Kottke T E, Trapp M A
Department of Health Sciences Research, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1998 Sep;73(9):815-23. doi: 10.4065/73.9.815.
To describe the factors critical to implementation of a nurse-based system to increase access for American Indian women to breast and cervical cancer screening.
We report the experience of 103 nurses at 40 clinics who were trained to use the nurse-based screening system. In addition, the critical elements are discussed in the context of one particularly successful site.
Fifteen factors were identified as critical to the implementation of a nurse-based cancer screening process once a nurse had been trained to perform clinical breast examinations and collect Papanicolaou (Pap) test specimens: knowledge of benefit, skills, organization, adequate return, perceived patient demand, perceived effectiveness, legitimacy, confidence, commitment, adequate resources, a data-driven iterative approach to program implementation, an objective measure of quality, leadership, the passage of time, and a focus on delivering the service to the patient. For example, in one site that was particularly successful, the nurses, administrators, and other key health-care professionals contributed their respective resources to implement the screening program. The program was also supported by the lay community, the state board of nursing, and the state health department breast and cervical cancer control program. During the 3-year study period, the 103 nurses performed screening tests on 2,483 women, and only 18 of the Pap test specimens were unsatisfactory.
Nurse-based systems designed to collect high-quality Pap test specimens and perform detailed clinical breast examinations can be implemented if the factors that are critical to implementation are identified and addressed.
描述对于实施以护士为基础的系统至关重要的因素，该系统旨在增加美国印第安女性获得乳腺癌和宫颈癌筛查的机会。
我们报告了40家诊所的103名护士接受培训以使用基于护士的筛查系统的经验。此外，在一个特别成功的地点的背景下讨论了关键要素。
一旦护士接受培训以进行临床乳腺检查并采集巴氏涂片（Pap）检测标本，有15个因素被确定为对实施基于护士的癌症筛查过程至关重要：对益处的了解、技能、组织、足够的回报、感知到的患者需求、感知到的有效性、合法性、信心、承诺、足够的资源、以数据驱动的迭代方法进行项目实施、质量的客观衡量、领导力、时间的推移以及专注于为患者提供服务。例如，在一个特别成功的地点，护士、管理人员和其他关键医疗保健专业人员贡献了各自的资源来实施筛查项目。该项目还得到了非专业社区、州护士委员会以及州卫生部门乳腺癌和宫颈癌控制项目的支持。在为期3年的研究期间，103名护士对2483名女性进行了筛查测试，巴氏涂片检测标本中只有18份不合格。
如果确定并解决对实施至关重要的因素，就可以实施旨在采集高质量巴氏涂片检测标本并进行详细临床乳腺检查的基于护士的系统。
