Wright Stella, McSherry Wilfred
NISCHR CRC North Wales Research Network, Abergele, Conwy.
J Clin Nurs. 2014 Jul;23(13-14):1866-76. doi: 10.1111/jocn.12435. Epub 2013 Dec 6.
To demonstrate how a national programme aimed to increase the amount of direct time nurses spend with patients', impacts on both staff and patient experience.
The Productive Ward is an improvement programme developed by the NHS Institute for Innovation and Improvement (2007, http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html) which aims to enable nurses to work more efficiently by reviewing process and practice, thus releasing more time to spend on direct patient care. However, there is little empirical published research around the programme, particularly concerning impact, sustainability and the patient perspective.
This manuscript presents the findings from qualitative interviews involving both staff and patients.
Semi-structured one-to-one interviews were conducted with patients (n = 8) and staff (n = 5) on five case study wards. Seven focus groups were held according to staff grade (n = 29).
Despite initial scepticism, most staff embraced the opportunity and demonstrated genuine enthusiasm and energy for the programme. Patients were generally complimentary about their experience as an inpatient, reporting that staff made them feel safe, comfortable and cared for.
Findings showed that the aims of the programme were partially met. The implementation of Productive Ward was associated with significant changes to the ward environment and improvements for staff. The programme equipped staff with skills and knowledge which acted as a primer for subsequent interventions. However, there was a lack of evidence to demonstrate that Productive Ward released time for direct patient care in all areas that implemented the programme.
Developing robust performance indicators including a system to capture reinvestment of direct care time would enable frontline staff to demonstrate impact of the programme. Additionally, staff will need to ensure that reorganisation and instability across the NHS do not affect sustainability and viability of the Productive Ward in the long term.
展示一项旨在增加护士与患者直接相处时间的全国性计划如何对员工和患者体验产生影响。
“高效病房”是英国国家医疗服务体系创新与改进研究所开发的一项改进计划（2007年，http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html），其目的是通过审查流程和实践，使护士能够更高效地工作，从而腾出更多时间用于直接的患者护理。然而，关于该计划的实证研究发表较少，尤其是在影响、可持续性和患者视角方面。
本手稿展示了对员工和患者进行定性访谈的结果。
在五个案例研究病房对患者（n = 8）和员工（n = 5）进行了半结构化一对一访谈。根据员工级别举行了七个焦点小组（n = 29）。
尽管最初存在怀疑，但大多数员工抓住了这个机会，并对该计划表现出真正的热情和活力。患者总体上对住院体验表示满意，称工作人员让他们感到安全、舒适且得到了照顾。
结果表明该计划的目标部分实现。“高效病房”的实施与病房环境的重大变化以及员工状况的改善相关。该计划为员工提供了技能和知识，为后续干预奠定了基础。然而，缺乏证据表明“高效病房”在所有实施该计划的领域都腾出了时间用于直接的患者护理。
制定强有力的绩效指标，包括一个记录直接护理时间再投资的系统，将使一线员工能够证明该计划产生的影响。此外，员工需要确保英国国家医疗服务体系的重组和不稳定不会长期影响“高效病房”的可持续性和可行性。
