Dwyer Trudy, Craswell Alison, Rossi Dolene, Holzberger Darren
Central Queensland University, Building 18 Rockhampton, Bruce Highway, Rockhampton, Q, 4702, Australia.
School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q, 4556, Australia.
BMC Health Serv Res. 2017 Jan 13;17(1):33. doi: 10.1186/s12913-017-1977-x.
Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.
Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.
Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.
This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.
减少老年护理机构（ACF）居民可避免的住院情况，能够改善居民体验及其健康结局。因此，多种形式的避免住院（HA）项目不断发展。在老年护理方面具备专业知识的执业护士（NP）有潜力为避免住院项目做出独特贡献。然而，对于该模式的服务评估以及所提供护理的质量，人们关注较少。本研究的目的是评估澳大利亚某地区一项HA服务中，老年护理NP护理模式的质量。
应用唐纳贝迪安的结构、过程和结果框架来评估NP护理模式的质量。澳大利亚执业护士研究中用于评估NP护理模式的标准化访谈提纲，指导了对九名健康专业人员（包括ACF护士、医生和专职医疗人员）、四名ACF居民及其家属以及两名NP的半结构化访谈。与唐纳贝迪安框架一致的理论驱动编码，指导了访谈数据的分析和结果呈现。
确定的结构维度包括HA服务的“内部延伸”性质、距离、专业监管的局限性以及住院护理模式。这些维度影响了将居民转介给NP的过程、NP的及时响应以及与其他专业人员的互动。NP花时间与居民建立联系、启动协作护理计划、提升老年护理人员技能以及充当专业内和专业间的协调者等过程，都促成了优质结果。本研究中的优质结果包括及时干预、避免住院、及时返家、与居民和家属合作（了解他们的需求）以及居民和健康专业人员的满意度。
本研究为老年护理HA服务中NP护理模式的贡献，以及工作人员如何操控过程维度以改善向NP的转介，提供了宝贵见解。本研究中的NP服务具有动态性、灵活性，能响应患者和组织的需求。
