The Cognitive Study On Implicit Rationing Of Nursing Care Of ICU Nurses In Three Grade A Hospital

Objective:Through in-depth understanding of the cognitive of ICU nurses on implicit nursing,explore the understanding and views of ICU nurses on implicit nursing,understand the occurrence and influencing factors of implicit nursing in ICU.Explore nurses to propose strategies to reduce implicit nursing,and provide guidance for further intervention research.Methods:This study adopts the descriptive phenomenology research method and ICU nurses from a Grade A hospital in Changchun City as the research objects by the sampling method of maximum sampling purpose.After being approved by the ethics committee of the school of nursing,Jilin University,the research subjects agreed and signed the informed consent for the investigation,and the semi-structured interview method was used to collect data.After interviewing 18 ICU nurses,the data reached saturation.At the end of the survey and interview text,the qualitative analysis software Nvivo12.0 was used to collate the coded data,and the seven-step analysis method of Colaizzi was used to analyze the interview text and finally form the theme.Data collection and analysis were conducted simultaneously during the study.Results: Through in-depth interviews and analysis of 18 ICU nurses,it is found that ICU nurses have different perceptions of implicit nursing.The interview is deeply analyzed and refined to form three core themes: the experience of implicit nursing,the decision-making process of implicit nursing,and the strategy of reducing implicit nursing.1.The experience of implicit nursing includes five sub-themes:(1)The degree of awareness of implicit nursing: Most nurses are not familiar with the terms and concepts of implicit care(2)The occurrence of implicit nursing conditions : The nurse’s personal characteristics,leadership and management skills,effective collaboration with doctors,and complex work environment can all affect implicit nursing.(3)The essence of implicit nursing: Under the influence of factors,the implementation of some life care(bed scrubbing,oral care,turning over,etc.),therapeutic care(pneumatic pump treatment,rehabilitation care,real-time monitoring,etc.)and protective care(cleaning and disinfecting bedside instruments,wearing isolation clothing)which are in the lower order are often limited.(4)The unintended consequences of implicit care :Nurses are not aware of the negative consequences of implicit care.(5)The difference between different shifts : There are differences in the incidence of implicit nursing in different shifts.2.The decision-making process of implicit care includes four sub-themes:(1)Assess resources and characteristics of work.(2)Formulate the nursing plan of the class.(3)Implement the time plan.(4)Evaluate the occurrence of implicit nursing.3.Strategies to reduce implicit care include three sub-themes:(1)To comprehensively improve the quality of nurses from the aspects of ability and body.(2)Supply of cultural resources.(3)Standardize the management mode.Conclusions: 4.1 This study adopts the qualitative research method and conducts in-depth interviews with 18 ICU nurses in third-class A hospitals,and concludes the three themes of " the experience of implicit nursing"," the decision-making process of implicit nursing" and "the strategy of reducing implicit nursing.",which enriches the related research on implicit nursing.4.2 ICU nurses may have richer experience of implicit nursing due to heavy workload and tight time.This study reveals the influencing factors and contents on implicit nursing in ICU.However,most ICU nurses do not understand the term of implicit nursing,nor can they correctly understand its meaning.In addition,for the results caused by implicit nursing,some nurses thought that it would not affect patients,while some nurses just expressed their concern and did not realize and pay attention to the adverse results caused by nursing service limitation to patients and themselves.Different nurses have different views on the difference between day and night nursing service limitations.These results fill in the gaps of previous studies and provide suggestions for future training and learning contents of nurses.4.3 The decision-making process of implicit nursing includes the assessment of the urgency of the nursing task,as well as the evaluation of the implementation conditions including material and time resources and the patient’s condition.Determine and prioritize patient care needs based on the assessment results.In the process of implementing the priority plan,overtime work,teamwork,reducing the quality of nursing,organizing nursing and other strategies are adopted to reduce the nursing service limitation.In reality,nurses also undertake non-nursing work,which increases the workload.Some nurses see this phenomenon of limited care as a comprehensive strategy,while others see it as neglect or neglect of the importance of certain kinds of care to the patient.This study explores the decision-making process to deepen researchers’ understanding of the occurrence of implicit nursing.4.4 From the perspective of nurses,this paper proposes strategies to reduce implicit nursing,and provides reliable suggestions and basis for future intervention plans to reduce the implicit nursing and improve the quality of nursing.