Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.
Emergency Services, Illawarra Shoalhaven Local Health District, NSW, Australia.
J Clin Nurs. 2018 Jan;27(1-2):e269-e286. doi: 10.1111/jocn.13932. Epub 2017 Oct 13.
To determine potential facilitators and barriers and tailor interventions to optimise future implementation of a patient-assessment framework into emergency nursing practice.
An evidence-informed patient-assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves the quality of patient assessments performed by emergency nurses. Facilitators and barriers must be understood and tailored interventions selected to optimise implementation.
A mixed-method convergent study design was used.
Thirty eight early career emergency nurses from five Australian hospitals participated in an education workshop on the HIRAID assessment framework. Simulated clinical scenarios enabled participants to experience conducting a patient assessment with and without using the framework. All participants completed surveys, interviews and focus groups to identify potential facilitators and barriers. Twenty three participants completed follow-up telephone surveys 4-6 months later. Quantitative and qualitative data were analysed separately using descriptive statistics and inductive content analysis, prior to integration. Implementation interventions were selected using the Behaviour Change Wheel.
Nine facilitators and nine barriers were identified to potentially effect implementation of the HIRAID assessment framework. Twelve of the 23 participants (52.2%) who completed follow-up surveys reported using the framework in the clinical setting. To optimise future implementation, the education workshop needs refinement, and environmental restructuring, modelling and social support are required.
A multimodal strategy is needed to promote future successful implementation of the HIRAID assessment framework into emergency nursing practice.
The successful implementation of the HIRAID assessment framework has the potential to improve nursing assessments of patients in emergency and other acute care settings. This study demonstrates how to systematically identify facilitators and barriers to behaviour change and select interventions to optimise implementation of evidence-informed nursing practices.
确定潜在的促进因素和障碍，并调整干预措施，以优化未来将患者评估框架应用于急诊护理实践。
一个基于证据的患者评估框架 HIRAID（病史、识别警示信号、评估、干预、诊断、沟通和再评估）可提高急诊护士进行患者评估的质量。必须了解促进因素和障碍，并选择调整干预措施以优化实施。
采用混合方法的收敛研究设计。
来自澳大利亚五家医院的 38 名早期职业急诊护士参加了关于 HIRAID 评估框架的教育研讨会。模拟临床情景使参与者能够体验在使用和不使用框架的情况下进行患者评估。所有参与者都完成了调查、访谈和焦点小组，以确定潜在的促进因素和障碍。23 名参与者在 4-6 个月后完成了后续电话调查。使用描述性统计和归纳内容分析分别分析定量和定性数据，然后进行整合。使用行为改变轮选择实施干预措施。
确定了九个促进因素和九个障碍，可能会影响 HIRAID 评估框架的实施。23 名完成后续调查的参与者中有 12 名（52.2%）报告在临床环境中使用了该框架。为了优化未来的实施，需要改进教育研讨会，并需要进行环境重构、建模和社会支持。
需要采用多模式策略来促进未来将 HIRAID 评估框架成功应用于急诊护理实践。
成功实施 HIRAID 评估框架有可能改善急诊和其他急性护理环境中患者的护理评估。本研究展示了如何系统地识别行为改变的促进因素和障碍，并选择干预措施来优化证据支持的护理实践的实施。
