School of Nursing & Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
Department of Social Sciences and Social Work, Bournemouth University, Poole, Dorset, UK.
J Adv Nurs. 2017 Dec;73(12):3119-3132. doi: 10.1111/jan.13367. Epub 2017 Aug 23.
To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice.
Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff.
Realist evaluation.
The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5 years from 2003-2008. Data were analysed using NiVivo8 and SPPS.
A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes.
Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning.
根据实施的快速反应系统的实际操作环节来检验快速反应系统的方案理论，以确定那些对实践中实现预期成果有影响的背景和机制。
快速反应系统允许使用早期预警系统识别病情恶化的患者，通过升级协议及早转介，并由有能力的工作人员在床边进行管理。
现实主义评估。
研究设计是北爱尔兰两家医院的四个病房的嵌入式多案例研究方法，遵循现实主义评估的原则。我们使用了各种混合方法，包括个人和焦点小组访谈、2010 年 6 月至 11 月的护理实践观察以及 2010 年 5 月至 10 月的早期预警系统审计数据和 2003 年至 2008 年 4.5 年的医院急性护理培训记录的文档分析。数据使用 NiVivo8 和 SPPS 进行分析。
跨案例分析突出了在实践中成功识别、转介和应对病情恶化患者的相似因素模式。主要促成因素是经验丰富的护士使用临床判断和由于实施早期预警系统协议而赋予护士权力。主要制约因素是人员配备不足和技能组合水平不当、协议的僵化实施以及文化上固有的沟通流程不佳。
快速反应系统的成功实施取决于采取组织和文化变革，这些变革促进了员工赋权、协议的灵活实施和持续的经验学习。
