为提供电话癌症症状管理的护士实施症状协议：一项比较案例研究。
Implementation of Symptom Protocols for Nurses Providing Telephone-Based Cancer Symptom Management: A Comparative Case Study.
作者信息
Stacey Dawn, Green Esther, Ballantyne Barbara, Tarasuk Joy, Skrutkowski Myriam, Carley Meg, Chapman Kim, Kuziemsky Craig, Kolari Erin, Sabo Brenda, Saucier Andréanne, Shaw Tara, Tardif Lucie, Truant Tracy, Cummings Greta G, Howell Doris
机构信息
Professor, School of Nursing, University of Ottawa, and Scientist, Ottawa Hospital Research Institute, Ottawa, Canada.
Director, Person Centred Perspective, Canadian Partnership Against Cancer, Toronto, Ontario, Canada.
出版信息
Worldviews Evid Based Nurs. 2016 Dec;13(6):420-431. doi: 10.1111/wvn.12166. Epub 2016 May 31.
BACKGROUND
The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence-informed protocols for symptom management.
AIM
To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone-based symptom support to cancer patients.
METHODS
A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases.
RESULTS
At baseline, >85% nurses rated protocols positively but barriers were identified (64-80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self-management. Twenty-two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support.
LINKING EVIDENCE TO ACTION
Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses' use of evidence-informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses' confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally.
背景
泛加拿大肿瘤症状分诊与远程支持（COSTaRS）团队制定了13项基于证据的症状管理方案。
目的
为向癌症患者提供电话症状支持的护士建立一种有效且可持续的方法来实施COSTaRS方案。
方法
一项比较案例研究以知识转化为行动框架为指导。为三个有护士提供电话支持的加拿大肿瘤项目创建了三个案例。研究人员和知识使用者团队：（a）评估影响方案使用的障碍和促进因素，（b）调整方案以供当地使用，（c）进行干预以消除障碍，（d）监测使用情况，以及（e）评估影响持续使用的障碍和促进因素。分析在案例内部和案例之间进行。
结果
在基线时，超过85%的护士对方案给予积极评价，但也发现了障碍（64 - 80%的护士需要培训）。患者和家属也指出了类似的障碍，并认为方案将提高护士在教授自我管理方面的一致性。22次COSTaRS研讨会覆盖了85%至97%的目标护士（N = 119）。护士在症状管理和使用COSTaRS方案方面更有信心（p <.01）。方案调整解决了一些障碍（例如，健康记录审批、制作袖珍版、随电话信息分发）。图表审核显示，在11%至47%的患者电话记录中记录了所使用的方案。持续使用需要组织协调和持续的领导支持。
将证据与行动联系起来
方案的采用情况与通过克服已识别障碍来评估量身定制干预措施以改善专业实践的试验类似。与知识使用者合作有助于对研究结果的解读，辅助方案调整，并支持实施。护理中的方案实施需要一种量身定制方法。一种多方面的干预方法增加了护士在与患者就症状进行电话沟通时对基于证据方案的使用。培训和其他干预措施提高了护士使用COSTaRS方案的信心，并且在一些有记录的电话中明显可见其采用情况。这些方案可进行调整以供全球患者和护士使用。
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