一项描述养老院护士对检测用药医嘱差异的意义建构的定性研究。
A qualitative study describing nursing home nurses sensemaking to detect medication order discrepancies.
作者信息
Vogelsmeier Amy, Anderson Ruth A, Anbari Allison, Ganong Lawrence, Farag Amany, Niemeyer MaryAnn
机构信息
S314 Sinclair School of Nursing, Columbia, MO, 65211, USA.
University of North Carolina at Chapel Hill, 2007 Carrington Hall, Chapel Hill, NC, 27599-7460, USA.
出版信息
BMC Health Serv Res. 2017 Aug 4;17(1):531. doi: 10.1186/s12913-017-2495-6.
BACKGROUND
Medication reconciliation is a safety practice to identify medication order discrepancies when patients' transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies.
METHOD
We used a qualitative methodology in a study of 13 RNs and 13 LPNs working in 12 Midwestern United States nursing homes. We used both conventional content analysis and directed content analysis methods to analyze semi-structured interviews. Four resident transfer vignettes embedded with medication order discrepancies guided the interviews. Participants were asked to describe their roles with medication reconciliation and their rationale for identifying medication order discrepancies within the vignettes as well as to share their experiences of performing medication reconciliation. The analysis approach was guided by Weick's Sensemaking theory.
RESULTS
RNs provided explicit stories of identifying medication order discrepancies as well as examples of clinical reasoning to assure medication order appropriateness whereas LPNs described comparing medication lists. RNs and LPNs both acknowledged competing demands, but when performing medication reconciliation, RNs were more concerned about accuracy and safety, whereas LPNs were more concerned about time.
CONCLUSIONS
Nursing home nurses, particularly RNs, are in an important position to identify discrepancies that could cause resident harm. Both RNs and LPNs are valuable assets to nursing home care and keeping residents safe, yet RNs offer a unique contribution to complex processes such as medication reconciliation. Nursing home leaders must acknowledge the differences in RN and LPN contributions and make certain nurses in the most qualified role are assigned to ensure residents remain safe.
背景
药物重整是一项安全措施，用于在患者转院时识别用药医嘱差异。在养老院中，注册护士（RN）和执业护士（LPN）都参与药物重整工作，这两组人员的教育背景和执业职责范围有所不同。然而，对于他们在解读用药医嘱以发现差异方面的实际操作差异，我们了解甚少。因此，本研究的目的是描述注册护士和执业护士在发现差异时的认知差异。
方法
我们采用定性研究方法，对美国中西部12家养老院的13名注册护士和13名执业护士进行了研究。我们使用传统内容分析法和定向内容分析法来分析半结构化访谈。四个嵌入用药医嘱差异的患者转院案例引导了访谈。参与者被要求描述他们在药物重整中的角色，以及在案例中识别用药医嘱差异的理由，并分享他们进行药物重整的经验。分析方法以韦克的认知理论为指导。
结果
注册护士提供了识别用药医嘱差异的明确案例以及临床推理示例，以确保用药医嘱的适当性，而执业护士则描述了比较用药清单的过程。注册护士和执业护士都承认存在相互冲突的需求，但在进行药物重整时，注册护士更关注准确性和安全性，而执业护士更关注时间。
结论
养老院护士，尤其是注册护士，在识别可能对患者造成伤害的差异方面处于重要地位。注册护士和执业护士都是养老院护理和保障患者安全的宝贵资产，但注册护士在药物重整等复杂过程中做出了独特贡献。养老院领导必须认识到注册护士和执业护士贡献的差异，并确保安排最合格的护士来确保患者安全。
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