一个供市政护士应对老年人健康状况恶化的决策支持系统。
A Decision support system (DSS) for municipal nurses encountering health deterioration among older people.
作者信息
Kihlgren Annica, Svensson Fredrik, Lövbrand Conny, Gifford Mervyn, Adolfsson Annsofie
机构信息
Faculty of Medicine and Health, School of Health Örebro University, SE-701 82 Örebro, Sweden.
Region Örebro Counties, Örebro, Sweden.
出版信息
BMC Nurs. 2016 Nov 8;15:63. doi: 10.1186/s12912-016-0184-0. eCollection 2016.
BACKGROUND
This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver.
METHODS
This study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system.
RESULTS
Using elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system.
CONCLUSIONS
The results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating to the vital parameters among older people and the use of the decision support system.
背景
本研究是名为ViSam的一个更大项目的一部分，包括对一个基于M (R) ETTS（快速紧急分诊与治疗系统）开发并适用于老年人的决策支持系统进行测试。该系统旨在让市政护士能够确定健康状况恶化的老年人的最佳护理级别。这个新系统将实现更结构化的评估，患者应能获得最佳护理，并改善向下一位护理人员的数据传输。
方法
本研究采用解释性方法，首先进行定量数据收集阶段，随后是基于焦点小组讨论得出的定性数据，这些讨论围绕护士使用决策支持系统的专业经验展开。进行焦点小组讨论是为了补充定量数据，以便更全面地了解决策支持系统。
结果
将决策支持系统的要素（饱和度、疼痛和总体健康状况等生命体征参数）与护士的决策相结合显示，转诊至医院的老年人中有94%最终住院。护士们觉得在使用决策支持系统时，他们的工作更具系统性，与他人的沟通更有效，并且感觉更专业。
结论
本研究结果表明，借助决策支持系统，能将正确的患者从市政家庭护理机构送往急诊科。这样可以避免可能导致健康状况恶化、幸福感下降和意识混乱的老年患者不必要的转诊。使用决策支持系统意味着医护人员（护士、救护车/急诊科/地区医生/SOS急救警报）之间开始进行更优化的沟通。理解的增加使得误解风险降低，医护人员之间的关系得到改善。然而，决策支持系统需要进行更广泛的测试，以加强与老年人生命体征参数以及决策支持系统使用相关的证据基础。
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