Bear M, Holcomb L
School of Nursing, University of Central Florida, Orlando, USA.
Public Health Nurs. 1999 Apr;16(2):79-86. doi: 10.1046/j.1525-1446.1999.00079.x.
This descriptive correlational study investigated the reliability of a new measure of client-nurse practitioner interaction, the Client Encounter Form (CEF), and used the CEF to describe the domains of client-nurse practitioner interaction that occurred during problem and preventative visits at a primary care clinic. The CEF is based on Cox's Interactional Model of Client Health Behavior. Data were collected from a convenience sample of 41 primary care clinic visits. Descriptive data on all clients and the patterns of use characterized by the CEF were collected using retrospective chart review (n = 60). Reliability testing showed the CEF has high interrater reliability; Cohen's Kappas for its dimensions ranged from 0.78-1.0. The CEF was also shown to be useable in a primary care clinic. Health information, affective support, goal setting, and technical procedures were consistently part of the nurse-client interactions in this sample, demonstrating they are part of the nurse practitioner model of care. Analysis revealed different patterns of interaction for preventative and problem-oriented visits. Preventative visits had higher levels of health promotion information, psychological affective support, and health promotion goal-setting behaviors. Problem visits included more information regarding the client's diagnosis, medications, and treatments, and more affective support related to the client's physical condition.
这项描述性相关性研究调查了一种衡量医患互动的新工具——患者诊疗表单（CEF）的可靠性，并使用该表单描述了在初级保健诊所进行问题诊疗和预防性诊疗期间发生的医患互动领域。CEF基于考克斯的患者健康行为互动模型。数据收集自41次初级保健诊所诊疗的便利样本。通过回顾性病历审查（n = 60）收集了所有患者的描述性数据以及CEF所表征的使用模式。可靠性测试表明，CEF具有较高的评分者间信度；其各维度的科恩kappa系数范围为0.78至1.0。研究还表明，CEF可在初级保健诊所使用。在该样本中，健康信息、情感支持、目标设定和技术操作始终是医患互动的一部分，表明它们是执业护士护理模式的一部分。分析揭示了预防性诊疗和问题导向性诊疗的不同互动模式。预防性诊疗具有更高水平的健康促进信息、心理情感支持和健康促进目标设定行为。问题诊疗包括更多有关患者诊断、药物和治疗的信息，以及更多与患者身体状况相关的情感支持。
