情景模拟演练对急诊儿科低年资急诊分诊护士岗位胜任能力及分诊质量的影响

目的探讨情景模拟演练对急诊儿科低年资急诊分诊护士岗位胜任能力及分诊质量的影响。方法选择2015年7月至2016年6月急诊儿科低年资护士25名为研究对象,均给予12个不同主题的情景模拟演练培训,比较培训前后护士岗位胜任能力、分诊质量。结果培训后,急诊分诊护士个性特征、护理评价、护患关系、专业能力、胜任能力等评分均明显高于培训前(P <0. 05),理论考试成绩、急诊分诊能力成绩均明显高于培训前(P <0. 05),患儿平均候诊时间明显短于培训前(P <0. 05),分诊准确率、家属满意度明显高于培训前(P <0. 05)。结论情景模拟演练有助于提高急诊儿科低年资急诊分诊护士岗位胜任能力,提高分诊质量,维系良好的护患关系。     

情景演练与特殊病例分析在分诊护士准入培训中的应用效果

目的探讨对分诊护士准入培训应用情景演练以及特殊病例分析的临床效果。方法 2018年1—8月我院对12名分诊护士进行准入培训,包括特殊病例分析以及情景演练,比较培训前后分诊护士综合理论知识、自我能力评价情况、分诊准确情况。结果培训后,分诊护士综合理论知识较培训前有明显提高(P 0. 05);对自我能力评价满意度明显优于培训前,差异有统计学意义(P 0. 05);对疑难案例分诊准确率明显优于培训前,差异有统计学意义(P 0. 05)。结论对分诊护士应用特殊病例分析以及情景演练培训,不仅可提高其综合能力,还有利于提高分诊准确率。     

情景模拟与案例分析在门诊护士培训中的应用

目的 探讨门诊分诊护士培训的内容与方法.方法 采用情景模拟与案例分析的培训方法对32名门诊护士进行培训.结果 培训后护士在分诊技巧、分析解决问题等方面进步显著.结论 将情景模拟与案例分析应用于门诊护士的培训中,不仅有利于巩固专科理论知识,提高护士的综合能力,而且利于提高应急处理能力,值得推广.     

抢救案例分享对急诊预检分诊质量的影响

目的探讨抢救案例分享对提升急诊预检分诊工作质量的影响。方法从2013年1月~12月,每周进行抢救案例分享1次,从分诊的角度进行分析、评价与改进,统计分析实施抢救案例分享前2012年及分享后2013年急诊患者的分诊率、分诊准确率、建立急诊病例规范性等各项急诊分诊质量指标。结果实施抢救案例分享前后急诊患者分诊率、分诊准确率、建立急诊病例规范性等各项分诊质量指标相比较,差异均具有统计学意义(均P0.01)。结论从分诊角度进行抢救案例分享,能够使护士充分认识到急诊预检分诊工作的重要性,提高护士在分诊工作中发现问题、分析问题与解决问题的能力,同时有效提高急诊预检分诊质量。     

情景模拟演练结合翻转课堂在提高急诊年轻护士抢救能力中的应用南京医科大学附属儿童医院急诊科 210008赵丽 彭明琦*

目的：构建情景模拟演练与翻转课堂相结合的培训模式,以提高低年资护士急救能力。方法：选择2015年7月～2016年6月间在本院急诊病区工作或轮转的27名年轻护士（专科工作年限≤3年）,进行情景模拟演练与翻转课堂相结合的培训,成立教学团队,编写情景模拟教学资料,包括：抢救情景模拟案例、抢救流程图、专科操作视频及考核标准,以翻转课堂的形式进行情景模拟案例培训。与2014年7月～2015年6月间在本院急诊病区工作或轮转的24名常规教学查房形式培训的护士比较,比较两组护士急诊专科理论知识、临床操作技能、综合抢救能力及两组年轻护士对培训方式的满意度。结果：两组年轻护士经过6个月培训后,试验组急诊专科理论知识（95.33±4.15）、临床操作技能（96.46±2.98）及综合抢救能力（93.56±2.43）评分,高于对照组急诊专科理论知识（90.65±7.15）、临床操作技能（89.32±6.58）及综合抢救能力（87.34±5.22）评分,对各自培训满意度调查结果试验组高于对照组,差异有统计学意义（P＜0.05）。结论：采用情景模拟演练与翻转课堂相结合的培训模式,能有效提高年轻护士急诊专科知识及综合抢救能力,年轻护士对情景模拟演练结合翻转课堂培训模式满意。     

首因效应提高患者对急诊科检诊分诊护士满意率探索

目的：探讨首因效应提高急诊患者对检诊分诊护士满意率的效果。方法：2013-01-2013-02急诊科对分诊检诊护士实施首因效应培训,采用自制调查表和本院分诊护士绩效考核表,对比分析2013-03-2013-05和2012-03-2012-05,急诊分诊检诊护士在实施前后分诊准确率、患者满意率、患者投诉率和绩效考核成绩。结果：实施首因效应实施前后分诊准确率、患者满意率、分诊护士投诉率和分诊护士绩效考核成绩比较,差异有统计学意义（P〈0.05）。结论：首因效应可以显著提高急诊护士分诊准确率、急诊患者对检诊分诊护士的满意率,提高绩效考核成绩,同时降低患者的投诉率。     

