Centre for Quality and Patient Safety Research - Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
Applied Artificial Intelligence Institute, Deakin University, Burwood, Victoria, Australia.
J Adv Nurs. 2022 Nov;78(11):3745-3759. doi: 10.1111/jan.15351. Epub 2022 Jul 7.
Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes.
Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital.
A multi-method qualitative study informed by frameworks of behaviour change and human-centred co-design.
The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human-centred co-design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis.
Analysis revealed a 5-step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient.
The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
护士在为老年人办理入院手续时采取的预防伤害措施对患者安全、可预防的患者伤害和住院时间有重要影响。需要新的解决方案来帮助护士在入院过程中平衡复杂性、高工作负荷和患者安全。
探讨护士在为老年人办理入院手续时预防伤害的实践经验。
基于行为改变框架和以人为中心的共同设计的多方法定性研究。
从澳大利亚墨尔本大都市地区一家大型公共卫生服务机构的五家普通内科病房中，有针对性地招募了 44 名护士、5 名其他学科的临床医生和 3 名消费者。在 2019 年 8 月至 2020 年 1 月期间，共进行了 8 次患者入院期间的自然观察和 4 次参与式以人为中心的共同设计工作坊，共收集了 12 小时的数据。对护士在 8 次患者入院期间的观察、现场记录和工作坊工件数据进行了定性内容和主题分析。
分析揭示了一个 5 步的旅程图，具有时间逻辑，捕捉了护士的经验，以及在为老年人办理入院手续时预防伤害实践的促进因素和障碍。达成共识的是，有三个优先特征可以帮助护士在为老年人办理入院手续时实施伤害预防实践：（1）优先考虑重要的护理；（2）根据个人情况调整护理；（3）了解患者的整体情况。
新颖的研究方法确定了护士在为老年人办理入院手续时的五个步骤和预防伤害的实践活动，以及帮助护士在这项复杂活动中确保患者安全的解决方案的关键特征。研究结果为进一步研究开发干预措施提供了基础，以帮助护士在处理高工作量的情况下进行管理。
