Nurse-led interventions

护士主导的干预措施
  • 文章类型: Journal Article
    美国国家艾滋病毒/艾滋病战略(NHAS)是一项全面的计划,概述了到2025年结束美国艾滋病毒流行(EHE)的具体目标。该战略还提供了预防新的艾滋病毒感染和改善艾滋病毒感染者健康结果的具体战略。EHE是一份配套文件,重点是在艾滋病毒流行集中的美国特定司法管辖区实现NHAS的目标。本文概述了NHAS和EHE,并提供了可用于结束美国HIV流行的计划和策略的示例。
    The US National HIV/AIDS Strategy (NHAS) is a comprehensive plan that outlines specific goals for Ending the HIV Epidemic in the United States (EHE) by 2025. The strategy also provides specific strategies to prevent new HIV infections and improve health outcomes for people with HIV. The EHE is a companion document which focuses on achieving the goals of the NHAS in specific US jurisdictions where the HIV epidemic is concentrated. This article provides an overview of the NHAS and EHE and provides examples of programs and strategies that can be used to end the HIV epidemic in the United States.
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  • 文章类型: Journal Article
    糖尿病患者(PWD)的全球患病率正在迅速增加。护士可以在多个领域为PWD提供糖尿病护理。由护士主导的干预措施可以支持PWD对糖尿病的有效管理,这可以积极改善临床结果。护士主导的糖尿病自我管理教育(DSME)是管理糖尿病(DM)的有效策略,因为它可以改善自我护理实践和有关糖尿病的知识。PWD通常需要在医院呆更长时间,这涉及较差的患者满意度和临床结果。由护士领导的DM管理诊所是一种可能改善疾病管理的新策略。糖尿病专科护士可以在改善住院患者的糖尿病护理方面发挥重要作用。各种研究表明,护士可以与其他各种医疗保健提供者合作,独立地为PWD提供护理。研究还表明,由护士领导的接受教育组的平均糖基化血红蛋白A1c水平显着降低。此外,护士主导的干预措施通常会显著改善糖尿病知识,心理结果,自我管理行为,和生理结果。这篇文献综述的目的是确定护士主导的干预措施对糖尿病管理的影响。此外,在这次审查中,许多护理干预措施和护士作为教育工作者的角色,DM管理中的动机和护理人员已经被广泛讨论。本文还总结了评估护理干预效果的结果,以及克服糖尿病护理护士现有和新出现的挑战的策略。
    The global prevalence of people with diabetes mellitus (PWD) is rapidly increasing. Nurses can provide diabetes care for PWD in several areas. Interventions led by nurses can support PWD for effective management of diabetes, which can positively improve clinical outcomes. Nurse-led diabetes self-management education (DSME) is an effective strategy to manage diabetes mellitus (DM) since it improves self-care practice and knowledge regarding diabetes. PWD often need to stay in hospitals longer, which involves poorer patient satisfaction and clinical outcomes. Nurse-led clinics for DM management are a new strategy to possibly ameliorate the disease management. Diabetes specialist nurses can play an important role in improving diabetes care in inpatient settings. Various studies have revealed that nurses can independently provide care to PWD in collaboration with various other healthcare providers. Studies also demonstrated that the nurse-led education-receiving group showed a significantly reduced level of average glycosylated haemoglobin A1c level. Moreover, nurse-led interventions often result in significant improvements in diabetes knowledge, psychological outcomes, self-management behaviours, and physiological outcomes. The purpose of this literature review was to identify the impact of nurse-led interventions on diabetes management. Moreover, in this review, a number of nursing interventions and the nurses\' roles as educators, motivators as well as caregivers in DM management have been extensively discussed. This article also summarises the outcomes that are measured to evaluate the impact of nursing interventions and the strategies to overcome the existing and emerging challenges for nurses in diabetes care.
