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首页> 外文期刊>International journal of older people nursing >Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales
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Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales

机译：在相互竞争的理论战场上老年慢性病患者护理轨迹的连续性

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Background: Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail. Objectives: To examine conditions for continuity and integration of the patient perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. Design: Explorative Participatory Action Research (PAR). Setting: An acute, general medical ward at a Danish university hospital. Participants: Hospital and municipality nurses (n = 29). Nursing records (n = 12). Method: Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. Results: Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient perspective in care trajectories of older, chronically ill patients. Although they adhered to these ideals, they rarely pursued them in practice. Hindering factors were: organisational values, episodic focus on patients and lack of time. They felt caught in a value conflict between nursing professional values and system values, which caused a feeling of powerlessness, maintaining status quo in their clinical practice. Conclusion: The prevailing episodic focus and the competing rationales on the ward constituted a barrier to continuity and integration of the patient perspective in a comprehensive way. Implications for practice: In order to change actual practice management and staff must demand and act on a practice based on professional nursing values, for instance by using PAR due to the empowered and innovative processes involved.
机译：背景：在照顾老年慢性病患者时，连续性至关重要。研究表明，整合患者自身状况的观点对于连续性和护理质量至关重要。然而，研究表明，卫生专业人员在与老年患者进行沟通方面存在许多问题，导致缺​​乏连续性并将患者观点纳入护理和治疗之中。尽管对这些问题进行了充分的调查，但它们仍然普遍存在。目的：检查在护理人员关于患者的交流中反映出来的，在老年慢性病患者护理中患者观点的连续性和整合性的条件。设计：探索性参与式行动研究（PAR）。地点：丹麦大学医院的急诊科。参加者：医院和市政护士（n = 29）。护理记录（n = 12）。方法：实地研究：观察，访谈，护理记录审核和日志。对数据进行清单和潜在内容分析。结果：参与者意识到在老年慢性病患者的护理过程中确保连续性，全面方法和综合患者观点的重要性。尽管他们坚持这些理想，但他们很少在实践中追求它们。阻碍因素包括：组织价值，对患者的关注和缺乏时间。他们感到陷入了护理专业价值观和系统价值观之间的价值冲突，这引起了一种无能为力的感觉，维持了他们在临床实践中的现状。结论：在病房中普遍存在的发作性焦点和相互矛盾的理由构成了以全面方式继续和整合患者观点的障碍。对实践的影响：为了改变实际实践，管理人员必须基于专业护理价值要求并采取行动，例如，由于所涉及的授权和创新过程而使用PAR。

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