Department of Anesthesiology, Holbaek University Hospital, Holbaek, Denmark.
Zealand University Hospital, Roskilde & The Institute of Regional Health Research, University of Southern Denmark, Denmark.
J Adv Nurs. 2017 Dec;73(12):3090-3101. doi: 10.1111/jan.13377. Epub 2017 Aug 14.
To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards.
Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety.
An explorative, qualitative design using focused ethnography was applied to the study.
Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU nurses in January-February 2016. Observation notes and interview transcripts were analysed using content analysis.
The theme "Communicative interaction as a process of sharing and adopting ownership" and the subtheme "Communicative interaction influenced by nurses individual expectations towards patient status and the handing over process" emerged from observation notes. From transcribed focus group interviews, the theme "Balancing and negotiating when passing on, consuming and adapting knowledge" was identified.
A lack of shared goals regarding handing over patients from a high monitoring unit to general wards causes communicative and collaborative difficulties, loss of information and potential risks to patients. Organizational attention in relation to ICU discharge is crucial to improve collaboration, communication and patient safety.
探讨 ICU 护士将多器官疾病患者转至普通病房时进行沟通互动的护理实践和认知。
沟通失败会给患者安全带来风险。当护士将患者从一个环境转至另一个环境时，他们会通过书面和口头进行沟通。深入了解护士的沟通互动以及护士对其互动的看法，对于促进以提高患者安全性为重点的临床干预措施至关重要。
采用聚焦民族志的探索性定性设计。
2015 年 11 月至 12 月，对 22 例从 ICU 转至普通病房的患者交接情况进行了 22 次临床情景的参与式观察，随后在 2016 年 1 月至 2 月进行了 5 次焦点小组访谈、3 次普通病房护士访谈和 2 次 ICU 护士访谈。采用内容分析法对观察记录和访谈记录进行分析。
从观察记录中得出主题“沟通互动是一个分享和承担责任的过程”和子主题“沟通互动受护士对患者状况和交接过程的个体期望影响”。从转录的焦点小组访谈中，确定了主题“在传递、消耗和适应知识时进行平衡和协商”。
缺乏关于将患者从高监测单位转至普通病房的共同目标会导致沟通和协作困难、信息丢失，并可能对患者造成潜在风险。关注 ICU 出院问题对于改善协作、沟通和患者安全至关重要。
