Desborough Jane, Banfield Michelle, Phillips Christine, Mills Jane
Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia.
National Institute for Mental Health Research, Australian National University, Canberra, Australia.
J Adv Nurs. 2017 May;73(5):1085-1096. doi: 10.1111/jan.13199. Epub 2016 Nov 30.
The aim of this study was to gain insight into the process of patient enablement in general practice nursing consultations.
Enhanced roles for general practice nurses may benefit patients through a range of mechanisms, one of which may be increasing patient enablement. In studies with general practitioners enhanced patient enablement has been associated with increases in self-efficacy and skill development.
This study used a constructivist grounded theory design.
In-depth interviews were conducted with 16 general practice nurses and 23 patients from 21 general practices between September 2013 - March 2014. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling focussing on the process and outcomes of patient enablement. Use of the storyline technique supported theoretical coding and integration of the data into a theoretical model.
A clearly defined social process that fostered and optimised patient enablement was constructed. The theory of 'developing enabling healthcare partnerships between nurses and patients in general practice' incorporates three stages: triggering enabling healthcare partnerships, tailoring care and the manifestation of patient enablement. Patient enablement was evidenced through: 1. Patients' understanding of their unique healthcare requirements informing their health seeking behaviours and choices; 2. Patients taking an increased lead in their partnership with a nurse and seeking choices in their care and 3. Patients getting health care that reflected their needs, preferences and goals.
This theoretical model is in line with a patient-centred model of health care and is particularly suited to patients with chronic disease.
本研究旨在深入了解全科护理咨询中患者赋能的过程。
全科护士角色的强化可能通过一系列机制使患者受益，其中之一可能是增强患者赋能。在针对全科医生的研究中，增强患者赋能与自我效能感和技能发展的提升相关。
本研究采用建构主义扎根理论设计。
2013年9月至2014年3月期间，对来自21家全科诊所的16名全科护士和23名患者进行了深入访谈。使用持续比较分析和理论抽样同时进行数据生成与分析，重点关注患者赋能的过程和结果。运用故事情节技术支持理论编码并将数据整合到理论模型中。
构建了一个明确界定的促进和优化患者赋能的社会过程。“在全科医疗中发展护士与患者之间赋能型医疗伙伴关系”的理论包含三个阶段：触发赋能型医疗伙伴关系、量身定制护理以及患者赋能的体现。患者赋能通过以下方面得以证明：1. 患者对自身独特医疗需求的理解，为其求医行为和选择提供依据；2. 患者在与护士的伙伴关系中发挥更大主导作用，并在护理中寻求选择；3. 患者获得反映其需求、偏好和目标的医疗服务。
该理论模型符合以患者为中心的医疗模式，尤其适用于慢性病患者。
