Department of Epidemiology and Preventive Medicine, Monash University, Australia.
Int J Nurs Stud. 2011 Jan;48(1):70-80. doi: 10.1016/j.ijnurstu.2010.05.018. Epub 2010 Jun 30.
Following recent reforms to Australia's health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide.
This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken.
The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters.
General practice settings in all regions of Australia.
108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting.
Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care.
The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3-41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9-59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1-92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8-39.1), followed by skin-related problems (20.0; 95% CI 17.3-22.8), and cardiovascular problems (11.0; 95% CI 8.7-13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving.
The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses' work. Whilst nurses' rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses' skills in the primary health care context.
澳大利亚医疗体系最近进行了改革，护士成为澳大利亚初级保健劳动力中重要且不断增长的一部分，但有关他们提供服务的资料却很少。
本研究旨在描述澳大利亚全科医疗中护士的患者就诊情况，包括患者特征、就诊原因、提供的治疗以及采取的其他措施。
这是一项全国性的横断面调查，每位参与的护士收集了 50 名护士-患者就诊的信息。
澳大利亚所有地区的全科医疗点。
对广告做出回应的 108 名护士中有 104 名完成了研究材料。参与者包括在全科医疗环境中工作的注册护士（1 级）和登记护士（2 级）。
数据收集于 2007 年 5 月至 2008 年 5 月间，采用情况简介问卷和一系列就诊记录表。收集的信息包括就诊原因、患者特征和所采取的措施。采用国际初级保健分类对数据进行分类。
最终数据集包括 5253 名护士-患者就诊。37.2%的患者（95%CI 33.3-41.2）年龄在 65 岁及以上，57.1%为女性（95%CI 54.9-59.5）。大多数就诊（90.7%）为医疗实践的现有患者（95%CI 89.1-92.7）。最常见的就诊原因是一般和未特指的问题（35.4/100 次就诊；95%CI 31.8-39.1），其次是皮肤相关问题（20.0；95%CI 17.3-22.8）和心血管问题（11.0；95%CI 8.7-13.3）。常见的管理措施包括体格检查（20.7/100 次就诊）、免疫接种（22.5）、诊断测试（10.6）和敷药（15.8）。约 30%的就诊涉及提供建议。
研究结果证实了全科护士角色的通科性质，涉及多种类型的患者和临床病症。当前的资金和组织安排对工作模式有明显影响，具有特定资金的任务（包括免疫接种和伤口护理）在护士工作中占据突出地位。虽然护士报告的疾病发生率与医生总体水平相似，但采取的具体措施和管理的问题不同。澳大利亚的新政策改革支持更大程度地发挥全科护士角色的灵活性，最大限度地提高护士在初级保健环境中技能的有效利用。
