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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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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(gè)英國A&E部門和輕傷單位都聘用的急診從業(yè)護(hù)士。對(duì)此有一些原因：能減少候診時(shí)間并且能讓初級(jí)醫(yī)生騰出手來治療更嚴(yán)重的病人，而且能彌補(bǔ)初級(jí)醫(yī)生在工作時(shí)間上的縮減。
這項(xiàng)實(shí)踐已經(jīng)得到審計(jì)署的鼓勵(lì)，同時(shí)作為急診醫(yī)療改革中“觀察和治療”協(xié)議的行動(dòng)指南。有關(guān)缺乏標(biāo)準(zhǔn)ENP培訓(xùn)和質(zhì)量的爭(zhēng)論正在進(jìn)行，而有關(guān)存ENP標(biāo)題的含義的也爭(zhēng)議不斷，主要是沒有普遍認(rèn)可的這個(gè)標(biāo)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(duì)ENPs I S提供的服務(wù)滿意。
RCN定義ENP為有經(jīng)驗(yàn)的注冊(cè)護(hù)士，這些護(hù)士經(jīng)過專業(yè)的附加訓(xùn)練，有些人能夠?qū)o差異病情的病人進(jìn)行評(píng)價(jià)，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(píng)估，適當(dāng)咨詢和X-射線注解，準(zhǔn)確診斷，和有效治療或權(quán)宜推薦。通過隨機(jī)控制試驗(yàn)顯示在治療輕傷病人方面，急診從業(yè)護(hù)士和高級(jí)家庭醫(yī)生一樣有效。Keltie et al認(rèn)為ENPs或許事實(shí)上提供了更高質(zhì)量的護(hù)理，因?yàn)橄鄬?duì)于高級(jí)家庭醫(yī)生，他們是有經(jīng)驗(yàn)的從業(yè)者，他們對(duì)輕傷獲得了更多的了解，而高級(jí)家庭醫(yī)生只在A&E工作六個(gè)月然后繼續(xù)。Byrne et al在他們一個(gè)小小的研究中發(fā)現(xiàn)病人尤其喜歡從護(hù)士從業(yè)者身上的交流標(biāo)準(zhǔn)，相比那些去看醫(yī)生的人，能從這些從業(yè)護(hù)士身上接受到更多健康教育和一級(jí)救助建議。為了讓咨詢時(shí)間更長，所以只能看較少的病人，但是Byrne et al認(rèn)為這些建議可以減少再次拜訪醫(yī)院的概率。Dolan擴(kuò)展了這個(gè)主題，堅(jiān)持認(rèn)為從業(yè)者應(yīng)該把焦點(diǎn)放在護(hù)理質(zhì)量，而不是速度上。在A&E的目標(biāo)急癥護(hù)理驅(qū)動(dòng)天里，這是值得考慮的。
Byrne et al等進(jìn)行的研究焦點(diǎn)在成人身上，但是 Keltie et al 發(fā)現(xiàn)ENPs能夠提高兒童護(hù)理質(zhì)量，尤其是有兒科醫(yī)學(xué)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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