Department of Nursing and Health Sciences, University of South-Eastern, Norway, Drammen, Norway; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
Drammen Hospital, Vestre Viken HF, Drammen, Norway.
Int J Nurs Stud. 2021 Jun;118:103910. doi: 10.1016/j.ijnurstu.2021.103910. Epub 2021 Mar 2.
To evaluate the implementation of advanced practice nursing for patients with minor orthopedic injuries, including comparison of outcomes in relation to advanced practice nurse versus standard (physician-led) care models.
A non-inferiority study was performed in an emergency department in Norway, where advanced practice nursing is in an initial stage of implementation. The non-inferiority design was chosen to test whether the new advanced practice nursing model does not compromise quality of care compared to the standard care model already in use.
Patients with minor orthopedic injuries were assessed and treated by either advanced practice nursing or standard (physician-led) care models. Participating patients were assigned to the professional available at presentation. In the nursing model, registered nurses worked at an advanced level/applied advanced practice nursing following in-house-training. Senior orthopedic specialists evaluated the diagnostic and treatment accuracy in both models. Data were collected in a tool developed for this study, from May to October 2019.
In total, 335 cases were included, of which 167 (49.9%) were assessed and treated in the nursing model. Overall, correct diagnosis was found in 97.3% (n = 326) of the cases, and correct treatment was found in 91.3% (n = 306) of the cases. In comparison of missed diagnosis between advanced practice nurse and the standard (physician-led) care model showed inconclusive results (risk ratio: 0.29, 95% CI: 0.06-1.36). In comparison of treatment outcomes, the results showed that the advanced practice nursing model was non-inferior (risk ratio: 0.45, 95% CI: 0.21-0.97).
Advanced practice nursing care models can be used to diagnose and treat minor orthopedic injuries without compromising quality of care. Further implementation of the advanced practice nurse care model is encouraged.
评估对接受小型骨科损伤治疗的患者实施高级实践护理的效果，包括比较高级实践护士与标准（以医生为主导的）护理模式的结果。
本研究在挪威的一家急诊科进行了一项非劣效性研究，在该急诊科，高级实践护理正处于初始实施阶段。选择非劣效性设计是为了测试新的高级实践护理模式是否不会降低已在使用的标准护理模式的护理质量。
采用高级实践护理或标准（以医生为主导的）护理模式对接受小型骨科损伤治疗的患者进行评估和治疗。参与患者根据就诊时可用的专业人员分配至相应的护理模式。在护理模式中，注册护士在内部培训后以高级水平/应用高级实践护理工作。资深骨科专家评估两种模式的诊断和治疗准确性。数据是在 2019 年 5 月至 10 月期间使用为该研究开发的工具收集的。
共纳入 335 例患者，其中 167 例（49.9%）接受护理模式评估和治疗。总体而言，97.3%（n=326）的病例得出正确诊断，91.3%（n=306）的病例得出正确治疗。高级实践护士和标准（以医生为主导的）护理模式之间的漏诊比较结果不确定（风险比：0.29，95%置信区间：0.06-1.36）。在治疗结果比较中，结果表明高级实践护理模式不劣效（风险比：0.45，95%置信区间：0.21-0.97）。
高级实践护理模式可用于诊断和治疗小型骨科损伤，且不会降低护理质量。鼓励进一步实施高级实践护士护理模式。
