Cordon Charissa P, Baxter Pamela, Collerman Ari, Krull Kirsten, Aiello Celia, Lounsbury Jennifer, MacPhee Maura, Udod Sonia, Alvarado Kim, Dietrich Tim, Akhtar-Danesh Noori, Ramachandran Meena, Meisenburg Natalie
Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada.
School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada.
Nurs Rep. 2022 Feb 14;12(1):100-111. doi: 10.3390/nursrep12010011.
Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients' care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients' acuity and dependency needs. Data on patients' priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients' holistic care needs and leaders' capacity to plan staffing assignments based on patients' priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.
美国各地的医院都在寻求实施符合“四重目标”主要目标的护理模式：改善人群健康状况、实现具有成本效益的护理服务以及提高患者和医护人员满意度。为了实现“四重目标”并满足患者的护理需求，汉密尔顿健康科学中心（HHS）着手重新设计护理服务模式，首先从护理服务的提供入手。2013年至2018年期间，HHS的12个临床项目实施了协同模式及其配套的协同患者需求评估工具，供护士客观评估患者的急症程度和护理需求。有关患者优先护理需求的数据被用于为HHS的护理服务模式重新设计提供依据，包括技能组合和人员配备水平。这个为期五年的项目是一项全组织范围的质量改进计划。作为评估的一部分，HHS的领导们与卫生服务护士研究人员合作开展了一项混合方法研究。本文描述了该研究定性部分的评估结果，其中包括对临床护士长和直接护理护士的访谈。数据采用描述性主题分析法进行分析。一些关键发现包括护士对患者整体护理需求的认识有所提高，以及领导们根据患者优先护理需求规划人员配置的能力有所增强。这些主题有助于为关键利益相关者（包括护士长和直接护理护士）提供建议。
