School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Qld, Australia.
J Clin Nurs. 2018 Mar;27(5-6):e992-e1003. doi: 10.1111/jocn.14119. Epub 2018 Feb 6.
To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting.
Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area.
A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework.
Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis.
Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene.
The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home.
Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies.
预测在解释护理人员对居民健康恶化的早期检测和提供疗养院亚急性护理的意图方面最重要的因素。
护理人员在管理病情恶化的居民和确定居民是否需要转院或留在疗养院方面发挥着关键作用；然而，关于影响他们意图的因素的文献很少。需要这些信息来支持旨在增强护理人员在这方面的信心和技能的避免住院计划。
使用计划行为理论作为框架的收敛平行混合方法研究。
在实施避免住院计划之前和之后，在一个有 94 张床位的疗养院对护理人员（n=75）进行了两次调查和焦点小组。对定量和定性数据进行了单独分析，并在最终分析中进行了合并。
护理人员的意图强烈，态度积极，随着避免住院计划的实施，态度变得更加积极，而且他们的控制感也合理；然而，重要参照者的影响是预测管理健康恶化居民的意图的最强因素。避免住院计划的支持赋予了员工权力，并增强了他们干预的信心。
计划行为理论有效地确定了参照者对护理人员管理健康恶化居民的意图的强烈影响。尽管护理人员对这一工作领域有合理的控制感，但他们认为从疗养院发起的避免住院计划中受益。
实施避免住院计划的管理人员应考虑参照者的作用，评估已知的障碍和促进因素，并采取措施确定其对当地情况的独特作用。各级护理人员在预防住院方面都发挥着作用，应在任何避免住院策略的设计、实施和评估中征求他们的意见。
