Eekholm Signe, Samuelson Karin, Ahlström Gerd, Lindhardt Tove
Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden.
Department of Internal Medicine, Copenhagen University Hospital, DK-2900 Hellerup, Denmark.
Healthcare (Basel). 2021 Nov 9;9(11):1524. doi: 10.3390/healthcare9111524.
The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses' (RNs') adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews ( = 2), field observations ( = 14), and individual follow-up interviews ( = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ''stolen time'-delivering nursing at the bottom of a hierarchy', and three themes: (1) 'under the dominance of stronger paradigms', (2) 'the loss of professional identity', and (3) 'the power of leadership'. These themes, each comprising two to three subthemes, illustrated that RNs' adherence to EBG recommendations was strongly influenced by the individual RN's professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager's leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.
该研究报告称，社区获得性肺炎（CAP）患者存在低质量护理和护理缺失的高发生率。优化护理治疗和护理将使CAP患者受益。本研究的目的是描述影响注册护士（RN）对入住CAP的老年患者护理遵循循证指南（EBG）建议的障碍和促进因素。在三个医疗单元进行了半结构化焦点小组访谈（n = 2）、实地观察（n = 14）和个人随访访谈（n = 10），并通过定性内容分析进行分析。我们发现了一个主主题：“被偷走的时间——在层级底层提供护理”，以及三个主题：（1）“在更强范式的主导下”，（2）“职业身份的丧失”，和（3）“领导力的力量”。这些主题各包含两到三个子主题，表明RN对EBG建议的遵循受到个体RN的专业精神和职业身份的强烈影响；情境障碍，包括跨学科团队、组织结构、文化以及对护理的评估；以及护士长的领导技能。本研究确定了一些核心因素，这些因素可能有助于RN理解医疗环境中阻碍和促进护理工作开展的潜在动态，并使他们更有能力改变实践。
