综合ICU护理交接班循证实践障碍和促进因素研究

doi:10.3761/j.issn.2096-7446.2025.05.016

摘要/Abstract

摘要：

目的探究综合ICU护理交接班循证实践的障碍和促进因素，为推动证据临床转化提供依据。方法采用目的抽样法，选取四川省自贡市某三级甲等医院综合ICU病区的护理管理者和临床护士为研究对象。基于实施性研究综合框架（consolidated framework for implementation research，CFIR）构建访谈提纲，采用半结构式访谈法访谈11名临床护士及护理管理者，采用定向内容分析法对访谈内容进行编码。结果通过访谈共得到涵盖CFIR框架4个维度的6个障碍因素、14个促进因素。归纳总结出4个主题，在实践者层面，综合ICU护士已经充分认识到交接班的重要性，并愿意将交接班循证实践方案列为优先完成事项，但普遍欠缺循证护理知识；在方案层面，交接班循证实践方案具备科学性及有效性，但方案的复杂性阻碍实施；在资源层面，交接班循证实践方案的实施需要人力、时间及信息化系统支持；在组织层面，科室文化、氛围、领导力促进交接班循证实践方案的实施。结论该研究从实践者、方案、可用资源及组织环境4个层面明确了护理交接班相关证据在临床转化的障碍和促进因素，为提升方案临床适用性、拟定变革策略提供了依据。

关键词: 重症监护病房, 实施性研究综合框架, 循证实践, 患者转接

Abstract:

Objective To explore the barriers and facilitators of evidence-based practice of comprehensive ICU nursing handoff，and provide basis for promoting clinical transformation of evidence. Methods Objective sampling method was used to select nursing managers and clinical nurses in comprehensive ICU ward of a tertiary grade A hospital in Zigong，Sichuan Province as research objects. The interview outline was constructed based on the consolidated framework for implementation research（CFIR），and 11 clinical nurses and nursing managers were interviewed by semi-structured interview method，and the interview contents were coded by directional content analysis method. Results A total of 6 barriers and 14 facilitators covering 4 fields of CFIR framework were obtained through interviews. There were 4 themes summarized. At the practitioner level，comprehensive ICU nurses had fully recognized the importance of handoff，and prioritized the evidence-based practice plan of handoff，but they lacked their own knowledge of evidence-based nursing. At the program level，the handoff evidence-based practice program was scientific and effective，but its complexity hindered its implementation. At the resource level，the implementation of the handoff evidence-based practice program needed manpower，time and information system support. In terms of organizational environment，department culture，atmosphere，and leadership promoted the implementation of evidence-based practice programs for transition. Conclusion This study identified the barriers and facilitators in the clinical transformation of evidence related to nursing handoff from the four levels of practitioners，program，available resources and organizational environment，and provided a basis for improving the clinical applicability of program and drafting implementation strategies.

Key words: Intensive Care Units, Consolidated Framework for Implementation Research, Evidence-Based Practice, Patient Handoff

邓颖一, 徐雯菁, 廖常菊, 李媛媛, 张翠翠, 明淑兰, 王敏, 丁娟, 陈晓丽. 综合ICU护理交接班循证实践障碍和促进因素研究[J]. 中华急危重症护理杂志, 2025, 6(5): 590-595.

DENG Yingyi, XU Wenjing, LIAO Changju, Li Yuanyuan, ZHANG Cuicui, MING Shulan, WANG Min, DING Juan, CHEN Xiaoli. An analysis of barriers and facilitators to evidence-based practice of comprehensive ICU nursing handoff[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 590-595.

图/表 2

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