1992年至2013年我国专科护士现状研究的文献分析

目的 探究我国在专科护士领域的研究现状,为培养和管理专科护理人才提供参考.方法 采用文献计量学方法,对收录在中国生物医学文献服务系统(SinoMed)、中文科技期刊数据库和中文科技期刊数据库中与专科护士有关的文献进行检索,对其文献数量、年度变化、文献类别、研究对象等进行分析.结果 共纳入符合标准的文献718篇,最早一篇为1992年综述类文献,而后文献数量逐年递增,文献以经验总结和综述类为主,ICU、手术室、急诊、糖尿病、肿瘤领域专科护士为研究热点.结论 我国关于专科护士的探索已在全国开展,但在定位、培训、认证、岗位管理等方面均缺少统一标准,亟待探索适合我国国情的专科护理人员发展之路.     

澳门社区专科护士培训的发展及反思

社区专科护士是医疗团队中的重要成员,在个人、家庭和社区健康促进、疾病预防的初级卫生保健服务中担当重要角色。该文旨在描述澳门特别行政区社区专科护士培训的起源和发展,分析现状,展望未来,并对社区专科护士培训提出建议。     

Community-based care in cystic fibrosis: role of the cystic fibrosis nurse specialist and implications for patients and families

Summary

Improved survival for cystic fibrosis has rapidly increased over the past four decades, with patients now living well into adult life. With changes in the structure of the National Health Service and the formation of provider units and general practitioner (GP) fund-holding practices, it is important to strengthen links between the hospital and community teams to ensure that the CF patient receives adequate care. Increasingly, treatment is being carried out at home, and this emphasis on home-based therapy demands that parents/carers and patients must acquire the skills and knowledge of complex therapies in order to optimize health. It is the role of the CF nurse specialist (NS) to educate those who will deliver the care, co-ordinate the provision of services at home, liaise with the CF team and community health-care professionals and to support the patient and their carers.     

The effectiveness of nurse-led care in people with rheumatoid arthritis: a systematic review

Objectives

The objective of this systematic review was to determine the effectiveness of nurse-led care in rheumatoid arthritis.

Design

Systematic review of effectiveness.

Data sources

Electronic databases (AMED, CENTRAL, CINAHL, EMBASE, HMIC, HTA, MEDLINE, NHEED, Ovid Nursing and PsycINFO) were searched from 1988 to January 2010 with no language restrictions. Inclusion criteria were: randomised controlled trials, nurse-led care being part of the intervention and including patients with RA.

Review methods

Data were extracted by one reviewer and checked by a second reviewer. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. For each outcome measure, the effect size was assessed using risk ratio or ratio of means (RoM) with corresponding 95% confidence intervals (CI) as appropriate. Where possible, data from similar outcomes were pooled in a meta-analysis.

Results

Seven records representing 4 RCTs with an overall low risk of bias (good quality) were included in the review. They included 431 patients and the interventions (nurse-led care vs usual care) lasted for 1-2 years. Most effect sizes of disease activity measures were inconclusive (DAS28 RoM = 0.96, 95%CI [0.90-1.02], P = 0.16; plasma viscosity RoM = 1 95%CI [0.8-1.26], p = 0.99) except the Ritchie Articular Index (RoM = 0.89, 95%CI [0.84-0.95], P < 0.001) which favoured nurse-led care. Results from some secondary outcomes (functional status, stiffness and coping with arthritis) were also inconclusive. Other outcomes (satisfaction and pain) displayed mixed results when assessed using different tools making them also inconclusive. Significant effects of nurse-led care were seen in quality of life (RAQoL RoM = 0.83, 95%CI [0.75-0.92], P < 0.001), patient knowledge (PKQ RoM = 4.39, 95%CI [3.35-5.72], P < 0.001) and fatigue (median difference = −330, P = 0.02).

Conclusions

The estimates of the primary outcome and most secondary outcomes showed no significant difference between nurse-led care and the usual care. While few outcomes favoured nurse-led care, there is insufficient evidence to conclude whether this is the case. More good quality RCTs of nurse-led care effectiveness in rheumatoid arthritis are required.     

老年患者护理需求与专科护士应对策略研究进展

随着我国老龄化社会的发展,越来越多的老年患者需要专科护士的护理.综述了老年患者的护理、健康教育和心理援助需求,并针对老年患者的护理需求,提出了老年专科护士的应对措施:即重视老年专科护士培养、普及老年护理教育、提供高质量的专业化指导、开展老年专科护理评估工具的研究,以满足老年患者多元化的护理需求,适应老龄化社会发展对专科护理的需求.

