乌干达穆拉戈医院的姑息治疗联络护士项目：一项采用混合方法的评估
A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods.
作者信息
Downing Julia, Batuli Mwazi, Kivumbi Grace, Kabahweza Josephine, Grant Liz, Murray Scott A, Namukwaya Elizabeth, Leng Mhoira
机构信息
Makerere University, PO Box 7757, Kampala, Uganda.
Makerere Palliative Care Unit, PO Box 7757, Kampala, Uganda.
出版信息
BMC Palliat Care. 2016 Apr 8;15:40. doi: 10.1186/s12904-016-0115-6.
BACKGROUND
Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46% of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96% had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit -MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital
METHODS
An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews.
RESULTS
A significant difference was seen in nurses' confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86%) and referred 334 (14%) to MPCU. Clinical guidelines/protocols were utilised in 50% of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013).
CONCLUSION
The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.
背景
整合姑息治疗（PC）并增强医护人员的能力对于实现普遍获得PC服务至关重要。2010年，乌干达穆拉戈医院46%的患者患有危及生命的疾病，其中96%有PC需求。大学/医院专科PC单元（马凯雷雷/穆拉戈姑息治疗单元-MPCU）实施了联络护士模式，以增强医院护士提供全科PC的能力。在两年多的时间里，培训并指导了27名联络护士，制定了11项临床协议。该研究的目的是评估穆拉戈医院姑息治疗联络护士项目的影响。
方法
采用了一种利用混合方法的评估方法，整合了定性和定量数据，包括：课程前后评估信心评级；课程评估表；临床指南可用性审计；联络护士活动表/行动计划审查；MPCU患者文件审查；最显著变化（MSC）；个人和焦点小组访谈。
结果
培训后护士的信心有显著差异（p<0.001）。从2012年7月到2013年12月，联络护士识别出2447名需要PC的患者，其中他们照顾了2113名（86%），并将334名（14%）转诊至MPCU。50%的病房使用了临床指南/协议。确定的主要主题包括：态度改变；发展新技能和知识；关系改变；护理结果改善，以及他们在整合PC过程中遇到的挑战。自该项目启动以来，医院诊治的PC患者有所增加（2011年为611例，2013年为1788例）。
结论
联络护士项目是将PC整合到全科服务中的一种实用模式。已就该项目的持续发展和扩展提出建议，作为在类似医疗环境中加强卫生系统的有效方法，以及改善医学和护理教育。
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