Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK; University College London Hospitals NHS Foundation Trust, London, UK.
Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK; University College London Hospitals NHS Foundation Trust, London, UK.
Int J Nurs Stud. 2018 Aug;84:61-77. doi: 10.1016/j.ijnurstu.2018.04.018. Epub 2018 Apr 30.
One to one specialling is a type of care which is provided to ensure the safety of patients who may be suffering from cognitive impairment, exhibit challenging behaviour, or may be at risk of falls or of causing harm to themselves or others. Care such as this, often referred to as 'specialling' or 'sitting' is common practice in most hospitals around the world, but there is a lack of evidence regarding its cost effectiveness and the quality of care provided.
The aim of this scoping review was to explore the breadth and scope of literature on one to one specialling, sitters and similar types of care in acute secondary care settings, in order to identify the challenges and concerns relating to the quality of care (process and outcomes) and cost effectiveness emerging from the literature, and determine the implications of this for policy, practice and future research.
This review was based on scoping review methodology following a five stage scoping review process. A keyword search was conducted in the following databases: MEDLINE, Scopus, CINAHL Plus, Web of Science, ProQuest Social Science, and ProQuest Nursing and Allied Health. The time limit placed on the search was January 2000 to April 2016. Inclusion and exclusion criteria were applied. The Mixed Methods Appraisal Tool was used to assess the quality of primary research articles.
Forty-four articles were included in the review. We found a lack of clarity in the terms used to describe one to one specialling and variability in what this type of care entails, who provides the care and the needs of patients requiring this type of care. High costs of specialling are often seen as a concern, but there was a lack of economic evaluations considering the full cost of specialling and balancing these against the benefits. Some of the articles proposed alternatives to one to one specialling or the use of sitters, but only some of these were evaluated.
There is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling.
一对一专门护理是一种为确保可能患有认知障碍、表现出挑战性行为、或有跌倒风险或伤害自己或他人风险的患者安全而提供的护理方式。这种护理方式，通常被称为“专门护理”或“坐班”，在世界上大多数医院都很常见，但关于其成本效益和提供的护理质量的证据不足。
本范围综述的目的是探讨急性二级保健环境中一对一专门护理、坐班和类似类型护理的文献广度和范围，以确定文献中出现的与护理质量（过程和结果）和成本效益相关的挑战和关注点，并确定这对政策、实践和未来研究的影响。
本综述基于范围综述方法，采用五阶段范围综述过程。在以下数据库中进行了关键字搜索：MEDLINE、Scopus、CINAHL Plus、Web of Science、ProQuest Social Science 和 ProQuest Nursing and Allied Health。搜索时间限制为 2000 年 1 月至 2016 年 4 月。应用了纳入和排除标准。使用混合方法评估工具评估主要研究文章的质量。
综述纳入了 44 篇文章。我们发现，用于描述一对一专门护理的术语不够明确，这种护理方式的具体内容、提供护理的人员以及需要这种护理的患者的需求存在差异。专门护理的高成本通常被视为一个问题，但缺乏考虑专门护理的全部成本并平衡这些成本与收益的经济评估。一些文章提出了替代一对一专门护理或使用坐班的方法，但只有其中一些方法得到了评估。
专门护理和一对一护理的具体内容存在广泛差异，这可能导致护理质量不佳。通过制定指南、培训和标准化决策工具，可以减少这种差异并提高护理质量。进一步研究一对一专门护理对患者结局和成本的影响，以及对专门护理替代方法的有力评估，将是有益的。
