Research Centre for Clinical and Community Practice Innovation, Griffith University and Princess Alexandra Hospital, Australia.
Int J Nurs Stud. 2011 Aug;48(8):918-25. doi: 10.1016/j.ijnurstu.2010.10.004. Epub 2010 Nov 16.
Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported.
To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction.
Pre-test post-test 2 group comparative design.
Two intensive care units in tertiary teaching hospitals in Australia.
A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units.
Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression.
Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p<0.05).
Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability.
先前已证实影响患者护理的因素包括有效决策、团队合作、循证实践、人员配备和工作满意度。临床查房有可能优化这些因素并影响患者结局，但重症监护护士并未采用这种策略。
确定在重症监护环境中实施护理查房对患者护理计划的影响，以及护士对实践环境和工作满意度的看法。
测试前-测试后 2 组比较设计。
澳大利亚 2 家教学医院的 2 个重症监护病房。
参与研究的重症监护病房全职或兼职注册护士（n=244）。
要求参与重症监护病房的护士在实施常规护理查房的 12 个月期间之前和之后填写护理环境量表-护理工作指数（PES-NWI）和护理工作生活满意度量表（NWSS）。描述并分类护理查房期间提出的问题。总结样本特征和量表评分，使用 t 检验分析连续变量，使用卡方检验分析分类变量，比较干预前后评分的差异。使用多元线性回归确定 PES-NWI 的独立预测因素。
护理查房共启动了 171 例患者的 577 项护理计划变更，这些变更与患者的身体、心理-个体、心理-家庭或专业护理方面有关。在研究期间，参与研究的 2 个单位的总 PES-NWI 和 NWSS 评分在干预前后相似。在研究期间，干预病房的 NWSS 护士间互动子量表评分提高（干预前：4.85±0.93；干预后：5.36±0.89，p=0.002），对照组无显著增加。与较高的 PES-NWI 独立相关的因素包括干预地点和在重症监护病房工作年限较短（p<0.05）。
在重症监护环境中实施护理查房是可行的，是启动患者护理变更的有效策略。需要在其他环境中应用和测试该策略，包括确定评估影响的最合适方法，以确定其可推广性。
