基于i-PARIHS框架的重症患者再喂养综合征预防及干预证据应用障碍因素分析

Analysis of Barriers to the Use of Evidence for Prevention and Intervention of Refeeding Syndrome in Critically Ill Patients Based on the I-PARIHS Framework

目的深入了解重症患者再喂养综合征预防及干预证据应用中存在的问题,为制订相应的行动策略提供依据。方法采取目的抽样法,于2022年10月-2022年12月选取上海市某三级甲等公立医院的重症监护室医生、护士进行半结构访谈,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)对访谈资料进行整理分析、提取。结果访谈内容归纳为3个主题,包括变革证据:证据应用与环境匹配度不足,证据应用实施是动态过程;变革接受者:实践者知识储备有待提高,重症患者依从性较差;组织环境:变革初期工作量增加,亟需完善信息化系统;缺乏指令性文件要求改变护理常规。结论项目实施者推行该证据应用项目时,应根据变革利益相关者的建议对证据进行临床情景调试,实施过程中注意动态调整治疗及护理措施,及时更新证据并积极开展相关培训,做好宣教,提高重症患者依从性,完善信息化系统进行患者全程管理,从而确保证据应用的持续性。

Objective To understand the problems existing in the prevention of refeeding syndrome in critically ill patients and the application of intervention evidence,and to provide the basis for the formulation of corresponding action strategies.Methods Objective sampling method was adopted to conduct semi-structured interviews with doctors and nurses in intensive care units of a Grade-III Class A public hospital in Shanghai from October to December 2022.The interview data were sorted out,analyzed and extracted according to the Action Facilitation Framework for the application of research results in the fi eld of health services(i-PARIHS framework).Results The interview content was summarized into three themes,included evidence of change:evidence application and environment did not match well;evidence application implementation is a dynamic process;change recipients:the knowledge reserve of practitioners needs to be improved,and the compliance of severe patients is poor;organizational environment:the workload increases in the early stage of reform,and it is urgent to improve the information system;lack of prescriptive documentation requiring changes in routine care practices.Conclusion Project implementation when carrying out the evidence application project,the evidence should be adjusted according to the suggestions of stakeholders,pay attention to the dynamic adjustment of treatment and nursing measures in the implementation process,timely update the evidence and actively carry out relevant training,do a good job of publicity and education to improve the compliance of critically ill patients,improve the information system for patient management,so as to ensure the continuity of evidence application.