Ebben Remco H A, Vloet Lilian C M, van Grunsven Pierre M, Breeman Wim, Goosselink Ben, Lichtveld Rob A, Mintjes-De Groot Joke A J, van Achterberg Theo
aFaculty of Health and Social Studies, Department Critical Care, HAN University of Applied Sciences bCanisius Wilhelmina Hospital cAmbulance Service Gelderland Zuid dScientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen eAmbulance Service Rotterdam Rijnmond, Rotterdam fAmbulance Service IJsselland, Zwolle gAmbulance Service Utrecht, Utrecht, The Netherlands.
Eur J Emerg Med. 2015 Jun;22(3):199-205. doi: 10.1097/MEJ.0000000000000133.
Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC).
A questionnaire was developed using the literature, a questionnaire and expert opinion. Ambulance nurses (n=452) from four geographically spread emergency medical services (EMSs) in the Netherlands were invited to fill out the questionnaire. The questionnaire included questions on influencing factors and self-reported adherence.
Questionnaires were returned by 248 (55%) of the ambulance nurses. These ambulance nurses' adherence to the NPAC was 83.4% (95% confidence interval 81.9-85.0). Bivariate correlations showed 23 influencing factors that could be related to the individual professional, organization, protocol characteristics and social context. Multilevel regression analysis showed that 21% of the variation in adherence (R=0.208) was explained by protocol characteristics and social influences.
Ambulance nurses' self-reported adherence to the NPAC seems high. To improve adherence, protocol characteristics (complexity, the degree of support for diagnosis and treatment, the relationship of the protocol with patient outcomes) and social influences (expectance of colleagues to work with the national protocol) should be addressed.
对院前指南和协议的遵守情况并不理想。了解影响因素对于提高遵守情况很有必要。本研究的目的是确定影响急救护士遵守《国家急救护理协议》（NPAC）的因素。
利用文献、一份问卷和专家意见编制了一份问卷。邀请了来自荷兰四个地理位置分散的紧急医疗服务（EMS）机构的452名急救护士填写问卷。问卷包括关于影响因素和自我报告的遵守情况的问题。
248名（55%）急救护士返回了问卷。这些急救护士对NPAC的遵守率为83.4%（95%置信区间81.9 - 85.0）。双变量相关性显示了23个可能与个体专业、组织、协议特征和社会背景相关的影响因素。多层次回归分析表明，协议特征和社会影响解释了21%的遵守情况差异（R = 0.208）。
急救护士自我报告的对NPAC的遵守率似乎很高。为提高遵守情况，应关注协议特征（复杂性、对诊断和治疗的支持程度、协议与患者预后的关系）和社会影响（同事对按照国家协议工作的期望）。
