Glasson Janet, Chang Esther, Chenoweth Lynn, Hancock Karen, Hall Tracy, Hill-Murray Frances, Collier Lesley
School of Nursing, Family and Community Health, University of Western Sydney, Richmond, and Health and Ageing Research Unit, South Eastern Sydney Area Health Service, NSW, Australia.
J Clin Nurs. 2006 May;15(5):588-98. doi: 10.1111/j.1365-2702.2006.01371.x.
The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process.
One of the challenges of nursing today is to meet the health-care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided.
This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence-base for an evolving model of care.
The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self-care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients.
The participatory action research process resulted in improved heath-care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient-centred care relationship based on Orem's self-care model.
This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting.
This study is significant because of its evidence-base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the 'grass roots' level. Therefore, being involved in the decision-making process provided an incentive to actively implement change.
本研究的主要目的是通过采用参与式行动研究过程来开发、实施和评估一种新的护理模式，从而提高急性病住院老年内科患者的护理质量。
当今护理工作面临的挑战之一是满足日益增长的老年人口的医疗保健需求。如果护士要解决自身认知与老年患者认知之间的差距，并考虑适合老年患者护理的护理概念模型，以提高所提供护理的质量，那么思考护理质量对老年患者意味着什么就很重要。
本研究是一项混合方法三角验证研究，通过参与式行动研究方法同时运用定量和定性方法，为不断发展的护理模式建立证据基础。
该模式在60名年龄至少65岁的急性病患者身上进行了测试。内科病房护士挑选了一个关键参考小组，包括研究人员，以促进参与式行动研究过程，基于奥瑞姆自我护理模式并结合“护士改善对医疗系统中老年患者的护理”教员方案（《美国护理杂志》1994年；94:21）开发、实施和评估一种新的护理模式，以改善为急性病老年患者提供的护理。
参与式行动研究过程使患者的医疗保健结果得到改善，例如从入院到出院期间日常生活能力有显著提高，关于用药方案的知识水平有显著提高，以及老年患者和护理人员所感知的对护理活动的满意度增加。在护理模式中实施教育课程提高了老年患者出院前的功能活动和用药方案知识水平。此外，通过反复解释程序，护士更加关注其个体患者的护理，基于奥瑞姆自我护理模式建立了以患者为中心的护理关系。
本研究证明了一种新的护理模式在提高急性内科病房老年患者护理质量方面的有效性。
本研究具有重要意义，因为它有证据基础，并展示了参与式行动研究过程如何使护士能够对其实践做出可持续的改变。该研究中的护士希望影响变革。计划中的变革不是由管理层规定的，而是由基层临床护理人员推动的。因此，参与决策过程为积极实施变革提供了动力。
