由护士主导的诊所对冠状动脉搭桥术后患者的安全性和有效性。
Safety and efficacy of a nurse-led clinic for post-operative coronary artery bypass grafting patients.
作者信息
Broers Carla, Hogeling-Koopman Jeanne, Burgersdijk Cees, Cornel Jan H, van der Ploeg J, Umans Victor A
机构信息
Department of Cardiology, Medical Center Alkmaar, PO Box 1800, 1815 JD Alkmaar, The Netherlands.
出版信息
Int J Cardiol. 2006 Jan 4;106(1):111-5. doi: 10.1016/j.ijcard.2005.03.009.
BACKGROUND
New opportunities are emerging for nurses as sovereign health care specialists. In accordance with British and American experience, several universities on the European Continent started Advance Nursing Practice programs for nurses to become certified nurse specialists, functioning as intermediates between the consultant, the ward nurse and the patient.
AIMS
This observational study was conducted to evaluate safety and efficacy of a nurse-led clinic for patients recovering after a successful coronary artery bypass grafting operation.
METHODS
From April 1999 to June 2002, 584 consecutive patients underwent a coronary artery bypass graft operation after which they were admitted to the cardiology ward. Subsequently, these patients were treated either by a certified nurse practitioner or by a resident. Both were supervised by an attending cardiologist. The study elapses three time phases: phase I (1999) first control period, phase II (2000-2002) the nurse practitioner was in charge, and phase III (2002) the second control period.
RESULTS
A total of 584 patients were admitted at a mean of 5.5 and 6.3 days after the operation (phase II vs I+III, respectively). Typically these patients were men (79%) with a mean age of 67+/-11 years. During the observation period, 349 patients were treated by the nurse practitioner and 235 by a resident (89 in phase I and 146 in phase III). Two patients suddenly died while admitted. All other patients recovered and were discharged. The nurse-treated patients (phase II) were discharged significantly sooner than those treated by the regular staff (11.5 vs 14.7 days; p<0.001, respectively). The 30-day mortality rate was 0.4% and did not differ between the respective patient or time-phase groups.
CONCLUSION
A nurse-led clinic for patients recovering from a coronary artery bypass graft operation was safely and efficaciously introduced in a large Dutch non-cardiac surgery hospital. This study protocol may serve as a preamble for upcoming nurse-led programs to developed and implement the sovereign care by nurse practitioners for various diseases and in different settings.
背景
护士作为自主的医疗保健专家，新的机遇正在涌现。根据英美经验，欧洲大陆的几所大学启动了高级护理实践项目，以使护士成为认证护士专家，充当顾问、病房护士和患者之间的中间人。
目的
本观察性研究旨在评估由护士主导的诊所对冠状动脉搭桥手术成功后康复患者的安全性和有效性。
方法
1999年4月至2002年6月，584例连续患者接受冠状动脉搭桥手术后入住心脏病病房。随后，这些患者由认证护士从业者或住院医生治疗。两者均由主治心脏病专家监督。研究历经三个阶段：第一阶段（1999年）为首个对照期，第二阶段（2000 - 2002年）由护士从业者负责，第三阶段（2002年）为第二个对照期。
结果
总共584例患者分别在术后平均5.5天和6.3天入院（分别为第二阶段与第一阶段 + 第三阶段）。这些患者通常为男性（79%），平均年龄67±11岁。在观察期内，349例患者由护士从业者治疗，235例由住院医生治疗（第一阶段89例，第三阶段146例）。两名患者在住院期间突然死亡。所有其他患者康复并出院。由护士治疗的患者（第二阶段）出院时间明显早于常规医护人员治疗的患者（分别为11.5天和14.7天；p<0.001）。30天死亡率为0.4%，各患者组或时间段组之间无差异。
结论
在一家大型荷兰非心脏外科医院中，安全有效地引入了由护士主导的针对冠状动脉搭桥手术康复患者的诊所。本研究方案可为即将开展的由护士主导的项目提供序言，以便护士从业者在不同疾病和不同环境中开展和实施自主护理。
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