不同层次护士重症护理思维能力的评估与管理对策

目的 了解不同层次护士重症护理思维能力，进一步加强重症护理质量管理。方法 对科内12名护士，采用护理叙事研究的方法，在参加完重症患者救护后1周在病例讨论会上讲述患者出现病情变化时的护理场景，再现护士的分析判断及处理过程，通过对照经集体讨论确定的护理标准，评估其重症思维能力。统计不同学历和不同职称护士重症处理的优秀、良好、不合格结果，以评估不同层次护士重症护理思维能力。结果 不同学历和不同职称的护士重症护理的思维能力不同，全日制本科学历护士的重症护理思维能力明显好于夜校大专学历护士（Z=3．314，P=0．001）和中专学历护士（Z=2．998，P=0．003），夜校大专学历护士与中专学历护士重症护理思维能力差异无统计学意义（Z=0．945，P=0．345）。主管护师的重症护理思维能力明显好于护师（Z=2．212，P=0．027）和护士（Z=3．805，P=0．00014），护师的重症护理思维能力与护士差异无统计学意义（Z=1．612，P=0．107）。结论 对不同层次护理人员在重症护理中思维能力的评估有助于提高重症护理质量及推进护理分级管理模式的建立，并促进临床护理教学模式的改革。

Evaluation and Analysis of Critical Nursing Thinking Ability of Nurses at Different Levels

Objective To understand the critical nursing thinking ability of nurses at different levels and further the management of critical nursing quality over severe diseases.Methods The nurses recalled the care scenes at the occurrence of critical diseases by way of nursing narration,reproducing the process of their analyzing,judging and treating the critical cases.Their nursing thinking ability were classified based on the statistical treatment of education degrees and professional titles plus their performances at care.Results The nursing thinking abilities varied with the nurses with different education degrees and professional titles.The nurses with undergraduate-schooling background were better than those collegiate ones(Z=3.314,P=0.001) and those two-year course students(Z=2.998,P=0.003),but the latter two groups of students showed no difference in view of thinking ability.The nurses with higher professional title of chief nurses were better than those with a title of nurses-in-charge(Z=2.212,P=0.027) and those common nurses(Z=3.805,P=0.00014),but the latter two showed no difference statistically(Z=1.612,P=0.107).Conclusion Evaluation and analysis of critical nursing thinking ability of nurses at different levels help the improvement of critical nursing quality and promote the establishment of nursing management at different levels and advance the reform of clinical nursing teaching mode.