La Trobe University, Melbourne and Faculty of Health and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
J Clin Nurs. 2009 Dec;18(23):3225-36. doi: 10.1111/j.1365-2702.2009.02914.x. Epub 2009 Sep 4.
To determine activities and outcomes of intensive care unit Liaison Nurse/Outreach services. The review comprised two stages: (1) integrative review of qualitative and quantitative studies examining intensive care liaison/outreach services in the UK and Australia and (2) meta-synthesis using the Nursing Role Effectiveness Model as an a priori model.
Acute ward patients are at risk of adverse events and patients recovering from critical illness are vulnerable to deterioration. Proactive and reactive strategies have been implemented to facilitate timely identification of patients at risk.
Systematic review.
A range of data bases was searched from 2000-2008. Studies were eligible for review if they included adults in any setting where intensive care unit Liaison Nurse or Outreach services were provided. From 1423 citations and 65 abstracts, 20 studies met the inclusion criteria.
Intensive care liaison/outreach services had a beneficial impact on intensive care mortality, hospital mortality, unplanned intensive care admissions/re-admissions, discharge delay and rates of adverse events. A range of research methods were used; however, it was not possible to conclude unequivocally that the intensive care liaison/outreach service had resulted in improved outcomes. The major unmeasured benefit across all studies was improved communication pathways between critical care and ward staff. Outcomes for nurses in the form of improved confidence, knowledge and critical care skills were identified in qualitative studies but not measured.
The varied nature of the intensive care liaison/outreach services reviewed in these studies suggests that they should be treated as bundled interventions, delivering a treatment package of care. Further studies should examine the impact of critical care support on the confidence and skills of ward nurses.
Advanced nursing roles can improve outcomes for patients who are vulnerable to deterioration. The Nursing Role Effectiveness Model provides a useful framework for evaluating the impact of these roles.
确定重症监护病房联络护士/外展服务的活动和结果。审查包括两个阶段：（1）对英国和澳大利亚重症监护联络/外展服务的定性和定量研究进行综合审查，（2）使用护理角色有效性模型作为先验模型进行元综合。
急性病房患者有发生不良事件的风险，从危重病中恢复的患者容易恶化。已经实施了主动和被动策略来促进及时识别有风险的患者。
系统综述。
从 2000 年至 2008 年，搜索了一系列数据库。如果研究包括任何提供重症监护病房联络护士或外展服务的环境中的成年人，则符合审查标准。从 1423 条引文和 65 个摘要中，有 20 项研究符合纳入标准。
重症监护联络/外展服务对重症监护死亡率、医院死亡率、非计划性重症监护入院/再入院、出院延迟和不良事件发生率有有益影响。使用了各种研究方法；然而，不能明确得出重症监护联络/外展服务导致改善结果的结论。所有研究中最重要的未测量益处是改善了重症监护和病房工作人员之间的沟通途径。定性研究中确定了护士在信心、知识和重症护理技能方面的改善，但未进行测量。
这些研究中审查的重症监护联络/外展服务的性质多种多样，这表明它们应被视为捆绑干预措施，提供一套护理治疗方案。进一步的研究应该检查重症监护支持对病房护士的信心和技能的影响。
高级护理角色可以改善易恶化患者的结局。护理角色有效性模型为评估这些角色的影响提供了一个有用的框架。
