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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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俺就是高興的太早，怎么了，不行��！

1樓 2011-04-28 18:08:20

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sltmac(金幣+1): 謝謝交流，歡迎常來~~ 2011-04-29 00:03:42
xiaowuheng(金幣+60, 翻譯EPI+1): 2011-04-29 22:39:06

ENPs IN A&E
整個英國A&E部門和輕傷單位都聘用的急診從業(yè)護士。對此有一些原因：能減少候診時間并且能讓初級醫(yī)生騰出手來治療更嚴重的病人，而且能彌補初級醫(yī)生在工作時間上的縮減。
這項實踐已經(jīng)得到審計署的鼓勵，同時作為急診醫(yī)療改革中“觀察和治療”協(xié)議的行動指南。有關(guān)缺乏標準ENP培訓和質(zhì)量的爭論正在進行，而有關(guān)存ENP標題的含義的也爭議不斷，主要是沒有普遍認可的這個標題能體現(xiàn)的定義。但是，盡管存在這些問題，文件記載了病人對ENPs I S提供的服務(wù)滿意。
RCN定義ENP為有經(jīng)驗的注冊護士，這些護士經(jīng)過專業(yè)的附加訓練，有些人能夠?qū)o差異病情的病人進行評價，給出診斷，治療并遣送病人回家或到其他的診所。胳膊受傷和髁上骨折的兒童正適合這種描述的ENP。這些孩子需要徹底的臨床評估，適當咨詢和X-射線注解，準確診斷，和有效治療或權(quán)宜推薦。通過隨機控制試驗顯示在治療輕傷病人方面，急診從業(yè)護士和高級家庭醫(yī)生一樣有效。Keltie et al認為ENPs或許事實上提供了更高質(zhì)量的護理，因為相對于高級家庭醫(yī)生，他們是有經(jīng)驗的從業(yè)者，他們對輕傷獲得了更多的了解，而高級家庭醫(yī)生只在A&E工作六個月然后繼續(xù)。Byrne et al在他們一個小小的研究中發(fā)現(xiàn)病人尤其喜歡從護士從業(yè)者身上的交流標準，相比那些去看醫(yī)生的人，能從這些從業(yè)護士身上接受到更多健康教育和一級救助建議。為了讓咨詢時間更長，所以只能看較少的病人，但是Byrne et al認為這些建議可以減少再次拜訪醫(yī)院的概率。Dolan擴展了這個主題，堅持認為從業(yè)者應(yīng)該把焦點放在護理質(zhì)量，而不是速度上。在A&E的目標急癥護理驅(qū)動天里，這是值得考慮的。
Byrne et al等進行的研究焦點在成人身上，但是 Keltie et al 發(fā)現(xiàn)ENPs能夠提高兒童護理質(zhì)量，尤其是有兒科醫(yī)學背景的ENPs，原因也可能是他們比SHOs更有可能精通治療兒科傷。

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2樓2011-04-28 21:36:27

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