应用文本挖掘方法分析患者跌倒发生的方式和原因

Falls as the result of interplay between nurses,patient and the environment:Using text-mining to uncover how and why falls happen

目的本研究旨在探讨从护士角度审视患者跌倒事件中患者、环境和护士实践的相互作用。方法从日本优质保健委员会项目设立的数据库中检索2016-2020年由护士登记的患者跌倒事件报告,并进行回顾性审查。逐字提取“跌倒的背景”中的文字描述,并采用文本挖掘的方法进行分析。结果共分析了4176例患者跌倒事件报告。这些跌倒事件中,79.0%是护士没有亲眼目睹的,8.7%发生在直接护理期间。通过文件聚类分析,共确定了16个集群。4个集群与患者状况有关,如患者的生理/认知功能下降、失去平衡、以及使用催眠剂和精神药物。3个集群与护士实践有关,其中包括缺乏对实际情形的认识、依赖于患者家属、以及护理程序执行不到位。6个集群与患者和护士有关,包括患者徒劳地使用床头警报器和呼叫铃、穿着不合适的鞋子、使用助行器和床栏杆方面存在问题、以及护士对患者的日常生活活动能力了解不足。1个集群为与椅子有关的跌倒,同时涉及患者和环境因素。2个集群同时涉及患者、护士和环境因素,这些跌倒发生在患者洗澡/淋浴或使用床边坐便器时。结论跌倒往往由于患者、护士和环境之间的动态相互作用引起。由于许多因素很难在短时间内改变,所以必须把重点放在护理和环境因素上,以预防和减少患者跌倒。其中,提高护士对患者跌倒的态势感知能力尤为重要,这影响着他们预防患者跌倒的决定和行动。

Objectives This study aimed to explore,from the perspectives of nurses,how patients,the environment,and the practice of nurses interact with each other to contribute to patient falls.Methods A retrospective review of incident reports on patient falls,registered by nurses between 2016 and 2020,was conducted.The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care.The text descriptions of the“background of falls”were extracted verbatim,and analyzed by using a text-mining approach.Results A total of 4,176 incident reports on patient falls were analyzed.Of these falls,79.0%were unwitnessed by nurses,and 8.7%occurred during direct nursing care.Document clustering identified 16 clusters.Four clusters were related to patients,such as the decline in their physiological/cognitive function,a loss of balance,and their use of hypnotic and psychotropic agents.Three clusters were related to nurses,and these included a lack of situation awareness,reliance on patient families,and insufficient implementation of the nursing process.Six clusters were concerned with patients and nurses,including the unproductive use of a bed alarm and call bells,the use of inappropriate footwear,the problematic use of walking aids and bedrails,and insufficient understanding of patients’activities of daily living.One cluster,chair-related falls,involved both patient and environmental factors.Finally,two clusters involved patient,nurse,and environmental factors,and these falls occurred when patients were bathing/showering or using a bedside commode.Conclusions Falls were caused by a dynamic interplay between patients,nurses,and the environment.Since many of the patient factors are difficult to modify in a short time,the focus has to be placed on nursing and environmental factors to reduce falls.In particular,improving nurses’situation awareness is of foremost importance,as it influences their decisions and actions to prevent falls.