社会影响、实施氛围和领导力对重症监护病房护士主导的早期活动行为的影响。
Effects of social influence and implementation climate and leadership on nurse-led early mobility behaviours in critical care.
机构信息
School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
BMJ Open Qual. 2022 Jun;11(2). doi: 10.1136/bmjoq-2022-001885.
INTRODUCTION
Early mobility (EM), initiating and advancing physical activity in the earliest days of critical illness, has been described as the most difficult component of the ABCDEF bundle to implement and coordinate. Successful implementation of EM in clinical practice requires multiple targeted implementation strategies.
OBJECTIVE
Describe the associations of nurses' EM attitudes, subjective norms, perceived behavioural control, intention, and implementation climate and leadership with self-reported and documented EM behaviour in the intensive care unit (ICU).
DESIGN
This was a two-site, descriptive, cross-sectional study to explore nurses' perception of the factors influencing EM adherence.
SETTING
Three ICUs (medical, surgical and cardiovascular) in an academic medical centre and two ICUs (medical/surgical and cardiovascular) in a regional medical centre in middle Tennessee.
PATIENTS
Critically ill adults.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
A 34-item investigator-developed survey, Implementation Leadership Scale, and Implementation Climate Scale were administered to ICU nurses. Survey development was informed by a Theory of Planned Behavior based elicitation study and implementation science frameworks.
RESULTS
The academic medical centre had markedly lower EM documentation. We found no difference in nurses' EM attitudinal beliefs, social influence, facilitators, and barriers at both sites. Nurses perceived moderate social influence to perform EM similarly across sites and considerable control over their ability to perform EM. We did note site differences for implementation climate and leadership and objective EM adherence with the regional community medical centre demonstrating statistically significant relationships of implementation climate and leadership with self-report and documented EM behaviours.
CONCLUSIONS
We identified contextual differences in implementation climate and leadership influence when comparing nurse EM behaviours. Streamlined documentation, leadership advocacy for interprofessional coordination and manpower support, and multicomponent context-based implementation strategies could contribute to better EM adherence.
简介
早期活动（EM）是指在危重病的最初几天内开始并推进身体活动，它被描述为 ABCDEF 捆绑包中最难实施和协调的部分。要在临床实践中成功实施 EM，需要多种有针对性的实施策略。
目的
描述护士对 EM 的态度、主观规范、感知行为控制、意图以及实施气候和领导力与 ICU 中自我报告和记录的 EM 行为之间的关联。
设计
这是一项在两个地点进行的描述性、横断面研究，旨在探讨护士对影响 EM 依从性因素的看法。
地点
田纳西州中部一所学术医疗中心的三个 ICU（内科、外科和心血管科）和一家地区医疗中心的两个 ICU（内科/外科和心血管科）。
患者
危重症成人。
干预措施
无。
主要观察指标
对 ICU 护士进行了一项由研究者制定的 34 项调查、实施领导力量表和实施气候量表。调查的制定是基于基于计划行为理论的启发式研究和实施科学框架。
结果
学术医疗中心的 EM 记录明显较少。我们在两个地点都没有发现护士在 EM 态度信念、社会影响、促进因素和障碍方面的差异。护士认为自己在执行 EM 方面受到中等程度的社会影响，并且对自己执行 EM 的能力有相当大的控制。我们确实注意到实施气候和领导力以及客观 EM 依从性方面的站点差异，与区域社区医疗中心相比，领导力与自我报告和记录的 EM 行为具有统计学意义的关系。
结论
在比较护士 EM 行为时，我们发现实施气候和领导力的影响存在环境差异。简化文档、领导层倡导跨专业协调和人力支持，以及基于多方面的实施策略，可以有助于提高 EM 的依从性。
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