Beta Iota, Associate Professor, College of Nursing, University of Cincinnati, Cincinnati, OH, USA.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Nurs Scholarsh. 2021 Nov;53(6):718-726. doi: 10.1111/jnu.12683. Epub 2021 Jun 2.
To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions.
This study was based on the concepts of Benner's Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department.
A panel of nine triage, education, and operational management experts were selected based on their publication and presentation history. This panel participated in three Delphi rounds, providing individual responses during each round. All responses were entered into a RedCap database, which allowed research team members to synthesize the results and return summaries to the participants. Final consensus was reached among this panel regarding recommendations for successful strategies to address triage interruptions that can be encompassed in a training module. The experts were then asked to identify the best instructional modality for teaching each of the interruption management strategies.
Eight strategies to mitigate the impact of interruptions were identified: (a) ensure nurses understand impact of interruptions; (b) ensure nurses understand consequences of interruptions on cognitive demands of healthcare workers that could influence behavior and lead to errors; (c) apologize to current patient before tending to interruption and give expectation of when you will return; (d) triage the interruption and decide to (i) ignore interruption, (ii) acknowledge, but delay servicing, interruption, or (iii) acknowledge and service interruption, delaying completion of interrupted task; (e) identify urgent communication as anything clinically significant that impacts the patient immediately or requires immediate intervention; (f) use focused questions to clarify whether interruption can wait; (g) redirect nonpriority interruptions; and (h) finish safety-critical task or tasks near completion before tending to an interruption. The Delphi participants recommended the best teaching modality was simulation for six of the strategies.
Participants agreed that there are strategies that can be taught to novice triage nurses to mitigate the impact of interruptions. The experts in operations management, emergency nursing, and education agree that creating simulations to teach each of these strategies is an effective way to educate nurses.
Interruptions impact the quality of care provided to patients. Training nurses to prevent interruptions and mitigate the impact of interruptions when they occur has the potential to improve patient outcomes.
使用 Delphi 法确定分诊护士有效管理中断的策略。
本研究基于 Benner 新手到专家模型的概念。采用在线修改 Delphi 方法，让分诊、教育和运营管理专家就成功应对急诊科分诊中断的策略达成共识建议。
根据发表和演讲记录，选择了 9 名分诊、教育和运营管理专家组成专家组。该小组参加了三轮 Delphi 研究，在每一轮研究中提供个人意见。所有回复均输入到 RedCap 数据库中，使研究小组成员能够对结果进行综合，并向参与者提供总结。专家组就成功应对分诊中断的策略达成最终共识，这些策略可以纳入培训模块。然后，专家们被要求确定教授每种中断管理策略的最佳教学模式。
确定了 8 种减轻中断影响的策略：（a）确保护士了解中断的影响；（b）确保护士了解中断对医疗工作者认知需求的影响，这可能会影响行为并导致错误；（c）在处理中断之前向当前患者道歉，并告知您何时返回；（d）对中断进行分诊，并决定（i）忽略中断，（ii）承认但延迟中断服务，或（iii）承认并服务中断，延迟完成中断任务；（e）将紧急沟通确定为对患者立即产生影响或需要立即干预的任何临床显著信息；（f）使用重点问题来澄清中断是否可以等待；（g）重新引导非优先级中断；（h）在处理中断之前完成接近完成的安全关键任务或任务。Delphi 参与者建议，对于其中 6 种策略，最佳教学模式是模拟。
参与者一致认为，可以教授新手分诊护士一些策略来减轻中断的影响。运营管理、急诊护理和教育方面的专家一致认为，创建模拟来教授这些策略中的每一个都是教育护士的有效方法。
中断会影响向患者提供的护理质量。培训护士预防中断并在发生中断时减轻其影响，有可能改善患者的治疗结果。
