脑卒中专科护理团队的建设与实践
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摘要
目的:建立脑卒中专科护理团队,对护士进行专科培养,分析专科护理团队的实践效果。方法:制定脑卒中专科护理团队建设方案,确定人员培养类别,培训内容包括国内前沿知识和院内基础知识培训,重点培养护士综合能力和专业技能。结果:通过5年的培养,护士在学历结构、职称结构、专业资质认证3个方面均有改善;脑卒中患者护理相关评价指标方面:平均住院日、平均住院费用、卒中绿色通道救治开展率、护理并发症/合并症发生率、卒中复发返院率比较,2017年优于2012年,差异有统计学意义(P<0.05);患者卒中评估、康复训练、健康教育、心理护理、营养管理、随访管理开展率及合格率比较,2017年优于2012年,差异有统计学意义(P<0.05);形成一系列卒中护理规范,取得多项学术科研成果。结论:对脑卒中护理团队有计划地进行建设,可以提高护士护理能力,为患者提供高质量的护理服务,达到了护教研相互促进的目的。
Objective: To establish a specialist nursing team in stroke unit, to train nurses in specialties, and to observe its effect on stroke patients. Methods: The stroke specialist training team construction plan was formulated, the personnel training category was determined, and the domestic frontier training plus in-hospital training method was adopted to train the nurses to cultivate the comprehensive ability and special skills of the nurses. Results: Through five years of training,significant changes had taken place in nursing team in terms of academic structure, professional title structure, and professional qualification certification. For indicators for evaluation of treatment outcomes of stroke patients, there were significant differences in average hospitalization days, average cost, stroke green channel treatment rate, the incidence of nursing complications and the rate of readmission. The indicators in 2017 were better than those in 2012(P<0.05); and there were significant differences in the compliance rate of the specialist assessment of stroke patients, rehabilitation training,psychological nursing, health education, nutrition management, follow-up management. In 2017, the indicators were better than those in 2012(P<0.05). What's more, a series of stroke nursing standards were formed, and many academic research results were achieved. Conclusion: The construction of the stroke nursing team can improve the nurses' ability in providing high-quality nursing services for patients, which help achieve the goal of mutual promotion of nursing education and research.
Objective: To establish a specialist nursing team in stroke unit, to train nurses in specialties, and to observe its effect on stroke patients. Methods: The stroke specialist training team construction plan was formulated, the personnel training category was determined, and the domestic frontier training plus in-hospital training method was adopted to train the nurses to cultivate the comprehensive ability and special skills of the nurses. Results: Through five years of training,significant changes had taken place in nursing team in terms of academic structure, professional title structure, and professional qualification certification. For indicators for evaluation of treatment outcomes of stroke patients, there were significant differences in average hospitalization days, average cost, stroke green channel treatment rate, the incidence of nursing complications and the rate of readmission. The indicators in 2017 were better than those in 2012(P<0.05); and there were significant differences in the compliance rate of the specialist assessment of stroke patients, rehabilitation training,psychological nursing, health education, nutrition management, follow-up management. In 2017, the indicators were better than those in 2012(P<0.05). What's more, a series of stroke nursing standards were formed, and many academic research results were achieved. Conclusion: The construction of the stroke nursing team can improve the nurses' ability in providing high-quality nursing services for patients, which help achieve the goal of mutual promotion of nursing education and research.
引文
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[7]王春娟,王伊龙,李子孝,等.初级卒中中心建设标准(2011更新版).中国卒中杂志,2012,7(8):646-657.Wang CJ,Wang YL,Li ZX,et al.Standards for the construction of primary stroke centers(2011update).Chinese Journal of Stroke,2012,7(8):646-657.
[8]钟代曲,钱春荣,黄志玉,等.脑卒中三级预防护理手册.北京:北京师范大学出版社,2016(9):1-172.Zhong DQ,Qian CR,Huang ZY,et al.Threelevel preventive nursing manual for stroke.Beijing:Beijing Normal University Press,2016(9):1-172.
