PDF(Pubmed)
Abstract：
OBJECTIVE: There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation, and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings.
METHODS: Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis.
RESULTS: Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don\'t use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don\'t use the word \"frail\" with patients, (6) frailty isn\'t always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources.
CONCLUSIONS: Implementation of frailty guidelines will remain challenging while staff avoid using the term \"frail,\" don\'t perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
METHODS: Twenty-three semistructured interviews were conducted with health professionals working in multidisciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by 2 researchers. A codebook was created and interviews were recoded and applied to the Framework Method of thematic analysis.
RESULTS: Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, 8 themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don\'t use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don\'t use the word \"frail\" with patients, (6) frailty isn\'t always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources.
CONCLUSIONS: Implementation of frailty guidelines will remain challenging while staff avoid using the term \"frail,\" don\'t perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
摘要：
目的：在医院环境中，老年患者的虚弱患病率很高。存在脆弱的指导方针，但迄今为止的实施一直具有挑战性。了解健康专业人士的态度，知识,关于虚弱的信念对于理解指南实施的障碍和促成因素至关重要,本研究的目的是在医院多学科康复团队中了解这些因素.
方法：对阿德莱德和悉尼的老年和康复病房的多学科团队中的卫生专业人员进行了23次半结构化访谈，澳大利亚。采访是录音，转录，并由两名研究人员编码。创建了一个码本，并对访谈进行了重新编码，并将其应用于主题分析的框架方法。
结果：开发了三个领域：诊断虚弱，关于脆弱的交流，管理脆弱。在这些领域中,确定了八个主题：(1)诊断虚弱有可疑的好处，(2)临床医生不使用脆弱的筛查工具，（3）虚弱可以根据外观和病史诊断，(4)脆弱有污名，(5)临床医生不要对患者使用“虚弱”这个词，(6)脆弱并不总是可逆的，(7)急性入院后护理缺乏连续性，(8)社区环境缺乏资源。
结论：在员工避免使用“脆弱”一词的同时，实施脆弱指南仍将具有挑战性，不要察觉到使用筛选工具的好处，并专注于虚弱的个体方面，而不是整体的综合症。临床冠军和关于脆弱识别的教育，可逆性,管理,和通信技术可以改善脆弱指南在医院的实施。
方法：对阿德莱德和悉尼的老年和康复病房的多学科团队中的卫生专业人员进行了23次半结构化访谈，澳大利亚。采访是录音，转录，并由两名研究人员编码。创建了一个码本，并对访谈进行了重新编码，并将其应用于主题分析的框架方法。
结果：开发了三个领域：诊断虚弱，关于脆弱的交流，管理脆弱。在这些领域中,确定了八个主题：(1)诊断虚弱有可疑的好处，(2)临床医生不使用脆弱的筛查工具，（3）虚弱可以根据外观和病史诊断，(4)脆弱有污名，(5)临床医生不要对患者使用“虚弱”这个词，(6)脆弱并不总是可逆的，(7)急性入院后护理缺乏连续性，(8)社区环境缺乏资源。
结论：在员工避免使用“脆弱”一词的同时，实施脆弱指南仍将具有挑战性，不要察觉到使用筛选工具的好处，并专注于虚弱的个体方面，而不是整体的综合症。临床冠军和关于脆弱识别的教育，可逆性,管理,和通信技术可以改善脆弱指南在医院的实施。
