Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting

: 目的: 描述护士对急诊医院环境下患者参与药物管理的决策、实践和看法。 背景: 用药差错会给患者招致意想不到的伤害。在医院环境中,护士在确保患者用药安全方面发挥着重要作用。调查护士的药物管理决策和实践以及他们对患者参与的看法,可能有助于通过揭示如何以及何时让患者参与医院药物管理来制定干预措施。 设计: 一项描述性的探索性研究设计。 方法: 从澳大利亚一家大型城市医院的两个外科和两个内科病房共招募20名护士。每名护士观察4小时,观察结束后进行访谈。数据于2015年收集,期限长达六个月。 观察结果记录在电子病例报告表上;访谈被录音并逐字转录。使用描述性统计、内容和专题分析对数据进行分析。 结果: 共观察到95例用药事件,每名护士2至8例。总共发生了56次中断,其中26次中断与药物有关。采访中出现了四大主题:处理不确定性;促进、构建和过滤信息;管理干扰,了解并让患者参与进来。 结论: 护士工作在一个瞬息万变的复杂适应系统中。承认和理解认知工作负荷和复杂的相互作用对于提高患者的安全性和减少用药过程中的错误是很有必要的。了解并让患者参与是护士用药安全策略的重要组成部分。. BACKGROUND: Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. DESIGN: A descriptive exploratory study design. METHODS: Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form; interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. RESULTS: Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty; facilitating, framing and filtering information; managing interruptions and knowing and involving patients. CONCLUSION: Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.