提高肾上腺素自动注射器的依从性：一项针对医疗保健专业人员的心理知情培训。
Improving adrenaline autoinjector adherence: A psychologically informed training for healthcare professionals.
机构信息
School of Psychology, University of Worcester, Worcester, UK.
College of Health, Life and Environmental Sciences, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
出版信息
Immun Inflamm Dis. 2019 Sep;7(3):214-228. doi: 10.1002/iid3.264. Epub 2019 Jul 9.
BACKGROUND
Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use.
OBJECTIVE
To evaluate the impact of a 90-minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees' knowledge, confidence and likelihood of using the strategies were expected to improve.
METHODS
Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact.
RESULTS
χ analyses were significant in most cases (P < .05), with sustained (6-8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees' knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts.
CONCLUSION
Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice.
CLINICAL RELEVANCE
Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.
背景
临床医生在培训过敏反应患者使用肾上腺素自动注射器时会采用教学方法，但患者的使用效果不佳。尽管存在这些行为的心理障碍，但在培训患者使用自动注射器时通常不会考虑这些因素。健康心理学原则表明，与患者一起探讨这些因素可以提高他们使用自动注射器的能力。
目的
评估 90 分钟的研讨会对临床医生培训策略和技术的影响，以探索和应对患者使用自动注射器的心理障碍。预计参加者的知识、信心和使用这些策略的可能性会提高。
方法
使用纵向混合方法设计评估影响。29 名支持英国医院和普通实践中过敏反应患者的临床医生（普通和专科护士、全科医生和药剂师）参加了此次研讨会。在研讨会前 1 周、1 至 3 周以及 6 至 8 周时在线评估自我评估的知识、信心和使用所教策略的可能性。在参加研讨会后，邀请临床医生进行电话访谈，以探索研讨会的影响。
结果
大多数情况下 χ 分析具有统计学意义（P <.05），在知识、信心和使用所教策略的可能性方面都有持续（6-8 周）的提高。访谈数据的主题分析表明，研讨会提高了参与者对护理路径的了解，增强了他们对过敏反应患者体验的理解，即心理上的而不仅仅是身体上的，改变了他们与这一群体和其他患者群体的沟通方式。然而，受访者认为缺乏时间和组织因素是在临床环境中使用所教策略和技术的障碍。
结论
培训临床医生使用心理知情策略可持续提高他们在患者自动注射器教育方面的信心和知识，以及他们在临床实践中使用策略的可能性。
临床相关性
在培训过敏反应患者使用自动注射器时，应探讨心理障碍。
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