急诊分诊护士培训需求的调查分析

目的:了解目前急诊分诊护士对培训内容及培训方式的需求,制定有针对性的培训计划,提高培训效果。方法:采用问卷调查法,对北京市3家三级甲等医院的122名急诊分诊护士进行调查。结果:所有被调查的护士均认为培训有必要。分诊护士对"急救技能"和"异常心电图识别"知识的需求最强烈,其次为"分诊技巧""临床暴力防御知识",对"护士礼仪知识"和"医院规章制度"相关知识的需求最弱。护士最需要的培训方式依次是"案例分析""理论授课"和"情景模拟"。结论:医院应对分诊护士按需进行分层培训,充分体现优质护理服务,同时提供多渠道、多方位的培训方式,切实提高培训效果和护理质量。     

高年资护士在急诊分诊工作中的作用

目的：提高急诊护士分诊的准确率。方法：2006／2008年临床实践由高年资护士承担急诊分诊工作。结果：急诊护士的分诊准确率明显提高。结论：急诊分诊工作非常重要,由高年资护士承担分诊工作,可以确保急诊危重患者的及时救治,同时对提高医院急诊抢救成功率起着至关重要的作用。     

以病案为基础的教学法结合情景模拟在门诊分诊护士应急能力培训中的应用

目的探讨以病案为基础的教学法(CBS)结合情景模拟在门诊分诊护士应急能力培训中的应用效果。方法 2018年1-4月我院应用CBS结合情景模拟教学法对29名门诊分诊护士进行了应急能力培训,比较培训前后分诊护士应急理论及技能考核成绩、分诊护士自我效能感、焦虑抑郁情绪、门诊分诊工作质量。结果 CBS结合情景模拟教学法进行门诊分诊护士应急能力培训后,门诊分诊护士应急理论、实践技能考核成绩明显高于培训前,培训后GSES评分较培训前明显提高,SAS评分及SDS评分明显低于培训前,差异均有统计学意义(P <0. 05)。结论应用CBS结合情景模拟教学法对门诊分诊护士进行应急能力培训,能明显提高分诊护士的应急能力,提高了分诊护士的自我效能感,改善了分诊护士焦虑抑郁不良情绪,对提高门诊分诊护理工作质量,预防门诊突发事件发生具有重要价值。     

加强培训提高急诊护士分诊的准确率

目的 提高急诊护士分诊的准确率.方法 将值班的有工作经验的12名护士随机分成2组,每组各6名,1组为实验组,对这6名护士进行系统的培训;另1组为对照组6名根据自己的工作经验进行工作.每组各分诊200例患者.结果 实验组的准确率明显高于对照组.说明对急诊护士进行系统的培训是增加急诊护士分诊准确率的更好途径.结论 有计划、有组织系统的对分诊护士进行合理的培训,是提高分诊护士分诊的准确率的关键步骤.     

Current status of emergency department triage in mainland China: A narrative review of the literature

In this review, the current status of emergency department triage in mainland China is explored, with the purpose of generating a deeper understanding of the topic. Literature was identified through electronic databases, and was included for review if published between 2002 and 2012, included significant discussion of daily emergency department triage in mainland China, was peer reviewed, and published in English or Chinese. Thematic analysis was used to identify themes which emerged from the reviewed literature. This resulted in 21 articles included for review. Four themes emerged from the review: triage process, triage training, qualification of triage nurses, and quality of triage. The review demonstrates that there is currently not a unified approach to emergency department triage in mainland China. Additionally, there are limitations in triage training for nurses and confusion around the role of triage nurses. This review highlights that emergency department triage in mainland China is still in its infancy and that more research is needed to further develop the role of triage.     

情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响

目的探讨情景模拟训练对低年资急诊分诊护士岗位胜任能力及分诊质量的影响。方法采用整群便利抽样法,选取2017年6月至2019年6月本院急诊科低年资护士25名作为研究对象。将情景模拟训练方法引入护士急救培训工作中,比较培训前后护士急救事件岗位胜任能力得分、护士急救技能得分。结果在模拟训练6个月后急诊护士专业知识、专业技术、专业能力及个人综合素质评分均显著高于训练前(P<0.05);CPR、插管配合、洗胃、吸痰、静脉穿刺及电除颤技能评分均显著高于训练前(P<0.05);综合操作时间短于培训前(P<0.05)。结论情景模拟训练应用于低年资急诊分诊护士中,可以显著提高低年资急诊护士的岗位胜任能力和急救技能水平,对提高医院急救成功率及护理水平均具有重要意义。     

Effectiveness of a 6-week online course in the Canadian Triage and Acuity Scale for emergency nurses.