[9]Dion JE.Management of ischemic stroke in the next decade:stroke centers of excellence.Journal of Vascular&Interventional Radiology,2004,15(1):S133-S141.
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[11]魏小妹,赵庆华,丁福.医院专科护理学习型团队建设的实践与效果.中华护理教育,2016,13(5):377-379.Wei XM,Zhao QH,Ding F.Practice and effect of hospital nursing and learning team building.Chinese Nursing Education,2016,13(5):377-379.
[12]朱晓萍,唐佳.降低聘用制护士离职率的实践与成效.中国医院管理,2010,30(7):61-62.Zhu XP,Tang J.Practice and effectiveness of reducing the turnover rate of hiring nurses.Chinese Hospital Management,2010,30(7):61-62.
[13]Mary TA,Judy R,Ann MD,et al.Lung cancer treatment rates and the role of the lung cancer nurse specialist:a qualitative study.BMJOpen,2015,5(12):e008587.
[14]Finkelman A.The clinical nurse specialist:leadership in quality improvement.Clinical Nurse Specialist,2013,27(1):31.
[15]Ford AL,Williams JA,Spencer M,et al.Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.Stroke,2012,43(12):3395-3398.
[16]徐群利,江云,胡贝贝,等.卒中中心组织化管理实践与思考.中华医院管理杂志,2017,33(5):366-368.Xu QL,Jiang Y,Hu BB,et al.Stroke center organizational management practice and thinking.Chinese Journal of Hospital Management,2017,33(5):366-368.
[17]钟代曲,钱春荣,沈盈盈,等.脑卒中三级预防健康教育方案的设计与应用.护理管理杂志,2016,16(10):755-757.Zhong DQ,Qian CR,Shen YY,et al.Design and application of a three-level preventive health education program for stroke.Journal of Nursing Administration,2016,16(10):755-757.
[18]张诗敏,杜雪平,胡海鹰.社区康复工作现状及对策研究.中国全科医学,2011,14(25):2918-2920.Zhang SM,Du XP,Hu HY.Research on the status quo and counter measures of community rehabilitation work.Chinese General Practice,2011,14(25):2918-2920.
[19]钟代曲,蒋晓江,曾登芬,等.微信平台在出院脑卒中患者管理中的应用.护理研究,2015(16):2029-2031.Zhong DQ,Jiang XJ,Zeng DF,et al.Application of WeChat platform in the management of stroke patients discharged.Chinese Nursing Research,2015(16):2029-2031.
[20]钟代曲,程晓东,沈盈盈,等.脑卒中患者网络化管理系统的研发与应用效果研究.中华护理杂志,2018,53(7):791-796.Zhong DQ,Cheng XD,Shen YY,et al.Research on the development and application of network management system for stroke patients.Chinese Journal of Nursing,2018,53(7):791-796.
[21]Mcelwaine P,Noone I,Harbison J.The stroke clinical nurse specialist role-the Irish experience.International Journal of Stroke,2015,10(4 sup):348.
[2]Liu L,Wang D,Wong KS,et al.Stroke and stroke care in China:huge burden,significant workload,and a national priority.Stroke,2011(42):3651-3654.
[3]Yang GH,Wang Y,Zeng YX,et al.Rapid health transition in China,1990-2010:findings from the global burden of disease study 2010.Lancet,2013,381(9882):1987-2015.
[4]Longhorne P.Organized inpatient(stroke unit)care for stroke.Stroke,2014,45(2):e14-e15.
[5]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010.中华神经科杂志,2010,14(2):4013-4017.Guidelines Writing Group for Acute Ischemic Stroke Diagnosis and Treatment,Cerebrovascular Disease Group of Chinese Medical Association Neurology Branch.Guidelines for the diagnosis and treatment of acute ischemic stroke in China2010.Chinese Journal of Neurology,2010,14(2):4013-4017.
