Lewis Mary, Pontin David
Bath and North East Somerset Primary Care Trust.
Paediatr Nurs. 2008 Apr;20(3):18-22. doi: 10.7748/paed2008.04.20.3.18.c6516.
Little is known about the working practices of community children's nurses and how they manage the complexities of working with children and young people with life-limiting, life-threatening and chronic ill-health conditions and their families. This action research project aimed to find ways of managing community children's nursing caseloads that would improve the efficiency, effectiveness and equity of services and inform negotiations with service commissioners.
A data collection template comprising six input categories was adapted from the Cornwall Community Trust's health visitor weighting framework to reflect the complexity of need and the family focus of the service provided. Data were collected for one year by nurses in one integrated community children's nursing and clinical psychology service in the Southwest of England. Qualitative interviews were held with the nurses to further explore patterns identified in the input data.
From the documentary analysis and the interviews it was possible to identify a typical ratio of client numbers in each category which allowed the nurses to be proactive in meeting children's and families' assessed needs. The numbers of clients on caseloads fluctuated over time and varied between geographical caseload areas. The type of work carried out by individual nurses varied depending on the type of contract for their locale. However, by weighting the clients in each category it was possible to arrive at a means of meaningful comparison in terms of family centred nursing.
The nursing input framework supports monthly caseload monitoring by community children's nurses and informs reports to the service commissioners as part of activity monitoring data. The mechanism will be tested in comparable services in the UK to gauge its transferability.
对于社区儿童护士的工作实践，以及他们如何应对身患危及生命、慢性疾病的儿童及其家庭的复杂情况，我们知之甚少。本行动研究项目旨在探寻管理社区儿童护理工作量的方法，以提高服务的效率、效果和公平性，并为与服务专员的谈判提供信息。
从康沃尔社区信托的健康访视员加权框架改编而来的一个包含六个输入类别的数据收集模板，以反映需求的复杂性和所提供服务以家庭为中心的特点。英格兰西南部一个综合社区儿童护理与临床心理学服务机构的护士收集了一年的数据。对护士进行了定性访谈，以进一步探讨输入数据中发现的模式。
通过文献分析和访谈，可以确定每个类别中客户数量的典型比例，这使护士能够积极主动地满足儿童及其家庭已评估的需求。工作量中的客户数量随时间波动，且在不同地理区域的工作量之间存在差异。个别护士开展的工作类型因所在地区的合同类型而异。然而，通过对每个类别中的客户进行加权，可以得出一种以家庭为中心的护理方面有意义的比较方式。
护理投入框架支持社区儿童护士每月对工作量进行监测，并作为活动监测数据的一部分为向服务专员的报告提供信息。该机制将在英国类似服务中进行测试，以评估其可转移性。