INTRODUCTION: There is increasing interest in 5-level triage systems in emergency departments; however, the adoption of a new system places heavy training demands on ED department nurses and physicians. One emerging training option is online learning. The purpose of this study was to explore the effectiveness of an online course in the 5-level Canadian Triage and Acuity Scale (CTAS) on the clinical practice of the triage nurse. METHODS: Interviews were held with 23 emergency nurses from across Canada. A chart audit of triage codes from 367 charts from 6 hospitals was conducted. RESULTS: The most consistent finding was that the majority of RN staff enjoyed the online course and believed it had improved their triage practice. Nurses believed that their patient assessments were more thorough, accurate, and consistent throughout the department. Improved communication between staff and with patients and families was identified. Nurses reported using what they learned to improve triage assessment. Triage accuracy was high; the overall agreement between CTAS graduates and the chart auditor/expert within one CTAS level was 99.7%. Nurses also identified a number of organizational barriers to CTAS implementation after the course. DISCUSSION: The online format appears to be an effective, efficient, and convenient way to educate large numbers of ED staff in CTAS. Further research is needed regarding the use of multimedia and computer online chat options to further enhance the online learning experience for nurses.     

我国二级及以上医院急诊分诊依据现状调查

目的调查国内急诊分诊执行情况及分诊依据的现状。方法采用自制调查问卷,对国内113所医院的274名急诊科护士进行急诊分诊执行情况及分诊依据现状的调查。结果目前急诊分诊护士要求不统一,急诊分诊标准存在不足,急诊分诊护士现有培训不能满足临床需要。结论我国在急诊分诊护士培养和急诊分诊标准的建立等方面尚不完善,建立统一规范的分诊标准和专职分诊护士将成为急诊分诊发展的趋势。     

Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions?

INTRODUCTION: A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios. METHODS: Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios. RESULTS: The registered nurses' percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50-69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage. DISCUSSION: The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.     

What general emergency nurses want to know about mental health patients presenting to their emergency department

This paper presents the findings of a qualitative project conducted to investigate the education and training requirements that non-mental health trained emergency nurses need to enable them to effectively care for psychiatric patients presenting to a West Australian emergency department. Non-mental health trained nurses are ill-equipped in their psychiatric knowledge, assessment and communication skills to provide best possible care to the one in ten patients presenting to the emergency department with a complex mental health issue. The area of assessment and management of mental health patients in the emergency department is a complex one and staff are required to assess, triage and manage these patients appropriately. Furthermore, with aggression and violence increasing, emergency department nurses are concerned about their safety in the workplace. Focus groups with emergency nurses and semi-structured interviews with subject matter experts were conducted at one West Australian teaching hospital. The findings of the project demonstrated that these nurses considered that customer focus, workplace aggression and violence, psychiatric theory, mental health assessment and chemical dependence as key learning areas. These findings will form a platform for further education and training for ED staff.     

A study of triage of paediatric patients in Australia

Objectives: To describe the triage of children in a sample of mixed and paediatric emergency departments in Australia in 1999 and to measure the inter‐rater reliability of the National Triage Scale when used by triage nurses for the triage of paediatric patients. Methods: A questionnaire was sent to 11 hospitals, including one paediatric and one mixed emergency department, in each state studied. Triage nurses were asked to assess 25 paediatric patient profiles and to assign appropriate triage categories to each profile. The number of responses within the modal triage category (concurrence), the percentage of responses with a concurrence of at least 50% and the number of responses within one triage category of the modal response (spread) of responses were measured. Triage data for 1999 from the same emergency departments were collected and numbers of children seen and admitted in each triage category were described. The patterns of distribution of triage categories for specific paediatric diagnoses (triage ‘footprints’) were also described. Data from mixed emergency departments were grouped and compared with data from paediatric emergency departments and any differences were described. Results: Seventy‐eight nurses in 10 hospitals responded to the questionnaire. Sixty‐three per cent of all responses had a concurrence of greater than 50%. Ninety‐four per cent of patient profiles were triaged to within one triage category of their modal response. Nurses in paediatric emergency departments (concurrence greater than 50% for 79% of responses) were significantly more consistent in their use of the National Triage Scale compared with nurses in mixed emergency departments (concurrence greater than 50% for 50% of responses). Paediatric emergency department triage nurses were more likely to use the full range of the National Triage Scale and were fourfold as likely to allocate triage categories 4 and 5 to patient profiles. Paediatric hospitals allocated patients to triage categories 4 and 5 for an average of 71% of presentations compared with 47% for mixed emergency departments. Specific diagnoses had characteristic distributions of triage categories, with similar differences seen when comparisons were made between mixed and paediatric emergency departments. Conclusion: Use of the National Triage Scale for the triage of paediatric patients by triage staff is not consistent and there are significant differences between the triage practices of paediatric and mixed emergency departments.