Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands.
Intensive Crit Care Nurs. 2024 Dec;85:103797. doi: 10.1016/j.iccn.2024.103797. Epub 2024 Sep 2.
To explore and describe the everyday practices (Work-As-Done) that hinder and facilitate patient care transitions from the intensive care unit (ICU) to the ward.
RESEARCH METHOD/DESIGN: Multiple qualitative case studies in the ICU and various specialized wards of three Dutch hospitals. Adult patients planned to be transferred were purposively sampled on a variety of characteristics along with their relative (if present), and the ICU and ward nurses who were involved in the transition process. Data were collected by using multiple sources (i.e., observations, semi-structured interviews and a qualitative survey) and then systematically analyzed using the thematic analysis approach until saturation was reached.
Twenty-six cases were studied. For each case, the actual transfer was observed. Sixteen patients, five relatives and 36 nurses were interviewed. Two patients completed the survey. Fifteen themes emerged from the data, showing that the quality of transitions is influenced by the extent to which nurses anticipate to patient-specific needs (e.g., providing timely and adequate information, orientation, mental support and aftercare) and to the needs of the counterpart to continue care (e.g., by preparing handovers) besides following standard procedures. Data also show that procedures sometimes interfere with what works best in practice (e.g., communication via a liaison service instead of direct communication between ICU and ward nurses).
Subtle, non-technical nursing skills play an important role in comforting patients and in the coordination of care when patients are transferred from the ICU to the ward.
These Work-As-Done findings and their underlying narratives, that are often overlooked when focusing on quality improvement, can be used as material to reflect on own practice and raise awareness for its impact on patients. They may stimulate healthcare staff in crafting interventions for optimizing the transition process.
探索和描述阻碍和促进从重症监护病房（ICU）到病房的患者护理过渡的日常实践（实际工作情况）。
研究方法/设计：在荷兰的三家医院的 ICU 和各种专科病房进行了多项定性案例研究。有计划从 ICU 转科的成年患者根据各种特征与他们的家属（如果有）以及参与过渡过程的 ICU 和病房护士一起进行了选择性抽样。通过使用多种来源（即观察、半结构化访谈和定性调查）收集数据，然后使用主题分析方法对数据进行系统分析，直到达到饱和状态。
研究了 26 例病例。对每例病例进行了实际转科观察。对 16 名患者、5 名家属和 36 名护士进行了访谈。2 名患者完成了调查。从数据中得出了 15 个主题，表明转科质量受到护士对患者特定需求的预期程度（例如，及时提供充分的信息、定向、心理支持和后续护理）以及对继续护理的对应方的需求（例如，通过准备交接）的影响，除了遵循标准程序之外。数据还显示，有时程序会干扰实践中最有效的方法（例如，通过联络服务进行沟通，而不是 ICU 和病房护士之间的直接沟通）。
在从 ICU 转科到病房时，微妙的非技术护理技能在安慰患者和协调护理方面发挥着重要作用。
这些实际工作情况的发现及其潜在的叙述，在关注质量改进时往往被忽视，可以作为反思自身实践的材料，并提高对其对患者影响的认识。它们可以激发医护人员制定干预措施，以优化转科过程。
