Frank Wilhelm, Konta Brigitte, Prusa Nina, Raymann Cornelia
ARWIG - Arbeitskreis für wissenschaftliche Gesundheitsversorgung, Wien, Österreich.
GMS Health Technol Assess. 2006 Feb 22;2:Doc04.
The concept "intensified nursing" is mentioned in differentiation to concepts of "nursing care" or "nursing" which intensifies resources or patient contact. Especially psychic and social needs of patients are very appreciated in nursing. A similar type of nursing is known under the concept "advanced nursing practice" (ANP) which means, that a specialised, academically trained nurse offers an extended nursing care in which a focus on the published knowledge of evidence based research is made.From the thin literature to this topic a selection of predetermined topics was analysed where at least two articles with a sufficient high methodical quality were available. The selected topic groups were: "Infant and paediatric nursing", "gerontology" and "oncology". Generally the five publications concerning infant and paediatric nursing could conclusive show a benefit of intensified nursing. Further research is still needed to prove intensified nursing care. Two publications could be found to the gerontological intensified nursing; both used an extended nursing model and an enlarged use of resources. Both studies demonstrated a measurable success in the applied parameters. Two studies also could be analysed in the oncological field in which successes were also provable by the applied parameters. The success was given especially in a higher patient satisfaction, one study showed an improved scheduling (time planning) of nurses.There was not one article concerning economic questions of intensified nursing care. It has to be taken into account that the financial resources have to be used effectively also in nursing nowadays. It has to be assumed that the costs are driven by increased use of resources. Savings can be achieved, however, in the form of avoided therapies and days in hospital by intensified nursing. The intensified nursing can be considered as similar cost-effective as conventional models of nursing.Ethically it is necessary to consider that the possibilities of the intensified nursing should be exhausted as much as possible for the patients. The daily work is limited, due to restrictions of resource. This means a conflict for nurses between knowledge and the predefined resource requirements which often leaded to overtaxing and dissatisfaction. It is desirable that decision makers of the health policy appreciate the evidence and promote intensified nursing care models.Nursing science has to do special research to prove the meaning and effectiveness of intensified nursing and establish this in the health care delivery system.
“强化护理”这一概念是相对于“护理服务”或“护理”概念而言的，后者是指增加资源投入或加强与患者的接触。在护理工作中，患者的心理和社会需求尤其受到重视。一种类似的护理类型以“高级护理实践”（ANP）概念为人所知，这意味着一名经过专业学术培训的护士提供扩展护理服务，其中注重基于循证研究的已发表知识。从关于该主题的少量文献中，分析了一系列预先确定的主题，这些主题至少有两篇方法学质量足够高的文章可供参考。所选主题组包括：“婴幼儿及儿科护理”、“老年医学”和“肿瘤学”。总体而言，关于婴幼儿及儿科护理的五篇出版物能够确凿地表明强化护理的益处。仍需进一步研究以证实强化护理服务。可以找到两篇关于老年强化护理的出版物；两者都采用了扩展护理模式并增加了资源使用。两项研究在应用参数方面都显示出可衡量的成效。肿瘤学领域也有两项研究可以分析，其中成效同样可通过应用参数得到证明。成效尤其体现在患者满意度更高方面，一项研究显示护士的排班（时间规划）得到了改善。没有一篇文章涉及强化护理服务的经济问题。必须考虑到，如今在护理工作中也必须有效地利用财政资源。可以假定成本是由资源使用增加所驱动的。然而，通过强化护理，可以以避免治疗和缩短住院天数的形式实现节约。强化护理可被视为与传统护理模式具有相似的成本效益。在伦理上，有必要考虑应尽可能为患者充分利用强化护理的可能性。由于资源限制，日常工作是有限的。这意味着护士在知识与预先确定的资源需求之间存在冲突，这常常导致负担过重和不满。希望卫生政策的决策者重视这些证据并推广强化护理模式。护理科学必须进行专门研究，以证明强化护理的意义和有效性，并将其确立在医疗保健提供系统中。
