优质护理示范病房健康助理员岗位设置与管理体会

总结在优质护理示范病房设置健康助理员并实施岗位职责管理的体会。医院13个优质护理示范病房设置健康助理员岗位并实行岗位职责管理。成立管理小组,制定并落实健康助理员的工作职责,开展岗前培训和在岗培训,并定期进行考核。健康助理员岗位职责管理实施后,健康助理员工作质量、医护人员及患者的满意度均提高。     

层级岗位管理在消毒供应中心中的应用

目的:探讨层级岗位管理在消毒供应中心(CSSD)中的应用效果。方法:对不同工作岗位的性质、类别加以分析,制定出该岗位的任职说明书,将任职条件和岗位职责进行了明确规定,院护理部对消毒供应中心护士的岗位层级比例进行了严格的规定,N0∶N1∶N2∶N3∶N4=2∶3∶5∶4∶1,同时将护士的专业技术水平和能力、工作经验、职称、学历作为岗位层级竞聘的要素;岗位排班与分工严格按照"能级应对人岗匹配"的原则进行,比较实施前后医护人员满意度及质量控制情况。结果:实施后医护人员满意度及质量控制均高于实施前(P0.05)。结论:通过层级岗位管理,提升了医护人员的工作效率和工作质量,服务意识得到了增强,工作积极性也得到了明显的改善,从而使得服务科室和工作人员的满意度得到了提高。     

设置护理工作流程对提高护理工作效率的影响

[目的]探讨在基层医院设置护理工作流程对提高工作效率、护理质量的影响。[方法]选用判断取样法对实施护理工作流程科室的医护人员及我院管理层进行问卷调查。[结果]实施护理工作流程后,90％以上医护人员和管理层的领导人员对服务质量影响各指标评价均为非常好和好。[结论]设置护理工作流程提高了工作效率,保证了护理质量,缩短了对新护士带教时间,规范了临床护理管理,使护理管理更具科学性,病人满意度大幅度提高。     

设置护理工作流程对提高护理工作效率的影响

[目的]探讨在基层医院设置护理工作流程对提高工作效率、护理质量的影响.[方法]选用判断取样法对实施护理工作流程科室的医护人员及我院管理层进行问卷调查.[结果]实施护理工作流程后,90%以上医护人员和管理层的领导人员对服务质量影响各指标评价均为非常好和好.[结论]设置护理工作流程提高了工作效率,保证了护理质量,缩短了对新护士带教时间,规范了临床护理管理,使护理管理更具科学性,病人满意度大幅度提高.     

护士岗位管理与绩效考核模式的建立及应用

目的探讨在绩效考核支撑下,护士实行岗位管理的方法及效果。方法根据医院临床需要制定护士分级框架,分析设置护士岗位,确定岗位资格标准,制定岗位职责,并建立与之相匹配的绩效考核分配方案。结果实施岗位管理及绩效考核后护士差错及患者投诉明显减少,护士及患者满意度上升,差异有统计学意义（P〈0．05）。结论护士岗位管理必须以绩效考核为支撑,才能显著提高护士工作积极性,增加护士主观能动性,有效提高护理质量及患者满意度。这种管理模式应在不断完善中深入开展。     

规范病人外出检查流程管理方法与评价

目的:规范医院住院病人外出检查的流程管理,提高医疗护理服务质量,确保病人安全。方法:科室通过建立病人外出检查登记本,在护士站设置检查信息专用白板和设置病人外出检查确认本三方面途径对408例病人实施规范病人外出检查流程。结果:408例病人外出检查前准备工作成功率为100%,病人核对准确率为100%,病人家属及医护人员满意度分别为97%、100%。结论:病人外出检查规范化流程管理可有效保证病人外出检查顺利,保障病人的安全,提高病人、家属及医护人员满意度。     

