【作者】 叶旭春； 刘朝杰； 刘晓虹；

【Author】 Ye Xuchun~1 Liu Chaojie~2 Liu Xiaohong~1 1 Nursing School of Second Military Medical University,800 Xiang Yin Road,Shanghai,P.R.China,200433, 2 School of public health,La Trobe University,Australia

【机构】 第二军医大学护理学院； 澳大利亚拉筹伯大学公共卫生学院；

【摘要】 背景:医疗卫生保健服务的根本宗旨是向患者提供安全有效的卫生保健服务。然而,患者安全问题在全球范围内都面临着严峻的挑战。自1999年美国医学会发布"犯错的是人"的研究报告以来,对医疗安全、患者安全的关注日益增加。近些年来,WHO世界患者安全联盟启动了诸多促进患者安全研究和实践的举措,其中,"患者参与患者安全"项目,即鼓励患者参与患者安全管理,即为其中的重要举措之一。然而,国内外关于患者参与的作用以及鼓励患者参与患者安全的策略的研究却十分有限。目的:本研究的目的在于探寻患者如何在医疗活动中发挥参与的作用,以及患者是如何感知和参与患者安全的。着眼"患者参与患者安全"和"医患沟通交流"两大主题,本研究的研究问题包括:患者对患者安全的感知如何?患者是怎样做出与自身健康相关的患者安全决策的?鼓励患者参与患者安全的最佳策略是什么?方法:本研究采用格拉泽传统扎根理论方法论原则,采用目的抽样、理论抽样、滚雪球抽样的方法,考虑访谈对象的性别、年龄、不良事件经历以及人口统计学特征的多样性,筛选出来自上海市6所医院(一级医院、二级医院、三级医院各2所)的34例出院患者(包括即将出院的患者)进行半结构式深度访谈(转录文字共406 847字),对其住院经历的体验、对患者安全的感知以及如何保障自身患者安全进行访谈,并收集部分网络媒体报道的医疗安全不良事件案例报道,作为访谈资料的补充。所有访谈均进行录音,并整理成word文字文档。采用质性研究资料分析软件Nvivo 7英文版对收集的资料进行整理,通过运用实质性编码、理论性编码的策略析出主题。结果:本研究析出"患者安全感知"和"互动式参与患者安全"两个核心主题。首先,患者认为患者安全是医疗安全的重要方面,是对与其自身生命安全或健康相关的患者安全概念、患者安全现象和患者安全保障的认识和理解。其次,析出"互动式参与患者安全"的8个类属,并据此构建了患者参与患者安全的理论框架,主要包括"决策性参与"、"照护性参与"、"诉求性参与"3个参与策略,"信任、信心、沟通、支持"4个原因要素,1个参与结果"有利",以及7个相关的理论假设。结论:构建了患者参与患者安全的理论框架,为患者参与患者安全的后续研究和实践提供理论指导。更多还原

【Abstract】 Background:Internationally,it has been increasingly recognized that providing effective and safe care is the ultimate goal in health care.However,great challenges have been faced in improving patient safety globally.Ever since the Institute of Medicine published its report ’To Err Is Human’ in 1999,concerns about medical errors and patient safety have multiplied.The WHO World Alliance for Patient Safety has launched a series of initiatives in recent years to improve both research and practice of patient safety across the world,which include a number of initiatives encouraging patient involvement in safety.For instance,’Patients For Patient Safety’ has been one of the main action areas to engage patients in safety management.However,research into the role of patients and strategies for enhancing patient involvement in safety has been limited.Objective:This project aims to find out what roles patients play in the safety of hospital care and their knowledge and attitudes towards safety of hospital care.Focusing on the theme of patient involvements and patient-providers communication,the main research questions include:(1) What is the perception and knowledge of patients about the safety of hospital care?(2) How do patients make decisions on the safety of their hospital care? (3)What is the best way to inform patients to engage in safety of hospital care? Methods:A qualitative research approach was adopted.A purposive sampling strategy incorporated with theoretical sampling and snowballing strategies was used to recruit participants from 2 primary,2 secondary and 2 tertiary hospitals in Shanghai.The sample of participants was selected to vary by gender,age,adverse events experience and social demographic characteristics to ensure the data contained a diverse sample.Media reports about patient safety and medical disputes were selected for supplementary data analysis.A total of 34 patients who have been recently discharged from hospitals were interviewed.They were asked to tell their experiences in hospitals,including their perceptions of safety and how they act to ensure their safety.All the interviews were recorded on digital recorders,and then transcribed into word documents.Nvivo 7.0 was used to help the data analysis.Important themes of experience of patients were extracted through substantive and theoretical coding strategy guided by the grounded theory.Results:Two themes were drawn from this qualitative study.Firstly,patients saw their safety in medical care as a vital element in safety,which include the concepts, contents and strategies of patient safety risk deduction.Secondly,a theme of interactive involvement in patient safety was drawn, including 8 categories,which eventually contributed to the development of a theoretical framework of patient involvement in patient safety.Three strategies of patient involvement in patient safety such as decisive involvement,caring involvement and complaining involvement in patient safety were concluded.Four elements including patient-provider trust,medical information support,imprompt communication between patient and professionals,and support both from family and professionals play important roles in helping patients engage in safety of hospital care.Benefit for patient safety is the ultimate outcome for patient involvement in safety.Seven hypotheses were drawn.Conclusions:A theoretical framework for enhancing patient involvement in patient safety was developed, which would guide the development of strategies for "Patient for Patient Safety".更多还原