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医护人员如何看待为智障儿童和青少年提供的医疗质量和安全性?一项采用框架分析法的定性研究。

What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis.

机构信息

Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia

Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.

出版信息

BMJ Open. 2023 Jul 25;13(7):e071494. doi: 10.1136/bmjopen-2022-071494.

DOI:10.1136/bmjopen-2022-071494
PMID:37491102
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10373726/
Abstract

OBJECTIVE

To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital.

DESIGN

Qualitative study.

SETTING

We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis.

PARTICIPANTS

There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff.

INTERVENTION

Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital.

RESULTS

Key themes elicited include .

CONCLUSIONS

Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.

摘要

目的

从医护人员的角度了解与智力残疾儿童和青少年相关的医院患者安全问题。这是之前一篇关于家长访谈其在医院的孩子患者安全体验的论文的后续内容。

设计

定性研究。

设置

我们对三级儿童医院的工作人员进行了半结构化访谈和焦点小组,基于患者安全教育框架的领域,并使用框架方法进行数据分析。

参与者

29 名女性和 7 名男性工作人员,年龄在 27 至 70 岁之间,来自多个科室和专业,包括辅助人员。

干预措施

根据患者安全框架开发了问题,这些问题是在与家长、研究人员和临床医生协商后提出的,他们探讨了工作人员对这些在医院住院的儿童的安全和优质护理的看法和经验。在 2021 年 4 月至 2022 年 5 月期间,对过去 12 个月内在医院照顾过智力残疾儿童和青少年的工作人员进行了 22 次访谈和 3 次焦点小组。

结果

得出的主要主题包括:

结论

工作人员需要考虑到额外的脆弱性,减轻对这一人群的家长、儿童和青少年的负面态度和偏见,以更好地与他们接触并建立关系。需要改进当前的系统,以防止这一人群的风险和安全问题的识别、预防和管理。未来的发展包括结合家长访谈、学术和灰色文献的数据,为这一人群制定安全能力,以培训和教育整个卫生系统的工作人员。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1156/10373726/e525641cfacd/bmjopen-2022-071494f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1156/10373726/e525641cfacd/bmjopen-2022-071494f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1156/10373726/e525641cfacd/bmjopen-2022-071494f01.jpg

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本文引用的文献

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Reported clinical incidents of children with intellectual disability: A qualitative analysis.报道的智障儿童临床事件:定性分析。
Dev Med Child Neurol. 2022 Nov;64(11):1359-1365. doi: 10.1111/dmcn.15262. Epub 2022 May 16.
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'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability.“微笑、欢笑和所有那些美好的事情”:护士对住院智障儿童和青少年的美好护理体验的看法。
J Adv Nurs. 2022 Sep;78(9):2933-2948. doi: 10.1111/jan.15256. Epub 2022 Apr 22.
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Interprofessional communication in the hospital setting : a systematic review of the qualitative literature.
医院环境中的跨专业沟通:定性文献的系统评价。
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J Appl Res Intellect Disabil. 2022 May;35(3):675-690. doi: 10.1111/jar.12978. Epub 2022 Jan 30.
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Nurses' attitudes and emotions toward caring for adults with intellectual disability: An international replication study.护士照顾智障成人的态度和情感:一项国际复制研究。
J Nurs Scholarsh. 2022 Jan;54(1):117-124. doi: 10.1111/jnu.12713. Epub 2021 Nov 5.
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The importance of supportive relationships with general practitioners, hospitals and pharmacists for mothers who 'give medicines' to children with severe and profound intellectual disabilities.与全科医生、医院和药剂师建立支持性关系对给患有严重和极重度智力残疾的儿童用药的母亲非常重要。
J Intellect Disabil. 2022 Mar;26(1):29-49. doi: 10.1177/1744629520951003. Epub 2020 Aug 20.
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Hospitalized children with intellectual disability: Parents as partners in their care.患有智力残疾的住院儿童:父母作为其护理的合作伙伴。
J Appl Res Intellect Disabil. 2020 Sep;33(5):917-926. doi: 10.1111/jar.12713. Epub 2020 Feb 19.
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Social Connections Among Siblings With and Without Intellectual Disability or Autism.有和没有智力障碍或自闭症的兄弟姐妹之间的社会联系。
Intellect Dev Disabil. 2020 Feb;58(1):19-33. doi: 10.1352/1934-9556-58.1.19.
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