护理部垂直管理下护理绩效管理模式的构建与评价

目的:探讨护理垂直管理下护理绩效管理模式的构建方法与评价效果。方法:实施护理部垂直绩效管理,护理部主导护士绩效分配方案,根据科室内部、外部风险测评、CMI值、平均护理时数等划定科室风险等级及风险系数,结合工作量指标、可控成本结余等计算科室绩效,护理部通过对的科室KPI考核、护士长对护士KPI考核成绩决定发放考核对象绩效比例,科室KPI与护士KPI考核指标与岗位职责、工作量、护理质量、综合能力等相关联。观察绩效改革前后护士对绩效的认同感、岗位满意度护理质量及专项管理的情况。结果:实施护理部垂直绩效管理后,护士对绩效、岗位的满意度、全院护理质量显著提升(P0.05)。结论:护理部垂直管理下护理绩效管理模式有助于提高护士工作积极性和满意度,有助于护理部对全院护理全局的强化管理。     

临床护理教学秘书岗位设立与实践

目的探讨护理教学秘书岗位设立在临床护理教学中的作用及效果。方法在我院设立专、兼职临床护理教学秘书岗位,制定岗位职责,设置教学班次,建立教学激励办法、培养和评价机制并应用于实践。结果在临床设立护理教学秘书岗位并通过系统的岗位管理,有效促进了教学秘书教学能力和积极性的提升,保障了教学效果,提高了学员满意度。结论临床护理教学秘书岗位的设立、管理与实施,使临床护理教学更加科学、规范和高效。     

实施住院总护士岗位制度的效果与评价

目的探讨实施住院总护士岗位制度的效果,以更好地保障晚夜间护理安全和质量,帮助年轻护士提高业务水平及应急能力。方法制定住院总护士岗位管理制度,选拔临床护理骨干,履行岗位职责。结果实施临床住院总护士岗位制度10个月以来,为各临床科室解决各种护理事件76起;住院总护士在管理能力、协调沟通能力、专业技术等方面都得到显著提高。结论临床住院总护士岗位制度的实施,为现有晚夜班护理技术力量的某些薄弱环节提供了有效的补充,进一步保障了晚夜间护理安全,提升了医院综合满意度。     

探索基层医院护理岗位管理的方法

探索基层医院护理岗位管理的有效方法与效果,落实卫生部关于开展护士岗位管理的指示精神,改革护理工作模式,结合医院及科室护理工作现状,将护理人员分为N0~N4 5级,制定相应的岗位职责和制度,分层级培训和考核护士,落实责任制整体护理,进一步深化绩效评价考核制度,使病人满意度及护士职业感不断提高,促进了护理质量持续改进,稳定了护理队伍,提升了优质护理服务的可持续发展。     

The impact on the workload of the Ward Manager with the introduction of administrative assistants

Locke R., Leach C., Kitsell F. & Griffith J. (2011) Journal of Nursing Management 19, 177–185
The impact on the workload of the Ward Manager with the introduction of administrative assistants Aim To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. Background Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. Method Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. Results Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. Conclusions There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. Implications for nursing management The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative support.     

多元化视角下护理部干事角色定位及素质要求

文章探讨了护理部干事在护理管理中扮演多元化角色的定位与素质要求,即:护士角色要求有良好的职业道德和思想素质、秘书角色要求有基本的管理和公关能力、督导者角色要求有敏锐的洞察力和清晰的思维、协调者角色要求有良好的服务意识和人际沟通能力、教师角色要求有广博的知识信息和良好的教师素质、学生角色要求有虚心的学习态度和勤学苦练的精...     

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.     