Abstract：

Accompanying with the development of our country's aging society, more and more elderly patients need the nursing of nurse specialism. This article reviewed the requirements of geriatric nursing care,health education and psychological aid. To aim directly at the nurse need of geriatric patients, suggest the coping intervention of the geriatric nurse specialism:reconstruct the cultivation of geriatric nurse specialism;popularize the health education of geriatric nursing;provide the high-quality professional instruction;carry out the research of geriatric special nursing evaluation instruments;so to satiate the varied nursing requirements and accommodate the requirements on nursing care accompanying with the progress of the aging society.     

Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264 health centres (91%) in Finland. The HT Guideline had been introduced into clinical practice in most health centres (89%). The style of implementation varied widely between health centres: at opposite ends of the implementation scale were 21 implementer health centres, which used multiple implementation channels, and 23 disseminator health centres, which used few or no implementation channels. The implementers had typically larger population bases and had organized services around the family doctor system, while the disseminators were smaller and had organized services according to a traditional model (appointments could be with any doctor in the surgery). CONCLUSION: The Finnish HT Guideline has become well known in most health centres since being introduced into clinical practice. However, the style of implementation varies markedly between health centres.     

The provision of critical care outreach services in England: findings from a national survey

PURPOSE: The aim of this study was to describe the development, introduction, implementation, and current models of critical care outreach services. MATERIALS AND METHODS: We conducted a national postal survey of National Health Service acute care hospitals in England that routinely provide care for level 1 patients (n = 239). RESULTS: Completed questionnaires were received from 191 (79.9%) hospitals; 139 (72.8%) had a formal critical care outreach service. A third (32.8%, 45/137) of services covered more than one hospital; 33.8% (45/133) of hospitals provided telephone advice 24 hours a day for 7 days per week, but less than 15% of hospitals offered follow-up or direct bedside clinical support on the same basis. There was wide variation in the proportion of hospital wards covered, the size and composition of the team, the aims of the service, and the balance between provision of direct care and advice. CONCLUSIONS: There are still a significant number of National Health Service acute care hospitals in England with no formal critical care outreach service. In addition, critical care outreach is being delivered in many different ways across the country, and thus means different things in different hospitals. The variation may reflect the lack of evidence as to which approaches are likely to be most effective.     

Breast care nursing in North Wales: an evaluation of breast care nursing from the perspective of practice nurses and district nurses

Background to the study: Breast care services for Wales have developed in response to government requirements that breast cancer care should be delivered only by specialist multi-disciplinary teams in cancer units treating at least 100 new breast cancer patients per year.Study aims: This paper presents the findings of the second stage of a three-stage study, which evaluated the North Wales Breast Care Nursing Service. The aim of this stage was to evaluate the breast care nursing service from the perspective of District Nurses and Practice Nurses.Methodological issues: A postal questionnaire was distributed to the total population of District Nursing Sisters (n=97) and Practice Nurses (n=243) within North Wales. The questionnaire comprised both open and closed items as well as a 15-item Likert Scale.Findings/conclusion: The study demonstrated the value of the BCNS, as perceived by two other community nursing disciplines within North Wales. The service was considered to be responsive, accessible and to offer support and advice for patients. Community nurses who were familiar with the BCNS service, or had used the service, considered BCNSs to have excellent clinical skills, on which they could draw as a resource. Nurses who were less familiar with the service considered that it should be promoted more effectively to community nurses. It is concluded that District Nurses could have a vital role in the care of women with breast cancer, but need support, advice and training from the BCNS service to enable them to provide a complementary role. This could ultimately enable BCNS time could be used more effectively.     

规范化培训模式在省级手术室专科护士培养中的实践及效果分析

目的：观察规范化教学及管理在省级手术室专科护士培训中的临床实践效果,建立并完善省级手术室专科护士培训的新模式。方法根据手术室的专科特点,进行问卷调研,运用德尔菲法设计与实施专科教学及管理方案,对手术室专科护士进行规范化培训。结果规范化培训模式实施后手术室专科护士的岗位胜任力和职业认可度显著提升,对培训的满意度明显提高。结论规范化培训模式的建立及应用对保证省级手术室专科护士的培训质量具有重要的意义。     

Developing palliative care practice in nursing and residential care homes: the role of the clinical nurse specialist

The development of practice is but one aspect of Clinical Nurse Specialists' (CNSs) work, and a number of factors act to shape the extent to which CNSs are able to work with and develop practice with nursing and residential care homes. A postal survey of 730 community CNSs in palliative care working in the UK was undertaken to explore the involvement of these nurses with nursing and residential care homes. Much of the focus of the involvement was reactive work meeting the direct clinical needs of residents, primarily with cancer. Although the CNSs perceived that there were some educational and care deficits in these care settings, the amount of proactive work undertaken to improve practice was limited. The development work undertaken was focused on educational initiatives and establishing link nurse systems. There is potential to develop palliative care practice in nursing and residential care homes through practice development initiatives.