1) identify local barriers to nursing presence on patient- and family-centered rounds (PFCR); and (2) increase nursing attendance during PFCR.
An electronic survey needs assessment was administered to nursing staff on a single acute medical care unit to identify local barriers to nursing presence on PFCR. Daily tracking of nursing presence on rounds was then performed over a 7-month period. During this time period, 2 Plan-Do-Study Act cycles were conducted. The first intervention was a workshop for nurses about PFCR. The second intervention was the development of a strategy to contact nurses by using a hands-free communication device so that nurses were notified when rounds were starting on their patients. To evaluate the impact of our interventions, a p-chart was generated for the outcome of average daily nursing attendance (%) on PFCR per week over the 7-month period.
Two barriers identified on the survey were: (1) nurses were uncertain if physicians valued their input during PFCR; and (2) nurses were unsure when the physician team would be conducting rounds on their patients. On the p-chart, the average percentage of nursing attendance before interventions was 47%. After the nursing workshop, no change in the mean nursing attendance on PFCR was noted. After initiation of the hands-free contact strategy, nursing attendance on PFCR rose to 80%.
A nursing contact strategy using a hands-free device led to a sustained increase in nursing attendance during PFCR.
本研究的目的是：（1）确定以患者和家庭为中心的查房（PFCR）中护士到场的当地障碍；（2）提高PFCR期间护士的到场率。
对一个急性医疗护理单元的护理人员进行电子调查需求评估，以确定PFCR中护士到场的当地障碍。然后在7个月的时间里每日跟踪查房时护士的到场情况。在此期间，进行了2个计划-实施-研究-改进循环。第一次干预是为护士举办关于PFCR的研讨会。第二次干预是制定一项使用免提通信设备联系护士的策略，以便在查房开始时通知护士有关其负责患者的情况。为评估我们干预措施的影响，绘制了一张p图，显示7个月期间每周PFCR中平均每日护士到场率（%）的结果。
调查中确定的两个障碍是：（1）护士不确定医生在PFCR期间是否重视他们的意见；（2）护士不确定医生团队何时会对其负责的患者进行查房。在p图上，干预前护士到场的平均百分比为47%。护理研讨会后，PFCR中护士到场的平均率没有变化。免提联系策略实施后，PFCR期间护士到场率升至80%。
使用免提设备的护理联系策略导致PFCR期间护士到场率持续提高。
