Khoshab, Hadi

Simorgh Research Repository

      دا஺ه ﻋ࢖ﻮم ﭘﺰﺷਔﯽ ໊ඟﻣﺎن  داﻧﺸﻜﺪه ﭘﺮﺳﺘﺎري و ﻣﺎﻣﺎﻳﻲ رازي    ﻣﻘﻄﻊ دﻛﺘﺮي ﭘﺮﺳﺘﺎري ﻧﺎﻣﻪ ﺎنﻳﭘﺎ      ﻋﻨﻮان:    ﻲﺒﻴﻣﻄﺎﻟﻌﻪ ﺗﺮﻛ ﻚﻳ ،ﻲﻗﻠﺒ ﻳﻲﻣﺒﺘﻼﺑﻪ ﻧﺎرﺳﺎ ﻤﺎرانﻴدر ﻣﺮاﻗﺒﺖ از ﺑ ﻲﻤﻴﻓﺮآﻳﻨﺪ ﻛﺎرﺗ ﻦﻴﻴﺗﺒ      ﺗﻮﺳﻂ: ﻫﺎدي ﺧﻮﺷﺎب   يﮔﺮ ﺮﻴﺗﺧﺎﻧﻢ دﻛﺘﺮ ﺑﺘﻮل  –اﺳﺘﺎد راﻫﻨﻤﺎ: ﺧﺎﻧﻢ دﻛﺘﺮ ﻋﺼﻤﺖ ﻧﻮﺣﻲ     اﺣﻤﺪي اﷲ ﻓﻀﻞ: آﻗﺎي دﻛﺘﺮ اﺳﺘﺎد ﻣﺸﺎور    7931- 8931ﺳﺎل ﺗﺤﺼﻴﻠﻲ:    ﭼﻜﻴﺪهﻣﺮاﻗﺒﺖ و درﻣﺎن  ﻲﻤﻴﺗ ﻜﺮدﻳرو ﺎزﻣﻨﺪﻴﻧ يﻤﺎرﻴو ﻣﺰﻣﻦ ﺑ ﺪهﻴﭽﻴﭘ ﺖﻴﺑﻪ ﻋﻠﺖ ﻣﺎﻫ ﻲﻗﻠﺒ ﻳﻲﺑﻪ ﻧﺎرﺳﺎ ﺎنﻳﻣﺒﺘﻼ :و ﻫﺪف ﻣﻘﺪﻣﻪ ﺗﺒﻴﻴﻦﻣﻄﺎﻟﻌﻪ ﺑﺎﻫﺪف  ﻦﻳدﻫﺪ. ا ﺶﻳدرﻣﺎن را اﻓﺰا ﻲو ﺑﻬﺘﺮ ﻣﻨﺎﺑﻊ، اﺛﺮﺑﺨﺸ ﺸﺘﺮﻴﺑ يﺮﻴﺑﺎ ﺑﻜﺎر ﮔ ﺗﻮاﻧﺪ ﻲﻣ ﻜﺮدﻳرواﻳﻦ ﻧﻮع ﻫﺴﺘﻨﺪ.   .ﺪﻳاﻧﺠﺎم ﮔﺮد ﻲﻗﻠﺒ ﻳﻲﻣﺒﺘﻼﺑﻪ ﻧﺎرﺳﺎ ﻤﺎرانﻴﻛﺎرﺗﻴﻤﻲ در ﻣﺮاﻗﺒﺖ از ﺑ ﻓﺮآﻳﻨﺪﺑﻪ دو روش ﻛﻴﻔﻲ و ﻛﻤﻲ ﺑﻪ ﺑﺮرﺳﻲ ﻛﺎرﺗﻴﻤﻲ در  7931ﺗﺎ  5931از ﺳﺎل  زﻣﺎن ﻫﻢدر اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﺮﻛﻴﺒﻲ  ﻫﺎ: ﻣﻮاد و روشي ا ﻨﻪﻴزﻣ، از روش ﺗﺌﻮري ﻛﻨﻨﺪه ﻣﺸﺎرﻛﺖ 95ﻣﺮاﻗﺒﺖ از ﺑﻴﻤﺎران ﻧﺎرﺳﺎﻳﻲ ﻗﻠﺒﻲ ﭘﺮداﺧﺘﻪ ﺷﺪ. در ﻗﺴﻤﺖ ﻛﻴﻔﻲ ﺑﻌﺪ از ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﻧﻔﺮ از  803ات ي ﻛﺎرﺗﻴﻤﻲ و در ﺑﺨﺶ ﻛﻤﻲ ﺑﺎ اﺳﺘﻔﺎده از اﺑﺰار اﺳﺘﺎﻧﺪارد ارزﻳﺎﺑﻲ ﺗﻴﻢ ﺑﻪ ﺑﺮرﺳﻲ ﻧﻈﺮﺮﻴﮔ ﺷﻜﻞﺑﺮاي ﺗﺒﻴﻴﻦ ﻓﺮآﻳﻨﺪ   وﺿﻌﻴﺖ ﻛﺎرﺗﻴﻤﻲ در ﻣﺮاﻗﺒﺖ از ﺑﻴﻤﺎران ﭘﺮداﺧﺘﻪ ﺷﺪ. در ﻣﻮرداﻋﻀﺎي ﺗﻴﻢ درﻣﺎن  "ﻲﻗﻠﺒ ﻳﻲﻧﺎرﺳﺎ ﻤﺎرانﻴﻣﺮاﻗﺒﺖ و درﻣﺎن ﺑ ﻢﻴدر ﺗ ﺪﻫﺎﻳو ﻧﺒﺎ ﺪﻫﺎﻳﺗﻘﺎﺑﻞ ﺑﺎ" ي ﺑﺨﺶ ﻛﻴﻔﻲ ﭘﮋوﻫﺶﻫﺎ ﺎﻓﺘﻪﺑﺮ اﺳﺎس ﻳ :ﻫﺎ ﺎﻓﺘﻪﻳﻳﻲ ﺑﻮدﻧﺪ ﻛﻪ اﻋﻀﺎي راﻫﻜﺎرﻫﺎ "ﻲﻤﻴو وﻓﺎق ﺗ ﺶﻳﺟﻬﺖ ﭘﻮﺗﻼش در ". ﺮدﻴﮔ ﻲﻣي دارد ﻛﻪ ﺗﻴﻢ در آن ﺷﻜﻞ ا ﻨﻪﻴزﻣاﺷﺎره ﺑﻪ و اﺷﺎره ﺑﻪ ﻓﺮآﻳﻨﺪي دارد ﻛﻪ اﻋﻀﺎ ﺑﺮاي رﺳﻴﺪن ﺑﻪ ﭘﻴﺎﻣﺪ آن ﻳﻌﻨﻲ  ﺑﺮدﻧﺪ ﻲﻣﺑﻬﺮه  