一项混合方法质量改进研究，旨在落实执业护士角色并改善长期护理机构中居民的护理服务。
A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities.
作者信息
Kilpatrick Kelley, Tchouaket Éric, Jabbour Mira, Hains Sylvie
机构信息
1Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada.
2Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada.
出版信息
BMC Nurs. 2020 Jan 29;19:6. doi: 10.1186/s12912-019-0395-2. eCollection 2020.
BACKGROUND
To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes.
METHODS
This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Data were collected from September 2015-August 2016. The cohort consisted of all residents ( = 538) followed by the nurse practitioners. Nurse practitioner interventions ( = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data.
RESULTS
Nurse practitioners ( = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified.
CONCLUSIONS
The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.
背景
为了更好地满足长期护理（LTC）机构居民（LTC患者）的需求，执业护士（NP）被提议作为质量改进计划的一部分。在加拿大魁北克的LTC机构中尚未开展相关研究，因为NP角色在该地区尚属新鲜事物。我们收集了提供者访谈、现场记录和居民结局数据，以确定LTC机构中的NP如何影响护理质量，并为这些角色在魁北克的更广泛实施提供参考依据。本文报告居民结局和现场记录情况。
方法
这项混合方法质量改进研究包括在魁北克的六个LTC机构中进行的前瞻性队列研究。数据收集时间为2015年9月至2016年8月。队列包括执业护士所跟踪的所有居民（n = 538）。对与药物、多重用药、跌倒、约束使用、转至急性护理机构和压疮相关的执业护士干预措施（n = 3798）进行了监测。对事件随时间发生情况进行了双变量分析和生存分析。对定性数据采用了内容分析法。
结果
6名执业护士在LTC机构中兼职工作，平均工作量为42至80名居民。各机构采用了共享护理模式或咨询模式。居民的平均年龄为82岁，三分之二为女性。入院时最常见的诊断是痴呆（62%，n = 331）。每位居民的干预次数（范围：2.2 - 16.3）取决于护理模式。每位居民的平均用药数量总体下降了12%，或在12个月内每30天下降10%。多重用药、跌倒、约束使用和转至急性护理机构的发生率均有所下降，且几乎未发现压疮。
结论
在魁北克的LTC机构中实施NP可提高居民的护理质量。结果表明，在研究期间，每位居民每天的平均用药数量、多重用药、跌倒、约束使用和转至急性护理机构的发生率均有所下降，这表明在LTC机构中更广泛地实施NP角色是改善居民护理的一项有用策略。尽管还需要进一步研究，但应优先采用咨询模式，因为我们的项目提供了这些新角色在魁北克LTC机构中所做贡献的初步证据。
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