School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia; Emergency Department, Mater Health Services, Brisbane, QLD, Australia.
Evidence in Practice Unit and The Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Mater Health, Brisbane, Australia.
Australas Emerg Care. 2021 Dec;24(4):248-254. doi: 10.1016/j.auec.2021.01.003. Epub 2021 Mar 13.
Nurse-initiated interventions potentially provide an opportunity for earlier response for time sensitive presentations to the Emergency Department, and may improve time-to-treatment, symptomatic relief and patient flow through the department.
To determine the effectiveness of nurse-initiated interventions on patient outcomes in the Emergency Department.
The review followed the JBI methodology for reviews of quantitative evidence. Each study was assessed by two independent reviewers and data were extracted from included papers using standardized data extraction tools. Outcomes of interest included time-to-treatment, relief of acute symptoms, waiting times and admission rates.
Twenty-six studies were included in the final review, with a total of 9144 participants. Nine were randomized control trials, 17 had a quasi-experimental design. Twelve of the studies involved pediatric patients only and 14 included adult patients only. Interventions, protocols and outcomes were heterogeneous across studies. Overall, nurse-initiated interventions were effective in reducing time-to-analgesia, time-to-treatment for acute respiratory distress as well as improved pain relief and decreased admission rates.
To achieve early intervention and timely relief of acute symptoms, nurses should seek to consistently implement nurse-initiated interventions into their care of patients in the Emergency Department. Several findings are made to inform practice, however future high-quality research with locally specific strategies is required to improve certainty and quality of findings.
护士主导的干预措施为急诊科时间敏感型就诊提供了更早响应的机会，并可能改善治疗时间、症状缓解和患者在科室中的流程。
确定护士主导的干预措施对急诊科患者结局的有效性。
本综述遵循 JBI 对定量证据的综述方法。由两名独立评审员对每项研究进行评估，并使用标准化的数据提取工具从纳入的论文中提取数据。感兴趣的结局包括治疗时间、急性症状缓解、等待时间和入院率。
最终综述纳入了 26 项研究，共 9144 名参与者。其中 9 项为随机对照试验，17 项为准实验设计。12 项研究仅涉及儿科患者，14 项研究仅包括成人患者。研究之间的干预措施、方案和结局存在异质性。总体而言，护士主导的干预措施在缩短镇痛时间、急性呼吸窘迫治疗时间以及改善疼痛缓解和降低入院率方面是有效的。
为了实现早期干预和及时缓解急性症状，护士应将护士主导的干预措施纳入其对急诊科患者的护理中。虽然有一些发现可以为实践提供信息，但需要进行具有本地特定策略的高质量未来研究，以提高发现的确定性和质量。
