尿路造口周围刺激性皮炎循证实践项目持续性应用的影响因素分析:一项基于i-PARIHS框架的质性研究

Factors influencing the sustainability of the evidence-based practice project for irritant dermatitis around urostomy:a qualitative study based on the i-PARIHS framework

目的探讨尿路造口周围刺激性皮炎循证实践项目持续性应用欠佳的影响因素。方法本研究为质性研究。采用目的抽样法,于2020年4—5月选取北京大学第一医院泌尿外科工作的12名护士为研究对象,对其进行半结构访谈,根据健康服务领域研究成果应用的行动促进框架(i-PARIHS框架)对获取的资料进行分析、提取。结果访谈结果发现,变革(证据)方面,尿路造口周围刺激性皮炎循证实践项目证据的本土化和持续性有待提高,包括证据与实践环境的匹配度较高、证据应用的连续性不足。变革接受者方面,项目实践者的领导力有待提高,包括实践者与研究者角色冲突、实践者知识储备不足、实践者价值观的冲突。组织环境方面,管理者领导力及项目信息化程度需要提升,包括领导者支持不足、设施便利性不足。结论制订护理循证实践项目初期,项目实施者应充分纳入利益相关者的意见进行本土化调试,考虑项目的持续应用性;今后应增加管理者、护士、实习学生的领导力,完善尿路造口人才的使用及培训,持续性进行尿路造口知识培训,完善信息化的随访系统,并持续性调整干预策略,确保项目进行。

Objective To explore the influencing factors of the poor sustainability of the evidence-based practice project for irritant dermatitis around urostomy.Methods This is a qualitative study.From April to May 2020,12 nurses working in the Urology Surgery of Peking University First Hospital were selected by purposive sampling for the semi-structured interview.The integrated-Promoting Action on Research Implementation in Health Services framework(i-PARIHS framework)was applied to analyze and extract the obtained data.Results The interview results found that,in terms of transform(evidence),the localization and continuity of evidence for the evidence-based practice project of irritant dermatitis around urostomy needed to be improved,including the high matching between evidence and practice environment,and the insufficient continuity of evidence application.In terms of transform recipients,the leadership of project practitioner needed to be improved,including the conflict between the roles of practitioners and researchers,the lack of knowledge reserves of practitioners,and the conflict among the values of practitioners.In terms of organizational environment,the leadership of managers and the imformatization degree of project needed to be improved,including insufficient support from leaders and insufficient facilities.Conclusions At the initial stage of formulating the nursing evidence-based practice project,the project implementer should fully incorporate the opinions of stakeholders for localization debugging,and consider the sustainability of the project.In addition,the leadership of managers,nurses and interns should be increased,the use and training of urostomy talents should be strengthened,the training of urostomy knowledge should be continued,the information-based follow-up system should be improved,and the intervention strategy should be continuously adjusted to ensure the project is carried out.