贴合住院患者生活护理需求的护理级别分类方法探讨

目的 探讨更贴合住院患者实际生活护理需求的护理级别分类方法,为分级护理改革提供依据.方法 采用整群抽样法选择内科、外科住院患者共502例,医生按常规开分级护理医嘱,责任护士应用Barthel指数对住院患者进行日常生活活动能力(activities of daily living,ADL)评估和护理分级,并采用生活护理问卷调查患者的生活护理需求.结果 502例患者中,医嘱护理分级与ADL护理分级经Spearman秩相关分析显示有统计学意义(rs=0.209,P<0.01);生活护理需求排序在2种分类方法中差别不大,但ADL护理分级方法比医嘱护理分级法与患者的生活护理需求一致性程度更高.结论 与医嘱护理分级相比,ADL护理级别分类法更能体现住院患者生活护理需求的个性化.     

临床分级护理现状及存在问题的调查研究

目的了解住院医师对患者分级护理相关内容的掌握程度,为临床护理提供较为客观、准确的护理等级评定方法。方法对63名住院医师进行问卷调查;对188例住院患者分别按医嘱护理分级、标准护理分级及Barthel指数分级法,进行一、二、三级护理登记与评分,并进行统计学处理。结果住院医师对各护理级别的内容及要求掌握不确切;医嘱护理分级与标准护理分级、Barthel指数分级的差异具有统计学意义(P<0.01),住院医师多用惯性思维提出护理级别,影响护士规范化的护理行为。结论住院医师应加强对分级护理内容的学习,提高对分级护理等级判断的准确性;同时应补充完善标准护理分级的内容,以人为本,确定患者对护理服务的依赖程度,突出个体差异与针对性,提高护理服务的效果及满意度。     

临床医师对临床分级护理的认知调查分析

目的 调查医护人员之间对现行的分级护理制度相关内容的认知差异,进一步研究护理分级分类标准及相应护理内容的制定.方法 采用自行设计的住院患者分级护理内容认知调查表,对某综合医院11个病区的各级别医生进行调查,并由护士对286例患者的护理等级对照现行的分级护理制度标准进行评估与医嘱对照后统计其差异.结果 82.3%的医生未曾接受分级护理相关知识教育,79%医生忽略患者"自理能力"是分级护理依据之一,85%医生认为护理等级医嘱应由护士参与确定;医护人员对分级护理的内涵认知差异有统计学意义(P<0.01).结论 临床医师对分级护理内涵知晓差.分级护理医护脱节,不利于分级护理的落实,现行的分级护理制度有待改革、完善,以满足患者所需,提高护理质量.     

医护共同制定分级护理级别的可行性研究

目的 探讨医护共同制定分级护理级别的可行性.方法 采用随机数字表法,将某综合性医院的223例成年住院患者分为试验组和对照组.试验组采用医护共同制定分级护理级别来对患者护理进行护理,对照组按现行标准遵医嘱进行分级护理.采用Barthel指数评定量表评定患者的自理能力,以<基础护理评价标准><患者对护理工作满意度调查表><直接护理项目和时间>作为护理质量评价指标.结果 两组相同护理级别之间,以及相同的病情观察级别,不同的生活自理能力(ADL)之间直接护理时间、满意度、基础评分的比较差异有统计学意义;试验组一级病情观察,不同ADL之间的直接护理时间、满意度、基础评分的比较差异有统计学意义;对照组一级护理、不同ADL之间的直接护理时间、满意度、基础评分的比较差异有统计学意义.结论 患者的需求具有个体化特征;现行的分级护理制度不完善,不能反映患者的病情和生活自理能力,不能满足患者的需求;医护共同制定分级护理级别能体现不同病情和生活自理能力患者的需求,在目前人力资源紧缺的现状下,能使护士的时间分配更合理.     

