Optimizacija oskrbe pacientov v onkološki zdravstveni negi na podlagi McGillovega sodelovalnega modela Optimising patient care in oncology nursing using the McGill Model of Nursing

Abstract

Izhodišča: McGillov model zdravstvene nege je celostni, sodelovalni pristop, ki poudarja aktivno vlogo pacienta, vključevanje bližnjih in krepitev psihosocialne podpore. Kljub uveljavljenosti v mednarodnem prostoru njegova uporaba v slovenski klinični praksi še ni bila raziskana. Namen raziskave je bil ovrednotiti, v kolikšni meri medicinske sestre na področju onkološke zdravstvene nege uporabljajo pristope McGillovega modela, ki vključujejo sodelovanje pacientov, vključevanje družinskih članov in krepitev psihosocialne podpore.
Metode: V kvantitativni presečni raziskavi je bilo k sodelovanju povabljenih približno 400 medicinskih sester, zaposlenih na področju onkološke zdravstvene nege. Vprašalnik je pričelo izpolnjevati 166 oseb, od tega ga je popolnoma izpolnilo 126 (odzivnost 31,5 % glede na populacijo medicinskih sester zaposlenih na področju onkološke zdravstvene nege). Večina anketirancev je bila ženskega spola (77,8 %). Povprečna starost anketirancev je bila 37,71 leta (s = 8,07) s povprečno delovno dobo na področju onkološke zdravstvene nege 9,66 leta (s = 7,93). Analiza je temeljila le na popolnoma rešenih vprašalnikih. Podatke smo zbrali z novo razvito lestvico, ki temelji na McGillovem sodelovalnem modelu. Anketiranci so trditve ocenjevali na petstopenjski lestvici, ki meri pogostost izvajanja pristopov ali stopnjo strinjanja z izjavo. Izvedli smo eksploratorno in konfirmatorno faktorsko analizo, Wilcoxonove in Mann–Whitneyjeve teste ter Spearmanovo korelacijo.
Rezultati: Faktorska analiza je potrdila tri konstrukte, ki pojasnjujejo 65,3 % skupne variance (KMO = 0,896; Bartlett p < 0,001). Empirične mediane vseh treh konstruktov so bile statistično značilno višje od teoretičnih (p < 0,001), kar pomeni, da so anketiranci poročali o uporabi pristopov McGillovega modela. Anketiranci z dostopom do pisnih protokolov ali organizacijsko podporo so dosegali višje rezultate (p < 0,001). Ugotovljene so bile zmerne do visoke pozitivne korelacije med uporabo pristopov in zaznavo izboljšanja oskrbe ter psihosocialnega stanja onkoloških pacientov (p < 0,001).
Zaključek: Rezultati potrjujejo, da se v onkološki zdravstveni negi pogosto uporabljajo pristopi McGillovega modela, kar pozitivno sovpada z zaznanim izboljšanjem kakovosti oskrbe. Model ima potencial za širšo in bolj formalizirano implementacijo v klinično prakso.

Abstract (Eng)

Background: The McGill Model of Nursing is a holistic, collaborative approach that emphasises the active role of the patient, the involvement of the family and the strengthening of psychosocial support. Although it has been established in the international literature, its implementation in Slovenian clinical practise has not yet been systematically investigated. The aim of this study was to investigate the extent to which oncology nurses apply the principles of the McGill Model, including patient participation, family involvement and psychosocial support.
Methods: Approximately 400 nurses working in the field of oncology nursing were invited to participate in this quantitative cross-sectional study. A total of 166 began the questionnaire and 126 completed it in full (response rate 31.5 %). Most of the respondents were female (77.8 %). Their mean age was 37.71 years (s = 8.07), with a mean length of professional experience in oncology nursing of 9.66 years (s = 7.93). The analysis was based solely on fully completed questionnaires. Data was collected using a newly developed scale based on the McGill Model of Nursing and on a five-point frequency and agreement scale. Exploratory and confirmatory factor analyses were performed, as well as Wilcoxon signed-rank tests, Mann-Whitney U tests and Spearman correlations.
Results: The factor analysis confirmed a three-factor structure explaining 65.3% of the total variance (KMO = 0.896; Bartlett’s p < 0.001). The empirical medians of all three constructs were significantly higher than the theoretical medians (p < 0.001), suggesting that respondents indicated the use of McGill Model approaches. Participants with access to written protocols or organisational support scored significantly higher (p < 0.001). Moderate to strong positive correlations were found between the use of these approaches and the perceived improvement in the quality of care and the psychosocial well-being of patients (p < 0.001).
Conclusion: The results confirm that approaches based on the McGill Model are commonly used in oncological care and are positively associated with perceived improvements in quality of care. This model has the potential for wider and more formalised implementation in the clinical setting in Slovenia.