Ball Carol, McElligot Maura
Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK.
Intensive Crit Care Nurs. 2003 Aug;19(4):226-38. doi: 10.1016/s0964-3397(03)00054-5.
This study seeks to make evident the complexity of issues associated with the delivery of care by nurses to the critically ill. Emphasis had been placed on the results and implications of these for nursing practice. For a more in-depth account, the full report can be accessed on www.lscn.co.uk.
Following multi-centre research ethics committee approval, 10 critical care units participated in the 3-month study. Data collection comprised 231 nurse interviews and 51 relative interviews during 33 observation participation periods.
Analysis demonstrated that the context of the critical care unit, in terms of geographical layout, unit activity, case mix and skill mix of nurses, had a major effect on the ability of nurses to contribute to the recovery of the critically ill. The effectiveness of the nursing resource appeared to be a function of knowledge (theoretical and patient related), experience and exposure. Nurses who were unused to a particular environment were not seen to be as effective as those who were. A model was constructed that identified the central tenets upon which nursing care can be optimised or compromised. When nursing care was optimised the difference nurses made potentially decreased risk to patients, enabled timely patient progression and increased the potential for patient recovery.
The results confirm that nurses have a significant contribution to make in the recovery of patients who have experienced critical illness. Recommendations are far reaching and include the need to develop a valid and reliable tool which addresses patients' need for nursing in terms of nurses' knowledge and experience, patient dependency and decreasing clinical risk across the continuum of care. Current nursing workload tools and patient:nurse ratios were seen to lack validity because they do not appraise the context in which care is delivered, define all nurses as equal and concentrate on activity rather than the effect nurses can have on the outcome of the critically ill.
本研究旨在揭示护士为重症患者提供护理所涉及问题的复杂性。重点关注这些问题的结果及其对护理实践的影响。如需更深入了解，请访问www.lscn.co.uk查看完整报告。
在获得多中心研究伦理委员会批准后，10个重症监护病房参与了为期3个月的研究。数据收集包括在33个观察参与期内对231名护士的访谈和对51名亲属的访谈。
分析表明，重症监护病房的环境，包括地理布局、病房活动、病例组合以及护士的技能组合，对护士促进重症患者康复的能力有重大影响。护理资源的有效性似乎是知识（理论知识和与患者相关的知识）、经验和接触程度的函数。不习惯特定环境的护士不如习惯该环境的护士有效。构建了一个模型，确定了优化或损害护理的核心原则。当护理得到优化时，护士所产生的差异可能会降低患者风险，使患者能够及时康复，并增加患者康复的可能性。
结果证实护士对重症患者的康复有重大贡献。建议影响深远，包括需要开发一种有效且可靠的工具，该工具根据护士的知识和经验、患者的依赖程度以及在连续护理过程中降低临床风险的情况来满足患者对护理的需求。目前的护理工作量工具和患者与护士的比例被认为缺乏有效性，因为它们没有评估护理提供的背景，将所有护士视为平等，并且关注的是活动而非护士对重症患者结局的影响。
