临床23项护理操作规范性的评价研究
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摘要
目的评价临床护士实际工作过程中23项常见护理操作的规范化程度。方法对北京市4所三级甲等医院40名护士的23项临床护理操作执行情况进行参与性观察,采用自设的临床常用护理操作技术操作流程记录评价表对其规范性进行评价。结果 23项护理操作在实际执行中规范化程度为66.30%±13.55%;无菌类操作的规范化程度高于非无菌类操作的规范化程度(P<0.01);实际操作中存在评估解释不足(34.78%±6.15%)、操作后健康指导欠缺(52.17%±6.15%)、三查七对落实欠佳(38.04%±2.17%)、抽药方法不够规范(100%)4个共性问题。结论临床实践中护理操作流程与医院的规范化操作流程存在差异,护理管理者应加强管理和培训,提高护理操作规范度,同时,也要根据学科发展修订临床护理操作规范。
Objective To evaluate the standardization degree of 23 frequently-used nursing skills in clinical settings. Methods The participant observation was carried out among 40 nurses from four tertiary hospitals in Beijing to understand the standardization degree of 23 common nursing skills.Self-designed record and evaluation form were used to evaluate the standardization degree. Results The general standardization degree of 23 nursing skills was66.30%±13.55%,according to the standardized operation procedures provided by hospitals.The standardization degree of aseptic operations was higher than that of non-aseptic operations(P<0.01). Four general problems were found during the evaluation including lack of assessment and explanation(34.78%±6.15%),lack of health education after the procedure(52.17%±6.15%),poor implementation of double-checking(38.04%±2.17%) and non-standard medication preparation(100%). Conclusion There are differences between actual nursing operation procedures in clinical settings and the standardized operation procedures provided by hospitals. Clinical nursing administrators should provide training to improve the standardization degree of nursing operations and revise nursing operation standardization regularly according to the development of nursing discipline.
Objective To evaluate the standardization degree of 23 frequently-used nursing skills in clinical settings. Methods The participant observation was carried out among 40 nurses from four tertiary hospitals in Beijing to understand the standardization degree of 23 common nursing skills.Self-designed record and evaluation form were used to evaluate the standardization degree. Results The general standardization degree of 23 nursing skills was66.30%±13.55%,according to the standardized operation procedures provided by hospitals.The standardization degree of aseptic operations was higher than that of non-aseptic operations(P<0.01). Four general problems were found during the evaluation including lack of assessment and explanation(34.78%±6.15%),lack of health education after the procedure(52.17%±6.15%),poor implementation of double-checking(38.04%±2.17%) and non-standard medication preparation(100%). Conclusion There are differences between actual nursing operation procedures in clinical settings and the standardized operation procedures provided by hospitals. Clinical nursing administrators should provide training to improve the standardization degree of nursing operations and revise nursing operation standardization regularly according to the development of nursing discipline.
引文
[1]梁丽芳,宋文爱.护士对护理操作技能考核的评价及分析[J].当代护士(中旬刊),2014(2):96-97.
[2]梁小芹.护理本科毕业生核心护理技能体系的构建[D].北京:北京协和医学院,2010.
[3]Needleman J.Nursing skill mix and patient outcomes[J].BMJQual Saf,2017,26(7):525-528.
[4]陈彩敏,刘瑛.护士标准化技术操作培训对护理质量的影响[J].临床医学研究与实践,2018,3(9):178-179.
[5]袁小萱.护士在临床护理操作中存在的问题及对策[J].甘肃医药,2017,36(8):699-700.
[6]付燕.护理人员医院感染预防控制知识培训效果评价研究[D].济南:山东大学,2013.
[7]王晶彦,张玲,候莉凤.护理管理中的风险管理分析[J].中国卫生产业,2016,13(22):150-152.
[8]朱兰坚.护理安全隐患相关因素分析与对策[J].中国护理管理,2009,9(4):67-68.
[9]沈峰平,席惠君,张玲娟,等.分级评价指标在临床护士护理技能操作培训中的应用效果评价[J].护理管理杂志,2017,17(8):584-585,605.
[10]吴丛玲.临床护理操作考核中问题和应对策略探析[J].医学信息,2014(28):264.
[11]黄秀秀,刘溢思,李馨,等.129项护理操作临床应用情况的调查分析[J].中华护理教育,2018,15(2):104-109.
[12]邓伟,马小琴.浙江省5家三级甲等综合医院护理技能临床执行频率及重要性的调查分析[J].护理学报,2015,22(19):31-35.
[13]刘溢思,吴瑛,张艳,等.对北京市某三级甲等综合医院122项护理操作技术使用频率及广度的调查分析[J].中华护理教育,2010,7(9):387-390.
