临床护士使用胸壁输液港的挑战与应对策略的质性研究 [中文引用][英文引用]

目的  深入了解临床护士使用胸壁输液港的挑战和应对策略，为采取针对性干预措施，提升静脉治疗品质提供依据。方法  采用描述性质性研究方法，于 2023 年 10 月— 2024 年 2 月采用目的抽样法选取某三级甲等综合医院 19 名临床护士进行深入访谈，用 Colaizzi 7 步分析法分析资料。结果  共提炼出 3 个主题 9 个亚主题：技术操作挑战与应对（患者体型差异引起的穿刺困难与应对、回血异常与应对、操作环境与姿势影响及调整策略）；心理压力应对与调试（初始穿刺操作时的紧张感与应对、输注中担心化疗药物外渗风险与应对、担忧输液港远期并发症与应对、对外院患者维护情况的不确定感与应对）；团队协作与风险规避（团队协作应对复杂情境、失败案例反思与风险规避）。结论  护士在胸壁港操作中面临多重技术挑战和心理压力，建议通过规范化培训、团队协作、应用辅助穿刺工具、研发智能化监测设备、可视化技术等手段提升操作安全性，同时优化操作环境，定期组织案例反思和经验分享，以持续提升静脉治疗护理品质。

Objective To investigate the challenges encountered by nurses in managing chest ports and the coping strategies to provide evidence for targeted measures to improve the quality of intravenous infusion therapy. Methods Between October 2023 and February 2024，purposive sampling was used to select 19 nurses from a Grade A tetiary general hospital for in-depth interviews with descriptive and qualitative study. Data were analysed using Colaizzi method. Results Three themes and nine sub-themes were extracted: challenges in technical operation and solutions（needle insertion difficulties arisen from differences of patient body size and coping methods，abnormal blood reflux and management approaches，impact of operating environment and posture on procedures and adjustment strategies）；coping and mitigation of psychological pressure（initial anxiety during insertion procedure and coping mechanisms，concerns about risk of extravasation of chemotherapy drug during infusion and management strategies，worries regarding long-term complications of implantable ports and coping approaches，uncertainty about handling externally referred patients and adjustment strategies）；team collaboration and risk mitigation（team collaboration in addressing complex clinical scenarios，reflection on failed cases and strategies for risk prevention）. Conclusion Multiple technical challenges and psychological stress are faced by nurses in management of chest ports. Improvement of the operation safety is recommended through standardised training，team collaboration， development of intelligent monitoring equipment，and visualisation technologies. Quality of intravenous infusion therapy could be improved by optimisation of operational environment and regular case studies to exchange experiences.