医护人员实施炎症性肠病患儿过渡指导促进及障碍因素的质性研究

目的 了解医护人员在实施炎症性肠病(inflammatory bowel disease, IBD)患儿过渡指导过程中的促进与障碍因素,为进一步在临床中实施过渡指导提供参考。方法 采用目的抽样的方法,选取2022年10月-2023年2月在上海市某2家三级甲等医院消化内科工作的10名护士及6名医生进行半结构式访谈,运用Colaizzi 7步分析法对资料进行整理分析,进行主题描述。结果 提炼出医护人员实施过渡指导的促进因素及障碍因素,促进因素的4个亚主题包括医护意识到患儿向成人过渡的重要性、患儿存在向成人过渡的需求、患儿及父母对医护人员的信任、同伴支持为患儿提供信息及情感支持,障碍因素的6个亚主题包括人力资源配置不当、过渡指导形式单一、过渡指导内容及流程不完善、医护未对患儿过渡准备情况进行个性化动态评估、患儿缺乏主动健康管理意识、父母过度参与患儿疾病管理。结论 医护人员在实施IBD患儿向成人过渡指导过程中存在着一定的促进和障碍因素,应正视设立多学科团队进行过渡指导的重要性,开发信息化过渡指导工具,完善过渡指导方案及工作流程,构建符合我国形势的过渡指导模式。     

临床护士实施课程思政教学促进及障碍因素的质性研究

目的 了解临床护士在实施课程思政教学过程中的促进与障碍因素,为进一步促进课程思政教学实施提供参考。方法 采用质性研究中的现象学研究方法,对10名临床护士进行半结构式深度访谈,对访谈资料进行转录、编码、类属分析。结果 提炼出临床护士实施课程思政教学的促进及障碍因素,促进因素主题的2个亚主题包括意识到课程思政教学的重要性、支持实习护士参与课程思政教学,障碍因素主题的4个亚主题包括人力资源配置不当、氛围缺乏、培训体系缺乏、实习护士重视不够。结论 临床护士在实施课程思政教学过程中存在着一定的促进及障碍因素,应正视临床护士、实习护士参与课程思政教学的重要性,优化人力资源配置,构建统一、规划的课程思政教育培训方案,建立全员共同参与课程思政教育培训的氛围。     

乳腺癌患者体重自我管理促进和障碍因素的质性研究

目的探讨乳腺癌患者体重自我管理(WSM)的促进和障碍因素, 旨在对乳腺癌患者进行WSM干预提供参考。方法本研究为描述性质性研究。采用目的抽样法, 选取2021年7—10月河北大学附属医院收治的17例乳腺癌患者为研究对象, 对其进行半结构式访谈。采用主题分析法进行资料分析。结果共提炼出乳腺癌患者WSM促进因素和障碍因素2个主题, 其中促进因素包括3个亚主题, 分别为正确的个人感知、积极的自我调节、积极的社会影响和社会支持;障碍因素包括5个亚主题, 分别为知识和技能欠缺、负面情绪、不良生活习惯、角色冲突、身体功能受限。结论医护人员应加强乳腺癌患者WSM健康教育, 改善患者对WSM的认知, 提高患者自我调节能力, 并加强患者症状自我管理, 鼓励其适度锻炼, 最终提高乳腺癌患者的WSM水平。     

日间化学治疗模式下医护人员对静脉治疗护士主导的血管通路共享决策认知与体验的质性研究

目的 明确日间化学治疗（化疗）模式下医护人员对现行血管通路共享决策模式的看法,并确定改进措施,以促进日间化疗血管通路共享决策模式的常规实施。方法 基于SWOT模型制定访谈提纲,采用目的抽样方法,选取2023年4月—6月天津医科大学肿瘤医院工作的7名医生和6名静脉治疗（静疗）护士进行半结构式访谈,并运用内容分析法进行资料分析。结果 内部优势提取出4个主题：缓解医生诊疗压力和决策压力、静疗专科护士有实施能力和意愿、促进血管通路的合理选择、提升日间化疗患者血管通路认可度和护患沟通黏性。内部劣势提取出4个主题：工作量增加、决策辅助工具不实用、实施流程不顺畅、信息化不完善。外部机会提取出3个主题：国家政策支持、日间化疗患者存在参与决策的意愿、循证依据充分。外部威胁提取出3个主题：日间化疗模式下医护沟通不畅、医护人员存在静疗相关认知差异、护士主导信心不足。结论 静疗护士主导的血管通路共享决策在日间化疗模式下存在一定优势,未来应把握现有机会,规避自身劣势,正视外部威胁,制定标准化的日间化疗模式下静疗护士主导的血管通路共享决策模式,促进日间化疗血管通路决策最佳循证实践。     

