Clinical Development Units (Nursing): the western Sydney approach

On 24 September 1997 Western Sydney Area Health Service and the University of Western Sydney, Nepean (Australia) launched a network of nine Clinical Development Units (Nursing). The approach taken towards the development of CDU(N)s in western Sydney differs substantially from those taken elsewhere in terms of preparation for CDU(N) leadership and the role of CDU(N) criteria in the designation ('accreditation') process. The rationale underpinning the western Sydney approach, together with details of a leadership preparation programme, are discussed.     

美国临床护士进阶制度的启示

本文通过介绍美国临床护士进阶制度专业化、高层次、重能力等方面的特点及意义,对我国临床护士发展的途径提出了建议:①设置专科岗位;②强化继续教育;③建立核心能力的标准指标;④探索适合我国国情的护理人力资源配置管理模式。     

Measuring the quality of judgement and decision-making in nursing

AIM: This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice. DISCUSSION: Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed. CONCLUSION: We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory.     

Availability and development of guidelines in a tertiary teaching hospital

OBJECTIVE: The purpose of this study was to review existing guidelines in clinical departments and describe their characteristics, development and implementation at a large teaching hospital in Sydney, Australia. METHODS: The study was undertaken in two stages. First, from September to November 2005, we reviewed and classified documents from eight departments as clinical practice guidelines (CPGs), clinical procedural protocols (technology and technique) or administrative guidelines. We also collected information about the scope, format and target user of the guidelines. Second, from March to June 2006, we interviewed department staff in seven of eight participating departments about the guidelines' development and implementation. A revised Appraisal of Guidelines Research and Evaluation questionnaire was used to collect data in both stages. RESULTS: A total of 368 of 509 documents reviewed were classified as CPGs. Almost 90% of the CPGs had five or fewer pages; nearly 80% had no references; and 90% had no application tools. The CPGs had been developed locally by each individual department. The departments used various methods to collect evidence. In six (albeit a different six departments in each case) of seven departments, clinicians' clinical experience was used in the analysis of the evidence; informal expert consensus was used for formulating recommendations; internal peer review was the major method used to review the guidelines (after drafting); hard copy of guidelines was the major medium used; and provision of educational material was the major implementation strategy. CONCLUSIONS: There was great variation in the number, availability and presentation of guidelines in the departments. There was a lack of standardized methods and narrow skills representation during guideline development.     

Organisation of a clinical trial unit — a proposal

Summary— The urgent need for the performance of more, better designed, and better conducted randomised clinical trials is increasingly recognised. Based on structured interviews with leading persons of 43 outstanding organisations and units involved in clinical trials in Europe and North America during 1993, ways of organising and staffing clinical trial units were investigated. The present proposal is based on this experience from which an attempt to extract a composite set of minimal requirements has been made regarding pertinent objectives and aims, organisational aspects, staffing, and estimated costs of establishing a clinical trial unit. The core staff is suggested to consist of two chief physicians, one statistician, one data manager, one project coordinator, and two secretaries. In order to fulfil the minimal requirements for running such a unit, it is calculated that about GBP 450,000 per year is needed to cover investments, core staff, and running costs, but excluding housing costs and costs of randomised clinical trials that do not originate from trial coordination. In return, such a unit should be able to mount and launch 6–7 multicenter randomised clinical trials during a 5 year period, corresponding to a total cost for coordination per trial of about GBP 340,000. However, with a larger staff more studies may be coordinated possibly reducing the cost per trial depending on greater effectiveness in utilisation of the basic facilities.     

临床药师参与脑梗死临床路径的效果

目的评价临床药师参与脑梗死临床路径管理的临床效果。方法将90例脑梗死患者随机分为观察组和对照组2组,每组45例。对照组采用常规脑梗死的临床管理方法,观察组采用临床药师参与的临床路径管理方法。比较2组的住院时间、住院费用;治疗12d后对2组患者进行神经功能缺损程度评分。结果与对照组相比,观察组住院时间明显缩短（P〈0.05）,住院费用明显降低（P〈0.05）。治疗12d后,观察组神经功能缺损程度分级与对照组比较,差异无统计学意义（P〉0.05）。结论临床药师参与临床路径管理能够显著缩短脑梗死患者住院时间、降低住院费用。     

Pragmatics in the Issuing of Sticks and Frames

This paper describes the shift in clinical practice from one where walking aids are issued on the basis of the patients' medical condition, to one where the aids are issued on the basis of the function they need to fulfil.It defines some of the conditions under which exceptions to the ‘traditional’ practice in terms of the type of walking aid issued and the height of the aid become acceptable.Its purpose is to challenge physiotherapists across a wide range of specialties and grades to question the basis on which they issue aids. It does this through the use of succinct clinical examples from current practice.It does not suggest that the approach taken is necessarily the right one, rather it describes an approach which many physiotherapists do take. As the approach suggested is different from what is frequently taught in the colleges of physiotherapy it is expected that the paper will provoke a lively debate which will be as much concerned about physiotherapists' beliefs as it will about what constitutes good practice.     

临床路径教学模式在临床教学管理中的应用及体会

目的总结临床教学路径的实施及管理过程,全面提高护理本科生的临床带教质量。方法运用临床路径的先进工作模式,规范教学内容,严格时间管理,注重流程质量控制,重视实习目标管理。结果经过实践证明,临床教学满意度呈上升趋势。结论临床教学路径的应用,提高了整体带教能力,使护理教学质量管理得以持续改进。