How can the practice nurse be more involved in the care of the chronically ill? The perspectives of GPs, patients and practice nurses.
How can the practice nurse be more involved in the care of the chronically ill? The perspectives of GPs, patients and practice nurses.
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DOI：
10.1186/1471-2296-7-14
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发表时间：
2006-03-03
影响因子：
2.9
通讯作者：
Szecsenyi, Joachim
中科院分区：
文献类型：
--
作者：
Rosemann, Thomas;Joest, Katharina;Szecsenyi, Joachim
背景技术背景：在美国、加拿大和澳大利亚等许多国家，都有一个完善的“中级”病人护理，如执业护士和/或医生助理。然而，在德国，只有一种职业在实践中协助医生，即实习护士。鲜为人知的是，目前的参与实习护士在病人的护理在德国和全科医生，助理和病人的态度有关增加参与。我们的研究的目的是获得定性信息的程度，目前参与治疗的病人和有关的可能性增加参与以及增加involvement.METHODS的障碍：我们进行了定性，半结构化的采访，20个全科医生，20个实习护士和20例患者在海德堡地区。访谈数字化记录，转录和内容分析与ATLAS。ti。结果：实践护士只轻微参与病人的治疗。全科医生和病人都对增加护理的参与持怀疑态度。病人对护士的专业背景持怀疑态度，担心医患关系恶化。全科医生还抱怨护士缺乏医学知识的教育。他们担心没有时间，也担心增加参与的努力得不到补偿。实习护士大多愿意更多地参与，认为这是一个欣赏他们的角色。重要的障碍是缺乏时间，超负荷的行政工作，以及缺乏专业知识。结论：实习护士很少参与病人的护理。全科医生比病人更怀疑增加参与。所有受访群体都接受的一个可能领域是病人教育，例如饮食咨询。新的治疗方法，如慢性病护理模式，将需要一个团队的方法，目前只有很少存在于德国的医疗保健系统。对实习护士进行更好的医学教育是必不可少的，但全科医生也必须接受，他们不能单独满足未来护理的要求。
BACKGROUND: A well established "midlevel" of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia. In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement.METHODS: We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti.RESULTS: Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge.CONCLUSION: Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach which currently only marginally exists in the German health care system. Better medical education of practice nurses is indispensable, but GPs also have to accept that they cannot fulfil the requirement of future care alone.