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实施基于循证的基础护理的定制化多维度策略:一项评估研究。

Tailored Multifaceted Strategy for Implementing Fundamental Evidence-Based Nursing Care: An Evaluation Study.

作者信息

Eekholm Signe, Samuelson Karin, Ahlström Gerd, Lindhardt Tove

机构信息

Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden.

Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 2, 2nd. Floor, DK-2900 Hellerup, Denmark.

出版信息

Nurs Rep. 2024 Dec 18;14(4):4070-4090. doi: 10.3390/nursrep14040297.

Abstract

: Extensive research has emphasised the persistent challenges and failures in providing hospitalised patients with fundamental evidence-based nursing care, often resulting in grave consequences for patient safety. Recommendations from implementation research indicate that a tailored theory- and research-based implementation strategy targeting contextual determinants can optimise the implementation of evidence-based clinical practice for the benefit of patients. This study evaluated the feasibility of an implementation strategy designed to improve the quality of nursing care by targeting behavioural and environmental barriers in a hospital setting. : Proctor's conceptual model for implementation was applied to evaluate the strategy based on eight outcomes: adoption, acceptability, appropriateness, fidelity, feasibility, penetration, sustainability, and costs. Data collection methods included field observations, informal and focus group interviews, registrations, and audits of electronic patient records. : The strategy was adoptive, acceptable, appropriate, and feasible in targeting complex environmental and behavioural determinants (at the individual, team, and management level), enabling successful implementation of fundamental evidence-based nursing care. However, fidelity, feasibility, and sustainability were challenged by competing organisational demands and time constraints. : The tailored, multifaceted strategy proved effective in addressing complex environmental and behavioural determinants across multiple levels, facilitating the implementation of fundamental evidence-based nursing care in a clinical practice. Further testing and larger-scale studies is needed to assess the strategy's transferability and its impact on nursing-sensitive patient outcomes in different clinical settings.

摘要

广泛的研究强调了在为住院患者提供基本的循证护理时持续存在的挑战和失败,这往往会给患者安全带来严重后果。实施研究的建议表明,针对背景决定因素的量身定制的基于理论和研究的实施策略可以优化循证临床实践的实施,以造福患者。本研究评估了一种旨在通过针对医院环境中的行为和环境障碍来提高护理质量的实施策略的可行性。运用普罗克特的实施概念模型,基于采用、可接受性、适宜性、保真度、可行性、渗透力、可持续性和成本这八项结果对该策略进行评估。数据收集方法包括实地观察、非正式访谈和焦点小组访谈、登记以及对电子病历的审核。该策略在针对复杂的环境和行为决定因素(在个人、团队和管理层面)方面是可采用的、可接受的、适宜的且可行的,能够成功实施基本的循证护理。然而,保真度、可行性和可持续性受到相互竞争的组织需求和时间限制的挑战。事实证明,这种量身定制的多方面策略在应对多个层面的复杂环境和行为决定因素方面是有效的,有助于在临床实践中实施基本的循证护理。需要进一步测试和大规模研究来评估该策略的可转移性及其在不同临床环境中对护理敏感型患者结局的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a358/11677046/01a38cece52f/nursrep-14-00297-g001.jpg

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