School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.
Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.
J Clin Nurs. 2021 Mar;30(5-6):803-818. doi: 10.1111/jocn.15620. Epub 2021 Jan 12.
Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration.
To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework.
The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines.
Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources.
The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated.
These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration.
Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.
临床医生未能识别和应对患者临床恶化与医院死亡率增加有关。应急响应团队在医院中实施，以支持直接护理临床医生管理患者恶化，但患者临床恶化在病房环境中经常未被临床医生识别或采取行动。迄今为止，尚无研究使用综合理论框架在多个地点检查为什么临床医生会延迟识别和对患者的临床恶化采取行动。
使用理论领域框架确定影响临床医生对患者临床恶化无反应或延迟反应的障碍和促进因素。
理论领域框架指导：（a）在两个地点进行的与临床医生、卫生消费者和家庭成员的半结构化访谈；（b）对归纳主题进行演绎分析，以确定最佳护理的障碍和促进因素。本研究符合 COREQ 研究指南。
确定了七个主题：（a）信息传递；（b）患者护理的所有权；（c）回应的信心；（d）知识和技能；（e）文化；（f）情感；和（g）环境背景和资源。
理论领域框架确定了传统的社会和专业等级制度以及由于环境背景和资源限制导致的专业群体之间的识别减少和有效关系发展的障碍。沟通过程受到这些限制的影响，并因政策制定不足和定期有效团队培训机会有限而进一步复杂化。结果，患者安全受到损害，临床医生感到沮丧。
这些结果为行为改变干预措施的制定、实施和评估提供了信息，并增加了对及时应对患者临床恶化的障碍和促进因素的了解。
结果有助于理解为什么临床医生会延迟对患者临床恶化做出反应，并提出了确定和挑战阻止跨学科合作和决策的传统等级制度和实践的关键建议。