依据CCU护理干预分级量表进行护理干预

目的依据评分量化决策CCU护理干预分级。方法修订及编制CCU护理干预分级量表（简称分级量表）,根据量表评分与医生开具医嘱护理等级相结合,对CCU住院的406例患者进行护理干预分级。结果依据量表评分分值界定护理干预评分分级范围,CCU护理干预级别无1级预防性护理,评估项目总分低于30分为2级护理,评估项目总分30～45分为3级护理,评估项目总分大于45分为4级护理;经检验,据分值判别护理干预级别与医嘱开具护理等级的一致性良好。结论护理干预级别分值的界定,为CCU分级护理决策提供了量化依据,使其更具临床实用及可操作性。护士与医生共同决策分级护理,也使医护关系变得更密切、更协调,使患者能在医院得到高质量的医疗、护理服务。     

脑卒中康复期患者护理等级细化标准及其临床应用

目的探讨实施脑卒中康复期患者细化护理等级对护理质量、患者及护士满意度的影响。方法应用Barthel指数量表评估患者的自理能力,根据患者的自理能力和疾病的特点制定护理级别的评定标准,明确服务标准,由责任护士组织实施。选择脑卒中康复期患者100例,分为对照组和观察组,对照组按医嘱执行护理等级,观察组按细化护理等级为患者提供护理。结果观察组护理质量评定总分、患者和护士满意度均明显高于对照组(均P0.05)。结论对脑卒中康复期患者应用护理等级细化标准实行分级护理,可提高患者护理质量和服务满意度。     

日常生活活动能力量表在分级护理管理中的应用研究

目的 探讨采用日常生活活动能力(ADL)量表Barthel指数评分进行护理分级对护理质量的影响.方法 将402例住院患者随机分为观察组221例和对照组191例.对照组患者由医生开写护理级别医嘱,由护士依照执行.观察组由责任护士根据患者的ADL得分确定患者的护理级别,给予相应的护理.针对不同护理级别的服务要求为2组患者实施相同的护理服务措施,同时将各护理级别的服务要求以书面形式公示给患者.采用《基础护理质量评价标准》、《住院患者对分级护理的满意度调查表》、《患者直接护理内容和时间测定表》进行检查和问卷调查,数据采用SAS软件进行分析.结果 (1)观察组直接护理时间、基础护理得分、患者对分级护理的满意度显著高于对照组(P＜0.01).(2)观察组ADLⅢ级43例直接护理时间、基础护理评价得分明显高于对照组医嘱Ⅰ级168例(P＜0.01),但分级护理的满意度得分二者比较差异无统计学意义(P＞0.05).(3)观察组211例3种护理分级方法的护理效果两两比较差异有统计学意义(P＜0.01).结论 在护理人力资源不足的现实情况下,应用ADL评分表进行护理分级,能提高基础护理质量,提高患者对护理工作的满意度.     

分级护理医嘱准确性调查分析

[目的]了解医嘱护理级别下达的准确性,完善分级护理制度,避免分级护理不当产生的负面影响.[方法] 随机抽取三级甲等医院住院病人1 848例,填写分级护理临床应用调查表,对医嘱护理级别是否与护士评定一致进行汇总分析.[结果] 医嘱护理级别准确性符合率:特级护理89.84%,一级护理85.31%, 二级护理77.19%, 三级护理90.60%,特级护理、一级护理医嘱内外科差异有统计学意义(P＜0.01).[结论] 分级护理制度相对陈旧,与整体护理不符,需要修订.建议应加强护理等级医嘱管理,对医生进行分级护理制度的培训;病情观察监护与护理级别分别开具,以保证执行制度的科学性、严肃性及可操作性.     

