Jeffreys L A, Clark A L, Koperski M
National Heart and Lung Institute, London.
Br J Gen Pract. 1995 Aug;45(397):415-8.
There are calls for the role of the practice nurse to be developed and extended. Before areas for further training and education can be identified, baseline data are needed on practice nurses' current activity and workload.
A study was undertaken to analyse the activity of practice nurses in two large inner city general practices and to assess the skills mix of the nursing staff required to meet the needs of the practices.
The study practices had a combined list of 26,000 patients, 80% of patients attracting a deprivation allowance. Each practice employed three practice nurses. A nurse activity index with 45 codes was constructed to describe patient-nurse consultations. Activity codes were categorized into traditional treatment tasks, extended role tasks or diagnosis and management tasks. For eight months, practice nurses in practices Y and Z recorded activity index codes for each patient consultation. Practice Y also recorded the source of referral and the age and sex of the patient.
There were 13,898 practice nurse consultations during the study period, equivalent to an annual nurse consultation rate of 0.8 per patient. Compared with the practice population as a whole, the patients attending the practice nurses in practice Y were older (mean age 43 years versus 37 years, P < 0.001). Those attending the practice nurses in practice Y were also more likely to be female (61% of consultations were with female patients compared with 50% of the practice population as a whole, P < 0.001). In practice Y, patients referred themselves to the practice nurse in 42% of consultations, 32% were follow-up consultations and in 25% of cases the patient had been referred by a doctor. The most common reasons for nurse consultation were blood tests (15% of procedures in practice Y and 18% in practice Z) and dressings (13% in both practices). Most procedures in practices Y and Z were in the traditional treatment category (61%), 26% were in the extended role category and 9% in the diagnosis and management category (3% coded 'other', 1% uncoded). Between practices, the greatest difference in recorded procedures was for asthma check ups (7% of procedures in practice Y compared with 2% in practice Z).
This study describes the workload of practice nurses in two inner city practices over eight months. Other practices could use the activity index to make comparisons over time and between practices. Up to 60% of nurses' work in the study practices could be done by a nurse without extended training and up to 30% could be done by a health care assistant, but with some loss of quality. It is suggested that half the nursing hours available to a practice should be offered by a nurse with extended training in order to undertake and develop extended role tasks and diagnosis and management tasks.
有人呼吁拓展执业护士的角色。在确定进一步培训和教育领域之前，需要关于执业护士当前活动和工作量的基线数据。
开展一项研究，分析两家市中心大型全科诊所中执业护士的活动，并评估满足诊所需求所需的护理人员技能组合。
研究中的两家诊所共有26000名患者，其中80%的患者领取贫困津贴。每家诊所雇佣三名执业护士。构建了一个包含45个编码的护士活动指数，以描述患者与护士的会诊情况。活动编码分为传统治疗任务、扩展角色任务或诊断与管理任务。在八个月的时间里，Y诊所和Z诊所的执业护士记录每次患者会诊的活动指数编码。Y诊所还记录了转诊来源以及患者的年龄和性别。
研究期间共进行了13898次执业护士会诊，相当于每名患者每年0.8次护士会诊率。与整个诊所人群相比，Y诊所中接受执业护士诊疗的患者年龄更大（平均年龄43岁对37岁，P<0.001）。Y诊所中接受执业护士诊疗的患者也更可能为女性（61%的会诊是与女性患者，而整个诊所人群中这一比例为50%，P<0.001）。在Y诊所，42%的会诊中患者直接找执业护士，32%是随访会诊，25%的病例是由医生转诊的。护士会诊最常见的原因是血液检查（Y诊所为15%的诊疗项目，Z诊所为18%）和换药（两家诊所均为13%）。Y诊所和Z诊所的大多数诊疗项目属于传统治疗类别（61%），26%属于扩展角色类别，9%属于诊断与管理类别（3%编码为“其他”，1%未编码）。两家诊所之间，记录的诊疗项目差异最大的是哮喘检查（Y诊所为7%的诊疗项目，而Z诊所为2%）。
本研究描述了两家市中心诊所执业护士八个月的工作量。其他诊所可以使用该活动指数进行时间上和不同诊所之间的比较。在研究诊所中，高达60%的护士工作可由未经扩展培训的护士完成，高达30%可由医疗护理员完成，但质量会有所下降。建议诊所提供的护理时间中有一半应由接受过扩展培训的护士提供，以便承担和开展扩展角色任务以及诊断与管理任务。
