Hoffman Leslie A, Happ Mary Beth, Scharfenberg Carmella, DiVirgilio-Thomas Dana, Tasota Frederick J
University of Pittsburgh School of Nursing, Pittsburgh, Pa., USA.
Am J Crit Care. 2004 Nov;13(6):480-8.
Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.
To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.
Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses).
Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for "long-stay" patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners' continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols.
Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner's role as medically oriented, the themes reflect a clear nursing focus.
关于急症护理执业护士在重症监护环境中对医疗管理团队贡献的信息有限。
从医学、呼吸治疗和护理这三个学科的角度，探讨急症护理执业护士对重症患者医疗管理的贡献。
邀请两个重症监护病房的主治医生、呼吸治疗师和护士列出急症护理执业护士提供的协作护理的3个优点和3个缺点。采用定性方法（编码/持续比较分析）来确定共同主题和子主题。总体回复率为35%（主治医生为69%，护士为26%）。
回复被归纳为4个主要主题：可及性、能力/知识、护理协调/沟通和系统问题。急症护理执业护士因其可及性、在患者日常管理方面的专业知识以及满足患者/家属需求的能力而受到重视，尤其是对于“长期住院”患者。此外，他们因致力于提供优质护理以及沟通技巧而受到尊重，这体现在对护理人员的教学、患者/家属的参与以及撤机方案的熟练运用上。医生重视急症护理执业护士护理的连续性、以患者/家属为中心以及敬业精神。护士重视他们的可及性、敬业精神以及以患者/家属为中心。呼吸治疗师重视他们的可及性、敬业精神以及在实施撤机方案方面的一致性。
回复反映了急症护理执业护士作为重症监护环境中医疗管理团队成员的独特优势。尽管人们认为急症护理执业护士的角色以医疗为导向，但这些主题反映出明显的护理重点。
