Boscart Veronique M, Heckman George A, Huson Kelsey, Brohman Lisa, Harkness Karen I, Hirdes John, McKelvie Robert S, Stolee Paul
a Conestoga College Institute of Technology and Advanced Learning , Kitchener , Ontario , Canada.
b Research Institute for Aging and School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada.
J Interprof Care. 2017 Sep;31(5):583-592. doi: 10.1080/13561820.2017.1340875. Epub 2017 Sep 6.
Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.
心力衰竭影响着高达20%的养老院居民，且与高发病率、高死亡率以及转至急症护理相关。养老院环境中心力衰竭管理的一个主要障碍是跨专业沟通有限。尽管在未解决跨专业沟通问题时可持续性有限，但基于指南的养老院心力衰竭管理项目可降低住院率。在两所方便选取的养老院的两个单元实施了一项试点干预措施“增强心力衰竭知识与跨专业护理”，以优化护理团队之间的跨专业护理流程。成立了一个核心心脏团队，参与者接受了针对心力衰竭管理原则和沟通流程的定制教育，以及每周的指导。我们之前的工作为该干预措施的可接受性和实施保真度提供了证据。本文重点关注该干预措施对工作人员心力衰竭知识、沟通和跨专业协作的初步影响。为了确定该干预措施对选定工作人员结果的初始影响，我们采用了定性设计，使用社会建构主义解释框架。研究结果表明，团队参与度、跨专业协作、沟通、心力衰竭知识以及临床结果都有明显提升。对工作人员的个人访谈揭示了增强沟通的创新方法，即在知识方面相互支持，并积极参与与居民及其家人的协作实践。通过组建核心心脏团队来让团队参与其中，成功地开发了用于心力衰竭管理的跨专业沟通流程。接下来要采取的进一步措施包括用更大的样本评估这种方法的可持续性和有效性。
