Pound P, Ebrahim S
Department of Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, London, UK.
Soc Sci Med. 2000 Nov;51(10):1437-46. doi: 10.1016/s0277-9536(00)00040-x.
The aim of this study was to identify aspects of the process of care that might help explain the improved outcomes associated with stroke units. Three different care settings for stroke patients, an elderly care unit and general medical ward in an inner-city teaching hospital and a stroke unit in another teaching hospital in the same city, were compared using non-participant observational methods. Nurses on the stroke unit and general medical ward usually engaged in standardised and functional interaction with patients, while nurses on the elderly care unit were observed to adopt a more personal and attentive approach with patients. Rehabilitation nursing was rarely observed on the stroke unit, never on the general medical ward but always on the elderly care unit. There was evidence of effective communication between nurses and therapists on the elderly care unit but this was not observed on the stroke unit. On the elderly care unit the team appeared divided, with therapists and nurses on one side and medicine on the other, while on the stroke unit the divide was between doctors and therapists on one hand and nurses the other. On the general medical ward there was no team working. The observed lack of rehabilitation nursing, nurses' disengagement from the team and nurses' observed lack of warmth towards patients on the stroke unit were all surprising findings. Further research needs to examine whether such findings would be reproduced in stroke units elsewhere. If so, it might be that the better outcomes achieved on stroke units are despite rather than because of the nursing they receive there.
本研究的目的是确定护理过程中的一些方面，这些方面可能有助于解释与卒中单元相关的改善结果。使用非参与性观察方法，对卒中患者的三种不同护理环境进行了比较，一种是市中心教学医院的老年护理单元和普通内科病房，另一种是同一城市另一家教学医院的卒中单元。卒中单元和普通内科病房的护士通常与患者进行标准化和功能性互动，而老年护理单元的护士则被观察到对患者采取更个性化和贴心的方法。在卒中单元很少观察到康复护理，在普通内科病房从未观察到，但在老年护理单元总是能观察到。有证据表明老年护理单元的护士与治疗师之间沟通有效，但在卒中单元未观察到这一点。在老年护理单元，团队似乎存在分歧，治疗师和护士一方，医生另一方，而在卒中单元，分歧存在于医生和治疗师一方与护士另一方之间。在普通内科病房没有团队协作。在卒中单元观察到缺乏康复护理、护士与团队脱节以及护士对患者缺乏热情，这些都是令人惊讶的发现。进一步的研究需要考察这些发现在其他地方的卒中单元是否会重现。如果是这样，那么卒中单元取得更好的结果可能是尽管而非因为那里提供的护理。