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  • 文章类型: Journal Article
    冠状动脉疾病(CAD)是全球患者死亡的主要原因之一。据世界卫生组织(WHO)报道,大约80%的心血管疾病可以通过改变生活方式来预防。CAD的管理涉及心血管危险因素的预防和控制,侵入性和非侵入性治疗,包括冠状动脉血运重建,坚持适当的药物治疗和定期门诊随访。护士主导的诊所主要是为了提供支持,教育,预防措施和对患者的心理支持,与治疗诊所完全不同。我们的审查重点是护士在心血管疾病的一级和二级预防和管理中的参与和意义。护士在介入心脏病学中起着至关重要的作用。它们在管理包括充血性心力衰竭在内的心脏并发症中也有重要作用,心房颤动和心脏移植。今天,护士主导的远程咨询策略的实施也获得了积极的意见。因此,在临床实践中,应实施护士主导的心血管疾病患者管理干预措施。基于治疗的进展,应开展更多的研究,以进一步调查护士主导的诊所在心血管疾病患者长期治疗和管理中的作用。
    Coronary artery disease (CAD) is one among the major causes of mortality in patients all around the globe. It has been reported by the World Health Organization (WHO) that approximately 80% of cardiovascular diseases could be prevented through lifestyle modifications. Management of CAD involves the prevention and control of cardiovascular risk factors, invasive and non-invasive treatments including coronary revascularizations, adherence to proper medications and regular outpatient follow-ups. Nurse-led clinics were intended to mainly provide supportive, educational, preventive measures and psychological support to the patients, which were completely different from therapeutic clinics. Our review focuses on the involvement and implication of nurses in the primary and secondary prevention and management of cardiovascular diseases. Nurses have a vital role in Interventional cardiology. They also have major roles during the management of cardiac complications including congestive heart failure, atrial fibrillation and heart transplantation. Today, the implementation of a nurse-led tele-consultation strategy is also gaining positive views. Therefore, a nurse-led intervention for the management of patients with cardiovascular diseases should be implemented in clinical practice. Based on advances in therapy, more research should be carried out to further investigate the effect of nurse-led clinics during the long-term treatment and management of patients with cardiovascular diseases.
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  • 文章类型: Journal Article
    背景:美国的医疗保健系统因效率低下而负担沉重,长期存在的健康不平等,和不可持续的成本。在护理专业和更广泛的医疗保健领域,人们越来越认识到需要进行范式转变,以解决持续存在的结构性问题并促进卫生公平。
    目的:尽管有证据表明健康的社会决定因素(SDOH)在塑造不公平的健康结果方面具有重要意义,在制定有效的护士主导计划以减轻有害的SDOH时,应用SDOH理论的实用工具仍然很少。
    方法:我们将现有的SDOH文献合成为一个启发式框架,用于概念化核心SDOH机制,constructs,和原则。
    结果:为了说明护士科学家如何使用该框架来指导SDOH缓解计划的制定,我们概述了美国拉丁裔艾滋病毒流行的三步示例应用。
    结论:我们的框架可以向护士主导的范式转变,跨实践的多层次SDOH缓解,教育,和研究。
    BACKGROUND: The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.
    OBJECTIVE: Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.
    METHODS: We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.
    RESULTS: To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.
    CONCLUSIONS: Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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  • 文章类型: Journal Article
    背景:关于肿瘤学护理中特定护理任务的影响,有一些评论。然而,缺乏跨癌症实体和阶段的合成。目的:综合评估癌症护理专业护士任务范围和有效性的评价结果。方法:我们在六个数据库中进行了系统搜索,并根据先验定义的纳入标准搜索了灰色文献,进行了Umbrella综述。进一步的步骤:标准化数据提取和质量评估,确定重叠程度,以及与健康相关的生活质量的结果测量的结构化叙述性总结,症状负担,护理服务/资源的利用,患者满意度。所有评论均根据EONS癌症护理教育框架和奥马哈系统干预计划进行分类。结果:筛选2,657个参考文献后,共纳入148项研究的11条综述(10条高质量)。特殊合格护士和高级执业护士在疾病过程中承担各种任务,尤其是与教育有关,咨询,和案件管理。对结果指标的影响喜忧参半,症状负担减轻的迹象增加。结论:具有扩展角色的特殊合格护士有可能为改善肿瘤学护理做出贡献。这强调了适当的任务配置文件和资格认证计划的重要性。需要更多基于理论框架模型的报告良好的研究。
    Background: Several reviews are available on the effects of specific nursing tasks in oncology care. However, a synthesis across cancer entities and stages is lacking. Aim: To synthesise the results of reviews assessing the scope and effectiveness of tasks of nurses specifically qualified in cancer care. Methods: We conducted an Umbrella Review based on systematic searches in six databases and a search for grey literature following a priori-defined inclusion criteria. Further steps: standardised data extraction and quality assessment, determination of the degree of overlap, and structured narrative summary on outcome measures of health-related quality of life, symptom burden, utilisation of care services/resources, and patient satisfaction. All reviews were categorised according to the EONS Cancer Nursing Education Framework and the Omaha System Intervention Scheme. Results: After screening 2,657 references, 11 reviews (10 high quality) for a total of 148 studies were included. Specially qualified nurses and advanced practice nurses take on a variety of tasks in the disease process, especially related to education, counselling, and case management. Effects on outcome measures are mixed, with increased indications of reduced symptom burden. Conclusion: Specially qualified nurses with expanded roles have the potential to contribute to improved oncology care. This emphasises the importance of appropriate task profiles and qualification programs. More well-reported studies based on theoretical framework models are needed.
