Nursing School of Porto, CINTESIS, Porto, Portugal.
Nursing School of Porto, Porto, Portugal.
Int Nurs Rev. 2018 Mar;65(1):122-130. doi: 10.1111/inr.12366. Epub 2017 Mar 13.
To propose nursing clinical practice changes to improve the development of patient self-management.
Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates.
Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management.
A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis.
The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities.
The implemented changes have improved health-related behaviours and clinical outcomes.
To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours.
IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes.
提出护理临床实践的改变，以促进患者自我管理的发展。
慢性阻塞性肺疾病是导致慢性发病、生活质量下降和高死亡率的主要原因之一。
控制疾病的进展，保持自我护理的自主性，维持生活质量，对患者来说极具挑战性，难以在日常生活中执行。然而，仍然缺乏证据支持护理临床实践的改变，以促进自我管理的发展。
在葡萄牙一家医院的内科住院病房和门诊部门进行了参与式行动研究。样本包括 52 名护士和 99 名患者。为了收集数据，我们使用了访谈、参与式观察和内容分析。
确定需要改进措施的护理临床实践的主要要素是医疗模式、医疗保健组织和支持决策过程的文件记录。具体的指导方针、提供支持决策的材料以及优化专业人员之间的信息共享，对变革过程产生了积极的影响。这种变化改善了与“改变”意识、希望、参与、知识和能力相关的自我管理技能的发展。
实施的变革改善了与健康相关的行为和临床结果。
为了支持自我管理发展技能，需要进行有效的护理临床实践变革。本研究表明，需要一系列技术和工具来帮助患者采取健康行为，这对于改善护理质量和临床结果至关重要。
护士和患者参与政策变革的概念化、实施和评估是改善护理质量和临床结果的基本问题。