达芬奇机器人辅助腹腔镜泌尿外科手术病人术后早期活动障碍因素的质性研究

目的:了解达芬奇机器人辅助腹腔镜泌尿外科手术病人执行早期活动的障碍因素,为机器人手术病人制订针对性的早期活动干预措施提供借鉴。方法:采用现象学研究,选取16例机器人手术后未执行早期活动的病人为研究对象,进行半结构式深入访谈,根据Colaizzi 7步分析法进行分析,提炼主题。结果:得出三大主题。病人对早期活动态度的主观障碍因素,即传统观念的束缚、恐惧与顾虑、负性情绪与性格改变;执行早期活动的客观障碍因素,包括疼痛、疲乏、胃肠道症状、直立不耐受、睡眠障碍、共存疾病;早期活动的外在影响因素,有治疗限制因素、医护认知不一致、流程和方案不明确、辅助工具受限、照护者参与不足因素。结论:医护人员应提高机器人手术病人对早期活动重要性的认知,采取多学科团队协作,制定切实可行的实施方案,使病人得到安全科学、快速有效的康复。     

乳腺癌术后患者伤口置管居家照护促进因素和障碍因素的质性研究

目的：通过对乳腺专科医护人员质性研究的视角,了解乳腺癌术后患者伤口置管居家照护的促进因素和障碍因素,以便为患者提供更加人性化的伤口置管居家照护服务。方法：采用现象学研究方法,以半结构式访谈方式对天津医科大学肿瘤医院乳腺科的19名医护人员进行深入访谈,进行现场录音和笔录,并采用分析软件Nvivo12.0及Colaizzi 7步法对访谈资料进行整理、分析。结果：患者伤口置管居家照护促进因素包括获得良好的家庭和社会支持、多元化及个性化的健康教育形式;障碍因素包括患者因素（自愿学习能力与认知不足及依从性差）、照护者因素（老年患者家属照护者及更换家属监管照护）和其他因素（独居患者及地域因素）。结论：作为临床医护人员应为患者主动提供针对性专业指导及信息支持,以解决其实际问题,帮助患者安全度过伤口置管居家期,减少并发症的发生,促进康复,进而提高其生活质量。     

实施口腔癌围术期免疫营养方案促进及阻碍因素的质性研究

目的:了解实施口腔癌围术期免疫营养支持管理方案的促进及阻碍因素,为有效推进口腔癌营养护理提供依据。方法:采用质性研究方法,以目的抽样法选取湖南省2所三级甲等医院的13名医护人员和15例病人进行半结构访谈,采用内容分析法整理、分析资料。结果:提炼出医护人员和病人对实施口腔癌围术期免疫营养支持管理方案促进及阻碍因素2个主题,每个主题分为政策支持因素、医护人员因素、患方因素3个亚主题。结论:实施口腔癌围术期病人免疫营养支持管理方案的促进及阻碍因素是多维度的,应重视政府、医护人员、病人和家属共同参与营养护理的重要性,构建适合病人、容易实施的口腔癌围术期病人免疫营养支持管理方案。     

乳腺癌相关淋巴水肿患者综合消肿治疗依从性的质性研究

目的 深入了解乳腺癌相关淋巴水肿患者综合消肿治疗（complete decongestive therapy,CDT）依从性的障碍因素与促进因素。方法 基于健康行动过程取向理论,采用目的抽样法,于2021年9月—2022年2月选取13例接受CDT的乳腺癌相关淋巴水肿患者进行半结构式访谈,采用内容分析法分析资料。结果 CDT依从性的障碍因素包括危险感知不足、消极的结果预期、自我效能感低、缺乏行为意图、缺少行动及应对计划,促进因素包括感知到治疗益处、重建社交自信、感知到水肿的危害、自我效能感增强、激发治疗动机、构建生活新常态。结论 乳腺癌相关淋巴水肿患者CDT的依从性受一系列障碍及促进因素的影响,今后可基于健康行动过程取向理论制订针对性的干预策略,提高其治疗依从性。     

共享决策在复发性胶质瘤患者中的研究进展

阐述胶质瘤复发的患者面临的决策挑战和共享决策的实施途径,分析共享决策在胶质瘤复发的患者实施中的障碍因素(包括患者、医护人员及社会因素),提出在我国推广共享决策理念、研制决策辅助工具、加强多学科合作、发挥专科护士的决策辅导作用的建议,以期提高复发性胶质瘤患者决策自我效能和决策质量,减少决策后悔。     

