Illawarra Shoalhaven Local Health District, Bulli Hospital, Warrawong, NSW, Australia.
Illawarra Shoalhaven Local Health District, DN&M District Nursing & Midwifery, Warrawong, NSW, Australia.
Int J Older People Nurs. 2020 Jun;15(2):e12302. doi: 10.1111/opn.12302. Epub 2019 Dec 30.
BACKGROUND AND/OR RATIONALE: "Specialling" is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness. To facilitate further investigation, a concept analysis of "specialling" was undertaken.
The aim of this paper was to report on a concept analysis on the practice of "specialling" pertaining to older people who have cognitive impairment when in hospital.
This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of "specialling." Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding.
A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the "Special" role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; and Organisational risk. The consequences of "specialling" were diverse with 6 themes: the "Special" role; the Older persons experience; Costly; "Special" use and nursing beliefs; Safety outcomes; and Opportunities.
The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person-centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study.
Nurses have an opportunity to lead care improvements by ensuring person-centred approaches in the care of older people with cognitive impairment.
本文旨在报告一项关于“specialling”实践的概念分析，该实践涉及在医院中患有认知障碍的老年人，以保持安全。
本研究采用罗杰斯的进化方法进行概念分析，以澄清该概念的属性、前因和后果，从而确定“specialling”的定义。Web of Science（核心合集和 Web of Science Medline）、CINAHL 和 SCOPUS 数据库被用于搜索相关文献。由于文献稀少，因此扩大了搜索范围，包括所有可以增加理解的来源。
共确定了（n=43）个来源。属性被主题化为 5 个类别：标签和描述；“特殊”角色；患者安全；患者护理；以及沟通。两个主题的前因：患者特征；以及组织风险。“specialling”的后果是多样化的，有 6 个主题：“特殊”角色；老年人的体验；昂贵；“特殊”使用和护理信念；安全结果；以及机会。
概念分析的过程为识别知识差距和实践挑战提供了一种手段。从这一分析中确定的定义为临床医生和研究人员提供了一个反思的机会，让他们在实施支持医院中老年人的护理计划时考虑这一问题。重要的是缺乏以人为本的方法，以及通过赋权发展护士领导能力的机会。这一分析的结果将为一项博士研究提供信息。
护士有机会通过确保以患者为中心的方法来改善对认知障碍老年人的护理，从而领导护理改进。
