Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.
Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.
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DOI：
10.1097/00130535-200403001-00004
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发表时间：
2004-03-01
影响因子：
7.6
通讯作者：
Salerno, Lucille D
中科院分区：
文献类型：
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作者：
Longo, Daniel R;Young, Jake;Salerno, Lucille D
背景和目标：在一项针对疗养院居民下呼吸道感染的大型前瞻性研究中，项目工作人员观察到，在一些设施中，及时识别潜在受试者始终存在困难。出于这个动机，我们进行了初步定性研究，以调查急性感染发作时疾病识别和启动管理的过程。我们寻找促进疗养院居民急性感染及时或延迟识别和治疗的因素。 设计：采用焦点小组和对参与疗养院居民急性疾病护理事件的居民、护士和医生进行深入半结构化访谈的定性研究。背景：四家疗养院参与下呼吸道疾病病程和结果的纵向研究 参与者：焦点小组包括具有疗养院护理经验的护士和医生。对参与六次急性疾病发作的人员进行了采访。受访者包括四名疗养院居民（另外两人认知能力不完整）、七名护士和六名医生或其工作人员。数据分析：从焦点小组贡献和访谈内容分析中确定主题。结果：我们确定了一个描述疾病识别和管理的四阶段模型。对访谈记录的内容分析揭示了影响有效护理及时性的 22 个因素，其中沟通问题是焦点。障碍包括： (1) 通信介质故障； (2) 晚上或周末发病，同时难以联系值班医生； （3）通过中介机构互动的临床决策者； (4) 传播不适当或不准确的信息； （5）换班时信息传递不充分； (6) 护士和医生之前的关系。 结论：有效识别和管理急性感染需要多层次的成功沟通；然而，故障很常见。我们的模型提供了一个改善疗养院急性疾病护理的框架，它提供了可能对疗养院质量改进活动有用的重要见解，并可能促进进一步的研究。
BACKGROUND AND OBJECTIVES: During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents.DESIGN: Qualitative study using focus groups and in-depth semi-structured interviews of residents, nurses, and physicians involved in episodes of acute-illness care in nursing home residents.SETTING: Four nursing homes participating in a longitudinal study of the course and outcomes of lower respiratory infection.PARTICIPANTS: Focus groups included nurses and physicians with experience in nursing home care. Interviews were conducted with those involved in six episodes of acute illness. Interviewees included four nursing home residents (two others were not cognitively intact), seven nurses, and six physicians or their staff.DATA ANALYSIS: Identifying themes from focus group contributions and content analyses of interviews.RESULTS: We identified a four-stage model describing illness identification and management. Content analysis of interview transcripts revealed 22 factors that influenced timeliness of effective care with communication problems commanding the central focus. Barriers included: (1) failure of the communication medium; (2) evening or weekend illness onset with concomitant difficulty in contacting an on-call physician; (3) clinical decision-makers who interact through intermediaries; (4) the communication of inappropriate or inaccurate information; (5) inadequate information transfer at shift changes; and (6) prior relationship between staff nurse and physician.CONCLUSION: Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.