将以人为本的叙事融入电子健康记录：研究方案。
Integration of Person-Centered Narratives Into the Electronic Health Record: Study Protocol.
机构信息
Heather Coats, PhD, APRN-BC, is Assistant Professor of Research, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora. Nadia Shive, BA, CCRC, is Professional Research Assistant, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora. Ardith Z. Doorenbos, PhD, RN, FAAN, is Nursing Collegiate Professor, College of Nursing, University of Illinois at Chicago, and Director of Palliative Care and Co-leader of Cancer Prevention and Control Program, University of Illinois Cancer Center, Chicago. Sarah Schmiege, PhD, is Biostatistician, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
出版信息
Nurs Res. 2020 Nov/Dec;69(6):483-489. doi: 10.1097/NNR.0000000000000463.
BACKGROUND
Incorporating a patient's personal narrative into the electronic health record is an opportunity to more fully integrate the patient's values and beliefs into care, thus creating opportunities to deliver high-quality/high-value, person-centered care.
OBJECTIVES
The aim of the study was to present a study protocol of a narrative intervention to (a) compare the effects of the narrative intervention to usual care on primary outcome of person's (patient) perceptions of quality of communication, (b) compare the effects of the narrative intervention on secondary outcomes of biopsychosocial well-being, and (c) examine the feasibility and acceptability of the narrative intervention from the perspective of both persons: the patient and the acute care bedside nurse.
METHODS
A randomized control trial is being conducted with a targeted enrollment of 80 patient participants and 80 nurse participants. The patient participants include individuals who are admitted to the acute care hospital for either heart failure or end-stage renal disease. An acute care beside nurse who has cared for the patient participant is also enrolled. Through a 1:1 random allocation scheme, stratified by illness, we will enroll 40 in the narrative intervention group and 40 in the usual care group. Patient participants will be assessed for patient-reported outcomes of patient's perception of quality of communication and biopsychosocial well-being.
RESULTS
The study began in October 2019; 53 potential patient participants have been approached, 21 have enrolled, and 20 have completed the data collection process.
DISCUSSION
The testing and integration of a person-centered narrative into the electronic health record is a novel approach to provide opportunities for improvement in communication between patients and nurses. The results from this study will provide important preliminary knowledge to inform future randomized clinical trials of narrative interventions leading to advances in how to best provide high-value, high-quality, person-centered care for persons living with serious illness.
背景
将患者的个人叙事纳入电子健康记录是一个将患者的价值观和信仰更全面地融入护理的机会，从而为提供高质量/高价值、以患者为中心的护理创造机会。
目的
本研究旨在介绍一项叙事干预研究方案，以（a）比较叙事干预与常规护理对患者对沟通质量感知的主要结果的影响，（b）比较叙事干预对生物心理社会福祉的次要结果的影响，以及（c）从患者和急性护理床边护士的角度探讨叙事干预的可行性和可接受性。
方法
正在进行一项随机对照试验，目标纳入 80 名患者参与者和 80 名护士参与者。患者参与者包括因心力衰竭或终末期肾病而住院的个体。也招募了照顾过患者参与者的急性护理床边护士。通过 1:1 随机分配方案，按疾病分层，我们将招募 40 名叙事干预组和 40 名常规护理组。患者参与者将评估患者对沟通质量和生物心理社会福祉的感知的患者报告结果。
结果
该研究于 2019 年 10 月开始；已经接触了 53 名潜在的患者参与者，有 21 名患者参与，并且有 20 名患者完成了数据收集过程。
讨论
将以患者为中心的叙事纳入电子健康记录的测试和整合是一种新颖的方法，可以为改善患者和护士之间的沟通提供机会。本研究的结果将为未来的叙事干预随机临床试验提供重要的初步知识，以推进如何为患有严重疾病的患者提供最佳的高价值、高质量、以患者为中心的护理。
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