Read S M, George S
Medical Care Research Unit, University of Sheffield Medical School, England.
J Adv Nurs. 1994 Apr;19(4):705-16. doi: 10.1111/j.1365-2648.1994.tb01142.x.
This paper reflects on the conduct of a pilot study which was intended to prepare the ground for a randomized, controlled clinical trial of the assessment and treatment of patients with minor injuries by nurse practitioners or senior house officers (junior doctors) in an accident and emergency department. The authors believe that such reflection makes a useful contribution to the growing debate about methodology in health services research. Following a brief literature review on nurse practitioners, the intended research design is explained. The authors then describe how observation in the chosen department led to a change in design, involving trial use of patient-kept diaries as a means of assessing outcome. Despite promising results from the third diary exercise, doubts remained about the validity of the relationship between process and outcome. The small number of patients managed by nurse practitioners compared to the greater number managed by junior doctors posed difficulties for randomization; similarities in pathways of care for patients managed by the two staff groups made it unlikely that differences in outcome could be demonstrated. These problems led to abandonment of the plan for a clinical trial at that point, but the authors believe that further exploration of the idea is desirable.
本文反思了一项试点研究的开展情况，该研究旨在为在急诊科由执业护士或高级住院医师（初级医生）对轻伤患者进行评估和治疗的随机对照临床试验奠定基础。作者认为，这种反思对卫生服务研究方法学方面日益激烈的争论做出了有益贡献。在对执业护士进行简要文献综述之后，解释了预期的研究设计。作者随后描述了在选定科室的观察如何导致设计的改变，包括尝试使用患者记录的日记作为评估结果的一种方式。尽管第三次日记记录活动取得了有希望的结果，但对于过程与结果之间关系的有效性仍存在疑问。与初级医生管理的患者数量相比，执业护士管理的患者数量较少，这给随机分组带来了困难；两个工作人员小组管理的患者护理途径相似，使得不太可能证明结果存在差异。这些问题导致当时放弃了临床试验计划，但作者认为对该想法进行进一步探索是可取的。