ﻫﺎ آني ﻣﺮاﻗﺒﺘﻲ از ﻫﺎ ﻢﻴﺗﺗﻴﻢ ﺑﺮاي داﺷﺘﻦ  ﻳﻲﻧﺎرﺳﺎ ﻤﺎرانﻴاز ﺑ ﻧﺎﻣﺮﺋﻲ ﻛﺎرﺗﻴﻤﻲ در ﻣﺮاﻗﺒﺖ يﺗﺎرﻫﺎ"از آن اﺳﺘﻔﺎده ﻛﺮدﻧﺪ. ﻃﺒﻘﺎت  "، دورﻧﻤﺎﻳﻲ روﺷﻦﻣﺤﻮر ﻤﺎرﻴﻣﺮاﻗﺒﺖ ﺑ" "ي ﻓﺮآﻳﻨﺪ ﻛﺎرﺗﻴﻤﻲ را ﺗﺸﻜﻴﻞ دادﻧﺪ. ﻫﺎ ﻛﻨﻨﺪه ﻞﻴﺗﺴﻬﺑﻪ ﺗﺮﺗﻴﺐ ﻣﻮاﻧﻊ و  "ﻣﺮاﻗﺒﺖ و درﻣﺎن يﺑﺮا ﻲﻣﺄﻣﻨ ﻢﻴﺗ"و  "ﻲﻗﻠﺒ ﺎرﻴو اﻧﺤﺮاف ﻣﻌ ﻦﻴﺎﻧﮕﻴﻣدر ﺑﺨﺶ ﻛﻤﻲ ﻧﻴﺰ "ﻣﻄﺎﻟﻌﻪ ﺑﻮد.  يﻃﺒﻘﻪ ﻣﺮﻛﺰﻧﻴﺰ  "در ﺟﻬﺖ اراﺋﻪ ﻣﺮاﻗﺒﺖ ﻣﺆﺛﺮ  يا ﺣﺮﻓﻪ ﻳﻲاﻓﺰا ﻫﻢو ﺳﻄﻮح ﻣﺨﺘﻠﻒ  ﻲﻗﻠﺒ ﻳﻲﻣﺒﺘﻼﺑﻪ ﻧﺎرﺳﺎ ﻤﺎرانﻴﻛﺎرﺗﻴﻤﻲ در ﻣﺮاﻗﺒﺖ از ﺑ ﺖﻴوﺿﻌ ﻦﺑﻴ. ﺑﻮد 2/14±0/53ﻛﺎرﺗﻴﻤﻲ  ﺖﻴوﺿﻌ ﻧﻤﺮه ﻢﻴﺗ ﺎدﻴﻧﻤﺮه ﻣﺮﺑﻮط ﺑﻪ ﺑﻌﺪ اﺳﺎس و ﺑﻨ ﻦﻴﺎﻧﮕﻴﻣ ﻦﻳﺸﺘﺮﻴﺑ. )50,0<p( وﺟﻮد داﺷﺖ يدار ﻲو ﺳﺎﺑﻘﻪ ﻛﺎر، اﺧﺘﻼف ﻣﻌﻨ ﻲﺟﻨﺴ ،ﻲﺳﻨ  .ﺑﻮد( 2/03±0/94) ﻲﻣﺮاﻗﺒﺘ ﻢﻴﺗ ﺖﻳﻣﺮﺑﻮط ﺑﻪ ﺑﻌﺪ ﻫﻮ ﻦﻛﻤﺘﺮﻳ و( 3/95±0/04)ﻲ ﻣﺮاﻗﺒﺘﺘﻧﻴﻪﺠ ﮔﻴﺮ:ي  ﻞﻴﻜﺸﺗﺗﻴﻢ ﺎﻫ و ﻊﻧاﻮﻣ ياراد ﻪﻛ ﺪﻨﭼﺮﻫ ﻲﺒﻠﻗ ﻲﻳﺎﺳرﺎﻧ نارﺎﻤﻴﺑ زا ﺖﺒﻗاﺮﻣ رد ﻲﺼﺼﺨﺗ يدوﺪﺤﻣﻳﺖ ﺎﻫ ،ﺖﺳا ﻲﻳ ﻊﻓر ﺖﻬﺟ رد شﻼﺗ ﺎﺑ ﺎﻣانآ ﺎﻫ ﻣﻲ ناﻮﺗ  ﻲﺘﺒﻗاﺮﻣ ﻪﺋارا نآ ﻪﺠﻴﺘﻧ ﻪﻛ ﻲﺷﻼﺗ .ﺪﻴﺳر رﻮﺤﻣ رﺎﻤﻴﺑ ﻲﺘﺒﻗاﺮﻣ ﻪﺑﺮﺛﺆﻣ  رﺎﻤﻴﺑ ياﺮﺑ ﻲﺒﻠﻗ ﻲﻳﺎﺳرﺎﻧﺖﺳا ﻪﭼﺮﮔا .ﻌﺿوﻴﺖ ﺑ زا ﺖﺒﻗاﺮﻣ رد ﻲﻤﻴﺗرﺎﻛﻴنارﺎﻤ ﺎﺳرﺎﻧ ﻪﺑﻼﺘﺒﻣﻲﻳ ﺒﻠﻗﻲ ﻄﺳﻮﺘﻣ ﺪﺣ ردﻲ دﻮﺑ ﻲﻟو شزﻮﻣآ ﺎﻫي ﺗرﺎﻛ درﻮﻣ رد ﺮﻤﺘﺴﻣﻴﻤﻲ ﻛﺮﺗ ﻪﺑ ﻪﺟﻮﺗ وﻴﺐ ﺎﻫي ﻨﺳﻲ ﺴﻨﺟ وﻴﺘﻲ ﻣ ﺐﺳﺎﻨﺘﻣﻲ ﺪﻧاﻮﺗ ﻮﺒﻬﺑ ردد  ﺖﺒﻗاﺮﻣ رد ﻲﻤﻴﺗرﺎﻛﺑ زاﻴنارﺎﻤ ﺎﺳرﺎﻧ ﻪﺑﻼﺘﺒﻣﻲﻳ ﺒﻠﻗﻲ ﺛﺄﺗﻴراﺬﮔﺮ .ﺪﺷﺎﺑ  هژاو ﺎﻫ:يﺪﻴﻠﻛ ي  ،ﻲﻤﻴﺗرﺎﻛنﺎﻣرد و ﺖﺒﻗاﺮﻣناﺮﻳا ،ﻲﺒﻴﻛﺮﺗ ﻪﻌﻟﺎﻄﻣ ،ﻲﺒﻠﻗ ﻲﻳﺎﺳرﺎﻧ ،  Abstract Background and Objectives: Patients with heart failure (HF) disease require a team-based approach for care and treatment because of the complex and chronic nature of the disease. The team approach in care, can increase the effectiveness