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沟通困境:蒙大拿州医疗机构间患者转院过程中患者信息交换时家庭护士观点的初步跨截面描述性研究

The Communication Conundrum: A Pilot Cross-Sectional Descriptive Examination of Family Nurse Perspectives Surrounding Patient Information Exchange During Interfacility Patient Transfers in Montana.

机构信息

Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA

School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

Res Theory Nurs Pract. 2024 Aug 21;38(3):382-405. doi: 10.1891/RTNP-2023-0115.

Abstract

Interfacility patient transfers are fraught with issues such as missed or ineffective communication in Montana given wide geographic distance between facilities and variance in resources. Inaccurate, absent, or delayed patient details may negatively affect patient outcomes and further result in duplicative testing and medication errors. The objective of this study was to describe the process of patient information communication during interfacility transfers as perceived by nurses practicing in Montana. The study design was a pilot cross-sectional descriptive approach. An online Qualtrics survey included demographic questions, two exploratory communication competence instruments, and four open-ended questions regarding communicating interfacility transfer patient information. A total of 33 nurses completed the study, with the majority practicing at a critical access hospital ( = 15, 47%). Communication competence mean scores increased with dyad conversations, and a lack of standardized handoff tools was noted as a challenge. Nurses identified the following as barriers in the interfacility transfer handoff: incivility, amount of paperwork, interoperability issues, incomplete or outdated information, time, and resources. There is wide variability in current communication practices, ranging from verbal to electronic document transfers. The rural healthcare space is prime to continue examinations surrounding workflow optimization, accuracy, and consistency in shared information exchange at the time of interfacility transfer. There is an opportunity for potential training and education surrounding effective communication, interpersonal behaviors that support cross-organizational interactions, and the development of a standardized handoff tool contextual for interfacility transfer patients.

摘要

医疗机构间的患者转院存在诸多问题,例如在蒙大拿州,由于医疗机构之间的地理距离较远,资源差异较大,导致沟通不畅或沟通无效。不准确、缺失或延迟的患者信息可能会对患者的治疗结果产生负面影响,并进一步导致重复检查和用药错误。本研究旨在描述蒙大拿州护士对医疗机构间转院患者信息沟通过程的看法。该研究设计为试点性横断面描述性方法。一项在线 Qualtrics 调查包括人口统计学问题、两项探索性沟通能力工具,以及四个关于沟通医疗机构间转院患者信息的开放性问题。共有 33 名护士完成了这项研究,其中大多数(=15,47%)在基层医疗机构工作。随着双人对话的进行,沟通能力的平均得分有所提高,并且缺乏标准化的交接工具被认为是一个挑战。护士们还发现了医疗机构间转院交接中的以下障碍:不礼貌、文书工作多、互操作性问题、信息不完整或过时、时间和资源。目前的沟通实践存在很大差异,从口头到电子文档传输不等。农村医疗保健领域是继续检查工作流程优化、共享信息交换准确性和一致性的绝佳机会。在医疗机构间转院时,围绕有效沟通、支持跨组织互动的人际行为以及为医疗机构间转院患者制定标准化交接工具的潜在培训和教育机会是存在的。

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