City University London, London, UK.
Int J Older People Nurs. 2010 Jun;5(2):116-27. doi: 10.1111/j.1748-3743.2010.00217.x.
This research sought to illuminate the distinct contributions made by Registered Nurses (RNs) and Care Assistants (CAs) to outcomes for older people in UK (nursing) care homes and to identify the outcomes of their work. This paper reports on aspects relevant to RNs.
Older people living in long-term residential care settings around the world are among the most vulnerable individuals within their communities and those with the most complex needs. Nursing has historically been fundamental in the delivery of these services but, in some countries, the role of Registered Nurses in residential care is coming under increasing scrutiny, particularly in the context of escalating costs and funding restrictions, a questioning of the need for a 24-hour 'health' professional presence in a 'social care' service and a lack of evidence on the distinct contribution that RNs make to outcomes in these settings.
A multi-method qualitative interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer (2003).
For Phase 1 of the study, RNs and CAs from care homes around the UK contributed examples of their work, which they identified as having made a 'significant' difference to older individuals. Phase 2 comprised researcher fieldwork (observations, interviews and documentary analysis) in three care homes around UK. Research participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes.
RN roles in care homes are broad and multifaceted. Distinct outcomes of RN work are consequent to their caring and their knowledge and skills developed through broad experience in a range of healthcare settings. Outcomes for residents from RN work include enhanced personhood and wellbeing, improved health and function, the prevention of problems/adverse outcomes and enhanced quality of life. RN outcomes have positive impact on relatives, staff and the homes in general.
There is potential to reconsider the broad, 'anything and everything' nature of the RN role in care homes identified in the research. However, given the complex healthcare needs of the current resident population, the 24-hour RN presence is deemed essential.
本研究旨在阐明英国（护理）养老院中注册护士（RNs）和护理助理（CAs）对老年人结果的独特贡献，并确定他们工作的结果。本文报告了与注册护士相关的方面。
生活在世界各地长期居住的老年人是社区中最脆弱的人群之一，也是最需要照顾的人群。护理在提供这些服务方面一直是至关重要的，但在一些国家，注册护士在养老院的角色越来越受到关注，尤其是在成本不断攀升和资金限制的情况下，对 24 小时“专业医疗”人员在“社会护理”服务中的必要性提出了质疑，以及对注册护士在这些环境中对结果的独特贡献缺乏证据。
采用多方法定性解释方法，采用结构-过程-结果框架，并以汉斯-格奥尔格·加达默尔（Hans-Georg Gadamer）的哲学解释学为基础（2003 年）。
在研究的第一阶段，英国各地养老院的 RNs 和 CAs 提供了他们认为对老年人有“显著”影响的工作示例。第二阶段包括在英国的三个养老院进行研究人员实地考察（观察、访谈和文献分析）。研究参与者包括 RNs、CAs、老年居民、亲属、家庭经理和在家庭中工作的专业人员。
养老院的 RN 角色广泛而多方面。RN 工作的独特结果是由于他们的关怀以及他们在各种医疗保健环境中积累的广泛经验所发展的知识和技能而来的。RN 工作对居民的结果包括增强的人格和幸福感、改善的健康和功能、预防问题/不良结果以及提高生活质量。RN 的结果对亲属、工作人员和整个家庭都有积极的影响。
有可能重新考虑研究中确定的养老院中 RN 角色的广泛的“无所不包”性质。然而，考虑到当前居民人口的复杂医疗需求，24 小时 RN 存在被认为是必不可少的。
