通过认知任务分析改善恶化患者的升级:了解按规定工作和按完成工作之间的差异
J Ede1, R Hutton2, P Watkinson3
1Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom.
International journal of nursing studies
|January 18, 2024
概括
识别患者病情恶化需要有效的护理升级. 这项研究发现,涉及升级的28%临床任务具有认知挑战性,突出了改善患者安全和减少死亡的关键领域.
科学领域:
- 提供医疗保健服务.
- 患者安全 患者安全
- 优化临床工作流程的优化
背景情况:
- 有效的护理升级对于检测和沟通医院患者病情恶化至关重要.
- 尽管有现有的协议,患者死亡仍然发生由于失败在升级护理.
- 了解现实世界的医疗保健专业实践 (完成的工作) 是解决升级挑战的关键.
研究的目的:
- 开发一个护理升级流程模型.
- 为了识别影响升级的性能变化.
- 检查升级过程中的相互依存关系.
主要方法:
- 应用认知任务分析采访了来自不同角色的30名临床专家 (护士,理疗师,医生等). ) 的情况.
- 使用框架分析进行分析,以确定与任务相关的护理升级要素.
- 使用功能共振分析模型表示发现.
主要成果:
- 确定了32个按完成工作的任务,扩展了按规定工作的8个任务 (NEWS2升级).
- 28% (9/32) 的这些任务被确定为具有高性能可变性的认知挑战.
- 三个相互依存的任务 ("综合数据"",关键升级决定"",确定临时行动") 代表了潜在的故障点.
- 临床信息系统的可用性不佳阻碍了数据同化,增加了认知负载.
结论:
- 临床判断是必不可少的,需要在升级协议和审计方面灵活.
- 需要改进的信息系统来合成患者数据,减少认知负载,并支持决策.
- 减少数据同化中的认知负载使医疗保健专业人员能够提供更好,更具创造性的护理.
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