Porter Rebecca B, Cullen Laura, Farrington Michele, Matthews Grace, Tucker Sharon
Rebecca B. Porter is a nursing practice leader and a clinical ethics resource nurse at the University of Iowa Hospitals and Clinics, Iowa City, where Laura Cullen is an evidence-based practice scientist, Michele Farrington is a clinical health care research associate, and Grace Matthews is a nursing practice leader. Sharon Tucker is the Grayce Sills Endowed Professor in psychiatric mental health nursing and director of the Translational Research Core at the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at the Ohio State University College of Nursing, Columbus; at the time of this writing, she was the director of nursing research, evidence-based practice and quality at the University of Iowa Hospitals and Clinics. Partial funding for this study was provided by the DAISY Foundation's J. Patrick Barnes Grant for Nursing Research and Evidence-Based Practice Projects. Contact author: Rebecca B. Porter,
Am J Nurs. 2018 May;118(5):24-33. doi: 10.1097/01.NAJ.0000532806.35972.29.
: Purpose: This study aimed to address the knowledge gap between implementing and sustaining evidence-based fall prevention practices for hospitalized patients by exploring perspectives of the interprofessional health care team.
A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center.
Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis.
Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention.
Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.
目的:本研究旨在通过探索跨专业医疗团队的观点,解决在为住院患者实施和维持基于证据的跌倒预防措施方面的知识差距。
采用定性设计,以获取中西部一家大型学术医疗中心各学科临床医生的见解。
2013年10月至2014年3月期间,共进行了4个同质的半结构化焦点小组讨论和3次个人访谈,涉及20名临床医生。对录音数据进行转录,并采用归纳定性分析方法进行分析。
参与者围绕基于证据的跌倒预防计划的可持续性提出了两个主要主题:跨专业医疗团队内部的沟通模式以及医院组织实践和要素的影响。还出现了几个子主题。参与者认为护理人员对跌倒风险评估和预防负有主要责任。
个人的专业认知和实践以及组织特征会影响基于证据的跌倒预防措施的可持续性。虽然所有团队成员都认识到患者跌倒是一个重大的质量和安全问题,但大多数人认为直接护理护士在领导跌倒预防工作方面负有主要责任。数据支持了有效的跨专业团队沟通和组织实践在整个住院单元维持基于证据的跌倒预防计划的重要性。此外,数据对将质量指标标记为“护理敏感”的合理性提出了质疑;证据表明团队方法是最好的。