Victoria Team, Ayoub Bouguettaya, Yunjing Qiu, Louise Turnour, Jane C. Banaszak-Holl, Carolina D. Weller, Geoffrey Sussman, Angela Jones, Helena Teede
We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.
我们调查了护士在急症护理服务中预防医院获得性压伤(PI)的经验,以更好地了解如何优化压伤预防。我们利用理论领域框架系统地确定了国际指南所要求的循证预防实践的障碍和促进因素。本研究是位于澳大利亚墨尔本的莫纳什学术健康科学中心(Monash Partners Academic Health Science Centre)的急性病医疗服务合作伙伴开展的有关 PI 监测和预防的复杂能力建设项目的一个组成部分。我们采用了定性描述设计。我们采访了在四家急症医疗服务机构的重症监护室、普通病房和 COVID 病房提供护理服务的 32 名护士。我们从墨尔本的四家大型急症护理服务机构(三家公立,一家私立)招募护士。她们中的大多数人每天都与医院感染 PI 的高危患者打交道。在理论领域框架的指导下,采用主题分析法对访谈记录进行编码和分析。所有参与者最常提及的领域包括知识、技能、社会/专业角色和身份、能力信念以及环境背景和资源。护士讨论的主要障碍包括:护士在识别和分期 PI 方面的知识和技能差距、护理工作量繁重和人员配备不足、与识别 PI 相关的污名化和自责,以及 COVID-19 大流行的加剧影响。讨论的主要促进因素包括培训计划、护理审核和反馈以及团队合作。与会者提出的改进建议包括:提供方便和量身定制的培训、视觉提醒以及解决护士面临的繁重工作量和情感障碍。为了支持护士提供最佳护理并预防医院获得性 PI,迫切需要投资于量身定制的培训计划以提高护士的知识水平,并进行组织改革以解决人员配备不足和工作量大的问题。
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