Concord Repatriation General Hospital, Sydney, NSW, Australia.
Faculty of Medicine & Health, Susan Wakil School of Nursing & Midwifery, University of Sydney, Camperdown, NSW, Australia.
J Clin Nurs. 2021 May;30(9-10):1295-1311. doi: 10.1111/jocn.15674. Epub 2021 Feb 15.
To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery.
Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment.
Descriptive, qualitative study.
Eighteen patients with chronic wounds from three wound services were engaged in semi-structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model.
Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight.
The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital.
Shared care between specialist and primary care should include evidence-based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient-held wound plans and upskilling of frontline clinicians.
探索不同类型的门诊伤口护理模式下患者对慢性伤口护理的体验。
慢性伤口给个人、家庭和医疗系统带来了巨大的负担。有证据表明，专科伤口诊所更有效且成本更低，但大多数门诊伤口护理是由普通社区护士提供的。对于患者如何体验不同类型的伤口护理模式以及这对他们适应内部/外部环境失衡的能力的后续影响，我们知之甚少。
描述性、定性研究。
从三个伤口服务中招募了 18 名患有慢性伤口的患者进行半结构化访谈。使用 Levine 的守恒模型对初始的归纳分析进行了精细化的演绎分析。
慢性伤口导致能量守恒以及个人、社会和结构完整性的失衡和随后的适应。护理过程和伤口护理系统的反应表明，专科伤口诊所可以在适当的时间为患者提供合适的人员和护理，护理的变异性较小。社区护理模式在有一个小团队的护士和一份记录的护理计划，并由专科伤口护士监督的情况下效果最佳。养老院是伤口护理的重要场所，这揭示了护理的变异性更高，专科伤口监督较少。
Levine 的守恒模型的应用为不同类型的伤口护理模式下患者对护士和系统元素的体验提供了理论理解和重要见解。具有医学专家转诊能力的专家伤口护士的监督是良好伤口护理的基石。在初级、老年护理和社区环境中，对护士进行定期审查的伤口护理计划和技能发展至关重要。
专科和初级保健之间的共享护理应包括基于证据的疼痛评估、明确的转诊途径、协作关系、远程医疗能力、患者持有的伤口计划和一线临床医生的技能提升。
