实施一项基于病房的计划,以改善老年住院患者的护理:对集群随机化CHERISH试验的过程评估
Alison M Mudge1,2,3, Prue McRae4,5, Adrienne Young6,7
1Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia. Alison.Mudge@health.qld.gov.au.
BMC health services research
|June 21, 2023
概括
"吃,走,参与"计划通过加强餐时间协助和社会参与,减少妄想,改善了老年患者的护理. 然而,不一致的移动性改进并没有减少功能衰退.
科学领域:
- 老年医学 老年医学
- 医疗保健 改善 科学 科学
- 实施科学 实施科学
背景情况:
- 老年住院患者面临高风险的医院相关的并发症,如妄想和功能下降.
- 适合老年人的护理实践,包括早期的流动性,营养,水分和认知/社会活动,可以减轻这些风险.
- 根据i-PARIHS框架的信息,Eat Walk Engage计划以前在一项试验中减少了妄想.
研究的目的:
- 在四个医院试验场所进行Eat Walk Engage计划的过程评估.
- 了解实施过程和影响计划有效性的上下文因素.
主要方法:
- 在医疗和外科病房进行了前性的多方法实施评估.
- 用英国医学研究委员会的指导来评估背景,实施策略和影响机制.
- 数据收集包括对老年患者的采访,结构化的饮食时间观察和活动映射.
主要成果:
- 多种不同的上下文障碍影响了跨站点的动态实施.
- 辅导员使用多种策略来实现45个改进,增强大多数场所的沟通,餐时间护理和认知/社会参与.
- 改善餐时间的护理和参与可能会解释妄的减少,而不一致的移动性变化可能会解释缺乏功能衰退的减少.
结论:
- 一种多层次的便利化方法支持在不同环境中进行适应性实施.
- 调查结果强调需要持续的便利化和时间来嵌入适合老年人的实践,以获得最佳结果.
- 环境因素对医院改进计划的实施和成功产生重大影响.
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