QEII Jubilee Hospital, Brisbane, Queensland, Australia.
School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
J Clin Nurs. 2019 Nov;28(21-22):3786-3795. doi: 10.1111/jocn.14979. Epub 2019 Jul 10.
To explore nurses' decision-making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings.
Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter-related bloodstream infection; however, emerging evidence is challenging traditional hang-time durations. Nurses' perceptions and contextual factors affecting decision-making for administration set replacement have not been assessed previously.
Qualitative study using focus groups with contextualism methodology and inductive analysis.
During November-December 2016, eight semi-structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio-recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7-step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation.
Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions.
Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice.
Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.
探讨护士在儿科和成人临床环境中对血管内接入装置输注的静脉输液套件更换的决策。
在临床实践中，静脉输液套件通常按规定时间间隔更换，目的是预防导管相关血流感染；然而，新出现的证据对传统的悬挂时间持续时间提出了挑战。之前尚未评估过影响输液套件更换决策的护士的看法和情境因素。
使用焦点小组和情境主义方法进行定性研究，并进行归纳分析。
2016 年 11 月至 12 月，在澳大利亚昆士兰州的两家大都市医院进行了 8 次半结构化焦点小组，共有 38 名护士参加。采访进行了录音并转录。两位作者独立审查了记录并使用 Braun 和 Clarke 的 7 步主题分析方法提取了重要陈述。COREQ 清单为报告研究方法、背景、结果、分析和解释提供了框架。
分析产生了五个关键主题：（a）感染预防，（b）物理安全，（c）患者偏好，（d）临床知识和信念，以及（e）工作量。输液套件更换可能是一项复杂的任务，特别是当患者有多种输注和不相容的药物时。护士根据患者偏好的看法，以及先前的经验、对同行专家和当地政策的了解，来协助他们做出决策。
护士在进行输液套件更换时，运用临床推理来平衡患者安全和偏好与竞争的工作场所需求。护士依靠以往的经验、医院和药物制造商的政策以及同行专家来指导他们的实践。
护士有时会出于患者病情、护士经验和工作量的考虑而偏离临床指南。本研究的结果表明，护士还会在这些竞争需求中平衡患者偏好和安全性的考虑。
