Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Qualitative Methods, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Int Nurs Rev. 2017 Sep;64(3):353-362. doi: 10.1111/inr.12377. Epub 2017 May 29.
The aim of this study was to explore hospital staff perceptions of the perceived challenges and outcomes of implementing a critical care outreach service.
A nurse-led critical care outreach service was designed and implemented to identify and treat acutely ill patients in a large tertiary care hospital in Iran.
A qualitative analysis of data from two focus groups and seven interviews was carried out using conventional content analyses techniques. A total of 24 hospital staff members participated, including critical care outreach team members, physicians, ward head nurses and ward staff.
Two main categories described the perceived challenges to the implementation of the critical care outreach service: 1) the hospital context, with four subcategories related to staff shortages, the instability of physician positions, the lack of specialized essential services and the absence of a system to establish do-not-resuscitate orders, and 2) staff resistance to different nursing priorities, routines and extra work. In two additional main categories, participants also described positive and negative perceived outcomes. The positive perceived outcomes included three subcategories of alleviating equipment shortages, improving nursing knowledge and patient care and improving patient and healthcare professional satisfaction.
While critical care outreach has the potential to improve patient perceived outcomes and both patient and provider satisfaction with care, the contextual and clinical realities in hospitals are significant and must be examined during the planning and implementation of future outreach.
A critical care outreach service in the context of an Iranian hospital has the potential to improve ward nurse familiarity with the care of acutely ill patients and the quality of palliative care. However, attention ought to be paid to the hospital's structural and contextual factors. Alleviating nursing shortages, reducing staff resistance and preparing goals of care guidelines that address restrictions on resuscitation could facilitate implementation of critical care outreach services.
本研究旨在探讨医院工作人员对实施重症监护外展服务的感知挑战和结果的看法。
在伊朗的一家大型三级保健医院，设计并实施了由护士主导的重症监护外展服务，以识别和治疗急性重病患者。
采用常规内容分析技术，对来自两个焦点小组和七个访谈的定性数据进行分析。共有 24 名医院工作人员参与，包括重症监护外展团队成员、医生、病房护士长和病房工作人员。
描述实施重症监护外展服务的感知挑战有两个主要类别：1）医院环境，有四个亚类与人员短缺、医生职位不稳定、缺乏专门的基本服务以及缺乏建立不复苏医嘱的系统有关；2）工作人员对不同护理优先级、常规和额外工作的抵制。在另外两个主要类别中，参与者还描述了积极和消极的感知结果。积极的感知结果包括三个亚类：缓解设备短缺、提高护理知识和患者护理水平以及提高患者和医疗保健专业人员的满意度。
虽然重症监护外展有可能改善患者的感知结果以及患者和护理人员对护理的满意度，但医院的背景和临床现实是重大的，在规划和实施未来的外展服务时必须加以考虑。
在伊朗医院的背景下，重症监护外展服务有可能提高病房护士对急性重病患者护理的熟悉程度和姑息治疗的质量。然而，应当注意医院的结构和背景因素。缓解护理人员短缺、减少工作人员抵制以及制定解决复苏限制的目标关怀指南，可以促进重症监护外展服务的实施。
