影响社区医院注册护士启动成人快速反应团队决策的因素
Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital.
作者信息
Jackson Shirley, Penprase Barbara, Grobbel Claudia
机构信息
Shirley Jackson, DNP, RN, CCRN, CCNS, is a clinical nurse specialist at Elliot Health System, Manchester, NH. Her clinical specialty is adult acute and critical care nursing. Barbara Penprase, PhD, RN, CNE, ANEF, is a professor at the School of Nursing, Oakland University Rochester; and endowed professor, Oakland University School of Nursing/Crittenton Hospital Medical Center, MI. Her research interests include alarm fatigue, empathy vs systemizing traits in nurses and frequent users of the Emergency Department. Claudia Grobbel, DNP, RN, is an assistant professor at Oakland University, Rochester, MI. Her expertise is in the area of cardiac care, leadership and administration. Her research interest is caring practice and the impact on quality care.
出版信息
Dimens Crit Care Nurs. 2016 Mar-Apr;35(2):99-107. doi: 10.1097/DCC.0000000000000162.
BACKGROUND
One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting.
OBJECTIVES
The purpose of this study was to examine beliefs and behaviors that influence registered nurses' decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas.
METHODS
One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses' beliefs and attitudes on and barriers to utilizing an RRT.
RESULTS
The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (ρ161 = -0.250).
DISCUSSION
Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.
背景
在急性病情恶化的患者中，影响患者预后的一个因素是护理人员延迟启动快速反应团队（RRT）；然而，对于在医疗外科和遥测环境之外的成人科室工作的护理人员，影响其启动RRT的因素方面存在知识空白。
目的
本研究的目的是调查影响注册护士在一家社区医院启动成人快速反应团队的信念和行为，该医院包括3个专科领域：医疗外科和遥测、围产期以及精神科。
方法
使用一份包含17个条目的李克特式量表对163名护士进行调查，以评估注册护士对使用RRT的信念、态度和障碍。
结果
对调查进行分析后得出3个因素：RRT障碍、RRT积极态度/启动意愿以及患者管理信念。其他研究中提到的启动RRT的障碍，包括团队的批评以及认为RRT会增加工作量或降低技能等，并未被发现是有影响力的考虑因素。在3个专科组之间，在RRT积极态度/启动意愿（F2,159 = 6.09，P = .003）和患者管理信念（F2,159 = 5.87，P = .003）方面存在显著差异。注册护士的工作年限与RRT障碍之间存在强烈的负相关（ρ161 = -0.250）。
讨论
各机构应检查RRT启动延迟情况，特别是在RRT启动前呼叫值班医生方面。专科组之间的差异凸显了跨专科开展关于识别急性病情恶化患者的教育的必要性。研究结果表明，经验不足的护士在患者急性病情恶化时需要经验丰富的同事的支持以及对工作量的临时调整。
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