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首页> 外文期刊>International Journal of Integrated Care >Building Nurse Navigation in colorectal cancer care
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Building Nurse Navigation in colorectal cancer care

机译：在大肠癌护理中建立护士导航

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Introduction : Patients and relatives may often experience significant psychological problems in cancer trajectories. An aggravating factor is existing gabs in the healthcare system regarding diagnosis and treatment. In Denmark navigation focuses primarily on getting the patient through the system within the specific department and do not necessarily consider their psychological health and their experience of gaps in the healthcare system. Both Canada and Denmark offers a healthcare system free of user charge, so despite their overall differences in distribution of responsibility and degree of freedom for delivering health care, Canadian nurse navigation might be a better support for Danes, as it has a focus on psychological health and offers to navigate the healthcare system across hospital and primary care regardless of place of treatment. Despite widely implemented, this approach has never been tested in a randomized controlled trial. The primary aim of the present study was to test and adjust the Canadian nurse navigation system to a Danish setting. Methods : Key documents were back and forth translated, nurse navigators were educated and the service was practiced in colon cancer trajectories. Audits were done regularly, and supervision of nurse navigators was added from the start and continued as needed. A qualitative study was performed with focus group sessions among nurse navigators and nurses in addition to interviews with selected GPs and patients. Transcriptions and participant validated notes were analysed and interpreted using a Riceour inspired approach. Nurse navigation was adjusted and continued. Results : After two months of feasibility test, corrections were made and nurse navigation was thereafter feasible in the following form: Working area : Creating continuity by following the patient throughout the disease trajectory, emotional support, and empowerment. Adjusting scheduled appointments with support from secretaries. Collaborators : Primarily the patient, but also the near relatives and healthcare professionals at hospitals and in primary care. Primary resources : The Danish Cancer Society and existing resources in the healthcare system. Formal contact to patients and relatives : Phone, SMS or face-to-face contact on the convenience of the patient and the relative. Minimum contacts : Four proactive main contacts: 1) Short after a biopsy are taken caused by suspicion of cancer, 2) before treatment, 3) after primary treatment and before a visit to the general practitioner, and 4) after an eventually offer of further treatment. Thereafter, patients were not ended, but received minimal proactive contact. Discussions: Patients and relatives gained benefit of the model, which is also found in former research. A few very sick patients did not remember much of the support from the healthcare staff, but found it natural and were pleased that their relatives (who were supported by the nurse navigator) had the strength to support them. Other research found that psychologically strong relatives indeed might support the patients and in this way nurse navigation was a success. The nurse navigator role was accepted by the healthcare staffs. Lessons learned : Nurses needs extra education to practice nurse navigation. Manager support and key persons’ commitment is crucial. Limitations : The nurse navigation is adjusted to a Danish setting. Suggestions for further research : A randomized controlled trial is running to test the primary hypothesis: Nurse navigation will prove superior to the mandatory navigation primarily with regard to patients’ self-evaluated self-efficacy, but also experienced continuity of care, fulfilled needs, health-related quality of life, and use of healthcare.
机译：简介：患者和亲戚可能经常会在癌症发展过程中遇到重大的心理问题。加剧因素是医疗保健系统中有关诊断和治疗的问题。在丹麦，导航主要侧重于让患者通过特定部门内的系统，而不必考虑他们的心理健康状况以及他们在医疗保健系统中的不足经验。加拿大和丹麦均提供免费的医疗保健系统，因此，尽管在责任分配和提供医疗保健的自由度方面存在总体差异，但加拿大护士导航可能会更好地为丹麦人提供支持，因为它专注于心理健康并提供在医院和初级保健之间导航医疗保健系统的方式，无论治疗地点如何。尽管已广泛实施，但从未在随机对照试验中对该方法进行过测试。本研究的主要目的是测试加拿大护士导航系统并将其调整为丹麦语设置。方法：对关键文件进行来回翻译，对护士导航员进行培训，并在结肠癌的治疗过程中进行此项服务。定期进行审核，从一开始就增加了对护士导航员的监督，并根据需要继续进行。进行了定性研究，除了对选定的全科医生和患者进行访谈外，还对护士导航员和护士进行了焦点小组会议。转录和参与者验证的笔记使用Riceour启发的方法进行了分析和解释。护士导航已调整并继续。结果：经过两个月的可行性测试后，进行了更正，此后可以采用以下形式进行护士导航：工作区域：通过跟踪患者的整个病程，情感支持和授权来创造连续性。在秘书的支持下调整预定约会。合作者：主要是患者，但医院和初级保健中的近亲和医护人员也是如此。主要资源：丹麦癌症协会和医疗系统中的现有资源。与患者和亲戚的正式联系：电话，短信或面对面的联系，以方便患者和亲戚。最少接触：四个积极的主要接触：1）因怀疑癌症而进行活检后不久，2）治疗前，3）初次治疗后，就诊之前，以及4）最终提供进一步的接触后治疗。此后，患者并没有终止，但是只接受了很少的主动接触。讨论：患者和亲戚都从该模型中受益，这在以前的研究中也发现了。少数病重的患者不记得医护人员的大量支持，但感到很自然，并感到高兴的是他们的亲戚（由护士导航员支持）有能力支持他们。其他研究发现，心理上坚强的亲戚确实可以为患者提供支持，通过这种方式，护士导航获得了成功。护士导航员的角色已被医护人员接受。获得的经验教训：护士需要接受额外的培训才能练习护士导航。经理的支持和关键人员的承诺至关重要。限制：护士导航已调整为丹麦语设置。进一步研究的建议：一项随机对照试验正在检验主要假设：主要就患者的自我评价自我效能，以及护理的连续性，满足的需求，健康而言，护士导航将被证明优于强制导航。相关的生活质量和医疗保健的使用。

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