围手术期保温措施实施障碍因素的质性研究

Qualitative study on the barriers to the implementation of thermal insulation measures in the perioperative period

目的探讨围手术期保温措施实施的障碍因素,为有针对性地优化团队实施体温管理提供参考。方法2020年12月至2021年5月采用目的抽样方法选取包括手术室护士、麻醉护士、麻醉医生和外科医生共43名,进行半结构式访谈。基于理论域框架制订访谈提纲并对访谈内容进行记录、转录,访谈记录使用直接内容分析进行编码,并识别影响围手术期保温措施实施行为的相关理论域框架(TDF)域。结果经过43次访谈后,数据达到了饱和。本研究找出了与理论域框架11个领域有关的障碍因素,分别为知识、技能、记忆注意力和决策过程、社会/专业角色/身份、环境背景和资源、关于能力信念、情绪、社会影响、强化、行为调节和关于后果的信息。结论基于理论域框架,手术团队实施围手术期保温存在知识和技能掌握不全;保温资源和管理不充足;缺乏监督反馈及沟通协作不良的障碍因素。

Objective To explore the barriers to the implementation of thermal insulation measures in the perioperative period,to provide a reference for the targeted optimization team to implement body temperature management.Methods After the approval of the Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University,a purpose-based sampling method was used from December 2020 to May 2021.A total of 43 nurses,anesthesiologists,anesthesiologists and surgeons were selected for semi-structured interviews.Based on the theoretical domain framework,an interview outline was developed and the interview content was recorded and transcribed.The interview recording was coded using direct content analysis,and the relevant theoretical domain framework(TDF)domains that affected the implementation of perioperative insulation measures were identified.Results After 43 interviews,the data reached saturation.This study identifies barriers related to 11 domains of the theoretical domain framework,namely knowledge,skills,memory attention and decision-making processes,social/professional roles and identities,environmental context and resources,beliefs about abilities,emotions,social influences,reinforcement,behavior regulation,and information about consequences.Conclusion Based on the theoretical domain framework,the surgical team has insufficient knowledge and skills to implement perioperative thermal insulation;insufficient thermal insulation resources and management;lack of supervisory feedback and poor communication and collaboration obstacles.