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  • 文章类型: Review
    背景:这篇综合综述旨在了解护理对阿片类药物使用障碍(OUD)患者健康结局的影响。
    方法:Whittemore和Knafl\(2005)的综合审查方法指导了审查过程。作者搜索PubMed,护理和相关健康文献累积指数(CINAHL),和OVID数据库供同行评审,英语文章描述了接受OUD药物治疗的人的护理。文献检索遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。
    结果:删除重复项后,通过数据库搜索确定了773篇文章;15篇文章符合纳入标准,并被纳入美国的最终审查,加拿大,爱尔兰,英格兰,和荷兰。出现了两个主题:(1)护士主导的护理对患者预后的影响;(2)护理角色和护理环境。研究强调了促进以患者为中心和患者满意度的护理方面。
    结论:注册护士在为接受OUD药物治疗的患者提供优质护理方面的重要性从文献综述中显而易见。审查中的研究强调了注册护士在影响接受OUD药物治疗的患者结局方面的重要作用,包括沟通和护理协调。
    结论:这篇综述强调了在OUD治疗环境中需要角色划分和进一步开发护士敏感指标的必要性。
    This integrative review aimed to understand the impact of nursing on the health outcomes of people with opioid use disorder (OUD).
    Whittemore and Knafl\'s (2005) integrative review methodology guided the review process. The authors searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and OVID databases for peer-reviewed, English language articles describing nursing care for people receiving medications for OUD. The literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
    A total of 773 articles were identified through the database searches after duplicates were removed; 15 articles met inclusion criteria and were included in the final review from the United States, Canada, Ireland, England, and the Netherlands. Two themes emerged: (1) The effect of nurse-led care on patient outcomes and (2) Nursing roles and the environment of care. Studies emphasized the aspects of nursing care that promote patient-centeredness and patient satisfaction.
    The importance of the registered nurse in providing quality care for people receiving medications for OUD is clear from the literature reviewed. The studies in the review highlighted important aspects of the registered nurses\' role in affecting outcomes for people receiving medications for OUD including communication and care coordination.
    This review highlights the need for role delineation and further development of nurse-sensitive indicators in the OUD treatment setting.
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  • 文章类型: Journal Article
    目的:生存护理是优质癌症护理的重要组成部分。尽管护士在提供有效和高效的护士主导的生存护理方面处于独特的地位,他们报告说,他们提供生存护理的经验是支离破碎的,资源不足,经常让病人感到苦恼。
    方法:在这里,我们报告了为期4年的研究计划和十多年的护士主导工作的高潮,改善前列腺癌患者的生存护理经验,包括:(1)国家专科前列腺癌护理服务的发展;(2)一项护理德尔菲研究,以确定前列腺癌生存护理经验和优先事项;(3)前列腺癌生存基本框架的开发,这提供了一个路线图,以提高质量前列腺癌生存护理在各种设置;和(4)通过我的个人计划的发展框架转化为护理实践,以人为中心,循证生存护理计划。
    结论:通过领导全国前列腺癌专科护理服务,提供协调的,现在可以实现以证据为信息的以人为中心的生存护理服务。这项工作计划表明,无论交付的设置或方式如何,通过将证据转化为日常临床实践,参与前列腺癌男性患者及其家人护理的专科护士正在领导最佳实践。
    结论:迫切需要解决前列腺癌诊断可能带来的重大挑战,护士站在最前线,领导幸存者护理服务,其中包括:(1)常规的痛苦筛查和转诊为量身定制的循证心理护理;(2)提供与有效症状管理相关的以人为本的护理;(3)自我管理支持;(4)向超出急性护理范围的其他服务提供路标。
    Survivorship care is an essential component of quality cancer care. Although nurses are uniquely positioned to deliver effective and efficient nurse-led survivorship care, they report that their experiences of survivorship care provision are fragmented, under-resourced, and often distressing for the patient.
