一个占地面积更大的新儿童医院,单间,v形病房设计:对护士提供病人护理和护士、病人和家庭体验的前后评估。

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES
Fenella J Gill, Helen Nelson, Natasha Bear, Mary Tallon, Catherine Pienaar, Jade Ferullo, Sue Baker
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引用次数: 1

摘要

背景:医院建筑设计对患者、家属和护士有关护理互动的影响尚不清楚。本研究报告了一项干预前和干预后的研究,旨在了解搬到澳大利亚珀斯一家新的儿童医院对护士工作流程活动以及患者、家属和护士经验的影响。方法:采用前后解释序贯设计,对护士工作任务进行观察;执业环境量表及护士工作指数的测量;每周对护士、病人和家属的经历进行调查;护士焦点小组和病人及家属的访谈。调查数据采用线性回归分析;定性数据分析采用专题方法。结果:护士走路的时间几乎翻了一番(p < 0.001),从T1(移动前)估计的10分钟到T4(移动后12个月)约20分钟,但护士提供病人护理的时间没有差异(p = 0.114)。执业环境量表和护士工作指数显示护理基础、护理质量(调整平均差值-0.08,p = 0.016)和人员配备和资源充足性(调整平均差值-0.19,p < 0.001)得分显著降低。这种下降反映在护士经验调查中,从T1到T3(迁移后3个月)的平均得分下降了-0.7 (p < 0.001),从T1到T4的平均得分下降了-0.4 (p = 0.002)。对定性数据的专题分析发现,最初的挑战似乎随着时间的推移而减少。护士报告了在新病房管理工作流程的困难和T3的疲惫感,但这在T4转变为更积极的账户。对于病人和家属来说,离开旧的和熟悉的环境,享受新环境的光线和空间,以及共同观察到T3的护士似乎更忙,这两者之间存在紧张关系。在T4,这些经历已经变成了“医院里的一家人”,并且相信护士总是在身边。结论:从护士、患者和家属的角度来看,新医院设计的好处和挑战都遇到了。护士在新环境中行走的时间增加了一倍,但提供病人护理的时间没有变化。随着时间的推移,随着护士适应新环境的工作,最初的实践挑战减少了。试验注册:ACTRN12618000775213。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A new children's hospital with a larger floor space, single rooms, and V-shaped ward design: A pre-post evaluation of nurse time providing patient care and nurse, patient, and family experiences.

Background: The impact of hospital building design on patients, families and nurses related to nursing care interactions is not well understood. This study reports a pre-post intervention study to understand the effects of the move to a new children's hospital in Perth, Australia, on nurse workflow activities and on patient, family, and nurse experiences.

Methods: We used a pre-post explanatory sequential design involving observation of nurse work tasks; measurement of the Practice Environment Scale and Nurse Work Index; weekly surveys of nurse, patient and family experiences; and nurse focus groups and interviews with patients and families. Survey data were analysed using linear regression; qualitative data analysis used a thematic approach.

Results: Nurse time spent walking almost doubled (p < 0.001), from an estimated 10 min at T1 (pre-move) to around 20 min at T4 (12 months post-move), but there was no difference in nurse time providing patient care (p = 0.114). The Practice Environment Scale and Nurse Work Index showed significantly reduced scores for nursing foundations for quality of care (adjusted mean difference -0.08, p = 0.016) and staffing and resource adequacy (adjusted mean difference -0.19, p < 0.001).This fall was mirrored in nurse experience surveys with a reduction in mean scores from T1 to T3 (3 months post-move) of -0.7 (p < 0.001) and from T1 to T4 of -0.4 (p = 0.002). Thematic analysis of qualitative data found that initial challenges appeared to reduce over time. Nurses reported difficulties managing workflow in the new wards and feelings of exhaustion at T3, but this changed to more positive accounts at T4. For patients and families there was a tension between leaving the old and familiar, enjoying the light and space of the new and shared observations that nurses appeared to be busier at T3. At T4, these experiences had changed to 'being a family in hospital' and confidence that a nurse was always close by.

Conclusions: Both benefits and challenges of the new hospital design were encountered from the perspective of nurses, patients, and families. Nurses spent double the time walking in the new environment, but time spent providing patient care was unchanged. Over time, the initial practice challenges reduced as nurses adapted to working in the new environment.

Trial registration: ACTRN12618000775213.

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来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
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