Wood Alison F, Tocher Jennifer, Rodgers Sheila
Lecturer, School of Health and Social Care, Edinburgh Napier University, UK.
Senior Lecturer, School of Health in Social Science, Department of Nursing Studies, University of Edinburgh, UK.
J Res Nurs. 2019 Dec;24(8):712-725. doi: 10.1177/1744987119883406. Epub 2019 Dec 4.
Direct patient care is a term used within nursing and healthcare to help quantify and qualify care delivery. Direct patient care time is considered as a valuable measure by healthcare providers to indicate efficiency and to quantify nursing work, however little is understood of the patient experience and care delivery in haemodialysis settings.
The aim of this study was to gain an understanding of patients' and nursing staff perceptions and experiences of 'direct patient care' within one haemodialysis unit.
A focused ethnographic approach utilised participant observations, informal questioning, photographs and 27 semi-structured interviews of registered nurses, clinical support workers and patients. Observation notes and interviews were transcribed and thematically analysed.
The key finding was the construction and reconceptualisation of care delivery in this setting. Care was identified to be delivered in two distinct ways, both of which allowed patients to feel cared for. 'Active care' where patients feel cared for when they are being dealt with directly by staff and 'Passive care' where patients feel cared for through staff availability and visibility.
Developing this understanding of patient care delivery in this specialism has highlighted some important aspects to the way care can be delivered which challenges current traditional understandings of direct patient care. Time spent with a patient is not the only important consideration to patient experience in haemodialysis. This understanding of passive care could improve care experiences in this setting.
直接患者护理是护理和医疗保健领域中使用的一个术语，用于帮助量化和界定护理服务的提供。直接患者护理时间被医疗保健提供者视为衡量效率和量化护理工作的一项重要指标，然而，对于血液透析环境中的患者体验和护理服务，人们了解甚少。
本研究的目的是了解一个血液透析单元内患者和护理人员对“直接患者护理”的看法和体验。
采用聚焦人种志方法，通过参与观察、非正式提问、拍照以及对注册护士、临床支持人员和患者进行27次半结构化访谈来收集数据。观察记录和访谈内容被转录并进行主题分析。
关键发现是该环境下护理服务的构建和重新概念化。护理被确定以两种不同的方式提供，这两种方式都能让患者感受到被关怀。“主动护理”是指患者在与工作人员直接接触时感受到被关怀，“被动护理”是指患者通过工作人员随时可用和可见而感受到被关怀。
对该专业领域患者护理服务的这种理解突出了护理服务提供方式的一些重要方面，这对当前对直接患者护理的传统理解提出了挑战。与患者相处的时间并非血液透析患者体验的唯一重要考量因素。对被动护理的这种理解可以改善该环境下的护理体验。
