网约护士胃管置入操作风险与应对策略的质性研究 [中文引用][英文引用]

目的  了解网约护士胃管置入操作风险与应对策略，为提高网约护理服务质量和安全性提供参考依据。方法  采用目的抽样法，选取内蒙古某三级甲等综合医院曾胃管置入上门服务的 13 名网约护士为研究对象，进行半结构化访谈，采用 Colaizzi 7 步分析法对访谈内容进行整理分析。结果  提炼出 2 个主题和 10 个亚主题。①患者和居家操作环境增加胃管置入风险：患者病情复杂，识别和应对难度大；突发窒息风险高，抢救条件不足；上门操作环境陌生，心理压力大；上门操作条件受限，风险识别难度高。②网约护士胃管置入的应对策略：反复实践积累经验，提升置管信心与判断能力；强化急救知识与技能，提升突发状况应变能力；加强护患沟通，提升患者信任与配合；多种方式确认置管位置，保障操作安全；仔细了解患者病情，降低置管风险；使用可替代工具，配合家属协作。结论  网约护士在胃管置入过程中面临较多挑战与风险，医疗机构及相关管理部门应积极采取相应策略，给予网约护士相关培训与指导，健全配套法规，完善平台管理机制，保障网约护士安全，提高“互联网 +护理服务”质量。

Objective To explore the challenges faced by online appointment nurses during nasogastric intubation and toprovide a reference for improvement of the quality and safety of the services provided by online appointment nursing. Methods Apurposive sampling was employed to select 13 online appointment nurses from our hospital who had previously provided home nasogastricintubation services for patients. Semi-structured interviews were conducted with the online appointment nurses. The results acquired fromthe interviews were analysed using Colaizzi’s method. Results Two themes were identified. Theme 1 covered the increased risks of nasogastric intubation due to the patients themselves and home environment，which included 4 sub-themes of difficulties in identificationand response due to complex conditions of patient，high risk of a sudden asphyxia with poor resuscitation facility，psychological stress fromunfamiliar home environment，and more challenges in risk identification due to limited conditions for performing home-based intubationprocedures；Theme 2 covered the coping strategies of online-scheduled nurses，which included the improvement of knowledge and skillsin emergency nursing to improve comfidence and judge ability of intubation，the strengthening of nurse-patient communication to builda trust and cooperation，the conduct of thorough assessment to ensure procedural safety，and the use of alternative tools and collaborationwith family members. Conclusion Online appointment nurses face challenges and risks from both of the procedures and patientsthemselves during home based nasogastric intubation. Hospitals and relevant management should actively implement correspondingstrategies，provide training and guidance for online appointment nurses，develop relevant regulations，and improve the managementmechanisms of the internet platform to ensure the safety of home based nasogastric intubation for online appointment nurses and improvethe quality of the“Internet Plus Nursing Services.”