居家医疗中的循证实践。一个讨论的跳板。

Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA.

Home Healthc Nurse. 1998 Jun;16(6):411-5.

Nursing has an increasing interest in EBP, and home healthcare nurses cannot afford to be left out of the loop. A variety of sources exist for home healthcare nurses to use in determining whether there is sufficient information for EBP. There are also various methods that can be used to develop EBP guidelines in home healthcare. Finally, home healthcare nurses have an ethical obligation to provide patient care that is effective and most likely to result in positive outcomes. Relying on tradition, intuition, and experimentation is no longer enough. It is hoped that this article will serve as a springboard, not the final word, for the development of EBP initiatives for home healthcare nurses. It is important also to "share the wealth" so that nurses and their patients can benefit. One way of doing this is to convene a group to evaluate current practice and publish the group consensus on the clinical issue of interest to home healthcare nurses. For example, Janet Steele, concerned about EBP, convenes a group of interested nurses from the agency to decide how the AHCRP guidelines can be incorporated into operations. This group rewrites the policies and procedures based on the CPGs, retrains the nursing and home care aide staff, and uses the patient information from AHCPR as the handouts for patients. Aside from the initial confusion relative to operational changes, EBP has enabled the nursing staff to be more consistent from patient to patient, and there is less confusion regarding what works for specific patient conditions. Evaluation of care 6 months after the change to EBP shows that patients have shorter times for healing, and fewer nursing visits are needed. This information is used by the agency administration in negotiations with payers on the quality of the care provided by the agency and is published in a peer reviewed journal such as Home Healthcare Nurse. Best of all, patient care no longer relies on tradition, intuition, and experimentation as colleagues throughout the country use these findings in their own agencies.

护理领域对循证实践（EBP）的兴趣与日俱增，家庭健康护理护士绝不能置身事外。家庭健康护理护士有多种信息来源可用于确定是否有足够的循证实践信息。在家庭健康护理中，也有各种方法可用于制定循证实践指南。最后，家庭健康护理护士有道德义务提供有效且最有可能带来积极结果的患者护理。仅依靠传统、直觉和经验已不再足够。希望本文能成为家庭健康护理护士循证实践举措发展的一个跳板，而非定论。“分享成果”也很重要，这样护士及其患者才能受益。一种做法是召集一个小组来评估当前的实践，并就家庭健康护理护士感兴趣的临床问题发表小组共识。例如，珍妮特·斯蒂尔关注循证实践，召集了该机构一群感兴趣的护士，以决定如何将美国医疗保健政策与研究机构（AHCRP）的指南纳入实际操作。这个小组根据临床实践指南（CPGs）重写政策和程序，对护理人员和家庭护理助理人员进行再培训，并将来自美国医疗保健政策与研究机构（AHCPR）的患者信息用作患者的宣传资料。除了最初对操作变化的困惑之外，循证实践使护理人员在对待不同患者时更加一致，对于针对特定患者病情有效的方法也减少了困惑。对改为循证实践6个月后的护理评估表明，患者愈合时间缩短，所需的护理访视次数减少。该机构管理层在与付款方就机构提供的护理质量进行谈判时使用这些信息，并发表在同行评审期刊上，如《家庭健康护理护士》。最棒的是，患者护理不再依赖传统、直觉和经验，因为全国各地的同行都在自己的机构中采用这些研究结果。