脑卒中患者延续性照护效果评价策略的质性研究

Strategies for outcome evaluation of continuous care for stroke patients: a qualitative study

目的 了解护理人员对脑卒中延续性照护效果评价的体验和建议,探讨脑卒中延续性照护效果评价的评价内容、评价主体、评价时间及评价困难,为制订完善的效果评价体系提供参考依据.方法 2018年8-9月,采用目的抽样法选取上海市二、三级综合性医院和社区卫生服务中心的10名神经内科及护理部的护理人员为研究对象.采用质性研究中的现象学研究方法,对研究对象进行半结构式访谈,并运用Colaizzi7步法对资料进行整理、分析、提炼主题.结果 提炼出5个主题:患者的结局是效果评价的重点;医院-社区联动影响延续性照护的效果;评价主体与评价内容有关;评价时间具有多阶段性;评价存在困难和挑战.结论 需立足患者的健康照护结局,规范结局评价指标;加强医院-社区联动,重视对"延续性"的管理与评价;充分发挥评价主体的优势,科学组合多元评价主体;设立多阶段评价时间,全程追踪评价效果;加强卫生政策支持,促进脑卒中延续性照护效果评价的顺利开展.

Objective To understand the experience and suggestions of nurses on the evaluation of the effect of continuous care for stroke, to explore the evaluation content, evaluation subject, evaluation time and evaluation difficulty of the evaluation of the effect of continuous care for stroke, and to provide reference for the establishment of a perfect evaluation system. Methods From August to September 2018, 10 nurses from Neurology Department and Nursing Department of Shanghai ClassⅡ and ClassⅢ general hospitals and community health service centers were selected as the research objects by purposive sampling method. Using the phenomenological research method in qualitative research, we interviewed the subjects in a semi-structured way, and used the Colaizzi 7-step method to sort out, analyze and refine the subjects. Results Five themes were extracted: the outcome of patients is the focus of effect evaluation;hospital community interaction affects the effect of continuous care;the evaluation subject is related to the evaluation content;the evaluation time is multi-stage;there are difficulties and challenges in the evaluation. Conclusions It is necessary to standardize the outcome evaluation index based on the patient's health care outcome;strengthen the hospital community interaction, and attach importance to the management and evaluation of "continuity";give full play to the advantages of the evaluation subject, scientifically combine multiple evaluation subjects;set up multi-stage evaluation time, track the evaluation effect in the whole process;strengthen the health policy support, and promote the smooth carry-out of the effect evaluation of stroke continuous care.