Olsson Lars-Eric, Karlsson Jón, Ekman Inger
Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, and Orthopaedic Department, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
J Adv Nurs. 2007 Apr;58(2):116-25. doi: 10.1111/j.1365-2648.2007.04209.x.
This paper reports a study to evaluate the contribution of nursing care within an integrated care pathway for patients with hip fracture.
There is growing interest in quality assurance in health care. Integrated care pathways are a method to achieve this goal, and are a multi-professional team approach where the requirement for nurses to work effectively within the team is important. However, the nurses' role and contribution within the team have not been well described.
A quasi-experimental, prospective study comparing an intervention group with a comparison group was carried out. One hundred and twelve independently living patients, aged 65 years or older and admitted to a Swedish hospital with a hip fracture, were consecutively selected. Pathological fracture and severe intellectual impairment (Pfeiffer's test <3 points) served as exclusion criteria. The intervention was designed to focus on patients' motivation and their prerequisites for rehabilitation and was based on the concept of transition. The main outcome measure was the number of patients restored to preoperative activities of daily living levels in 2003-2004.
In the intervention group 21% were restored to activities of daily living to level A (independent) at discharge, whereas only 5% in the comparison group were restored to this level. No patients in the intervention group, admitted as independent, remained at activities of daily living level F (dependent), whereas 16% remained at level F in the comparison group (P=0 x 003).
When admitting older patients with a hip fracture, it is important to acquire good knowledge about each patient and their prerequisites and to offer them accelerated rehabilitation in accordance with their individual ability. By monitoring process indicators during the transition, serious deviations from the care plan can be avoided.
本文报告一项研究，以评估护理在髋部骨折患者综合护理路径中的作用。
医疗保健领域对质量保证的兴趣日益浓厚。综合护理路径是实现这一目标的一种方法，它采用多专业团队协作方式，护士在团队中有效工作的要求至关重要。然而，护士在团队中的角色和贡献尚未得到充分描述。
开展了一项准实验性前瞻性研究，将干预组与对照组进行比较。连续选取了112名65岁及以上、因髋部骨折入住瑞典一家医院且独立生活的患者。病理性骨折和严重智力障碍（ Pfeiffer测试<3分）作为排除标准。干预措施旨在关注患者的康复动机及其康复前提条件，并基于过渡概念设计。主要结局指标是2003 - 2004年恢复到术前日常生活活动水平的患者数量。
干预组中21%的患者在出院时恢复到日常生活活动A水平（独立），而对照组中只有5%的患者恢复到该水平。干预组中以独立状态入院的患者在出院时无一人停留在日常生活活动F水平（依赖），而对照组中有16%的患者停留在F水平（P = 0.003）。
收治老年髋部骨折患者时，了解每位患者及其康复前提条件并根据其个人能力为他们提供加速康复很重要。通过在过渡过程中监测过程指标，可以避免严重偏离护理计划的情况。
