Wergeland Daniel, Harsten Kristine, Klarare Anna, Steindal Simen A
Lovisenberg Diaconal University College, Oslo, Norway.
Department of Haematology, Oslo University Hospital, Oslo, Norway.
J Clin Nurs. 2022 Nov;31(21-22):3190-3199. doi: 10.1111/jocn.16155. Epub 2021 Nov 26.
To explore hospital nurses' experience assessing changes in the health status of stem-cell transplanted patients in home care (HC).
Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients' health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses' experience assessing patients' health status at home when patients undergo stem-cell transplantation were found.
Qualitative study with an explorative design.
Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist.
Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients' general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments.
Effective communication and clinical intuition enhanced the assessment of patients' general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments.
Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients' health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses' confidence in their assessments.
探讨医院护士在家庭护理（HC）中评估干细胞移植患者健康状况变化的经验。
接受干细胞移植的患者在家庭护理中是在家中而非医院病房接受治疗。医院护士每天探访患者，并在评估患者健康状况方面发挥关键作用。先前关于干细胞移植患者家庭护理的研究主要集中在家庭护理与医院护理的安全性上。未发现有关护士在患者接受干细胞移植时在家中评估患者健康状况经验的研究。
采用探索性设计的定性研究。
通过对14名负责干细胞移植患者家庭护理的医院护士进行个人半结构化访谈收集数据。使用系统文本浓缩法进行数据分析。本研究的报告遵循COREQ清单。
数据分析得出三个类别：1）有效的沟通和临床直觉可增强对患者总体健康状况的评估；2）在远程评估中依靠个人判断具有挑战性；3）进行远程临床评估有一些关键促进因素。
有效的沟通和临床直觉增强了对患者总体健康状况的评估。远程评估期间缺乏实地在场使得在评估过程中运用临床直觉变得困难。造血干细胞移植经验被视为有助于进行准确的远程临床评估的重要因素。
负责医院家庭电话护理的护士应接受远程沟通培训，并应在家庭探访期间跟随医院家庭护士学习，以获得评估患者健康状况的经验。应考虑使用视频会议和远程患者监测等远程医疗方面的手段，以进行更准确的远程评估。这可能会带来更有效的评估，减少再入院率，并增强护士对其评估的信心。