综合性医院Barthel指数评分纳入护理分级的现状调查

[目的]调查某市综合性三级医院住院病人自理能力(Barthel指数评分)纳入分级护理的医嘱实施情况。[方法]根据2014年颁布卫生行业标准《护理分级》内容自行设计调查问卷,对我院543名临床医生、护士进行调查;同时分别抽取开始实施标准5个月及2年后(除儿科及监护病房)的住院病人护理级别医嘱及Barthel指数评分进行对比分析。[结果]临床医生、护士对2014年颁布卫生行业标准《护理分级》实施时间、内容、Barthel指数内容知晓情况有差异(P0.01);医嘱护理级别与标准护理级别和Barthel指数评分符合率均低。医嘱级别与标准级别比较总符合率分别为标准实施5个月的71.1%及2年后的67.7%,相距近两年时间无显著提高(P0.05),医嘱护理级别和Barthel指数的交叉重合率分别为标准实施5个月的39.0%及2年后的51.1%(P0.01);Barthel指数评分分级与标准护理级别符合率分别为标准实施5个月的77.8%及2年后的89.6%(P0.01)。[结论]各级领导应重视加强对《护理分级》的贯彻学习,从制度上规范可操作的级别护理确立流程,加强对临床医护人员的培训及督查,进一步规范执行分级护理内容,完善分级护理制度。     

服务质量差距模型在多元文化护理中的应用

目的 探讨特需患者期望与感知到的护理服务之间的差距及弥合措施.方法 采用自行设计问卷对上海某大学附属医院特需部35名外籍患者进行需求调查;对全体护士实施差距护理措施管理,包括了解患者期望制度、选择正确的服务设计和标准、执行标准及执行服务传递与对外承诺匹配制度;比较实施前后护士多元文化护理认知水平和患者及医生的满意度.结果 患者需求期望主要有:保护隐私,外语交流,就医便捷,尊重宗教信仰、习俗禁忌及遵守社交礼仪等;99%护士认为学习多元文化护理知识是满足患者期望的前提.特需护理服务应提供多元文化护理:实施前后护士多元文化护理认知差异(P<0.05)和怠者及医生满意度差异(P<0.01,P<0.05)均有统计学意义.结论 服务质量差距模型在特需护理管理中的应用具有可行性,有效提高了特需护理服务质量.     

重视护士长在护理质量控制中的作用

为了适应现代护理工作要求,实行科学的标准化管理和全面有效的质量控制,护士长作为三级护理质量管理网络第三级机构的领导者,起着至关重要的作用。在护理管理工作中必须重视加强护士长的质量控制意识,加强护士长的培训,不断提高护士长的道德品质、专业技术和组织领导等方面的素质。加强对护士长护理质量控制的监督检查,抓好护士长的护理质量控制,是提高全院护理质量的关键。     

Nursing agency and governance: registered nurses' perceptions

AIM: To explore registered nurses' perceptions of standards of nursing practice and factors that affect nursing practice standards. BACKGROUND: Nursing governance affects nurses' ability to manage nursing practice standards. Lack of nursing professional autonomy has been associated with occupational dissatisfaction, stress, turnover and low morale, which impact upon care quality. METHOD: Grounded theory was used. Data, gathered by semistructured interviews with 142 nurses, theoretically sampled from three National Health Service hospitals were analysed using constant comparative analysis. FINDINGS: Nurses were dissatisfied with their governance over factors that they believed had most influence on nursing practice standards. Perceived lack of control over factors that affect practice standards generated dissatisfaction, frustration and demoralization. CONCLUSIONS: Nurses' perceived lack of governance over their practice requires investigation and attention if occupational dissatisfaction, stress, turnover and low morale, which impact on quality care, are to be reduced. Dissatisfaction with nursing governance indicates a need to review nurses' professional involvement in clinical governance.     

六西格玛方法在病区护理质量管理中的应用

目的六西格玛管理方法被引进病区护理质量管理的主要目的是提升护理质量,找出缺陷,提出改进方法,确立工作重点,追求“零缺陷”。方法采用六西格玛管理方法将我科2003年1月~2005年3月护理质量检查结果进行比较分析。结果用六西格玛水平值衡量护理10项指标,部分指标在2~4西格玛水平范围,与标准值相差2~4个级别,反映出护理水平的差距。结论六西格玛管理方法在病区护理管理工作中应用,将更好地发挥出护理人员在临床工作中的潜能,追求护理质量的优质性,提高病人的满意度。     

Quality of pediatric nursing care in Finland: children's perspective

This study assessed the quality of pediatric nursing care as perceived by children (N = 388) aged 7 to 11 in Finland. The children rated as excellent the nursing environment, the nurses' humanity and trustworthiness, and caring and communication. They were most critical about the nurses' entertainment activities such as playing with them. Children's age and type of admission were both related to the amount of information they received. The instrument used in the study needs to be developed and tested further.     