    Here we report the culmination of a 4-year program of research and more than a decade of nurse-led work, to improve the survivorship care experience for men with prostate cancer comprising of: (1) the evolution of a national specialist prostate cancer nursing service; (2) a nursing Delphi study to determine prostate cancer survivorship care experiences and priorities; (3) the development of the Prostate Cancer Survivorship Essentials Framework, which provides a road map for improving quality prostate cancer survivorship care across a variety of settings; and (4) the translation of the framework into nursing practice through the development of My Personal Plan, a person-centered, evidence-informed survivorship care plan.
    Through the leadership of a national prostate cancer specialist nursing service, the provision of a coordinated, evidence-informed person-centered survivorship care service is now achievable. This program of work has demonstrated that irrespective of the setting or mode of delivery, specialist nurses involved in the care of men with prostate cancer and their families are leading best practice through the translation of evidence into everyday clinical practice.
    There is an urgent need to address the significant challenges that a prostate cancer diagnosis can bring, and nurses are at the forefront and lead survivorship care delivery, which includes: (1) routine distress screening and referral to tailored evidence-based psychological care; (2) the provision of person-centered care that connects to effective symptom management; (3) self-management support; and (4) signposting to additional services which extend beyond the acute care setting.
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  • 文章类型: Randomized Controlled Trial
    背景:谵妄是行为的急性变化,以波动的过程为特征,注意力不集中,和杂乱无章的思维。对于重症监护中的危重成年人,据报道,谵妄的发生率至少为30%,并且与短期和长期并发症有关。住院时间更长,死亡风险增加,和长期的认知问题。
    目的:本研究的目的是确定护士主导的谵妄预防方案在降低重症监护成人谵妄发生率和持续时间方面的有效性。
    方法:进行了一项混合阶梯式楔形整群随机对照试验,以评估护士主导的干预措施的实施和传播的有效性,以减少成人的谵妄发生率和持续时间在悉尼西南部的四个成人重症监护病房。澳大利亚。
    结果:从2019年5月到2020年2月,在10个月的时间里,2618招生,在2566名患者中,包括在研究中。在最初的3个月基线期之后,每个月,在四个重症监护病房之一中,护士主导的干预措施都会随机交叉,到审判的第七个月,所有单位接受干预至少3个月.急性谵妄的发生率为10.7%(95%置信区间[CI]=9.1-12.4%),与干预前(基线)期间的14.1%(95%CI=12.2-16.2%)相比(调整后的比率[adjRR]=0.78,95%CI=0.57-1.08,p=0.134).干预前和干预后的平均无谵妄天数分别为4.1天(95%CI=3.9-4.3)和4.4天(95%CI=4.2-4.5),分别(调整后的差异=0.24天[95%CI=-0.12至0.60],p=0.199)。
    结论:在引入护士领导后,非药物干预,以减轻谵妄的负担,在接受重症监护的成年人中,我们观察到谵妄发生率或谵妄持续时间无统计学显著下降.
    BACKGROUND: Delirium is an acute change in behaviour, characterised by a fluctuating course, inattention, and disorganised thinking. For critically ill adults in the intensive care, the incidence of delirium has been reported to be at least 30% and is associated with both short-term and long-term complications, longer hospital stay, increased risk of mortality, and long-term cognitive problems.
    OBJECTIVE: The objective of this study was to determine the effectiveness of a nurse-led delirium-prevention protocol in reducing the incidence and duration of delirium among adults admitted to intensive care.
