School of Nursing, Midwifery and Social Care, Edinburgh Napier University, UK.
J Adv Nurs. 2011 Jul;67(7):1558-67. doi: 10.1111/j.1365-2648.2010.05589.x. Epub 2011 Feb 18.
To investigate how one aspect of anticipatory care is understood and delivered in practice. 'Anticipatory care' in this context can be understood as proactive care, which is oriented towards prevention of adverse events.
Scotland has identified the intention to move away from a preoccupation with acute care and invest in health improvement and anticipatory care. Community nurses are the key, yet little is known about how they understand and deliver anticipatory care.
A qualitative case study design using individual in-depth interviews (n=10), observation (n=9) and focus groups (n=5) was selected. Five focus group interviews were carried out with district nurses, practice nurses and health visitors. Subsequently, nine observation events took place, each focused on a single nurse/client encounter. Data were collected during 2008 and 2009 in one Community Health Partnership in Scotland.
Two approaches to anticipatory care emerged; these were influenced by participants' roles and responsibilities. Approach 1 derives from Government policy agenda and is focused on protocol-focused management of long-term illness. Approach 2 is synonymous with long-standing nursing activity focused on holistic care of individual patients. Both approaches are proactive in nature.
There is scope to develop a more conceptually complex model of anticipatory care, building on this initial exploration, within which all aims, roles, practices and methods of evaluation can be located and clearly visible. This offers the potential to enable practitioners to interpret and apply policy--otherwise change may be limited and result in service gaps.
探讨预期护理的一个方面在实践中是如何被理解和实施的。在这种情况下，“预期护理”可以理解为主动护理，旨在预防不良事件。
苏格兰已确定意图摆脱对急性护理的关注，投资于健康改善和预期护理。社区护士是关键，但对于他们如何理解和提供预期护理知之甚少。
选择了定性案例研究设计，包括个人深入访谈（n=10）、观察（n=9）和焦点小组（n=5）。与地区护士、执业护士和健康访问者进行了五次焦点小组访谈。随后，进行了九次观察活动，每次都集中在一名护士/患者的单次接触上。数据于 2008 年至 2009 年在苏格兰的一个社区卫生合作组织中收集。
出现了两种预期护理方法；这些方法受到参与者角色和责任的影响。方法 1 源自政府政策议程，侧重于长期疾病的基于协议的管理。方法 2 与长期护理活动同义，侧重于个体患者的整体护理。这两种方法都具有前瞻性。
在这一初步探索的基础上，可以进一步发展一种更具概念复杂性的预期护理模型，在此模型中，可以定位和清晰地看到所有目标、角色、实践和评估方法。这为从业者提供了一种解释和应用政策的潜力，否则可能会限制变化并导致服务差距。
