Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance.
Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance.
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DOI：
10.1186/s12912-016-0196-9
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发表时间：
2017
期刊：
影响因子：
3.2
通讯作者：
Banzett RB
中科院分区：
文献类型：
--
作者：
Baker KM;DeSanto-Madeya S;Banzett RB
呼吸困难(呼吸不适)是一种常见的令人痛苦的症状。常规评估和记录可以改善管理，减轻痛苦。常规记录呼吸困难的一个主要障碍是担心它会对护理工作流程产生有害影响，并且不容易被护士接受。我们机构的护士最近开始评估和记录所有内外科患者入院时的呼吸困难，并在他们住院期间每班一次。在实施呼吸困难测量一年后，我们探讨了护士对呼吸困难评估的方法，他们对患者反应的感知，以及他们对呼吸困难测量的效用和负担的感知。我们通过三个部分的实践评估从护士那里获得反馈：1)一系列有记录的焦点小组对护士的访谈，2)对护士进行常规呼吸困难和疼痛评估的时间运动观察，以及3)部分基于焦点小组提出的问题的随机、匿名的在线调查。94%的受访护士报告说，进行呼吸困难评估很容易或很容易。没有一名护士报告评估呼吸困难对工作流程产生负面影响，许多护士报告说，这通过提高他们的意识积极地改善了他们的实践。我们的时间运动数据显示，呼吸困难的评估和记录只需不到一分钟的时间。护士认可常规测量的重要性，并同意大多数患者能够提供有意义的呼吸困难评分。护士们发现患者报告非常有用，并将其与观察到的体征结合起来，对患者病情的变化做出反应。在这项研究中，我们证明了常规的呼吸困难评估和记录被我们机构的护士广泛接受。我们的护士将常规的呼吸困难评估和记录完全融入到他们的实践中，并认为这改善了以患者为中心的护理。本文的在线版本(doi：10.1186/s12912-0160196-9)包含补充材料，授权用户可以使用。
Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses’ approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement. We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups. Ninety-four percent of the nurses surveyed reported administering the dyspnea assessment is “easy” or “very easy”. None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient’s condition. In this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care. The online version of this article (doi:10.1186/s12912-016-0196-9) contains supplementary material, which is available to authorized users.