背景:这项研究的目的是探索,在一家偏远的医院,急诊科医疗服务提供者的经验和对围绕患者决定出院的因素的看法。次要目标是深入了解当前管理DAMA病例方案的工作人员经验,并探讨其降低DAMA发病率的建议。
方法:这是一项横断面研究,涉及一项调查和半结构化访谈,探索医疗保健提供者(n=19)对被认为影响DAMA的因素的看法,管理DAMA的当前实践和实践改进建议。卫生专业人员(医生,护士,原住民卫生工作者)都在偏远社区医院的急诊科工作,昆士兰,澳大利亚。与DAMA影响因素有关的反应以三点评分量表提供,从“无影响/影响很小”到“影响非常强”。DAMA管理协议的响应是从“很少/从不”到“总是”的三点评分量表。调查后进行了半结构化访谈,并更详细地探讨了参与者的看法和当前的DAMA管理协议。
结果:来自各行业共19名参与者的反馈提出了四个突出但相互关联的主题:患者,文化,卫生服务和卫生提供者,以及健康素养和教育相关因素。被认为对DAMA事件有很大影响的因素包括酒精和药物滥用(100%),缺乏文化敏感的医疗服务(94.7%),和家庭承诺或义务(89.5%)。医疗保健提供者关于预防DAMA的建议提出了正确沟通的主题,文化安全护理(正确的地方,合适的时间)和合适的员工来支持DAMA预防。医疗保健提供者描述了土著联络官(ILO)发挥的关键作用以及填补这一职位的重要性。
结论:DAMA是一个多方面的问题,受个人和医院系统相关因素的影响。与会者一致认为,国际劳工组织和/或土著卫生工作者在急诊室的存在可能会减少澳大利亚土著居民的DAMA发生率,这些土著居民在DAMA比率中所占比例过高,特别是在澳大利亚的农村和偏远地区。
BACKGROUND: The aim of the study was to explore, in one remote hospital, emergency department healthcare providers\' experience and perceptions of the factors surrounding a patient\'s decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence.
METHODS: This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers\' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital,
Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from \'no influence/little influence\' to \'very strong influence\'. DAMA management protocol responses were a three-point rating scale from \'rarely/never\' to \'always\'. Semi-structured interviews were conducted after the survey and explored participants\' perceptions in greater detail and current DAMA management protocol.
RESULTS: Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled.
CONCLUSIONS: DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.