    METHODS: A hybrid stepped-wedge cluster randomised controlled trial was conducted to assess the effectiveness of the implementation and dissemination of the nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adults intensive care units in the southwest of Sydney, Australia.
    RESULTS: Between May 2019 and February 2020, over a 10-month period, 2618 admissions, among 2566 patients, were included in the study. After an initial 3-month baseline period, each month there was a random crossover to the nurse-led intervention in one of the four intensive care units, and by the 7th month of the trial, all units were exposed to the intervention for at least 3 months. The incidence of acute delirium was observed to be 10.7% (95% confidence interval [CI] = 9.1-12.4%), compared to 14.1% (95% CI = 12.2-16.2%) during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78, 95% CI = 0.57-1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention periods were 4.1 days (95% CI = 3.9-4.3) and 4.4 days (95% CI = 4.2-4.5), respectively (adjusted difference = 0.24 days [95% CI = -0.12 to 0.60], p = 0.199).
    CONCLUSIONS: Following the introduction of a nurse-led, nonpharmacological intervention to reduce the burden of delirium, among adults admitted to intensive care, we observed no statistically significant decrease in the incidence of delirium or the duration of delirium.
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  • 文章类型: Journal Article
    本研究旨在通过对文献的系统回顾,评估护士主导的干预措施在预防重症监护病房出院后的心理健康障碍方面的有效性。搜索是在MEDLINE(通过PubMed)中进行的,CINAHL,PsycINFO,和Cochrane图书馆数据库,用于与此类干预措施有关的研究。两名独立审稿人分析了这些研究,提取的数据,并评估了证据的质量。确定了六篇符合条件的文章,所有这些都是关于重症监护病房出院后的创伤后应激障碍。有些干预是在入院期间进行的,有些是在出院后进行的。一项研究发现,入院期间的多媒体教育改善了出院后一周的焦虑和抑郁。其余五项研究得出的结论是,护士主导的干预措施并不能预防重症监护病房出院后三个月至一年的精神健康障碍。我们的评论显示,对护士主导的干预措施在重症监护病房出院后预防心理健康障碍的有效性的研究很少。这些干预措施的时间和内容,以及对护士的适当培训,似乎是关键因素。因此,多学科干预可能比仅由护士领导的干预更有效.
    This study aimed to evaluate the effectiveness of nurse-led interventions for the prevention of mental health disorders after intensive care unit discharge through a systematic review of the literature. The searches were conducted in the MEDLINE (via PubMed), CINAHL, PsycINFO, and Cochrane Library databases for studies pertaining to such interventions. Two independent reviewers analyzed the studies, extracted data, and assessed the quality of the evidence. Six eligible articles were identified, all of which were regarding post-traumatic stress disorder after intensive care unit discharge. Some of the interventions were conducted during the admission and some after the discharge. One study found that multimedia education during admission improved anxiety and depression one week after discharge. The remaining five studies concluded that nurse-led interventions did not prevent mental health disorders three months to one year after intensive care unit discharge. Our review revealed a paucity of research into the effectiveness of nurse-led interventions for the prevention of mental health disorders after intensive care unit discharge. The timing and the content of these interventions, and the adequate training of nurses, appear to be key factors. Therefore, multidisciplinary interventions are likely to be more effective than those led by nurses alone.
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  • 文章类型: Journal Article
    慢性阻塞性肺疾病(COPD)是全球第三大死亡原因,2019年造成332万人死亡。COPD管理已日益成为一般和医院实践的主要组成部分,并导致了不同的护理模式。护士主导的干预措施对COPD患者满意度和临床结局显示出有益的影响。这项系统评价是为了确定和评估护士主导的COPD患者的干预措施,物理,和临床状态。审查是根据系统审查和荟萃分析(PRISMA)声明的首选报告项目进行的。根据纳入标准评估每份手稿的相关性,我们检索了全文,根据需要,来得出我们的结论。数据提取由两名审阅者独立进行,使用Cochrane偏差风险工具评估偏差风险。48篇文章被纳入分析,重点是医院对COPD患者的管理,呼吸和初级护理。护理管理被证明在提高生活质量方面非常有效,情绪状态,COPD患者的肺和体力。相比之下,与社区护士相比,医院和呼吸护士实施干预措施的有效性更高。
    Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses.
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