由护士主导的诊所的组织与实施：从五个国家的经验中汲取的教训

The Organisation and Implementation of Nurse-Led Clinics: Lessons Learned From the Experiences in Five Countries.

作者信息

Cerulus Marie, Duerinckx Nathalie, Dobbels Fabienne, Heeren Pieter, Dauvrin Marie, Detollenaere Jens, Van den Heede Koen, Pape Eva, Coolbrandt Annemarie, van Achterberg Theo, Deschodt Mieke

机构信息

Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.

Competence Center of Nursing, University Hospital Leuven, Leuven, Belgium.

出版信息

J Adv Nurs. 2025 May 7. doi: 10.1111/jan.17012.

AIM

To describe the organisation of nurse-led clinics and the factors facilitating or hindering their implementation based on experiences in five countries.

DESIGN

Descriptive multimethod study.

METHODS

We analysed policy documents, nursing competency profiles and scientific literature and conducted 27 semi-structured interviews with stakeholders from the Netherlands, Ontario, Ireland, France and Finland between April and June 2023. We summarised relevant information on nurse-led clinic organisation in categories and mapped contextual factors following the Context and Implementation of Complex Interventions framework.

RESULTS

In the Netherlands, Ontario and France, nurse-led clinics are implemented in all care settings. In all regions, clinics are led by nurses with varied educational backgrounds, but master-trained advanced practice nurses have more autonomy than bachelor-trained nurses. In France and Ireland, expanded scope of nursing practice is expected to be formally documented in a practice agreement or protocol. In all regions, nurses can prescribe medication under specific conditions. Interviewees stressed the relevance of continuous education for nurses and clear role delineation to facilitate the implementation of nurse-led clinics and collaboration with physicians. Organisational readiness, practical support and research to demonstrate quality, safety and cost-effectiveness of nurses' expanded roles were drivers of successful nurse-led clinic integration.

CONCLUSION

Nurse-led clinics operate across various care settings and are staffed with nurses from diverse educational backgrounds, requiring adequate training and experience for autonomous practice. Successful implementation depends on clear role delineation, close collaboration with healthcare professionals, and supportive educational, legal and financial frameworks to ensure sustainable integration.

IMPACT

Our comprehensive description of the organisation of nurse-led clinics-including legal, financial, educational and practical aspects- along with our analysis of contextual factors supporting their implementation, provides guidance to policymakers and healthcare organisations considering the successful and sustainable adoption of this model of care within their healthcare system.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

目的

根据五个国家的经验，描述护士主导诊所的组织形式以及促进或阻碍其实施的因素。

设计

描述性多方法研究。

方法

我们分析了政策文件、护理能力概况和科学文献，并在2023年4月至6月期间对来自荷兰、安大略省、爱尔兰、法国和芬兰的利益相关者进行了27次半结构化访谈。我们将关于护士主导诊所组织的相关信息进行分类总结，并按照复杂干预的背景与实施框架梳理背景因素。

结果

在荷兰、安大略省和法国，护士主导诊所在所有护理环境中均有实施。在所有地区，诊所由教育背景各异的护士领导，但拥有硕士学历的高级实践护士比本科学历的护士拥有更多自主权。在法国和爱尔兰，预计扩大的护理实践范围将在实践协议或规程中正式记录。在所有地区，护士在特定条件下可以开药。受访者强调了护士持续教育和明确角色划分对于促进护士主导诊所的实施以及与医生协作的重要性。组织准备情况、实际支持以及证明护士扩大角色的质量、安全性和成本效益的研究是护士主导诊所成功整合的推动因素。

结论

护士主导诊所在各种护理环境中运作，工作人员来自不同教育背景，自主执业需要足够的培训和经验。成功实施取决于明确的角色划分、与医疗保健专业人员的密切协作以及支持性的教育、法律和财务框架，以确保可持续整合。

影响

我们对护士主导诊所组织的全面描述——包括法律、财务、教育和实际方面——以及我们对支持其实施的背景因素的分析，为考虑在其医疗保健系统中成功且可持续采用这种护理模式的政策制定者和医疗保健组织提供了指导。

患者或公众贡献

无患者或公众贡献。