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ENPs IN A&E Emergency nurse practitioners are employed in A&E departments and minor injury units throughout the UK. There are several reasons for this: the need to reduce waiting times and release junior doctors to treat more seriously ill patients, and to compensate for the reduction in junior doctors'working hours. This practice has been encouraged by the Audit Commission as well as guidance on streaming and the 'see and treat' protocols of Reforming Emergency Care. Debate about the lack of standardised ENP training and qualifications is ongoing, and there is continued controversy about the implications of the ENP title in that there is no universally recognised definition of what the role entails. But despite these problems patient satisfaction with the service provided by ENPs I S well documented. The RCN defined an ENP as an experienced registered nurse who has undergone specific additional training, someone who can assess patients with undifferentiated conditions, and diagnose, treat and discharge patients home or to another clinicians. Children with elbow injury and possible supracondylar fracture clearly fit within this role description. They require thorough clinical assessment, appropriate requesting and interpretation of X-rays, accurate diagnosis, and effective management or expedient referral. Emergency nurse practitioners have been shown in randomised controlled trials to be as effective as senior house officers (SHOs) in managing patients with minor injunes. Keltie et al argue that ENPs might in fact provide higher quality care because they are experienced practitioners who have gained much understanding of minor injuries compared to SHOs, who work in A&E for six months and then move on. Byrne et al, in their small study, find that patients are particularly pieased with the standard of communication from nurse practitioners, and receive more health education and first aid advice than those who see doctors. This makes consultations longer so fewer patients are seen but Byrne et al argue that this advice can reduce the rate of reattendance. This theme is expanded by Dolan who holds that quality of care, rather than speed, should be the focus for practitioners. This is worth considering in these target driven days of A&E care. The study by Byrne et al is adult focused, but Keltie eta/ find that ENPs, particularly those with a paediatric background, can improve the quality of children's care also because they are more likely to be skilled in managing paediatric injuries than SHOs. |
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kongxiangshi
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sltmac(金币+1): 谢谢交流，欢迎常来~~ 2011-04-29 00:03:42
xiaowuheng(金币+60, 翻译EPI+1): 2011-04-29 22:39:06
sltmac(金币+1): 谢谢交流，欢迎常来~~ 2011-04-29 00:03:42
xiaowuheng(金币+60, 翻译EPI+1): 2011-04-29 22:39:06
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ENPs IN A&E 整个英国A&E部门和轻伤单位都聘用的急诊从业护士。对此有一些原因：能减少候诊时间并且能让初级医生腾出手来治疗更严重的病人，而且能弥补初级医生在工作时间上的缩减。 这项实践已经得到审计署的鼓励，同时作为急诊医疗改革中“观察和治疗”协议的行动指南。有关缺乏标准ENP培训和质量的争论正在进行，而有关存ENP标题的含义的也争议不断，主要是没有普遍认可的这个标题能体现的定义。但是，尽管存在这些问题，文件记载了病人对ENPs I S提供的服务满意。 RCN定义ENP为有经验的注册护士，这些护士经过专业的附加训练，有些人能够对无差异病情的病人进行评价，给出诊断，治疗并遣送病人回家或到其他的诊所。胳膊受伤和髁上骨折的儿童正适合这种描述的ENP。这些孩子需要彻底的临床评估，适当咨询和X-射线注解，准确诊断，和有效治疗或权宜推荐。通过随机控制试验显示在治疗轻伤病人方面，急诊从业护士和高级家庭医生一样有效。Keltie et al认为ENPs或许事实上提供了更高质量的护理，因为相对于高级家庭医生，他们是有经验的从业者，他们对轻伤获得了更多的了解，而高级家庭医生只在A&E工作六个月然后继续。Byrne et al在他们一个小小的研究中发现病人尤其喜欢从护士从业者身上的交流标准，相比那些去看医生的人，能从这些从业护士身上接受到更多健康教育和一级救助建议。为了让咨询时间更长，所以只能看较少的病人，但是Byrne et al认为这些建议可以减少再次拜访医院的概率。Dolan扩展了这个主题，坚持认为从业者应该把焦点放在护理质量，而不是速度上。在A&E的目标急症护理驱动天里，这是值得考虑的。 Byrne et al等进行的研究焦点在成人身上，但是 Keltie et al 发现ENPs能够提高儿童护理质量，尤其是有儿科医学背景的ENPs，原因也可能是他们比SHOs更有可能精通治疗儿科伤。 |
2楼2011-04-28 21:36:27
