医护合作型分级护理决策模式对产妇分娩结局的影响

目的：探讨产科医护人员共同制定护理级别临床实践及效果。方法将在产科病区住院的129例产妇采用电脑产生随机数的方法分为常规组（62名）和合作组（67名），常规组采用传统方法根据医生医嘱实施护理分级，合作组应用医护合作型分级护理决策方式进行护理分级，即责任护士通过Barthel指数量表对产科住院患者进行评分，医生依据此评分，根据患者病情决定护理级别。比较两组产妇产后出血量及对护理的满意度。结果两组产妇的护理级别比较，差异有统计学意义（ uc ＝3．54，P＜0．05）。合作组产妇产后出血量为（377．5±83．9） ml，感染的并发率为2．99％；常规组产妇产后出血量为（456．9±78．3）ml，感染并发率为8．06％，两组比较差异有统计学意义（t/χ2分别为6．93，4．18；P＜0．05）。合作组患者满意度为97．01％，常规组为90．32％，两组比较差异有统计学意义（χ2＝4．20， P＜0．05）。结论分级护理的制定应全面评估患者的病情及生活自理能力，医护合作型分级护理决策模式可降低产妇并发症发生的风险，提高护理分级的科学性、合理性，提高护理质量及患者满意度。

Effect of grading nursing by physician-nurse collaboration decision-making on birth outcomes of puerpera

Objective To explore the clinical practice and effect of grading nursing jointly made by doctors and nurses in the obstetrics .Methods One hundred and twenty-nine patients hospitalized in the obstetrics were randomly divided into the conventional group （n=62） and the cooperative group （n=67）.The conventional group received the traditional grading nursing according to the doctor ’ s advice, and the cooperative group received the grading nursing jointly made by doctors and nurses that is the patients hospitalized in the obstetrics were scored by the responsibility nurse through Barthel index scale , and then the doctor decided the grade of nursing according to the score and patient condition .The postpartum hemorrhage and satisfaction of nursing were compared between two groups .Results There was the difference in grade of nursing between two groups, and the difference was statistically significant （uc =3.54, P 〈0.05）.The amount of postpartum hemorrhage was （377.5 ±83.9） ml in the cooperative group , and was （456.9 ±78.3） ml in the conventional group, and the difference was statistically significant （t=6.93, P〈0.05）.The incidence rate of infection was 2.99%in the cooperative group , and was 8.06%in the conventional group , and the difference was statistically significant （χ2 =4.18, P〈0.05）.The satisfaction of patient was 97.01% in the cooperative group, and was 90.32% in the conventional group, and the difference was statistically significant （χ2 =4.20, P〈0.05）. Conclusions Grading nursing should be a comprehensive assessment of the patient ’ s condition and self-care ability, the grading nursing model by physician -nurse collaboration decision-making can reduce the risk of complications , improve the scientific and reasonable of grading nursing , and increase the quality of nursing and satisfaction of patient .