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探索澳大利亚范围内标准化护理术语的知识和使用情况。

Exploring the Knowledge and Use of Standardised Nursing Terminology Across Australia.

机构信息

Monash Health, Melbourne, Australia.

Metro South Health, Melbourne, Australia.

出版信息

Stud Health Technol Inform. 2024 Sep 24;318:6-11. doi: 10.3233/SHTI240883.

Abstract

Standardised nursing terminologies (SNTs) support the visibility of nursing work and documentation, enabling data sharing and comparison. An online survey assessed the knowledge and use of SNTs and revealed barriers and enablers to their use by Australian nurses. Just over half of the respondents were familiar with SNTs before the survey, a quarter reported a reasonable understanding of SNTs, just under half reported previous use of a SNT, and less than 14% indicated a current use of a SNT in their workplace. Perceived benefits to SNTs identified by respondents included a reduction in variation and the ability to evaluate the effectiveness of nursing care by measuring outcomes. Both barriers and enablers to the use of SNTs included education and training, standardisation and contextualisation across Australia, and integration into any electronic medical record system. Nurses are poorly informed on what SNTs are and how they can be leveraged to support their work and documentation. There is a need for an Australia-wide strategic approach to ensure the future of nurses' work is visible, and SNTs are purposefully and correctly implemented across the country.

摘要

标准化护理术语(SNTs)支持护理工作和文档的可见性,实现了数据共享和比较。一项在线调查评估了澳大利亚护士对 SNTs 的了解和使用情况,揭示了使用 SNTs 的障碍和促进因素。在调查之前,只有略多于一半的受访者熟悉 SNTs,四分之一的受访者报告对 SNTs 有一定的了解,近一半的受访者报告之前使用过 SNTs,不到 14%的受访者表示在工作场所当前正在使用 SNTs。受访者认为 SNTs 的好处包括减少差异以及通过衡量结果来评估护理服务的有效性。使用 SNTs 的障碍和促进因素包括教育和培训、澳大利亚境内的标准化和情境化以及整合到任何电子病历系统中。护士对 SNTs 是什么以及如何利用它们来支持他们的工作和文档了解甚少。需要采取全澳范围的战略方法来确保护士工作的未来是可见的,并且 SNTs 在全国范围内有目的地和正确地实施。

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