急诊护士能否安全准确地为低风险成年创伤患者移除颈椎固定器：一项综合综述。
Can emergency nurses safely and accurately remove cervical spine collars in low risk adult trauma patients: An integrative review.
作者信息
Smith Nicola, Curtis Kate
机构信息
Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Emergency Department, St. Vincents Public Hospital, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia.
Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Trauma Service, St George Hospital, Gray St, Kogarah 2217, Australia.
出版信息
Australas Emerg Nurs J. 2016 May;19(2):63-74. doi: 10.1016/j.aenj.2016.01.003. Epub 2016 Mar 19.
BACKGROUND
Well validated clinical decision rules exist to facilitate the safe removal of collars in the alert, orientated, low risk adult trauma patient, however this practice is traditionally conducted by medical staff. The aim of this review is to synthesise current evidence to determine the efficacy of emergency nurses in safely and accurately removing cervical spine collars using cervical spine rules, in alert, orientated, low risk trauma adult patients.
METHODS
A multi-method search strategy was used to find primary research studies followed by a rigorous screening and quality appraisal process. Data from included articles were extracted, grouped and synthesised.
RESULTS
Nine quantitative research articles resulted in four key findings: the inter-rater reliability between nurses and doctors clearing the cervical spine was high (kappa range (0.61-0.80)); nurses can safely implement the cervical spine clinical decision rule; use of a cervical spine clinical decision rule decreases the time patients are immobilised and; nurses felt confident applying a cervical spine clinical decision rule.
CONCLUSION
Appropriately trained emergency nurses can safely apply cervical spine rules to alert, orientated, low risk adult trauma patients. Implementation of nurses clearing cervical spines should include training and ongoing monitoring.
背景
存在经过充分验证的临床决策规则，以促进在警觉、定向、低风险的成年创伤患者中安全移除颈托，然而这一操作传统上由医务人员进行。本综述的目的是综合现有证据，以确定急诊护士在使用颈椎规则安全、准确地为警觉、定向、低风险的成年创伤患者移除颈椎颈托方面的效果。
方法
采用多方法检索策略查找原始研究，随后进行严格的筛选和质量评估过程。提取、分组并综合纳入文章的数据。
结果
九篇定量研究文章得出了四个关键发现：护士与医生在颈椎检查方面的评分者间信度较高（kappa范围为0.61 - 0.80）；护士能够安全地实施颈椎临床决策规则；使用颈椎临床决策规则可减少患者固定的时间；护士对应用颈椎临床决策规则感到自信。
结论
经过适当培训的急诊护士能够安全地将颈椎规则应用于警觉、定向、低风险的成年创伤患者。护士进行颈椎检查的实施应包括培训和持续监测。
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