Birmingham City University, Faculty of Health, Education and Life Sciences, 017 Ravensbury, City South Campus, Edgbaston, Birmingham, UK, B153TN.
J Eval Clin Pract. 2019 Aug;25(4):664-675. doi: 10.1111/jep.13075. Epub 2018 Nov 28.
Internationally, clinical guidelines as checklists are increasingly used in acute ward practice to standardize the delivery and raise the quality of care on acute hospital wards. However, when guideline-checklists are implemented repeatedly, health providers' intentions to carry out this type of behaviour are not well understood. Therefore, the objective of this study was to evaluate nurses' and health care assistants' (HCAs) intentions to implement a "care round checklist"; a guideline-intervention repeated hourly on hospital wards. Furthermore, an extended Theory of Planned Behaviour (TPB) model's usefulness in explaining this type of behaviour was also evaluated.
A theory-informed questionnaire, guided by the TPB, habit, and clinical context variables, was developed to measure the guideline-checklist behaviour. Quantitative questionnaire data were analysed using descriptive and inferential tests to establish differences in nurses' and HCAs' intentions and the predictive value of the model.
A sample of 270 nurses and HCAs returned questionnaires from 24 wards in a major hospital in England. The extended TPB model explained 20% of nurses and 24% of HCAs reported intentions to implement a care round checklist, a modest proportion of intent. Attitude and perceived control best predicted nurses' intentions, and attitude and practice habit HCAs' intentions. TPB belief variables helped explain why nurses and HCAs intentions were different.
Statistically, the extended TPB model highlighted that nurses and HCAs intentions to implement this type of guideline are predicted by different variables. This implied professional "role" as an important variable in explaining differences in intentions, which should be evaluated and integrated into the future design of this type of checklist. Further variables could be added to explain and learn more about intentional thinking for this type of behaviour and should help to develop a theoretical understanding of intentions underpinning this type of behaviour and ultimately improve patient care.
在国际上，临床指南检查表越来越多地被用于急性病房实践，以规范护理服务并提高急性病房的护理质量。然而，当指南检查表被反复实施时，卫生提供者实施这种行为的意图尚不清楚。因此，本研究的目的是评估护士和医疗保健助理（HCAs）实施“护理查房检查表”的意图；这是一种在医院病房每小时重复的指南干预措施。此外，还评估了扩展的计划行为理论（TPB）模型在解释这种行为方面的有用性。
根据 TPB、习惯和临床背景变量，制定了一个理论指导的问卷，以衡量指南检查表行为。使用描述性和推断性测试对定量问卷数据进行分析，以确定护士和 HCAs 意图的差异以及模型的预测价值。
来自英格兰一家大医院 24 个病房的 270 名护士和 HCAs 填写了问卷。扩展的 TPB 模型解释了 20%的护士和 24%的 HCAs 实施护理查房检查表的意图，这是一个适度的比例。态度和感知控制对护士的意图预测最好，而态度和实践习惯对 HCAs 的意图预测最好。TPB 信念变量有助于解释为什么护士和 HCAs 的意图不同。
从统计学上讲，扩展的 TPB 模型强调了护士和 HCAs 实施这种类型指南的意图是由不同的变量预测的。这意味着专业“角色”是解释意图差异的一个重要变量，应该在未来这种类型检查表的设计中进行评估和整合。可以添加其他变量来解释和更多地了解这种行为的意图思维，并有助于从理论上理解这种行为的意图基础，并最终改善患者护理。
