Booth Joanne, Hillier Valerie F, Waters Karen R, Davidson Ian
Caledonian Nursing and Midwifery Research Centre, Glasgow Caledonian University, Glasgow, UK.
J Adv Nurs. 2005 Mar;49(5):465-73. doi: 10.1111/j.1365-2648.2004.03319.x.
This paper reports a study which aimed to explore the effects of education on the practice of nurses working in stroke rehabilitation units.
It has been suggested that a key component of the success of stroke units in reducing mortality and disability is the contribution made by nurses, but debate continues around their specific role. Literature has concentrated on nurses' perceptions of their role rather than their actual activities with patients. In studying the effects of education on nurses' practice with stroke patients there is a need to identify what nurses actually do, rather than what they say they do.
A quasi-experimental, non-equivalent control group design was used to study two stroke rehabilitation units. Non-participant observation was conducted during morning care sessions, focusing on styles of physical interaction. Base-line observations were recorded in each unit, after which the staff in the intervention unit received 7 hours' education, specifically focused on therapeutic handling in relation to morning care activities. Following this, postintervention observations were conducted and comparisons of interaction styles made between units.
Twenty-six staff and 37 patients took part in the study. Following the education, staff in the intervention unit showed a change in physical interaction style more in line with therapeutic practice, with the proportion of 'doing for' interventions reducing (45.4% vs. 33.2%; P < 0.05). The proportion of facilitatory interventions increased (3.9% vs. 6.1%) however, this difference was not statistically significant (P = 0.098). The change in styles of practice was achieved with no increased demand on nurses' time.
Education for nurses which aims to change styles of interaction with stroke patients can be effective. However, further research is required to identify the effect of nursing interventions on patient outcomes following stroke.
本文报告了一项旨在探讨教育对在中风康复单元工作的护士实践的影响的研究。
有人认为，中风单元在降低死亡率和残疾率方面取得成功的一个关键因素是护士所做的贡献，但围绕他们的具体角色仍存在争议。文献集中在护士对其角色的认知上，而非他们与患者的实际活动。在研究教育对护士护理中风患者实践的影响时，有必要确定护士实际做了什么，而非他们声称自己做了什么。
采用准实验性、非等效对照组设计对两个中风康复单元进行研究。在晨间护理时段进行非参与式观察，重点关注身体互动方式。在每个单元记录基线观察结果，之后干预单元的工作人员接受了7小时的教育，特别侧重于与晨间护理活动相关的治疗性操作。在此之后，进行干预后观察，并对各单元之间的互动方式进行比较。
26名工作人员和37名患者参与了该研究。教育之后，干预单元的工作人员在身体互动方式上出现了更符合治疗实践的变化，“为患者做”的干预比例降低（45.4%对33.2%；P<0.05）。促进性干预的比例有所增加（3.9%对6.1%），然而，这种差异无统计学意义（P=0.098）。实践方式的改变在未增加护士工作时间需求的情况下实现。
旨在改变与中风患者互动方式的护士教育可能是有效的。然而，需要进一步研究以确定护理干预对中风后患者结局的影响。
