设计一种行为变化轮引导的实施策略,用于低氧性呼吸衰竭和ARDS护理途径,以准障碍物
Ken Kuljit S Parhar1,2, Gwen E Knight3, Andrea Soo3
1Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada ken.parhar@albertahealthservices.ca.
BMJ open quality
|December 30, 2023
概括
实施基于证据的治疗途径,治疗低氧性呼吸衰竭 (HRF) 和急性呼吸困扰综合征 (ARDS) 面临障碍. 制定了一项实施策略,以克服这些挑战,并提高重症监护机构的患者护理质量.
科学领域:
- 关键护理医学 关键护理医学
- 实施科学 实施科学
- 医疗服务研究 医疗服务研究
背景情况:
- 基于证据的实践与低氧性呼吸衰竭 (HRF) 和急性呼吸困扰综合征 (ARDS) 的现实应用之间存在差距.
- 护理途径可以提高质量,但面临实施障碍.
- 这项研究旨在确定HRF/ARDS最佳实践途径实施的障碍,并设计一个量身定制的战略.
研究的目的:
- 确定实施HRF和ARDS最佳实践护理途径的障碍.
- 设计一个以科学为基础的实施策略,以克服已识别的障碍.
- 根据重症监护机构的情况调整策略.
主要方法:
- 对HRF/ARDS的多学科,基于证据的护理途径进行了评估.
- 一项调查对阿尔伯塔省17名成年重症监护室 (ICU) 临床医生进行了调查.
- 使用行为变化轮和理论领域框架 (TDF) 的定性分析确定了障碍.
- 行为改变技术 (BCT) 分类学和APEASE标准被用于设计实施战略.
主要成果:
- 调查回复显示了16个信念陈述,9个主题和9个相关的TDF领域,临床医生群体和环境之间存在差异.
- 确定并评估了26名候选BCT;23人被选中.
- 最终的战略包括8个关键组成部分:审计和反,教育,培训,临床决策支持,现场冠军,提醒,实施支持和赋权.
结论:
- 确定了实施最佳实践护理途径的障碍.
- 设计了一个基于科学的缓解策略实施.
- 未来的工作将评估该战略在通过临床医生的行为改变和坚持基于证据的护理来提高护理质量的有效性.
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