乳腺癌相关性淋巴水肿患者治疗决策辅助需求的混合研究

目的：明确乳腺癌相关性淋巴水肿患者治疗决策困境的现状,以期为医护人员实施决策辅助提供参考。方法：采用量性及质性的混合研究方法。量性研究采用目的性抽样法,选取2021年5月至2022年5月在天津市某三级甲等肿瘤专科医院就诊的乳腺癌相关性淋巴水肿患者190例作为研究对象进行问卷调查;质性研究通过目的性抽样和最大差异抽样,选取问卷调查中存在决策困境的患者进行质性访谈。结果：回收有效调查问卷187份（98.42%）,决策困境得分为26.56(16.06,38.28)分,其中45例（24.1%）患者得分>37.5分,存在决策拖延,102例（54.5%）患者得分≥25分存在决策困境。质性研究共提炼出4个主题,分别为乳腺癌相关性淋巴水肿知识及治疗认知不足;专业化决策信息不足;负性情绪的影响;支持系统不足。结论：乳腺癌相关性淋巴水肿患者普遍存在治疗决策困境,提示医护人员应重视患者的健康教育、心理支持等,并给予相应干预措施。     

Treatment decisions on antidepressants in nursing homes: a qualitative study

Objective

To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes.

Design and subjects

A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation.

Results

The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants.

Conclusions

This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.Key Words: Antidepressants, nurses, nursing homes, physicians, qualitative study, treatment decisionsAntidepressants are prescribed to many nursing home patients, but knowledge is sparse regarding the factors determining doctors’ treatment decisions.

• Doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression.
• Antidepressants were usually the sole treatment provided, and patients were kept on medication even though staff members were not certain whether the antidepressants were effective.
• Registered nurses reported that auxiliary nursing staff requested drug treatment, and doctors felt some pressure to prescribe antidepressants.

     

Nurses' roles in discharge decision making in an adult high dependency unit.

An ethnographic approach was used to investigate the roles which nurses take in the discharge decision making process in an adult High Dependency Unit (HDU). Participant observation and unstructured interviews were the data collection methods used. Four themes were identified. The first theme encompassed the relationship of nurses with medical staff. Tension was felt between nursing and medical staff, although this was not demonstrated in direct communication between the two professions. Nurses took a submissive role in order to avoid conflict, but this also enabled them to manipulate doctors. Another theme was the unique value of the nurse which was defined as the 'holistic' view which nurses took towards patients which was different to that taken by other health care professionals. Nurses undertook an important administrative role. They had substantial responsibility for bed management and became more proactive in decision-making when there was pressure on HDU beds. Issues associated with decision making were highlighted, as although nurses wanted to contribute to discharge decision making, they were often uncomfortable with this role. There is scope for further investigation into the working relationship of nurses and medical staff, how administrative roles of nurses influence their ability to provide patient care and whether the opinions expressed with regard to decision making are widespread within the nursing community.     

NICU医护人员对家庭参与式护理的认知与实践调查

目的 调查NICU医护人员对家庭参与式护理（family-integrated care,FICare）的认知、态度及实践现状,为构建FICare方案提供参考。 方法 自行编制调查问卷,采用便利抽样法,于2021年3月10日—30日对13个省市23所三级甲等医院的764名NICU医护人员进行调查。结果 共调查5所儿童专科医院、7所妇幼保健院/妇女儿童医院、11所综合医院,回收655份有效问卷,有效问卷回收率为85.7%。医护人员对FICare的认知得分为（68.22±7.99）分,得分率为90.96%;态度得分为（27.34±4.14）分,得分率为78.11%。17所医院已经开展FICare,但不同类型医院实践方法差异较大,儿童专科医院开展比例较高（80.0%）。影响FICare开展的主要因素包括病房条件有限、人力资源不足、缺乏科学系统的运行方法等。 结论 医护人员对FICare的认识不够全面,有必要开展针对性的培训。有实践经验的医院可联合制订科学、规范的FICare流程,发挥辐射引领作用,指导并促进下级医疗机构开展FICare。     

Quality improvement in primary health care using computerised journal,exemplified by a smoking cessation programme for diabetic patients

Objective. To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. Design and subjects. A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. Results. The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. Conclusions. This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.     

Exploring a culture of caring

AIM: The delivery of patient-centered care is basic to a large midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. SUBJECTS AND METHODS: The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. RESULTS AND CONCLUSIONS: Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that "caring begets caring," with 2 subthemes: "relationships of care" and "the context of caring." Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring.     

