英国社区护理中高级实践的界定：政策实施前后的横断面比较研究
The Delineation of Advanced-Level Practice Within UK District Nursing: A Cross-Sectional Comparative Study Before and After Policy Implementation.
作者信息
Unsworth John, Oldman Crystal, Atkinson Joanne, Comparcini Dania, Simonetti Valentina, Cicolini Giancarlo, Mikkonen Kristina, Tomietto Marco
机构信息
Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
Section of Nursing, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari 'Aldo Moro', Bari, Italy.
出版信息
Int Nurs Rev. 2025 Sep;72(3):e70091. doi: 10.1111/inr.70091.
INTRODUCTION
Advanced practice nursing is key in response to increasing healthcare demands and the need for Universal Health Coverage. District nursing, which involves care for people in their own homes, has undergone a significant transformation to manage complex long-term conditions and reduce hospital admissions.
AIM
This study aims to identify the advanced practice domains of UK district nurse team leaders, before and after policy reforms designed to prevent unnecessary admission to hospital. A secondary aim is to compare the advanced practice domains of district nurse team leaders with those of advanced practice nurses working in family and community nursing.
METHODS
A cross-sectional study was conducted. Data were collected via an online survey using the Family and Community Nursing Advanced Practice Scale, assessing five key domains of advanced practice. The study employed ANOVA and t-tests to compare groups.
RESULTS
A total of 448 district nurse team leaders participated in this study, and secondary data from 548 family and community nurses were retrieved. No significant differences were found across qualification groups for most advanced practice domains, except for medication prescribing. Comparisons with advanced practice nurses in family and community settings revealed significantly higher scores in all domains and similar scores in leadership competencies.
DISCUSSION
Experiential learning plays a crucial role in developing advanced practice competencies beyond formal qualifications. The results align with Kolb's theory, highlighting the importance of clinical exposure and mentorship in shaping advanced nursing skills.
CONCLUSION
District nurse team leaders exhibit key advanced practice competencies. Credentialing frameworks may help formally recognise the expertise developed through clinical experience.
IMPLICATIONS FOR NURSING AND HEALTH POLICY
Policymakers should consider enhancing experiential learning opportunities and credentialing systems to support district nurses in their transition to advanced practice.
引言
高级实践护理对于应对日益增长的医疗保健需求以及全民健康覆盖的需求至关重要。地区护理涉及在患者家中提供护理服务，为管理复杂的长期病症和减少住院人数，这一领域已发生了重大变革。
目的
本研究旨在确定在旨在预防不必要住院的政策改革前后，英国地区护士团队领导者的高级实践领域。次要目的是比较地区护士团队领导者与从事家庭和社区护理的高级实践护士的高级实践领域。
方法
进行了一项横断面研究。通过在线调查使用家庭和社区护理高级实践量表收集数据，评估高级实践的五个关键领域。该研究采用方差分析和t检验进行组间比较。
结果
共有448名地区护士团队领导者参与了本研究，并检索到了548名家庭和社区护士的二级数据。除了药物处方外，在大多数高级实践领域的资格组之间未发现显著差异。与家庭和社区环境中的高级实践护士相比，所有领域的得分均显著更高，领导能力得分相似。
讨论
体验式学习在培养超越正式资格的高级实践能力方面起着至关重要的作用。研究结果与科尔布的理论一致，强调了临床接触和指导在塑造高级护理技能方面的重要性。
结论
地区护士团队领导者展现出关键的高级实践能力。认证框架可能有助于正式认可通过临床经验发展起来的专业知识。
对护理和卫生政策的启示
政策制定者应考虑增加体验式学习机会和认证系统，以支持地区护士向高级实践的转变。
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