基于理论域框架的ICU护士执行身体约束缩减行动障碍因素的质性研究

Barriers of ICU nurses perform physical restraint minimization actions:a qualitative study based on theoretical domains framework

目的:探讨ICU护士执行身体约束缩减行动的障碍因素,为制定身体约束标准化管理方案提供依据。方法:基于理论域框架(TDF)制定访谈提纲,采用目的抽样法对天津市某三级甲等医院的12名ICU护士进行半结构式访谈,按照TDF的相关领域对转录后的资料进行归类,用内容分析法对访谈资料进行分析。结果:ICU护士对身体约束缩减行动理解存在偏差、对约束替代措施内容的不熟悉是其执行身体约束缩减行动的障碍因素之一;身体约束缩减方案评估工具、决策流程的不规范对缩减约束行动的开展造成了一定阻碍;环境因素的限制及对缩减约束结果的担忧,使ICU护士没有足够的信心去执行;科室缺乏支持缩减约束的组织氛围,难以引起护士对执行约束缩减行动的重视,进而削减执行的动力。结合理论域框架将上述因素分别归属为知识、自我效能、环境背景和资源、社会影响、行为规范5个领域。结论:知识、自我效能、环境背景和资源、社会影响及行为规范为ICU护士执行身体约束缩减行动的障碍因素。科室要在明确障碍因素的基础上,加强领导层对执行缩减约束的重视和支持。制定缩减约束评估决策规范化流程以及培训方案,倡导团队协作,创造支持身体约束缩减行动的组织氛围,坚定ICU护士执行缩减约束的信心,促进身体约束缩减行动的持续实施。

Objective:To explore the obstacle factors for ICU nurses to perform physical restraint minimization action,and to provide reference for formulating standardized physical restraint management plan.Methods:The interview outline was developed based on the theoretical domains framework(TDF).Totally 12 ICU nurses from a tertiary hospital in Tianjin were selected for semi-structured interviews by purposive sampling,the transcribed texts were categorized according to the relevant domains of TDF,and the interview data were analyzed by content analysis.Results:In the current clinical work,ICU nurses had bias in understanding of physical restraint minimization action and unfamiliarity with the content of alternative restraint measures,which was one of the obstacles to their implementation of physical restraint minimization action.The decision process of evaluation tool of physical restraint minimization plan was not uniform and standardized,which has caused some obstacles to the development of restraint minimization action.The limitation of environmental factors and the concern about the outcome of reduction constraints made ICU nurses not confident enough to perform;The lack of organizational atmosphere supporting reduction constraints in the department made it difficult for nurses to pay attention to the implementation of reduction actions,and thus reduce the motivation of implementation.Combined with TDF,the above obstacles were classified into 5 domains:knowledge,beliefs about capabilities,environmental context and resources,social influences,behavioural regulation.Conclusion:On the basis of clarifying the obstacle factors,the department needs to strengthen the leadership’s attention and support to the implementation of physical restraint minimization,and develop the standardized decision-making process of restraint reduction assessment and training programs to advocate team cooperation,create an organizational atmosphere supporting physical restraint minimization action,encourage ICU nurses to firmly implement the confidence of restraint minimization,and promote the continuous implementation of physical restraint minimization action.