针对护士在老年人长期医疗保健环境中参与药物停用的综合系统评价。
An integrative systematic review of nurses' involvement in medication deprescription in long-term healthcare settings for older people.
作者信息
Vaismoradi Mojtaba, Mardani Abbas, Crespo Manuel Lillo, Logan Patricia A, Sak-Dankosky Natalia
机构信息
Faculty of Nursing and Health Sciences, Nord University, Universitetsalléen 11, Bodø 8049, Norway.
Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia.
出版信息
Ther Adv Drug Saf. 2024 Oct 16;15:20420986241289205. doi: 10.1177/20420986241289205. eCollection 2024.
BACKGROUND
Deprescription of medications for older people in long-term care settings is crucial to enhance medication safety by reducing polypharmacy and minimizing related adverse events. Nurses as the member of the multidisciplinary healthcare team can support deprescription initiatives, but there is a gap in comprehensive knowledge about their roles.
OBJECTIVES
To investigate the role and contribution of nurses in deprescribing medications within the multidisciplinary pharmaceutical care context of long-term healthcare for older people.
DESIGN
A systematic review utilizing an integrative approach was performed.
METHODS
Multiple databases were searched, including PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest and Embase, focusing on studies published in English from 2014 to 2024. The preliminary search yielded 4872 studies, which were then refined to 32 qualitative and quantitative studies chosen for data analysis and narrative synthesis. Thematic comparisons and analysis led to the creation of meaningful categories integrating the studies' findings to meet the review's objective.
RESULTS
The review findings were classified into categories: 'necessity and benefits of deprescribing', 'multidisciplinary collaboration for deprescribing', 'nurse role in deprescribing', 'identified challenges to deprescribing', 'involvement of older people and families in deprescribing'. They illustrated and exemplified various aspects of nurses' roles and contributions in deprescription initiatives within the multidisciplinary pharmaceutical care team, such as support for reducing doses, discontinuing medications or transitioning to safer alternatives, as well as factors influencing this process.
CONCLUSION
The main dimensions of nurses' roles and contributions in deprescription initiatives encompass monitoring, communicating and educating. Challenges to nurses' active participation in deprescribing, such as the need for increased knowledge, confidence and inclusion in team discussions, should be addressed through education, training and changing attitudes. These steps are essential for improving the safety of medication deprescribing in long-term care settings.
TRIAL REGISTRATION
The review was registered under PROSPERO ID: CRD42023486484, and can be accessed at crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486484.
背景
在长期护理机构中，减少老年人的用药量对于提高用药安全性至关重要，这可以减少多重用药并将相关不良事件降至最低。护士作为多学科医疗团队的成员，可以支持减少用药量的举措，但他们对自身角色的全面认识存在差距。
目的
探讨护士在老年人长期医疗的多学科药物治疗背景下，在减少用药量方面的作用和贡献。
设计
采用综合方法进行系统评价。
方法
检索了多个数据库，包括PubMed（涵盖MEDLINE）、Scopus、CINAHL、ProQuest和Embase，重点关注2014年至2024年以英文发表的研究。初步检索得到4872项研究，然后筛选出32项定性和定量研究用于数据分析和叙述性综合分析。通过主题比较和分析，创建了有意义的类别，整合了研究结果以满足综述的目的。
结果
综述结果分为以下几类：“减少用药量的必要性和益处”“减少用药量的多学科协作”“护士在减少用药量中的作用”“减少用药量面临的挑战”“老年人及其家庭在减少用药量中的参与”。这些结果阐述并举例说明了护士在多学科药物治疗团队的减少用药量举措中的各种角色和贡献，例如支持减少剂量、停药或改用更安全的替代药物，以及影响这一过程的因素。
结论
护士在减少用药量举措中的主要作用和贡献包括监测、沟通和教育。护士积极参与减少用药量面临的挑战，如需要增加知识、信心以及参与团队讨论，应通过教育、培训和改变态度来解决。这些措施对于提高长期护理机构中减少用药量的安全性至关重要。
试验注册
该综述已在PROSPERO注册，注册号为CRD42023486484，可在crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486484查阅。
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