进行与未进行特定医疗行为的伤口、造口及失禁护理护士工作模式的差异：一项多中心时间与动作研究
Differences in the working pattern among wound, ostomy, and continence nurses with and without conducting the specified medical act: a multicenter time and motion study.
作者信息
Sakai Yukie, Yokono Tomoe, Mizokami Yuko, Sanada Hiromi, Okuwa Mayumi, Nakatani Toshio, Sugama Junko
机构信息
Department of Clinical Nursing, Graduate Course of Nursing Science, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa-shi, Ishikawa 920-0942 Japan.
School of Health Sciences Faculty of Medicine, Nigata University, 2-746 Asahimaci-toori, Chuo-ku, Nigata 951-8518 Japan.
出版信息
BMC Nurs. 2016 Nov 29;15:69. doi: 10.1186/s12912-016-0191-1. eCollection 2016.
BACKGROUND
To overcome the shortage of medical care delivery in the rapidly aging Japanese society, the Ministry of Health, Labour and Welfare in 2010 started to train the nurses to be able to conduct the specified medical acts. The Japanese Nursing Association conducted the educational program to train the wound, ostomy, and continence nurses for the specified medical act of wound care. However, the difference between wound, ostomy, and continence nurses who conducted the medical act and those who did not was not clear. The aim of this study was to determine how trained wound, ostomy, and continence nurses spend their time during their entire shift in an acute hospital setting.
METHODS
In this prospective observational study, we selected those wound, ostomy, and continence nurses who received advanced training in the wound management program (T-WN) in 2011-2012. Wound, ostomy, and continence nurses who did not receive the training (N-WN) were also recruited as controls. We conducted a time and motion study during subject's day shifts for 1 week. We calculated the time spent on tasks based on a task classification code that was created to facilitate a two-group comparison.
RESULTS
Six T-WNs and five N-WNs were our analysis subjects. T-WNs spent significantly more time on direct care than did N-WNs ( = 0.00). Moreover, in the sub-categories s of direct care, T-WN spent significantly more time on "treatment" than did N-WN ( = 0.01). T-WN spent significantly more time on treatment with ( = 0.03) or without ( = 0.01) physicians than did N-WN. In the treatment activities, T-WN performed significantly more time on foot care ( = 0.01), wound cleansing ( = 0.01) and conservative sharp wound debridement ( = 0.01) than did N-WN. Frequencies of direct care interventions for the patients was significantly different between T-WN and N-WN ( = 0.04).
CONCLUSIONS
T-WNs frequently engaged in direct care provided treatment for patients with chronic wounds.
背景
为克服日本社会快速老龄化带来的医疗服务短缺问题，厚生劳动省于2010年开始培训护士以使其能够实施特定医疗行为。日本护士协会开展了教育项目，培训伤口、造口及失禁护理护士进行伤口护理这一特定医疗行为。然而，实施该医疗行为的伤口、造口及失禁护理护士与未实施的护士之间的差异并不明确。本研究的目的是确定经过培训的伤口、造口及失禁护理护士在急症医院环境中整个轮班期间是如何分配时间的。
方法
在这项前瞻性观察研究中，我们选取了那些在2011 - 2012年接受过伤口管理项目高级培训的伤口、造口及失禁护理护士（T - WN）。未接受培训的伤口、造口及失禁护理护士（N - WN）也被招募作为对照。我们在研究对象的日班期间进行了为期1周的时间动作研究。我们根据为便于两组比较而创建的任务分类代码计算在各项任务上花费的时间。
结果
6名T - WN和5名N - WN是我们的分析对象。T - WN在直接护理上花费的时间显著多于N - WN（P = 0.00）。此外，在直接护理的子类别中，T - WN在“治疗”上花费的时间显著多于N - WN（P = 0.01）。T - WN在有（P = 0.03）或没有（P = 0.01）医生在场的情况下进行治疗所花费的时间显著多于N - WN。在治疗活动中，T - WN在足部护理（P = 0.01）、伤口清洁（P = 0.01）和保守性锐器清创术（P = 0.01）上花费的时间显著多于N - WN。T - WN和N - WN对患者进行直接护理干预的频率存在显著差异（P = 0.04）。
结论
T - WN经常参与直接护理，为慢性伤口患者提供治疗。
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