J CI标准下儿童外科医护人员手卫生时间点执行情况调查

【目的】调查医疗机构评审联合委员会国际部（joint commission international,JCI）标准下儿童外科病房医护人员手卫生时间点执行情况,分析JCI标准下手卫生管理制度对儿童外科医护人员手卫生执行率的影响。【方法】2013年1月连续7个白昼工作时间段,对本院骨科、泌尿外科、普外科、新生儿外科等共6个儿童外科病区100名医务人员（医生25名,护士75名）,按照JCI标准下手卫生管理要求进行现场调查,参照WHO《医务人员手卫生指南》,对调查对象在手卫生时间点的洗手行为进行统计分析,并与2012年同期手卫生执行率比较。【结果】记录835次需实施手卫生情况,实际实施手卫生586次,执行率为70．18％,显著高于本院2012年同期执行率（70．18％ vs 51．30％,P＜0．05）。护士手卫生总执行率（76．98％）高于医生手卫生总执行率（63．34％）,医护不同时间点手卫生执行率有较大差异（P ＜0．05）。【结论】JCI标准下手卫生管理制度强调细节管理,注重培训,能进一步提高医务人员手卫生意识,规范医务人员手卫生行为,促进手卫生执行率的提高。     

护士对老年轻度认知障碍患者参与临床决策认知的质性研究

目的 深入了解长期护理轻度认知障碍（mild cognitive impairment,MCI）患者的护士对老年MCI患者参与临床决策的认知和建议,为促进医患共享决策提供参考。 方法 运用现象学研究法,于2020年11月—2021年2月选取13名长期护理MCI患者的护士进行半结构式深入访谈,采用Colaizzi 7步分析法对访谈资料进行分析。 结果 护士对老年MCI患者参与临床决策的认知可归纳为5个主题：①患者参与临床决策是尊重患者意愿的体现;②患者参与临床决策是综合提升护理质量的保障;③患者参与临床决策受其决策能力所限;④情绪消极应对状况影响患者参与临床决策;⑤患者参与临床决策在临床实施受阻。护士对老年MCI患者参与临床决策的建议可归纳为3个主题：①进一步激发患者的决策意识;②呼吁家属支持;③期望改善实施条件。 结论 医患共享决策具有重要的实践意义,但在临床实施中存在一定的阻碍。今后仍需加强患者的决策意识,培养护士的决策能力,完善医患共享决策的实施条件,以充分发挥护士的引导作用。     

临床护理人员对循证护理认识的调查

目的通过调查上海市综合性医院护理人员对实施循证护理障碍和有利因素的认识,了解障碍产生的根源和有利循证护理开展的各因素。方法采用Funk等设计的循证护理障碍量表对上海市部分综合性医院的563名护理人员进行问卷凋查。结果不同学历、职务及职称的护士对实施循证护理障碍的认识在统计学上无差异（P〉0．05）;不同学历、职务及职称的护士对实施循证护理有利因素的认识在统计学上存在差异（P〈0．05）,但其中护师与护士相比较未显示有差异（P〉0．05）。结论循证护理是护理发展的必然趋势,要充分认识循证护理障碍所产生的根源,积极寻求促进循证护理开展的有利因素并有效地开展循证护理。     

Factors influencing the optimal selection of central venous access devices: A qualitative study of health care team members’ perspectives

ObjectiveThis study aimed to explore health care team members’ understanding of the factors influencing the optimal selection of central venous access devices (CVADs).MethodsThe data of the study was collected using semi-structured interviews. Twenty-six hospital medical staff (four hospital manager, 15 head nurses, 7 nurse) with experience in peripheral or central catheterization from four regions (Northern China, Southern China, Northwest China, and Qinghai-Tibet China) in China were interviewed between June and October 2021. Content analysis was used to analyze the data.ResultsThe results revealed five themes and 14 sub-themes. Patients: concerns, resources, requirements, and evaluation (security concerns, support resources, life requirements, evaluation among patients); nurses: awareness, knowledge, and popularizing methods (awareness of intravenous therapy, understanding of professional knowledge, forms of popularizing methods); doctors: support and involvement (support for decision-making, involvement in intravenous work); hospital managers: authority, quality control and continuing education (management of catheterization authority, quality control of intravenous infusion, investment in continuing education) and environment: differences and commonalities (differences in social support, and current commonalities).ConclusionNurses and other healthcare team members’ understanding, selection, use, and recommendation of CVADs have an indirect effect on patients’ decision-making. Therefore, hospital managers and government departments can indirectly strengthen medical team cooperation and improve learning education in order to improve the safety of patients receiving intravenous infusions.