Stacey Dawn, Carley Meg, Ballantyne Barbara, Skrutkowski Myriam, Whynot Angela
School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Eur J Oncol Nurs. 2015 Jun;19(3):268-77. doi: 10.1016/j.ejon.2014.11.002. Epub 2014 Dec 17.
To assess factors perceived to influence nurses' use of symptom protocols when providing remote management for oncology patients.
A mixed methods descriptive study was guided by the Knowledge-to-Action Framework. In 2013, 8 focus groups and 7 interviews were conducted with 49 nurses or patients/family members in three ambulatory oncology programs within different provincial healthcare systems. Role-play with a protocol was used during nurse focus groups/interviews. Nurses who provided remote symptom support received a survey. Data was triangulated using thematic analysis guided by the Ottawa Model of Research Use.
Over 90% of nurses provide telephone support during regular hours only. These symptom protocols were being used by 14% of nurses at one program. Nurses rated the protocols positively for content and format (>85%) but 20% indicated too complex. Protocol facilitators were systematic approach, comprehensive, and evidence-based. Protocol barriers were too long, not for symptom clusters, and inadequate space for documenting. To facilitate use, nurses need to enhance their knowledge (73%) and skills (58%), get access to resources, and obtain performance feedback. Nurse barriers included the learning curve, being unaware of protocols, and feeling tied to a script. Organizational barriers were communication challenges with patients, lack of electronic charting, and no clear direction to use them (54%).
Several barriers and facilitators were perceived to influence the use of symptom protocols. Nurses and patients/family members identified similar factors. Interventions are needed to overcome barriers to nurses using the protocols such as education, clear organizational mandate, and integration with documentation.
评估在为肿瘤患者提供远程管理时，被认为会影响护士使用症状处理方案的因素。
一项混合方法描述性研究以知识转化为行动框架为指导。2013年，在不同省级医疗系统的三个门诊肿瘤项目中，对49名护士或患者/家属进行了8次焦点小组讨论和7次访谈。在护士焦点小组讨论/访谈期间使用了方案角色扮演。为提供远程症状支持的护士进行了一项调查。数据采用由渥太华研究应用模型指导的主题分析进行三角验证。
超过90%的护士仅在正常工作时间提供电话支持。在一个项目中，14%的护士使用了这些症状处理方案。护士对方案的内容和格式评价较高（>85%），但20%的护士表示过于复杂。方案促进因素包括系统方法、全面性和循证性。方案障碍包括太长、不适用于症状群以及记录空间不足。为便于使用，护士需要提高知识水平（73%）和技能（58%），获取资源并获得绩效反馈。护士方面的障碍包括学习曲线、不了解方案以及感觉受脚本束缚。组织方面的障碍包括与患者的沟通挑战、缺乏电子病历以及使用方案时没有明确指示（54%）。
人们认为有几个障碍和促进因素会影响症状处理方案的使用。护士和患者/家属识别出了相似的因素。需要采取干预措施来克服护士使用方案的障碍，如教育、明确的组织指令以及与记录的整合。
