Goodman H C, Perrin E C
Nurs Res. 1978 Jul-Aug;27(4):233-7.
History-taking, disposition, and telephone communication skills of pediatric nurse practitioners, pediatric house officers, and practicing pediatricians were assessed and compared. To evaluate the management of five common acute pediatric problems, a "programmed mother" made 148 unidentified calls to these health professionals during evening hours. The calls were tape recorded, and scored for history-taking, disposition, and interviewing skills. The scoring system, developed by a panel of 11 experts, assessed the relevance and completeness of each history obtained. Nurse practitioners averaged 79.6 percent of the total possible score, as compared to 52.6 percent for pediatricians (p less than .001). When disposition was similarly analyzed, the nurse practitioners scored significantly higher than pediatricians. Analyzing only those items of history-taking and disposition deemed most critical by the panel, nurse practitioners included 91 percent and pediatricians only 55 percent (p less than .001). Parameters of interviewing skill were scored by the interviewer and each author with agreement of 80 percent or above; nurse practitioners obtained significantly higher scores than pediatricians (p less than .001). Calls handled by nurses averaged 7.4 minutes, those by pediatricians 3.2 minutes (p less than .001). Nurse practitioners, it was concluded, can safely and effectively share responsibility with physicians for night and weekend telephone call coverage for a pediatric practice with adequate physician back up.
对儿科执业护士、儿科住院医生和执业儿科医生的病史采集、病情处理及电话沟通技巧进行了评估和比较。为评估对五种常见小儿急性病症的处理，一名“模拟母亲”在夜间向这些医疗专业人员拨打了148次未透露身份的电话。通话进行了录音，并对病史采集、病情处理及问诊技巧进行评分。由11名专家组成的小组制定的评分系统，评估了所获取的每份病史的相关性和完整性。执业护士平均得分占总分的79.6%，而儿科医生为52.6%（p小于0.001）。对病情处理进行类似分析时，执业护士的得分显著高于儿科医生。仅分析小组认为最关键的那些病史采集和病情处理项目时，执业护士涵盖了91%，而儿科医生仅涵盖55%（p小于0.001）。问诊技巧参数由面试官和每位作者评分，一致性达80%或以上；执业护士的得分显著高于儿科医生（p小于0.001）。护士处理的电话平均时长为7.4分钟，儿科医生处理的为3.2分钟（p小于0.001）。得出的结论是，在有足够医生支持的情况下，执业护士可以安全有效地与医生共同承担儿科诊所夜间和周末电话值班的责任。
