Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Harold's Cross, Dublin 6w, Ireland.
School of Nursing & Midwifery, Trinity College Dublin, Ireland.
Int J Nurs Stud. 2018 Jan;77:115-129. doi: 10.1016/j.ijnurstu.2017.09.005. Epub 2017 Sep 12.
Although rheumatology nursing has been shown to be effective in managing patients with rheumatoid arthritis, patient outcomes sensitive to nursing interventions (nursing sensitive outcomes) have not been systematically studied.
The objective of this study was to identify and delineate relevant patient outcomes measured in studies that reported nursing interventions in patients with rheumatoid arthritis.
A systematic search was conducted from 1990 to 2016. Inclusion criteria were (i) patients with rheumatoid arthritis, (ii) adult population age ≥16years, (iii) nurse as part of the care team or intervention delivery, (iv) primary research only, (v) English language, and (vi) quantitative studies with nursing sensitive outcomes.
Medline, CINAHL, Ovid nursing, Cochrane library and PsycINFO databases were searched for relevant studies.
Using the predetermined inclusion/exclusion criteria, nine reviewers working in pairs assessed the eligibility of the identified studies based on titles and abstracts. Papers meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Programme tools were used to assess the quality of the included studies. Data on nursing sensitive outcomes were extracted independently by two reviewers. The Outcome Measures in Rheumatology comprehensive conceptual framework for health was used to contextualise and present findings.
Of the 820 articles retrieved, 7 randomised controlled trials and 3 observational studies met the inclusion criteria. Seventeen nursing sensitive outcomes were identified (disease activity, clinical effects, pain, early morning stiffness duration, fatigue, patient safety issues, function, knowledge, patient satisfaction, confidence in care received, mental health status, self-efficacy, patient attitude/perception of ability to control arthritis, quality of life, health utility, health care resources, death). These fitted into 10 health intervention domains in keeping with the pre-specified conceptual framework for health: disease status, effectiveness, safety, function, knowledge, satisfaction, psychological status, quality of life, cost, death. A total of 59 measurement instruments were identified comprising patient reported outcome measures (n=31), and biologic measures and reports (n=28).
This review is notable in that it is the first to have identified, and reported, a set of multidimensional outcome measures that are sensitive to nursing interventions in rheumatology specifically. Further research is required to determine a core set of outcomes to be used in all rheumatology nursing intervention studies.
尽管风湿病护理已被证明在管理类风湿关节炎患者方面是有效的，但对护理干预敏感的患者结局（护理敏感结局）尚未进行系统研究。
本研究的目的是确定并描述在报告类风湿关节炎患者护理干预的研究中测量的相关患者结局。
从 1990 年到 2016 年进行了系统检索。纳入标准为：（i）类风湿关节炎患者，（ii）年龄≥16 岁的成年人群，（iii）护士作为护理团队或干预提供的一部分，（iv）仅限原始研究，（v）英语语言，以及（vi）具有护理敏感结局的定量研究。
Medline、CINAHL、Ovid 护理、Cochrane 图书馆和 PsycINFO 数据库均用于检索相关研究。
使用预定的纳入/排除标准，9 名配对工作的审查员根据标题和摘要评估确定研究的资格。符合纳入标准的论文被检索并进一步评估全文。使用关键评估技能计划工具评估纳入研究的质量。两名审查员独立提取护理敏感结局的数据。使用风湿病结局测量综合概念框架对健康进行背景化和呈现研究结果。
在 820 篇文章中，有 7 项随机对照试验和 3 项观察性研究符合纳入标准。确定了 17 个护理敏感结局（疾病活动度、临床效果、疼痛、晨僵持续时间、疲劳、患者安全问题、功能、知识、患者满意度、对护理的信心、心理健康状况、自我效能、患者对控制关节炎能力的态度/看法、生活质量、健康效用、卫生保健资源、死亡）。这些结局符合预先指定的健康概念框架，归入 10 个健康干预领域：疾病状态、效果、安全性、功能、知识、满意度、心理状态、生活质量、成本、死亡。共确定了 59 个测量工具，包括患者报告的结局测量（n=31）和生物测量和报告（n=28）。
本研究的一个显著特点是，首次确定并报告了一套针对风湿病护理的多维敏感结局测量指标。需要进一步研究以确定一套在所有风湿病护理干预研究中都可以使用的核心结局指标。
