中国执业护士培训试点项目应用的障碍和促进因素：以CFIR为指导的描述性定性研究

IF 3.6 2区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Nurse Education Today Pub Date : 2024-11-22 DOI:10.1016/j.nedt.2024.106501

Qian Zhang , Shifan Han , Wenjing Dong , Gege Cao , Zhenyu Wang , Mingzi Li , Ruifang Zhu

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引用次数: 0

摘要

背景国际护士理事会发布的《护士处方权指南》显示，全球已有 44 个国家或地区立法授予护士处方权。在美国，27 个州、2 个地区和华盛顿特区已授权认证执业护士享有包括处方权在内的全部执业权力，而且这一势头还在不断加强。目前，在中国大陆，虽然有少数机构启动了执业护士试点培训项目，但还没有国家法律授权执业护士开处方。然而，人们对影响开处方的因素知之甚少。本研究旨在确定、评估和综合两个试点培训项目中的执业护士和利益相关者对中国大陆护士处方潜在发展和实施的障碍和促进因素的看法。设计采用描述性定性研究设计。研究在中国大陆的两所执业护士试点机构进行。参与者来自两所试点机构的5名执业护士、3名合作者、3名政策制定者和3名执业护士培训者。结果在实施研究综合框架的五个领域中，我们发现了影响执业护士处方潜在实施的 31 个障碍和 50 个促进因素。障碍主要包括变革紧迫性不足、缺乏政策和法律支持、处方教育和培训不足以及公众意识薄弱。促进因素包括护士的实际处方经验、她们在角色扩展方面的能力和信心、有效的团队合作以及医疗机构内强烈的需求导向。探索阻碍或促进执业护士发展的因素至关重要，以便有效支持其在医疗系统中的实施，同时为该领域的未来发展制定战略。在国家政策尚未颁布的情况下，我们试点工作的成果将对国家政策产生重大影响。

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Barriers and facilitators to the application of nurse practitioners' training pilot programs in China: A CFIR-guided descriptive qualitative study

Background

The Guidelines on Prescriptive Authority for Nurses released by the International Council of Nurses indicate that 44 countries or territories worldwide have enacted legislation granting prescriptive authority to nurses. In the US, 27 states, two territories, and Washington, D.C. have authorized certified nurse practitioners full practice authority, including prescriptive authority, and momentum is building. Currently, in mainland China, there is no national legal mandate for nurse practitioners to prescribe, although a few institutions have initiated pilot training programs for nurse practitioners. However, little is known about the factors influencing their prescribing. Research on the value of such pilot programs from the perspectives of nurse practitioners and stakeholders is required.

Aim

The purpose of this study is to identify, assess and synthesize the perceptions of nurse practitioners and stakeholders in two pilot training programs on the barriers and facilitators to the potential development and implementation of nurse prescribing in mainland China.

Design

A descriptive qualitative research design.

Settings

The study was conducted at two nurse practitioner pilot institutions in mainland China.

Participants

Five nurse practitioners, three collaborators, three policymakers and three trainers of nurse practitioners from two pilot institutions.

Methods

Data were collected via semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to orient the data analysis.

Results

Within the five Consolidated Framework for Implementation Research domains, we identified 31 barriers and 50 facilitators influencing the potential implementation of nurse practitioner prescribing. Barriers mainly included insufficient urgency for change, lack of policy and legal support, inadequate education and training on prescribing, and low public awareness. Facilitators encompassed nurses' practical prescribing experience, their competence and confidence in role expansion, effective teamwork, and a strong demand orientation within healthcare settings.

Conclusion

Our findings suggest that China possesses significant potential to successfully carry out nurse practitioner prescribing initiatives. It is crucial to explore factors hindering or promoting the development of nurse practitioners to effectively support their implementation within healthcare systems while strategizing for future advancements in this area. In the case that the national policy has not yet been promulgated, the outcomes derived from our pilot work will carry substantial influence over national policies.

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来源期刊

Nurse Education Today 医学-护理

CiteScore

6.90

自引率

12.80%

发文量

349

审稿时长

58 days

期刊介绍： Nurse Education Today is the leading international journal providing a forum for the publication of high quality original research, review and debate in the discussion of nursing, midwifery and interprofessional health care education, publishing papers which contribute to the advancement of educational theory and pedagogy that support the evidence-based practice for educationalists worldwide. The journal stimulates and values critical scholarly debate on issues that have strategic relevance for leaders of health care education. The journal publishes the highest quality scholarly contributions reflecting the diversity of people, health and education systems worldwide, by publishing research that employs rigorous methodology as well as by publishing papers that highlight the theoretical underpinnings of education and systems globally. The journal will publish papers that show depth, rigour, originality and high standards of presentation, in particular, work that is original, analytical and constructively critical of both previous work and current initiatives. Authors are invited to submit original research, systematic and scholarly reviews, and critical papers which will stimulate debate on research, policy, theory or philosophy of nursing and related health care education, and which will meet and develop the journal''s high academic and ethical standards.