Goldie Catherine L, Prodan-Bhalla Natasha, Mackay Martha
School of Nursing, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3.
Can J Cardiovasc Nurs. 2012 Fall;22(4):8-15.
High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role.
To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital.
Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction.
Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p < or = 0.01), and had undergone more complicated surgical procedures (p < or =0.01). After discharge, more patients in the hospitalist-led group had visited their family doctor within a week (p < or =0.02) and measures of satisfaction relating to teaching, answering questions, listening and pain management were higher in the ACNP-led group.
CONCLUSION/IMPLICATIONS: Although challenges in recruitment yielded a lower than anticipated sample size, this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.
在加拿大心脏外科手术后的环境中，对急性护理执业护士（ACNP）的高需求超过了支持该角色的方法严谨的研究。
在加拿大一所大学附属的三级护理医院的心脏外科术后病房，比较由ACNP主导的护理与由住院医师主导的护理的效果。
计划进行紧急或择期冠状动脉搭桥和/或瓣膜手术的患者被随机分配到由ACNP主导的术后护理组（n = 22）或由住院医师主导的术后护理组（n = 81）。ACNP和住院医师均与心脏外科医生合作。结果变量包括住院时间、医院再入院率、术后并发症、随访预约的依从性、心脏康复的参与情况以及患者和医疗团队的满意度。
两组之间的基线人口统计学特征相似，但ACNP主导组中更多患者进行了紧急手术（p≤0.01），并且接受了更复杂的手术程序（p≤0.01）。出院后，住院医师主导组中更多患者在一周内拜访了他们的家庭医生（p≤0.02），并且在教学、回答问题、倾听和疼痛管理方面的满意度测量中，ACNP主导组更高。
结论/启示：尽管招募方面的挑战导致样本量低于预期，但本研究有助于我们了解ACNP在心脏外科术后护理中的作用。我们的研究结果支持ACNP在这种情况下的作用，因为接受ACNP护理的患者与住院医师主导的护理有相似的结果，并且在某些护理指标上报告了更高的满意度。
