A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center.
A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center.
复制标题
DOI：
10.1186/1940-0640-7-7
复制
发表时间：
2012-05-02
影响因子：
3.7
通讯作者：
Gordon AJ
中科院分区：
文献类型：
--
作者：
Broyles LM;Rodriguez KL;Kraemer KL;Sevick MA;Price PA;Gordon AJ
不健康的酒精使用包括从危险饮酒到酒精使用障碍的酒精消费范围。常规酒精筛查、短暂干预（BI）和转诊治疗（RT）通常被认可用于改善门诊环境中不健康酒精使用的识别和管理。然而，可能影响住院环境中的筛查、BI和RT实施的因素（特别是如果由护士提供）尚不清楚，必须确定这些因素，以有效地计划护士提供BI的随机对照试验（RCT）。本研究的目的是确定潜在的障碍和促进因素与护士提供的酒精筛查，BI和RT住院患者。我们进行了录音焦点小组与护士从三个医疗外科单位在一个大型城市退伍军人事务医疗中心。转录本进行了分析，使用修改扎根理论技术，以确定关键主题的预期障碍和促进护士提供的筛选，BI和RT在住院设置。共有33名内外科护士（97%为女性，83%为白色）参加了七个焦点小组之一。护士们一致认为，对住院患者进行护士提供的筛查、BI和RT存在以下障碍：（1）缺乏酒精相关知识和技能;（2）围绕酒精相关护理的跨学科合作和沟通有限;（3）酒精评估方案不足，与电子病历整合不良;（4）对患者负面反应和有限的患者解决酒精使用的动机的关注;（5）筛查、BI和RT与急性护理范例和护理角色的可疑兼容性;和（6）后勤问题（例如，时间/隐私）。建议护士提供的筛选，BI和RT的促进者集中在提供者和系统层面的因素相关：（1）提高提供者的知识，技能，沟通和协作;（2）扩大护理和护理角色的过程;（3）增强电子病历功能。针对住院患者的护士提供酒精BI的RCT应考虑以下因素：酒精筛查、BI和RT方面的全面提供者教育;有效记录和计划酒精相关护理的记录保存系统;跨学科通才和专家发挥积极作用的混合实施模式;以及持续的合作伙伴关系，以促进生成BI在住院患者中疗效的额外证据。
Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration; (2) expanded processes of care and nursing roles; and (3) enhanced electronic medical record features. RCTs of nurse-delivered alcohol BI for hospitalized patients should include consideration of the following elements: comprehensive provider education on alcohol screening, BI and RT; record-keeping systems which efficiently document and plan alcohol-related care; a hybrid model of implementation featuring active roles for interdisciplinary generalists and specialists; and ongoing partnerships to facilitate generation of additional evidence for BI efficacy in hospitalized patients.