[14]赵静.铺床教学中关于大单被套折叠方法的体会[J].特别健康,2017(16):184.
[15]胡仙琴,张美丽,项灵斐.临床护理安全事件相关因素及对策分析[J].中华现代护理杂志,2015,21(14):1712-1714.
[16]周舫.基础护理质量存在的问题与对策[J].中国医药指南,2013(21):330-331.
[17]王洪丽.基于护理质量数据平台统计结果的护理结构指标数据准确性分析[J].中国卫生标准管理,2018(2):13-14.
[18]Rosenberg K.California mandated nurse-patient ratios deemed successful[J].Am J Nurs,2011,111(10):17.
[19]文佐娟.实施标准化护理操作流程中存在的问题分析[J].中国实用医药,2010,5(20):257-259.
[20]植少娟,袁碧,刘和菊.护理安全管理相关因素和对策探讨[J].医学信息(下旬刊),2011(8):295-296.
[21]Papastavrou E,Andreou P,Efstathiou G.Rationing of nursing care and nurse-patient outcomes:a systematic review of quantitative studies[J].Int J Health Plann Manage,2014,29(1):3-25.
[22]秦阳,吕胜南,张婷婷,等.以工作量为基础评价和优化护士配备的方法研究[J].齐鲁护理杂志,2016,22(1):38-40.
[23]许红霞,徐宇红,阮丽.PDCA管理模式对提升护理操作实践能力的效果观察[J].实用临床医药杂志,2014,18(22):214-215.
[24]黄燕琴,袁秋影,危小敏.规范化培训在提高低年资护士工作能力中的应用[J].齐鲁护理杂志,2016,22(22):115-117.
[25]段小芳.加强操作培训在提高年轻护士素质中的作用[J].全科护理,2013,11(12):1123.
[26]Chant S,Jenkinson T,Randle J,et al.Communication skills:some problems in nursing education and practice[J].J Clin Nurs,2002,11(1):12-21.
[27]周新霞,程平.护理操作流程对护理质量的影响因素分析[J].护理实践与研究,2011,8(22):55-57.
[28]张雪莲.住院患者对护士操作技术满意度调查及其影响因素分析[D].新乡:新乡医学院,2014.
[29]杨红伟,金凤,于晶,等.三级甲等医院住院患者对护理操作告知需求的调查[J].上海护理,2017,17(1):35-37.
[30]秦殿菊,杨建新,封桂英.自考本科生静脉输液考核中执行查对制度情况分析[J].护士进修杂志,2009,24(24):2237-2240.
[31]胡素容,章俊梅,胡庆新,等.影响护理给药查对制度正确执行的相关因素研究[J].西部医学,2012,24(9):1818-1820.
[32]胡忠华,王国蓉,巴智明.护士查对行为研究[J].四川医学,2015,36(5):748-751.
[33]江美玲,刘燕珍,陈灼燕.床边给药双重身份核对落实情况调查分析[J].中国卫生标准管理,2017,8(13):177-179.
[34]屠蕾,高歌,张渊.PDA条形码扫描核对技术在护士安全用药中的应用[J].护理学杂志,2013,28(22):63-65.
[35]张银华,袁群,易霞,等.护理本科生对护理技能教学与临床护理实践差异的认知研究[J].全科护理,2015,13(21):2122-2123.
[36]Williams K,West EA.Approaches to nursing skills training in three countries[J].Int Nurs Rev,2012,59(2):230-236.
[37]周晓娟,曹教育,管翠华.低分子肝素钙留置空气注射法减少相关并发症的效果观察[J].健康必读(中旬刊),2011(8):57-58.
[38]高丽娟,韩红芳.皮下无痛注射方法的研究进展[J].中国实用护理杂志,2014,30(28):47-48.
[2]梁小芹.护理本科毕业生核心护理技能体系的构建[D].北京:北京协和医学院,2010.
[3]Needleman J.Nursing skill mix and patient outcomes[J].BMJQual Saf,2017,26(7):525-528.
[4]陈彩敏,刘瑛.护士标准化技术操作培训对护理质量的影响[J].临床医学研究与实践,2018,3(9):178-179.
[5]袁小萱.护士在临床护理操作中存在的问题及对策[J].甘肃医药,2017,36(8):699-700.
[6]付燕.护理人员医院感染预防控制知识培训效果评价研究[D].济南:山东大学,2013.
[7]王晶彦,张玲,候莉凤.护理管理中的风险管理分析[J].中国卫生产业,2016,13(22):150-152.
