Enhancing Implementation of Complex Critical Care Interventions through Interprofessional Education.
Enhancing Implementation of Complex Critical Care Interventions through Interprofessional Education.
复制标题
通过跨专业教育加强实施复杂的重症监护干预措施。
DOI：
10.34197/ats-scholar.2020-0169oc
复制
发表时间：
2021-09
期刊：
影响因子：
1.9
通讯作者：
Girard TD
中科院分区：
文献类型：
--
作者：
Rak KJ;Kahn JM;Linstrum K;Caplan EA;Argote L;Barnes B;Chang CH;George EL;Hess DR;Russell JL;Seaman JB;Angus DC;Girard TD
背景：许多需要团队合作的重症监护干预措施被缓慢和可变地采用，尽管有强有力的证据支持它们的使用。我们假设，针对整个跨专业团队(而不是孤立的专业)的教育干预是加强重症监护病房(ICU)复杂干预措施实施的一种有效方式。目的：作为检验这一假说的第一步，我们试图就团队动力学、证据转换和跨专业教育以及围绕ICU预防性拔管后无创呼吸机(NIV)中团队实践的当前知识、态度和实践征求意见。方法：我们使用半结构访谈和焦点小组对护士、呼吸治疗师和内科医生进行了定性评估，这些护士、呼吸治疗师和内科医生在一个综合卫生系统的四家医院的四个ICU工作。ICU是根据学术地位与社区地位的差异来选择的。我们使用主题内容分析方法反复分析文本。结果：从2018年12月至2019年1月，我们进行了32次访谈(34人)和3次焦点小组(20人)。参与者包括31名护士、15名呼吸治疗师和8名内科医生。参与者对他们的团队如何合作有积极的看法，但讨论了团队动力(例如，领导包容性)影响护理协调的方式。与会者对跨专业教育持好感，并就首选内容和交付分享了建议(例如，包括特定于专业的内容和面向团队的内容)。尽管参与者报告经常使用NIV作为治疗，但他们描述了很少使用NIV作为预防策略，护士和呼吸治疗师描述了使用的挑战，如感觉到患者不适。在对拔管后呼吸衰竭高危患者的处理上，有特定于ICU的差异，一些患者倾向于推迟拔管。结论：参与者报告乐观地认为，跨专业教育可以是一种可以接受的有效方式，以提高证据转化为实践的能力。与会者还详细说明了实施预防性拔管后NIV的具体患者和ICU范围的障碍。这些关于ICU中团队合作的信息，对跨专业教育的建议，以及使用目标循证实践的障碍和促进者，可以为以增加干预的可接受性、适当性和可行性的方式制定新的教育战略提供信息。
Background: Many critical care interventions that require teamwork are adopted slowly and variably despite strong evidence supporting their use. We hypothesize that educational interventions that target the entire interprofessional team (rather than professions in isolation) are one effective way to enhance implementation of complex interventions in the intensive care unit (ICU). Objective: As a first step toward testing this hypothesis, we sought to qualitatively solicit opinions about team dynamics, evidence translation, and interprofessional education as well as current knowledge, attitudes, and practices surrounding the use of one example of a team-based practice in the ICU—preventive postextubation noninvasive ventilation (NIV). Methods: We conducted a qualitative evaluation using semistructured interviews and focus groups with nurses, respiratory therapists, and physicians working in four ICUs in four hospitals within an integrated health system. ICUs were selected based on variation in academic versus community status. We iteratively analyzed transcripts using a thematic content analysis approach. Results: From December 2018 to January 2019, we conducted 32 interviews (34 people) and 3 focus groups (20 people). Participants included 31 nurses, 15 respiratory therapists, and 8 physicians. Participants had favorable views of how their teams work together but discussed ways team dynamics (e.g., leader inclusiveness) impact care coordination. Participants viewed interprofessional education favorably and shared suggestions regarding preferred content and delivery (e.g., include both profession-specific and team-oriented content). Though participants reported frequently using NIV as a treatment, they described rarely using NIV as a preventive strategy, and nurses and respiratory therapists described challenges to use such as perceived patient discomfort. There were ICU-specific differences in management of patients at a high risk for respiratory failure after extubation, with some preferring to delay extubation. Conclusion: Participants reported optimism that interprofessional education can be an acceptable and effective way to improve translation of evidence into practice. Participants also detailed patient-specific and ICU-wide barriers to the implementation of preventive postextubation NIV. This information about teamwork in the ICU, suggestions for interprofessional education, and barriers and facilitators to use of a target evidence-based practice can inform the development of novel educational strategies in ways that increase acceptability, appropriateness, and feasibility of the intervention.