Lyte Geraldine, Milnes Linda, Keating Peggy, Finke Arthur
School og Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, UK.
J Clin Nurs. 2007 Jul;16(7B):123-32. doi: 10.1111/j.1365-2702.2005.01542.x.
To present an overview of review management of childhood asthma in one UK primary care trust with respect to organization and perceptions of key stakeholders and children's and families' needs.
Review management of childhood asthma in primary care is important in addressing the continuing high levels of morbidity. However, the delivery of this service appears to be fragmented, so it is not known how well primary care asthma clinics function. Children's, parents' and professionals' perceptions of such clinics and the roles they play within them are also poorly understood.
A qualitative case study design was used in the study. This is a form of enquiry that investigates contemporary issues within their real life contexts, using particular situations within the case to describe important phenomena.
Eighteen children, 16 parents, 14 practice purses and 14 general practitioners from 14 general practices in one primary care trust were interviewed. Review appointments were observed and asthma-related documentation examined.
Key findings point to diversity in the service and that key stakeholders' view practice nurses as primarily responsible for the review management. However, there are issues related to their levels of responsibility, other health professionals' roles and interdisciplinary communication. Finally, families felt some of their needs were neglected and professionals reported uncertainties in providing family-centred care.
This case study indicates that responsibility for review consultations in childhood asthma needs to be formalized, including a more proactive and family-centred approach. There are implications for the practice nurse role regarding professional education and preparation for family-centred care.
This paper shows that unstructured, diverse care delivery persists in primary care; children and their families identify both strengths and unmet needs in review management visits; and professionals have uncertainties about providing effective child and family-centred care.
概述英国一个初级医疗信托机构中儿童哮喘复诊管理情况，涉及组织架构、关键利益相关者的看法以及儿童和家庭的需求。
初级医疗中儿童哮喘的复诊管理对于解决持续高发的发病率问题至关重要。然而，这项服务的提供似乎较为分散，因此并不清楚初级医疗哮喘诊所的运作情况。儿童、家长和专业人员对这类诊所及其在其中所扮演角色的看法也了解甚少。
本研究采用定性案例研究设计。这是一种调查形式，在现实生活背景中研究当代问题，利用案例中的具体情况来描述重要现象。
对来自一个初级医疗信托机构14家全科诊所的18名儿童、16名家长、14名执业护士和14名全科医生进行了访谈。观察了复诊预约情况，并检查了与哮喘相关的文件。
主要研究结果表明服务存在多样性，关键利益相关者认为执业护士主要负责复诊管理。然而，在他们的责任水平、其他健康专业人员的角色以及跨学科沟通方面存在问题。最后，家庭觉得他们的一些需求被忽视了，专业人员表示在提供以家庭为中心的护理方面存在不确定性。
本案例研究表明，儿童哮喘复诊咨询的责任需要明确，包括采用更积极主动和以家庭为中心的方法。这对执业护士在专业教育和以家庭为中心护理准备方面的角色有影响。
本文表明，初级医疗中无组织、多样化的护理提供方式仍然存在；儿童及其家庭在复诊管理就诊中既指出了优势也指出了未满足的需求；专业人员在提供有效的儿童和家庭中心护理方面存在不确定性。
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