等级护理实施中存在的问题与建议

分析等级护理实施中存在的问题。划分等级依据与适应范围的不一致性;等级确定缺乏严谨客观性;护理标准要求不当,缺乏可操作性;收费标准与护理价值严重背离;护理措施落实不到位。有针对性地提出建议,旨在提高等级护理质量。     

上海社区老年护理工作内容调查

目的 了解上海市社区老年护理工作内容。方法 2000年对20家示范性社区卫生服务中心的卫生服务科的科长20人作社区护士工作内容的问卷调查;2001年对社区居民204人作社区护理需求的问卷调查以及对社区护士108人作工作内容的问卷调查;2002年社区护士55人以工作日记记录法作5d的记录,再经专家修正,确立工作内容。结果 2000年调查：上海已全面开展了“家庭病床”的对老年慢性病患者的护理操作;2001年调查：老年护理中的3项位居社区护理需求和提供各自33项中的前四位;2002年调查：社区老年护理的直接护理时问占总时问的29.82％,应包括3项职能、5项活动和45项任务,已实施32项。结论 上海社区老年护理是社区护理的重要部分,能以需求为导向、不断扩展服务对象和内容。     

Standardized nursing care plans for acute care SCI: improved documentation

Adequate documentation of spinal cord injury (SCI) nursing care is necessary for evaluation of patient progress and compliance with standards of care. The objective criteria used to evaluate nursing care include the nursing data base, the care plan, and the nurses' notes. The nursing care plan reflects the needs of the SCI client and is the basis from which documentation about these needs arises. Standards for acute care SCI nursing were recently developed for the 10 designated SCI centers in Florida. To improve the documentation of these standards, neuroscience nurses at Shands Hospital developed standardized care plans that can be individualized for each SCI client. The implementation of these care plans improved documentation of the standards for acute care SCI nursing. Additional benefits included an increased awareness of the nursing diagnoses among staff nurses and improved equality of care for the SCI client.     

The patient educator role in nursing.

A stratified random sample (N = 1,230) of staff nurses, nurse administrators, and nurse educators were surveyed for their perceptions of the extent of nurses' responsibility for patient education and of the level of achievement of patient education by nurses. It was found that all three groups rated nurses' responsibility for patient education at a high level. Although the staff nurse group had statistically significant lower ratings (p = .0005) for nurses' level of responsibility for patient education, all three groups rated nurses' responsibility above 4 on a 5-point scale, with 5 reflecting primary (highest) responsibility. However, achievement of patient education was rated by all three groups below 3, the "good" rating on a 5-point scale, with 5 reflecting an excellent rating. The findings of this study indicate that the role of the nurse as patient educator needs to be strengthened. The satisfactory achievement of patient education is essential for the advancement of the nurse's role as patient educator.     

Nurses' professional and personal values

The purpose of this study was to measure professional and personal values among nurses, and to identify the factors affecting these values. The participants were 323 Israeli nurses, who were asked about 36 personal values and 20 professional values. The three fundamental professional nursing values of human dignity, equality among patients, and prevention of suffering, were rated first. The top 10 rated values all concerned nurses' responsibility towards patients. Altruism and confidentiality were not highly rated, and health promotion and nursing research were rated among the last three professional values. For personal (instrumental) values, honesty, responsibility and intelligence were rated first, while ambition and imagination were rated 14th and 16th respectively out of 18. Significant differences (P < 0.05) were found among some personal and professional values rated as functions of culture, education, professional seniority, position and field of expertise. The results may assist in understanding the motives of nurses with different characteristics and help to promote their work according to professional ethical values.