Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Monash University, Melbourne, Victoria, Australia.
Int Wound J. 2020 Jun;17(3):587-600. doi: 10.1111/iwj.13308. Epub 2020 Feb 7.
The purpose of this review was to identify the role and contribution of community-based nurse-led wound care as a service delivery model. Centres increasingly respond proactively to assess and manage wounds at all stages - not only chronic wound care. We conducted an integrative review of literature, searching five databases, 2007-2018. Based on inclusion and exclusion criteria, we systematically approached article selection and all three authors collaborated to chart the study variables, evaluate data, and synthesise results. Eighteen studies were included, representing a range of care models internationally. The findings showed a need for nurse-led clinics to provide evidence-based care using best practice guidelines for all wound types. Wound care practices should be standardised across the particular service and be integrated with higher levels of resources such as investigative services and surgical units. A multi-disciplinary approach was likely to achieve better patient outcomes, while patient-centred care with strong patient engagement was likely to assist patients' compliance with treatment. High-quality community-based wound services should include nursing leadership based on a hub-and-spoke model. This is ideally patient-centred, evidence-based, and underpinned by a commitment to developing innovations in terms of treatment modalities, accessibility, and patient engagement.
本次综述旨在明确以社区为基础、护士主导的伤口护理作为一种服务提供模式的作用和贡献。各中心越来越积极主动地应对,评估和管理各个阶段的伤口——不仅是慢性伤口护理。我们对文献进行了综合回顾,搜索了五个数据库,时间跨度为 2007 年至 2018 年。基于纳入和排除标准,我们系统地进行了文章选择,所有三位作者合作绘制了研究变量图,评估了数据,并综合了结果。有 18 项研究入选,代表了国际上各种护理模式。研究结果表明,需要护士主导的诊所提供基于证据的护理,使用针对所有伤口类型的最佳实践指南。伤口护理实践应在特定服务中标准化,并与更高水平的资源(如调查服务和外科单位)相结合。多学科方法可能会取得更好的患者结果,而以患者为中心的护理和患者的积极参与可能会帮助患者遵守治疗方案。高质量的社区为基础的伤口服务应包括以轮辐式模型为基础的护理领导。这最好是以患者为中心、基于证据的,并致力于在治疗方式、可及性和患者参与方面发展创新。