McAiney Carrie A, Haughton Dilys, Jennings Jane, Farr Dave, Hillier Loretta, Morden Pat
Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Hamilton Family Health Team and Geriatric Psychiatry Service, St. Joseph's Healthcare Hamilton, CMHS, Hamilton, Ontario, Canada.
J Adv Nurs. 2008 Jun;62(5):562-71. doi: 10.1111/j.1365-2648.2008.04628.x.
This paper is a report of a study examining a practice model for Nurse Practitioners (NPs) working in long-term care (LTC) homes and its impact on staff confidence, preventing hospital admission, and promoting early hospital discharge.
The recent introduction of NPs in LTC homes in Ontario, Canada, provided an opportunity to explore unique practice models. In a pilot project, two full-time equivalent NPs provided primary care to a consortium of 22 homes serving approximately 2900 residents. The practice model was based on the specific needs of the homes and residents.
The NPs working in this project prospectively collected data (from July 2003 until June 2004) on their clinical activities and resident outcomes. Directors of Care (n = 18) of the participating homes completed a questionnaire (March 2004) assessing the impact on prevention of hospitalization and staff confidence.
The NPs had 2315 clinical contacts in the 1-year period; the majority (64%) were follow-up contacts. Many contacts were for uncomplicated medical problems or more complex but straightforward medical issues, and had positive outcomes. Hospital admission was prevented in 39-43% of cases. NPs had a positive impact on improving staff confidence, but no impact on facilitating early discharge from hospital.
Practice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.
本文报告一项关于在长期护理（LTC）机构工作的执业护士（NP）的执业模式及其对员工信心、预防住院和促进早期出院影响的研究。
加拿大安大略省近期在长期护理机构引入执业护士，为探索独特的执业模式提供了契机。在一个试点项目中，两名全职等效的执业护士为一个由22所机构组成的联盟提供初级护理，这些机构服务约2900名居民。该执业模式基于这些机构和居民的特定需求。
参与该项目的执业护士前瞻性收集（从2003年7月至2004年6月）其临床活动和居民结局的数据。参与机构的护理主任（n = 18）完成一份问卷（2004年3月），评估对预防住院和员工信心的影响。
在1年期间，执业护士有2315次临床接触；大多数（64%）是随访接触。许多接触是针对不复杂的医疗问题或更复杂但直接的医疗问题，且有积极结果。39% - 43%的病例预防了住院。执业护士对提高员工信心有积极影响，但对促进早期出院没有影响。
旨在满足长期护理机构和居民独特需求的执业模式可以提高护理质量，即使执业护士与居民的比例较低。关键利益相关者参与确定护理重点和规划有助于该模式的成功。