[8]朱兰坚.护理安全隐患相关因素分析与对策[J].中国护理管理,2009,9(4):67-68.
[9]沈峰平,席惠君,张玲娟,等.分级评价指标在临床护士护理技能操作培训中的应用效果评价[J].护理管理杂志,2017,17(8):584-585,605.
[10]吴丛玲.临床护理操作考核中问题和应对策略探析[J].医学信息,2014(28):264.
[11]黄秀秀,刘溢思,李馨,等.129项护理操作临床应用情况的调查分析[J].中华护理教育,2018,15(2):104-109.
[12]邓伟,马小琴.浙江省5家三级甲等综合医院护理技能临床执行频率及重要性的调查分析[J].护理学报,2015,22(19):31-35.
[13]刘溢思,吴瑛,张艳,等.对北京市某三级甲等综合医院122项护理操作技术使用频率及广度的调查分析[J].中华护理教育,2010,7(9):387-390.
[14]赵静.铺床教学中关于大单被套折叠方法的体会[J].特别健康,2017(16):184.
[15]胡仙琴,张美丽,项灵斐.临床护理安全事件相关因素及对策分析[J].中华现代护理杂志,2015,21(14):1712-1714.
[16]周舫.基础护理质量存在的问题与对策[J].中国医药指南,2013(21):330-331.
[17]王洪丽.基于护理质量数据平台统计结果的护理结构指标数据准确性分析[J].中国卫生标准管理,2018(2):13-14.
[18]Rosenberg K.California mandated nurse-patient ratios deemed successful[J].Am J Nurs,2011,111(10):17.
[19]文佐娟.实施标准化护理操作流程中存在的问题分析[J].中国实用医药,2010,5(20):257-259.
[20]植少娟,袁碧,刘和菊.护理安全管理相关因素和对策探讨[J].医学信息(下旬刊),2011(8):295-296.
[21]Papastavrou E,Andreou P,Efstathiou G.Rationing of nursing care and nurse-patient outcomes:a systematic review of quantitative studies[J].Int J Health Plann Manage,2014,29(1):3-25.
[22]秦阳,吕胜南,张婷婷,等.以工作量为基础评价和优化护士配备的方法研究[J].齐鲁护理杂志,2016,22(1):38-40.
[23]许红霞,徐宇红,阮丽.PDCA管理模式对提升护理操作实践能力的效果观察[J].实用临床医药杂志,2014,18(22):214-215.
[24]黄燕琴,袁秋影,危小敏.规范化培训在提高低年资护士工作能力中的应用[J].齐鲁护理杂志,2016,22(22):115-117.
[25]段小芳.加强操作培训在提高年轻护士素质中的作用[J].全科护理,2013,11(12):1123.
[26]Chant S,Jenkinson T,Randle J,et al.Communication skills:some problems in nursing education and practice[J].J Clin Nurs,2002,11(1):12-21.
[27]周新霞,程平.护理操作流程对护理质量的影响因素分析[J].护理实践与研究,2011,8(22):55-57.
[28]张雪莲.住院患者对护士操作技术满意度调查及其影响因素分析[D].新乡:新乡医学院,2014.
[29]杨红伟,金凤,于晶,等.三级甲等医院住院患者对护理操作告知需求的调查[J].上海护理,2017,17(1):35-37.
[30]秦殿菊,杨建新,封桂英.自考本科生静脉输液考核中执行查对制度情况分析[J].护士进修杂志,2009,24(24):2237-2240.
[31]胡素容,章俊梅,胡庆新,等.影响护理给药查对制度正确执行的相关因素研究[J].西部医学,2012,24(9):1818-1820.
[32]胡忠华,王国蓉,巴智明.护士查对行为研究[J].四川医学,2015,36(5):748-751.
[33]江美玲,刘燕珍,陈灼燕.床边给药双重身份核对落实情况调查分析[J].中国卫生标准管理,2017,8(13):177-179.
[34]屠蕾,高歌,张渊.PDA条形码扫描核对技术在护士安全用药中的应用[J].护理学杂志,2013,28(22):63-65.
[35]张银华,袁群,易霞,等.护理本科生对护理技能教学与临床护理实践差异的认知研究[J].全科护理,2015,13(21):2122-2123.
[36]Williams K,West EA.Approaches to nursing skills training in three countries[J].Int Nurs Rev,2012,59(2):230-236.
[37]周晓娟,曹教育,管翠华.低分子肝素钙留置空气注射法减少相关并发症的效果观察[J].健康必读(中旬刊),2011(8):57-58.
[38]高丽娟,韩红芳.皮下无痛注射方法的研究进展[J].中国实用护理杂志,2014,30(28):47-48.