护士在医院中使用伤害预防策略对老年患者的障碍和促进因素：一项横断面调查。
Barriers and enablers to nurses' use of harm prevention strategies for older patients in hospital: A cross-sectional survey.
机构信息
School of Nursing and Midwifery and Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
Implementation Science and Health Systems, School of Population Health, University of New South Wales, Sydney, NSW, Australia.
出版信息
J Adv Nurs. 2022 Nov;78(11):3710-3720. doi: 10.1111/jan.15269. Epub 2022 Apr 22.
BACKGROUND
Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse-led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood.
AIM
The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting.
DESIGN
Anonymous, online, cross-sectional survey.
METHODS
The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight-factor framework for comprehensive harm prevention. The STROBE reporting checklist was used.
RESULTS
Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9-10/10) (p = .024), and awareness of strategies for the eight-factor framework (p = .019) were significant enablers of comprehensive harm prevention.
CONCLUSION
Targeted evidence-based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward.
背景
住院期间可预防的伤害对全球卫生系统构成了重大挑战。护士主导的策略为全面预防伤害提供了保障，以确保医院中最脆弱的患者的安全，但护理中的差距仍然很常见。在急性住院期间，护士预防患者伤害的角色和活动还没有被充分了解。
目的
本研究旨在确定护士对老年人在急性医院环境中接受全面预防伤害的实施的感知促进因素和障碍。
设计
匿名、在线、横断面调查。
方法
在 2019 年，澳大利亚一家三级卫生服务机构的三家医院的五个普通内科病房，使用经改编的影响患者安全行为问卷（Influences on Patient Safety Behaviours Questionnaire，IPSBQ）收集数据。参与者还对他们对整体护理质量、遗漏护理以及对全面预防伤害的八项框架策略的认识进行了评分。采用 STROBE 报告清单。
结果
各病房的回应率在 35%至 58%之间，共产生了 132 份完整的调查问卷进行分析。行为调节（3.28）、能力信念（2.96）和环境背景和资源（2.73）的高平均得分表明，护士认为这些领域是促进因素。意图（1.65）、后果信念（1.69）、乐观（1.72）和专业角色与身份（1.85）等领域的低平均得分表明，这些因素是护士全面预防伤害的障碍。高感知护理质量（评分 9-10/10）（p=0.024）和对八项框架策略的认识（p=0.019）是全面预防伤害的显著促进因素。
结论
有针对性的基于证据的策略，包括教育、说服、激励、强制和示范，对于促进护士全面预防伤害最有用。然而，为了达到最有效的效果，伤害预防策略可能需要针对每个病房进行调整。
Zotero 插件