背景:尽管采用国际标准来识别和应对恶化,急性医院病房的工作人员并不总是识别警告标志。患者和家庭发起的护理计划升级在帮助早期识别方面显示出一些好处,但在许多临床实践领域并没有广泛使用。
目的:探讨(a)患者和亲属急性恶化的经历和(b)患者,亲属和医疗保健专业人员对急性成人医院病房中患者和家庭发起的护理升级的障碍或促进者的看法。
方法:我们使用Cochrane方法进行了定性综述。两名审稿人独立筛选研究,提取的数据,并使用定性批判性评估工具评估质量。使用主题综合分析结果,并使用GRADE-CERQual评估结果的置信度。
方法:MEDLINE,CINAHL,EMBASE,2005年至2019年8月的PsychINFO数据库和灰色文献。
方法:任何具有定性元素并专注于成年患者和亲属的恶化经历和对护理升级的看法的研究设计。
结果:我们纳入了代表120名参与者的5项研究,并使用GRADE-CERQual评估证据的确定性为中等。研究结果表明,许多患者/亲属有能力检测急性恶化,然而,各种因素既是倾听的障碍,也是促进者。这些包括个人因素,对角色的看法,与医护人员的关系质量,和组织因素。理论上的理解表明,患者和相对参与升级取决于固有能力和影响赋权的因素。
结论:这篇综述强调,需要设计患者和家庭逐步升级的护理干预措施,以改善患者/亲属-临床医生的合作和责任分担。
结论:在设计和实施患者和家庭发起的逐步升级护理干预措施时,需要解决这些因素,以促进更积极的伙伴关系。
BACKGROUND: Despite international standards for recognition and response to deterioration, warning signs are not always identified by staff on acute hospital wards. Patient and family-initiated escalation of care schemes have shown some benefit in assisting early recognition, but are not widely used in many clinical practice areas.
OBJECTIVE: To explore (a) patients\' and relatives\' experiences of acute deterioration and (b) patients\', relatives\' and healthcare professionals\' perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards.
METHODS: We conducted a qualitative
review using Cochrane methodology. Two reviewers independently screened studies, extracted data, and appraised the quality using a qualitative critical appraisal tool. Findings were analysed using thematic synthesis and confidence in findings was assessed using GRADE-CERQual.
METHODS: MEDLINE, CINAHL, EMBASE, PsychINFO databases and grey literature from 2005 to August 2019.
METHODS: Any research design that had a qualitative element and focused on adult patients\' and relatives\' experiences of deterioration and perceptions of escalating care.
RESULTS: We included five studies representing 120 participants and assessed the certainty of evidence as moderate using GRADE-CERQual. Findings indicated that a number of patients/relatives have the ability to detect acute deterioration, however, various factors act as both barriers and facilitators to being heard. These include personal factors, perceptions of role, quality of relationships with healthcare staff, and organisational factors. Theoretical understanding suggests that patient and relative involvement in escalation is dependent on both inherent capabilities and the factors that influence empowerment.
CONCLUSIONS: This
review highlights that patient and family escalation of care interventions need to be designed with the aim of improving patient/relative-clinician collaboration and the sharing of responsibility.
CONCLUSIONS: These factors need to be addressed to promote more active partnerships when designing and implementing patient and family-initiated escalation of care interventions.