提供有效的创伤护理：服务提供者的观点对提高护理质量的潜力（嵌套在多中心纵向定量研究中的定性研究）
Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).
作者信息
Beckett Kate, Earthy Sarah, Sleney Jude, Barnes Jo, Kellezi Blerina, Barker Marcus, Clarkson Julie, Coffey Frank, Elder Georgina, Kendrick Denise
机构信息
University of the West of England, Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Education Centre, Bristol, UK.
Department of Sociology, Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey, UK.
出版信息
BMJ Open. 2014 Jul 8;4(7):e005668. doi: 10.1136/bmjopen-2014-005668.
OBJECTIVE
To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision.
DESIGN
Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis.
SETTING
Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas.
PARTICIPANTS
40 service providers from a range of disciplines.
RESULTS
Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice.
CONCLUSIONS
Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.
目的
探讨为伤者提供护理的服务提供者对于以下方面的看法：服务满足患者需求的程度，以及他们对导致已发现的服务提供差距的因素的看法。
设计
定性研究嵌套于一项定量多中心纵向研究中，该定量研究评估工作年龄成年人意外伤害的长期影响。服务提供者的抽样框架基于定量研究中患者报告的服务使用情况、患者访谈以及先前受伤的外行人研究顾问的建议。通过半结构化访谈获取服务提供者的观点。使用主题分析法对数据进行分析。
背景
参与者从四个研究中心（布里斯托尔、莱斯特、诺丁汉和萨里）及周边地区的急性医院信托机构的一系列场所和服务中招募。
参与者
来自一系列学科的40名服务提供者。
结果
服务提供者描述了两种不同的创伤护理模式：一种是“理想”模式，基于对伤害影响的专业知识和最佳护理模式的认识；另一种是基于国民医疗服务体系（NHS）实际情况的“现实”模式。参与者的“理想”模式与高质量有效创伤护理的标准一致，虽然有服务符合理想模式的例子，但“现实”护理也可能是零散且不公平的，在服务提供方面存在重大差距。服务提供者的描述证明了他们对患者需求的全面理解、对最佳实践的认识、同情心和研究能力，但也揭示了限制知识在实践中实施的重大组织和资源障碍。
结论
服务提供者设想了一种及时、公平、有效且全面的创伤护理“理想”模式，但这可能与目前提供的护理不同。他们的经验为改善服务以弥合“现实”与“理想”护理之间的差距提供了许多建议。利用服务提供者的观点为服务设计和提供提供信息可以提高护理质量、患者体验和护理结果。
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