Analysis Of Current Situation And Demand Of Cardiovascular Nurses' Palrticipation In Anticoagulation Management For Atrial Fibrillation

BackgroundThrombosis associated with atrial fibrillation(AF)results in severe dysfunction and high mortality,which brought critical risks to patients with AF.Anticoagulation becomes a core strategy for stroke prevention associated with AF.However,anticoagulation is prone to cause serious medication errors.Other factors will significantly affect the anticoagulant effect and increase the risk of bleeding,such as individual differences in drug metabolism and drug interactions.In China,patients have insufficient education.The anticoagulant therapy is somehow underused.As a huge medical resource,nurses play an indispensable role in the management of a professional team,but they still did not play a major part.The knowledge of nurses,demands of risk assessment and clinical decision were not well reported.Objectives1.To investigate the knowledge,attitudes and clinical practice of nurses toward anticoagulation management.2.To explore the behavioral changing process and demands of nurses,pvoviding decision-making for managers to promote the anticoagulation management.Methods1.Quantitative study:Nurses in the cardiovascular departments of seven tertiary hospitals in two districts of Guangdong Province were selected by a convenient sampling.A cross-sectional web-based survey was carried out by using a self-designed questionnaire including the general information and the k:nowledge-attitude-practice survey in anticoagulation management for AF.Researcher made an online questionnaire and coordinated with every head nurse in the cardiovascular departments.Those head nurses explained the purpose and methods of the survey to get the informed consent of the nurses,and then distributed the online questionnaire to Wechat groups.2.Qualitati-ve study:The Grounded theory method by Corbin&Stauss was performed.Nurses in the cardiovascular department of the certain tertiary hospital were selected,and nurses graded by N1-N4 were finally chose by the open,axial and selective sampling.Semi-structured interview outlines were used to conduct in-depth interviews.Analysis started with the first data by the open,axial and selective coding in order to analyze the behavioral changing process and demands of nurses in anticoagulation management for AF.Results1.Quantitative study:A total of 150 respondents were included.The median and quartile score of knowledge is 4(2-5),which showed a statistically significant with age,education,title and work experience.Title was the influencing factor with knowledge.The median and quartile score of the attitudes is 17(14-20),which showed a statistically significant with age.Age was the influencing factor with attitudes.In clinical practice,61.3%of the respondents were reported to provide medication instruction,10.7%of the respondents to persist on following up and 18.7%of the respondents to participate in clinical decision-making.2.Qualitative study:A total of 8 nurses graded by N1-N4 were interviewed.In the positive process of behavioral changing in anticoagulation management,self-refection was tracked through all the periods as follows:recognition basis,consciousness awaken and behavior remodeling.With the promotion of emotional experience and intrinsic value,nurses' demands in the three periods are the job responsibility,workflow and cultural belief,respectively.ConclusionsThis study shows poor knowledge and good attitudes related to anticoagulation management for AF among nurses.Their practice remained to be improved.The demands of job responsibility,workflow and cultural belief should be evaluated and satisfied to promote the anticoagulation management for AF.An individual behavior-based approach to education is needed in clinical practice.