Persoon Anke, Banningh Liesbeth Joosten-Weyn, van de Vrie Wim, Olde Rikkert Marcel G M, van Achterberg Theo
Department of Geriatrics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
J Clin Nurs. 2009 Jul;18(13):1930-6. doi: 10.1111/j.1365-2702.2009.02811.x.
Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock.
To evaluate why and how geriatric nurses observe the cognitive functioning of their patients.
Survey.
A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis.
The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%).
Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect.
This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarily to develop a validated observation scale.
护士对患者认知功能进行每日观察具有很高的生态效度，因为认知功能是在自然环境中全天候进行观察的。
评估老年护理人员观察患者认知功能的原因及方式。
调查。
对七家急症医院老年病房的护士进行有目的抽样，使用自行编制的问卷。问题为开放式。通过内容分析法对数据进行分析。
97名护士完成了问卷（回复率77%）。对护士报告的众多目的进行分类后发现四个主题：调整护理干预措施（51%）、确定出院安排（46%）、支持医学诊断和治疗（43%）以及描绘功能能力的具体要素（34%）。护士们还报告了许多不同的观察领域（众数为2；范围为0至7），其中只有73%是实际的认知领域。最常提及的认知领域是精神运动行为（63%），其次是执行功能（48%）、语言（37%）、注意力（33%）、思维（25%）和意识（20%）。
老年护理人员不仅每日观察患者的认知功能以支持医学诊断，还用于指导护理干预措施及确定出院安排。评估领域差异较大，因为参与者对认知功能概念的理解模糊、不完整且常常不正确。
这是第一项调查老年护理人员每日观察患者认知功能原因的研究。此外，我们还探究了他们对认知功能概念的理解。基于评估内容由其目的决定这一事实，进行每日观察的目的必须明确且清晰表述。为了以明确无误的方式观察患者，有必要制定一个经过验证的观察量表。
