儿童静脉输液装置选择证据转化障碍和促进因素分析  

Barriers and facilitators of evidence implementation for the selection of intravenous infusion devices in children

作　　者：张青青 顾莺 ZHANG Qingqing;GU Ying(School of Nursing,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学护理学院,上海市200032 [2]复旦大学附属儿科医院护理部

出　　处：《中国护理管理》2024年第4期501-506,共6页Chinese Nursing Management

基　　金：2022年度市级医院诊疗技术推广及优化管理项目(SHDC22022221);中华医学会杂志社2021-2022年护理学科研究课题重点项目(CMAPH-NRP2021009)。

摘　　要：目的:探讨儿童静脉输液装置选择的相关证据在临床转化的潜在障碍和促进因素,为拟定变革策略提供依据。方法:基于整合式健康服务领域研究成果应用的行动促进框架的促进指引清单,通过焦点小组访谈,对某三级甲等专科医院10个病区的37名专业人员开展5次访谈,采用内容分析法进行资料分析。结果:共分析出儿童静脉输液装置选择证据转化的障碍因素9条,其中变革层面2条,分别是缺乏基于指南选择输液装置的相关制度或常规、证据挑战固有的思维方式;接受者层面4条,分别是护士对选择输液装置的变革动机不足、护士缺乏选择输液装置的知识和技能、护士缺乏主导输液装置选择的权限、缺乏人力资源和设备资源;组织环境层面3条,分别是组织机构内无明确的激励措施、变革对组织机构的优先战略提出挑战、缺乏有效的多学科合作机制。分析出促进因素3条,分别为证据质量高,护患均可从中受益;变革型领导力推动变革;变革与卫生系统的优先战略一致。结论:本研究从变革、接受者、组织环境3个层面明确了儿童静脉输液装置选择的相关证据在临床转化的障碍和促进因素,为拟定变革策略,构建循证实践方案提供了依据。Objective:To explore the potential barriers and facilitators of the clinical translation of the evidence for the selection of intravenous infusion devices in children,and to provide a basis for formulating reform strategies.Methods:Based on the i-PARIHS Facilitation Checklist,37 professionals from 10 wards of a tertiary grade A specialized hospital were interviewed for 5 times through focus group interviews,and the data were analyzed by content analysis method.Results:This study analyzed 9 barriers to evidence translation for intravenous infusion devices selection in children.Two at the innovation level,which were lack of guideline-based systems or routines related to intravenous infusion devices selection,and evidence challenging people's way of thinking.Four at the recipients level,which were insufficient motivation for nurses and physicians to change,lack of knowledge and skills of nurses,lack of authority to change of nurses,and lack of human and equipment resources.Three at the context level,which were no clear incentives and supports for change within the organization,change challenges the organization's priority strategies,and lack of effective multidisciplinary collaboration mechanisms.Three facilitators were analyzed,which were high quality of evidence increased benefit to nurses and patients,transformational leadership to drive change,and alignment of change with priority strategies of the health system.Conclusion:This study identified the barriers and facilitators in the knowledge translation for the selection of intravenous infusion devices in children from the three levels of innovation,recipients and context,providing a basis for the formulation of change strategies and the construction of evidence-based practice programs.

关 键 词：儿童 静脉输液 输液装置选择 循证实践 促进因素 障碍因素 焦点小组访谈 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]