[6]国家卫生和计划生育委员会神经内科医疗质量控制中心.中国卒中中心建设指南.中国卒中杂志,2015,10(6):499-507.National Health&Family Planning Commission Neurology Medical Quality Control Center.China stroke center construction guide.China Stroke Journal,2015,10(6):499-507.
[7]王春娟,王伊龙,李子孝,等.初级卒中中心建设标准(2011更新版).中国卒中杂志,2012,7(8):646-657.Wang CJ,Wang YL,Li ZX,et al.Standards for the construction of primary stroke centers(2011update).Chinese Journal of Stroke,2012,7(8):646-657.
[8]钟代曲,钱春荣,黄志玉,等.脑卒中三级预防护理手册.北京:北京师范大学出版社,2016(9):1-172.Zhong DQ,Qian CR,Huang ZY,et al.Threelevel preventive nursing manual for stroke.Beijing:Beijing Normal University Press,2016(9):1-172.
[9]Dion JE.Management of ischemic stroke in the next decade:stroke centers of excellence.Journal of Vascular&Interventional Radiology,2004,15(1):S133-S141.
[10]Jauch EC,Saver JL,Adams HP,et al.Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke,2013,44(3):870-947.
[11]魏小妹,赵庆华,丁福.医院专科护理学习型团队建设的实践与效果.中华护理教育,2016,13(5):377-379.Wei XM,Zhao QH,Ding F.Practice and effect of hospital nursing and learning team building.Chinese Nursing Education,2016,13(5):377-379.
[12]朱晓萍,唐佳.降低聘用制护士离职率的实践与成效.中国医院管理,2010,30(7):61-62.Zhu XP,Tang J.Practice and effectiveness of reducing the turnover rate of hiring nurses.Chinese Hospital Management,2010,30(7):61-62.
[13]Mary TA,Judy R,Ann MD,et al.Lung cancer treatment rates and the role of the lung cancer nurse specialist:a qualitative study.BMJOpen,2015,5(12):e008587.
[14]Finkelman A.The clinical nurse specialist:leadership in quality improvement.Clinical Nurse Specialist,2013,27(1):31.
[15]Ford AL,Williams JA,Spencer M,et al.Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.Stroke,2012,43(12):3395-3398.
[16]徐群利,江云,胡贝贝,等.卒中中心组织化管理实践与思考.中华医院管理杂志,2017,33(5):366-368.Xu QL,Jiang Y,Hu BB,et al.Stroke center organizational management practice and thinking.Chinese Journal of Hospital Management,2017,33(5):366-368.
[17]钟代曲,钱春荣,沈盈盈,等.脑卒中三级预防健康教育方案的设计与应用.护理管理杂志,2016,16(10):755-757.Zhong DQ,Qian CR,Shen YY,et al.Design and application of a three-level preventive health education program for stroke.Journal of Nursing Administration,2016,16(10):755-757.
[18]张诗敏,杜雪平,胡海鹰.社区康复工作现状及对策研究.中国全科医学,2011,14(25):2918-2920.Zhang SM,Du XP,Hu HY.Research on the status quo and counter measures of community rehabilitation work.Chinese General Practice,2011,14(25):2918-2920.
[19]钟代曲,蒋晓江,曾登芬,等.微信平台在出院脑卒中患者管理中的应用.护理研究,2015(16):2029-2031.Zhong DQ,Jiang XJ,Zeng DF,et al.Application of WeChat platform in the management of stroke patients discharged.Chinese Nursing Research,2015(16):2029-2031.
[20]钟代曲,程晓东,沈盈盈,等.脑卒中患者网络化管理系统的研发与应用效果研究.中华护理杂志,2018,53(7):791-796.Zhong DQ,Cheng XD,Shen YY,et al.Research on the development and application of network management system for stroke patients.Chinese Journal of Nursing,2018,53(7):791-796.
[21]Mcelwaine P,Noone I,Harbison J.The stroke clinical nurse specialist role-the Irish experience.International Journal of Stroke,2015,10(4 sup):348.