Vetter-Smith Molly, Lemaster Joseph, Olsberg Joshua, Kruse Robin, Day Tamara, Mehr David
University of Missouri, Columbia 65211, USA.
West J Nurs Res. 2012 Dec;34(8):1023-42. doi: 10.1177/0193945911436106. Epub 2012 Feb 6.
This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.
本研究考察了护士搭档在五家农村基层医疗诊所提供糖尿病自我管理（DSM）支持的作用及效果。每家诊所配备两至九名医疗服务提供者和一名护士搭档；除一家诊所外，其余诊所的护士均为执业护士（LPN）。通过对医疗服务提供者的访谈以及对患者互动的观察，评估护士的角色、诊所流程及沟通模式。运用沉浸 - 结晶法，三个主要主题解释了护士搭档角色的差异：医疗服务提供者的“把关人”角色、诊所工作流程中时间和空间的压缩，以及护士的教育背景和经验。虽然护士的教育和经验很重要，但在一些诊所，医疗服务提供者通过有针对性的沟通以及投入时间和空间，促进护士参与DSM支持，从而最有效地将DSM支持融入其实践中。一些量化指标有所改善；尤其是糖化血红蛋白水平和患者血糖测量频率。研究结果为在基层医疗诊所利用护士提供DSM支持提供了指导。
