自杀预防循证护理指南的临床应用与质量改进研究OA
Building a culture of suicide prevention and care:Implementation of an evidence-based guideline of the Registered Nurses' Association of Ontario in a Chilean occupational hospital
目的 该研究描述了在智利圣地亚哥1所三级职业医院实施安大略省注册护士协会(Registered Nurses' Association of Ontario,RNAO)自杀预防最佳实践指南(Best Practice Guideline,BPG)的应用过程,并提供自杀行为的基线特征描述.方法 该研究为以知识转化行动(Knowledge-to-Action,KTA)框架为指导实施的横断面描述性研究.BPG的实施包括3个步骤:1)评估指南在该医院实施的实际情况;2)通过KTA循环的前4个阶段对RNAO自杀预防BPG的26条推荐意见进行适应性调整;3)采用2024年4月至2025年4月的数据描述自杀行为的基线特征.数据来源包括急诊就诊记录、住院记录、精神科联络会诊记录、患者安全报告以及员工培训记录.采用描述性统计对数据进行分析.结果 初步评估显示,该医院对RNAO自杀预防BPG推荐意见的依从性不一:9条完全达标,12条部分达标,4条未达标(另有1条不适用).情境分析揭示了个体、团队和组织层面的关键促进与阻碍因素,并确定了优先利益相关方.基于上述结果,制订了因地制宜的策略,包括流程标准化、员工培训、结构化转诊路径以及环境安全措施.调查数据显示,急诊就诊共7 936人次,其中577人次(7.3％)涉及自杀行为;在368例以精神健康问题为主要诊断的住院患者中,336例(91.3％)与自杀风险相关;精神科联络会诊在内外科病房记录为7例;患者安全报告识别出3起与自杀相关的警讯事件,均导致轻至中度伤害.结论 该实施研究表明,以KTA框架为指导的循证护理有助于实现自杀风险的标准化检测与管理.该研究初步描述了职业医疗环境中自杀行为的特征,并强调了因地制宜的策略、持续培训以及机构文化变革对于支持实施工作的重要性.
Objectives:We aimed to describe the implementation process and provide a baseline characterization of suicidal behavior during the first year of implementing the Registered Nurses' Association of Ontario(RNAO)Best Practice Guideline(BPG)for suicide prevention in a tertiary occupational hospital in Santiago,Chile. Methods:A cross-sectional descriptive study was guided by the Knowledge-to-Action(KTA)framework.The implementation process included:1)assessment of the local context;2)adaptation of 26 RNAO BPG recommendations through the first four phases of the KTA cycle;and 3)use of institutional data from April 2024 to April 2025 to establish a baseline of suicidal behavior.Data sources included Emergency Department(ED)consultations,hospital admissions,liaison psychiatry referrals,patient safety reports,and staff training records.Data were analyzed using descriptive statistics. Results:The preliminary assessment identified variable levels of compliance with the RNAO BPG rec-ommendations,with 9 fully met,12 partially met,and 4 unmet.Contextual analysis revealed key bar-riers and facilitators at the individual,team,and organizational levels,and identified priority stakeholders.Based on these findings,context-adapted strategies were developed,including protocol standardization,staff training,structured referral pathways,and environmental safety measures.Institutional data showed 7,936 ED consultations,of which 577(7.3％)involved suicidal behavior.Among 368 admitted patients with primary mental health diagnoses,336(91.3％)were linked to suicide risk.Liaison psychiatry documented 7 cases from medical-surgical wards,while patient safety records identified three suicide-related sentinel events associated with mild to moderate harm. Conclusions:Implementation demonstrated that evidence-based nursing,guided by the KTA frame-work,supports standardized detection and management of suicide risk.These findings provide an initial characterization of suicidal behavior in an occupational health setting and underscore the importance of context-adapted strategies,continuous training,and institutional cultural change to support implementation.
Daniela Godoy;Pamela Vidal;Francisca Abarca;Javiera Peña
循证实践实施科学健康护理质量改进自杀
Evidence-based practiceImplementation scienceHealth careQuality improvementSuicide
《国际护理科学（英文）》 2026 (3)
316-322,7
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