Effects of intensive gait-oriented physiotherapy during early acute phase of stroke

We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation initiated very early after stroke. Therapy content and interrater reliability of the assessments were also analyzed. Of 22 patients, 19 (average 8.0 d poststroke) completed the study. Before rehabilitation, 13 patients were unable to walk or needed two assistants to walk and 6 patients needed one assistant. Patients spent a daily maximum of 1 h therapy time to obtain 20 min of walking. Additional physiotherapy was also provided during the 3 wk therapy period. Seven structured motor tests were recorded before and after rehabilitation and at 6 months postrehabilita tion, and perceived exertion was followed during physiotherapy. After rehabilitation, 16 patients could walk unassisted and 3 needed one assistant to walk. Mean +/- standard deviation exercise walking distance was 10,784 +/- 4,446 m and exercise was ranked as slightly strenuous. After 3 wk, the patients' 10 m walking time, ankle spasticity, lower-limb muscle force, and motor scale scores improved (p < 0.05). The early intensive rehabilitation was well tolerated and only three patients dropped out. Improved motor abilities were seen in all stroke patients.     

The effect of participation in a weight loss programme on short-term health resource utilization

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervised weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization.     

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data

ObjectivesThe aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data.DesignLogistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury.SettingEleven acute care metropolitan hospitals in Western Australia.SamplePatients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006–2007) and 130,540 in the post-test period (2009–2010).ResultsThe results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia.ConclusionThe results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.     

Nurses', midwives' and patients' perceptions of trained health care assistants

AIM: This paper reports on part of a larger study and outlines Registered Nurses' and Midwives' perceptions of, and satisfaction with, trained health care assistants in a regional hospital setting in the Republic of Ireland. BACKGROUND: An increased reliance upon health care assistants in the clinical setting has highlighted the need to consider how staff and patients perceive the health care assistant role. FINDINGS: Nurses were satisfied with the work undertaken by trained health care assistants and considered that they contributed positively to patient care and supported nurses/midwives by undertaking non-professional duties. However, maternity clients reported that health care assistants were mostly giving direct care, and their availability was perceived to be better than that of qualified staff. Some nurses/midwives were reluctant to assume responsibility for delegation of direct care duties to health care assistants. CONCLUSION: The employment of health care assistants yields positive outcomes for staff and female clients but consideration must be given to role clarity. Further research into how qualified staff perceive health care assistants is important as such perceptions influence delegation, integration, role development and acceptance of health care assistants.     

Relationship between nurses' perceptions of nursing assistant roles and information‐sharing behaviors: A cross‐sectional study

Information‐sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information‐sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self‐administered, cross‐sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co‐ordination and co‐operation among team members; and (iv) increasing the amount of information on patients among team members. Information‐sharing behaviors included “expressing,” “asking,” “linguistic response,” and “feedback.” Multiple regression analyses for each nurse's information‐sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information‐sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information‐sharing behaviors.     

行政护理查房的做法和体会

目的探讨开展护理行政查房的方法,为临床解决实际问题,提高护理管理质量及效率。方法由医院护理质控组对被查房科室进行护理质量检查;召开行政查房会议,反馈护理质控检查情况：被查房科室护士长对质控检查中存在问题提出整改意见及提出需要医院协调解决的问题;院长对行政护理查房情况进行总结,提出下一步护理质量安全管理重点及努力方向,对需医院协调解决的问题进行解答和协调落实。结果本院自2002年开展行政查房以来,无出现1起重大护理安全事件及投诉。通过护理行政查房解决护理难点问题25件。合同护士流失率从50％下降到1％。结论护理行政查房是提高护理管理质量和效率的有效方法．体现了以人为本的管理理念。     

医院护工社会化管理模式的探讨

目的:探讨医院护工社会化管理模式,以规范护工管理,提升陪护服务质量。方法:采用护工公司及护理部的双重管理模式,护理部成立专门的监管部门,统一制定及实施各项监管制度,重视素质及技能培训,规范四级质量检查措施和考核方案,定期召开三方座谈会。结果:患者及医务人员对护工的满意度与前期相比明显提高,护工的聘请率上升,陪护天数持续增加,满意度差异有统计学意义,P0.01。结论:由护工公司直接管理、护理部统一监管的双重管理模式是护工管理的新模式;规范化管理,强化培训及多方监督是提供优质陪护服务的保证。