Decoyna Jovie Ann Alawas, McLiesh Paul, Salamon Yvette Michelle
Clinical Nurse Specialist, Cabrini Health, Victoria, Australia.
Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia.
Int J Orthop Trauma Nurs. 2018 May;29:32-40. doi: 10.1016/j.ijotn.2018.02.005. Epub 2018 Feb 27.
A major goal of care for orthopaedic surgical patients is the achievement of their pre-morbid functional level or at least an improvement of their functional ability. However, patients with altered mental status can significantly impact this and other outcomes and influence the delivery of care. Patient mobilisation is a role shared by both nurses and physiotherapists.
To enhance the understanding of nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status.
Three nurses and three physiotherapists were recruited using purposive sampling. Data was collected through interviews and analysed using Burnard's 14 stages of thematic content analysis.
Four main categories emerged from the study: altruism, interprofessional specialist practice, patient dynamics and challenges. Nurses and physiotherapists' experience have more similarities than differences under the four categories.
Nurses and physiotherapists experience numerous challenges from both patient and resources related factors such as environment, staffing and time limitations; safety risks to patient and staff; and communication barriers due to patient's altered mental state. While tensions and variations in priorities of care delivery exist between the two groups, interdisciplinary collaboration of both professional groups was clearly evident and enabled optimisation of mobilisation goals for this patient population and revealed more similarities than differences in their experience. Patient and staff safety takes precedence over mobilisation and safety risks in this patient group can be mitigated by adequate resources, competence, and teamwork.
骨科手术患者护理的一个主要目标是达到其病前的功能水平，或者至少提高其功能能力。然而，精神状态改变的患者会对这一目标及其他结果产生重大影响，并影响护理的实施。患者活动是护士和物理治疗师共同承担的职责。
加深对护士和物理治疗师护理术后精神状态改变的骨科患者的经验的理解。
采用目的抽样法招募了三名护士和三名物理治疗师。通过访谈收集数据，并使用伯纳的14个主题内容分析阶段进行分析。
该研究得出了四个主要类别：利他主义、跨专业专科实践、患者动态和挑战。在这四个类别下，护士和物理治疗师的经验更多的是相似之处而非差异。
护士和物理治疗师在患者及资源相关因素方面面临诸多挑战，如环境、人员配备和时间限制；对患者和工作人员的安全风险；以及由于患者精神状态改变导致的沟通障碍。虽然两组在护理重点上存在紧张关系和差异，但两个专业团队之间的跨学科合作显然很明显，这使得该患者群体的活动目标得以优化，并且揭示出他们的经验更多的是相似而非不同。在这个患者群体中，患者和工作人员的安全优先于活动，充足的资源、能力和团队合作可以减轻安全风险。
