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新生儿肠道外科手术增强恢复协议实施的障碍和促进因素
Mallory N Perez1, Maxwell Wilberding2, Goeto Dantes3
1Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
在新生儿肠道手术中实施手术后增强恢复 (ERAS) 协议面临挑战. 关键障碍包括患者的变化,不同的优先事项,沟通缺口,不清楚的定义和对变化的抵抗,需要定制策略才能成功采用.
科学领域:
- 儿科手术 儿科手术
- 增强的恢复协议 恢复协议
- 新生儿护理 新生儿护理
背景情况:
- 2020年,手术后增强恢复 (ERAS) 协会发布了指导方针,以减少接受肠道手术的新生儿的生理压力.
- 本研究调查了利益相关者如何看待新生儿ERAS协议的采用和可接受性,并确定了实施障碍和促进者.
研究的目的:
- 探索有关新生儿增强恢复协议的可接受性和采用性的利益相关者的看法.
- 确定影响新生儿肠道外科手术ERAS指南实施的障碍和促进因素.
主要方法:
- 七个半结构焦点小组与来自美国六家医院的36个不同的利益相关者进行了讨论.
- 用MAXQDA分析了成绩单,采用了结合的诱导和演方法,随后进行了主题分析.
主要成果:
- 议定书的实施情况各不相同,一些要素 (例如母乳营养) 的采用率很高,但其他要素 (例如早期肠道养) 的接受率很低.
- 出现了五个主要主题:新生儿外科患者群体的异质性,利益相关者的竞争优先事项,跨团队的护理协调,组件定义的明确性和对实践变革的开放性.
结论:
- 实施前的评估揭示了新生儿肠道手术的特殊需求.
- 有效实施需要就目标人群达成共识,利益相关者协调一致,改善护理协调,改进定义,以及更好地适应实践变化.
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