Fischer Lisa, Klingshirn Hanna, Horacek Sarah, Muths Sabine, Reuschenbach Bernd
Katholische Stiftungshochschule München, München, Deutschland.
Katholische Stiftungshochschule München, München, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2023 Apr;177:82-92. doi: 10.1016/j.zefq.2023.01.011. Epub 2023 Mar 16.
Outpatient intensive care for people on home mechanical ventilation (HMV) is a complex area of care with high demands on the nurses specialised in this field. Internationally, academic qualification as an Advanced Practice Nurse (APN) has become established in these fields of specialised care. Despite the large number of further training opportunities, there is no university qualification for home mechanical ventilation in Germany. Based on a demand- and curriculum analysis, this study therefore defines the role of an APN for home mechanical ventilation (APN-HMV).
The study structure is based on the PEPPA framework (Participatory, Evidence-based and Patient-focused Process for the Development, Implementation and Evaluation of Advanced Practice Nursing). The need for a new model of care was determined with a qualitative secondary analysis based on interviews with health care professionals (n = 87) and a curriculum analysis (n = 5). Analyses were conducted using the Hamric model with a deductive-inductive approach. Subsequently, the main problems and objectives to improve the model of care were agreed upon in the research group, and the APN-HMV role was defined.
The qualitative secondary data analysis illustrates the need for APN core competencies, especially in the psychosocial area and in family-centred care. The curriculum analysis resulted in a total of 1,375 coded segments. The focus of the curricula was on the central competency "direct clinical practice" (1,116 coded segments) and thus on ventilatory and critical care measures. Based on the results, the profile of APN-HMV could be defined.
The introduction of an APN-HMV can usefully complement the skill and grade mix in outpatient intensive care and counteract care problems in this highly specialised area. The study provides a basis for the development of appropriate academic programmes or advanced training courses at universities.
为接受家庭机械通气（HMV）的患者提供门诊重症护理是一个复杂的护理领域，对该领域的专科护士有很高要求。在国际上，高级实践护士（APN）的学术资格已在这些专科护理领域确立。尽管有大量的进修机会，但德国尚无针对家庭机械通气的大学学历资格。因此，基于需求和课程分析，本研究界定了家庭机械通气高级实践护士（APN-HMV）的角色。
本研究结构基于PEPPA框架（高级实践护理发展、实施和评估的参与式、循证和以患者为中心的过程）。通过对医疗保健专业人员（n = 87）的访谈和课程分析（n = 5）进行定性二次分析，确定了对新护理模式的需求。使用Hamric模型采用演绎-归纳法进行分析。随后，研究小组商定了改善护理模式的主要问题和目标，并界定了APN-HMV的角色。
定性二次数据分析表明需要APN的核心能力，特别是在心理社会领域和以家庭为中心的护理方面。课程分析共产生1375个编码片段。课程重点是核心能力“直接临床实践”（1116个编码片段），因此侧重于通气和重症护理措施。基于这些结果，可以界定APN-HMV的概况。
引入APN-HMV可以有效地补充门诊重症护理中的技能和职级组合，并解决这一高度专业化领域的护理问题。该研究为大学开发适当的学术课程或高级培训课程提供了基础。
