背景:全面的患者评估对于安全的患者护理至关重要。护士的患者评估框架通常仅限于已经改变生命体征并有恶化风险的患者。或特定的风险或身体系统,如跌倒,压力伤和格拉斯哥昏迷评分。全面和结构化的循证护理评估框架,考虑整个患者并超越生命体征,特定风险和单一系统在住院设置中不常规使用,但对于确定患者恶化的早期风险很重要.
目的:本综述的目的是确定用于全面评估住院患者的护理评估工具或框架,并确定这些工具对患者和卫生服务结果的影响。
方法:进行了范围界定文献综述。医学文献在线分析和检索系统(MEDLINE),护理和相关健康文献累积指数(CINAHL),ProQuest论文和论文,Embase和Scopus是搜索中使用的数据库。首次搜索于2021年8月进行,并于2022年11月重复。未设置日期参数。参与者,概念,上下文(PCC)框架用于指导研究问题的发展,并合并纳入和排除标准。遵循PRISMA-ScR清单项目,以确保使用方法上合理的清单。
结果:纳入了评估六个护理评估框架的十项主要研究。在五个护理评估框架中,没有一个明确设计用于普通病房护理,而是急诊科或特定的患者群体,比如肿瘤学。四项研究报告了可靠性和/或有效性;两项报告了患者结果,四项报告了员工满意度。
结论:缺乏用于普通住院病房的循证护理患者评估框架。现有的评估工具主要是针对特定的患者队列设计的,特定的身体系统或已经恶化的患者。
■为了患者安全,需要一个框架来实现在这种环境下对患者进行结构化评估的方法,评估的一致性,护理人员的支持和信心,以升级护理。常规的系统护理评估也可以帮助患者及时升级。
结论:这项研究解决了什么问题?这项研究解决了缺乏用于住院患者的循证护理评估框架的问题。这样做的影响是,它强调了基于证据的需求,整个患者评估框架,供护士用于入住病房环境的患者。主要发现是什么?这篇综述发现了有限的综合性,用于普通病房住院地区的患者评估框架。那些确定的患者没有在这个患者队列中得到验证,并且针对的是已经恶化的患者。这项研究将在哪里以及对谁产生影响?这篇综述有可能影响未来的研究和患者护理。它强调,大多数研究都集中在对已经恶化的患者进行检测和升级护理的过程上。需要一个基于证据的常规护理评估框架,用于住院患者进入病房环境,以促进积极的患者预后并防止恶化。
■这篇综述有助于现有的护理患者评估框架知识,然而,它也突出了几个差距。目前,没有已知的,已验证,整体,整体用于普通病房住院设置的结构化护理患者评估框架。然而,使用此类评估框架的区域(如急诊科)已显示出积极的患者结果和工作人员可用性.住院病房患者将从常规中受益,在病情恶化发生之前,针对患者积极预后的结构化护理评估。
BACKGROUND: A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence-based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration.
OBJECTIVE: The aim of this
review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes.
METHODS: A scoping literature
review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA-ScR Checklist Item was followed to ensure a methodologically sound checklist was used.
RESULTS: Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction.
CONCLUSIONS: Evidence-based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient.
UNASSIGNED: A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation.
CONCLUSIONS: What problem did the study address? This study addresses the lack of evidence-based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence-based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment. What were the main findings? This
review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating. Where and on whom will the research have an impact? This
review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence-based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration.
UNASSIGNED: This
review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.