Edwards Nancy, Davies Barbara, Ploeg Jenny, Virani Tazim, Skelly Jennifer
School of Nursing and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
BMC Nurs. 2007 Jun 28;6:4. doi: 10.1186/1472-6955-6-4.
Although referring patients to community services is important for optimum continuity of care, referrals between hospital and community sectors are often problematic. Nurses are well positioned to inform patients about referral resources. The objective of this study is to describe the impact of implementing six nursing best practice guidelines (BPGs) on nurses' familiarity with patient referral resources and referral practices.
A prospective before and after design was used. For each BPG topic, referral resources were identified. Information about these resources was presented at education sessions for nurses. Pre- and post-questionnaires were completed by a random sample of 257 nurses at 7 hospitals, 2 home visiting nursing services and 1 public health unit. Average response rates for pre- and post-implementation questionnaires were 71% and 54.2%, respectively. Chart audits were completed for three BPGs (n = 421 pre- and 332 post-implementation). Post-hospital discharge patient interviews were conducted for four BPGs (n = 152 pre- and 124 post-implementation).
There were statistically significant increases in nurses' familiarity with resources for all BPGs, and self-reported referrals to specific services for three guidelines. Higher rates of referrals were observed for services that were part of the organization where the nurses worked. There was almost a complete lack of referrals to Internet sources. No significant differences between pre- and post-implementation referrals rates were observed in the chart documentation or in patients' reports of referrals.
Implementing nursing BPGs, which included recommendations on patient referrals produced mixed results. Nurses' familiarity with referral resources does not necessarily change their referral practices. Nurses can play a vital role in initiating and supporting appropriate patient referrals. BPGs should include specific recommendations on effective referral processes and this information should be tailored to the community setting where implementation is taking place.
尽管将患者转介至社区服务对于实现最佳的护理连续性很重要，但医院和社区部门之间的转介往往存在问题。护士在告知患者转介资源方面具有良好的条件。本研究的目的是描述实施六项护理最佳实践指南（BPG）对护士熟悉患者转介资源及转介实践的影响。
采用前瞻性前后对照设计。针对每个BPG主题，确定转介资源。有关这些资源的信息在护士教育课程中进行了介绍。来自7家医院、2家上门护理服务机构和1家公共卫生单位的257名护士随机样本完成了实施前后的问卷调查。实施前和实施后问卷的平均回复率分别为71%和54.2%。对三项BPG进行了病历审核（实施前n = 421，实施后n = 332）。对四项BPG进行了出院后患者访谈（实施前n = 152，实施后n = 124）。
护士对所有BPG资源的熟悉程度均有统计学显著提高，并且有三项指南的自我报告转介至特定服务的情况有所增加。在护士工作所在机构的服务中观察到更高的转介率。几乎完全没有向互联网资源的转介。在病历记录或患者的转介报告中，实施前后的转介率没有显著差异。
实施包括患者转介建议的护理BPG产生了不同的结果。护士对转介资源的熟悉程度不一定会改变他们的转介实践。护士在启动和支持适当的患者转介方面可以发挥至关重要的作用。BPG应包括关于有效转介流程的具体建议，并且此信息应根据实施所在的社区环境进行调整。
