基于内容分析法探讨新形势下护士长管理工作

目的探讨新形势下护士长管理工作的重点、难点及创新点。方法以护士长工作重点、难点、创新点为主题,综合专科、人员、自身,结合日常管理工作进行20 min汇报,采用内容分析法对其进行归纳及分类统计。结果护士长报告的管理重点前两位为保障安全管理(55.38%)和保障护理质量(47.69%);积极团队文化建设(43.08%)与护士专业能力提升(35.38%)是护士长面临最多的管理难点;创新点体现在积极团队文化的建设(30.77%)和护士专业能力的培养(24.62%)等。结论护理部管理者应进一步加强护士长对重点问题的管理,帮助护士长积极克服管理难点,搭建平台促进护士长分享管理创新点,对于创建高水平的管理人才梯度,提升高效科学的管理水平具有重要意义。     

Process evaluation of a trial evaluating a multidisciplinary nurse-led home visiting programme for vulnerable older people

Purpose.?This article describes the content of and adherence with a nurse-led home visiting programme (Dutch Geriatric Intervention Programme; DGIP) for vulnerable older people. The randomised Dutch EASYcare Study showed positive patient endpoints for DGIP. Describing content and adherence is rarely performed, but highly important for understanding the results of trials.

Method.?DGIP is a complex multicomponent intervention tailored to the patients' needs. This process evaluation describes these components and patient characteristics and creates meaningful clusters of these specific components using hierarchical cluster analysis. Both patient/caregiver and physician adherence rates and possible predictors were investigated.

Results.?In line with the heterogeneity among the subjects, the individual treatment plans turned out to be highly tailored. Cluster analysis identified five clusters of intervention components. DGIP turned out to be largely unsuitable for one group of very vulnerable older participants in urgent need of more care. Overall, physician adherence was 75% and was better than patient adherence (51% complete/partial adherence). Adherence levels increased when both patients, caregivers and physicians received recommendations.

Conclusions.?The content of a multicomponent tailored home-visiting programme was very diverse, matching the heterogeneity among frail elderly subjects. Detailed process and cluster analysis helped to understand the content of the intervention, sharpen target criteria and identify possibilities to improve adherence.