of treatment by using the resources better. The aim of this study was to explain the process of teamwork in caring for patients with HF. Material and method: In this concurrent mixed method  study, a qualitative and quantitative approach was designed to investigate teamwork in the caring of HF patients from ٢٠١٦ to ٢٠١٨. In the qualitative section, after interviewing with ٥٩ participants, the grounded theory method used for explaining the process of teamwork formation and in the quantitative section, the standard taem assessment quastionary, used to asked viewpoint of ٣٠٨ members of the treatment team about the status of team work in patient care. Findings: Based on the findings of the qualitative section “Conflict of do's and don'ts in the care and treatment team of HF patients” refers to the context in which the team is formed. “Striving for team scrutiny and consensus” were strategies which team member used to have effective teams and imply to the process that the members used to achieve the consequence of "patient centerism care, A clear perspective ". Main categories “Invisible cobwebs in caring for patients with HF” and “team a safe place for care and treatment” were respectively as barriers and facilitators of the team work process. “Professional co-operation to provide effective care” was the focal concept.  In the quantitative part, the mean and standard deviation of teamwork was ٢٫٤١±٠٫٣٥. There was a significant difference between the teamwork status of caring for patients with HF and age, sex and job experience (p<٠٫٠٥). The highest mean was for team basis dimension (٣٫٥٩±٠٫٤٠) while the lowest was for team identity (٢٫٣٠±٠٫٤٩). Conclusion: Dispite having barriers and limitations in conforming specialized teams to care for patients with HF, trying to eliminate them, can achieve patient-centered care. An attempt that result to providing effective care for the HF patient. Although the teamwork status was modest in caring for patients with HF, But continuous training on teamwork and paying attention to appropriate age and gender combinations of the team can be effective in improving teamwork in caring for patients with HF. Key words: Teamwork, Care and Treatment, Heart Failure, Mixed method Study, Iran             Kerman University of Medical Sciences  Faculty of Nursing and Midwifery  In Partial Fulfillment of the Requirements for the Degree Ph.D   Title: Explaining the Process of Teamwork in Caring of Patients with Heart Failure, A Mixed method study   By: Hadi Khoshab  Supervisors: Dr. Esmat Nouhi, Dr. Batool Tirgari  Advisors: Dr. Fazlolah Ahmadi    Year: ٢٠١٨  

Explaining the Process of Teamwork in Caring of Patients with Heart Failure, A Mixed method study

http://eprints.kmu.ac.ir/29386/1/6840.pdf

Explaining the Process of Teamwork in Caring of Patients with Heart Failure, A Mixed method study

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