基于Kaiser模型的山东某市儿科护理风险事件识别评估与改进对策

The identification,evaluation and improvement strategies of pediatric nursing risk events in a city of Shandong Province based on the Kaiser model

目的旨在对山东某市门、急诊儿科科室的护理风险事件进行识别与分析评估,得出发生儿科护理风险事件主要风险因素。方法采用随机调查法,研究团队自2016年9—12月期间对来自山东某市的1个主区和10个县(市)医院儿科科室的医、护、技人员和行政管理的中层干部109人进行问卷调查。首先成立护理专家团队,遵循Kaiser模型构建适合于儿科护理特点的风险事件种类识别,之后编制问卷用来采集儿科护理风险事件的相关数据,以便进行主要儿科护理风险事件的识别和评估。结果经过对某市儿科科室护理风险事件的识别和评估发现,儿科护理风险事件相对风险值的30%从高到低排序依次为:护理人员锐刺伤(51.48%)、家属投诉情况(51.00%)、护患法律纠纷(47.13%)、大规模伤害事件(40.82%)、儿童发生感染(40.76%)、儿童流行病爆发(40.64%)。结论针对得出的儿科护理风险事件主要风险因素,结合儿科特点,本文建议从加强儿科护理人员风险安全意识、合理处理护患纠纷矛盾、提高突发事件的应急能力、规范儿科科室的护理感染管理等方面来采取措施,为儿科科室和职能部门减少儿科护理风险事件的发生,加强后续儿科护理风险管理、风险控制和风险考核等环节,保障儿科护理人员合法权益和儿童患者的安全,提高儿科护理服务质量提供决策参考。

Objective The purpose of this paper is to identify and assess the nursing risk events in a city of Shandong province of China, and to find the main risk factors for the controlling pediatric nursing risk events. Methods A ques- tionnaire survey was conducted among 109 doctors, nurses, technicians and middle administrators from hospitals in Shan- dong province. A nursing expert team was set up before revising contents of the original Kaiser model on risk event identi- fication and made it suitable for pediatric nursing. And then the questionnaire was prepared for data collection, identifica- tion and assessment of pediatric nursing risk events. Results The six events of main risks of pediatric nursing faced were： sharp stab （51.48%） , family complaints （51.00%）, legal disputes between nurses and patients （47.13%）, mass injury events （40.82%）, infection （40.76%）, and epidemic outbreak （40.64%）. Conclusion Medical insti- tutions and health decision makers should develop appropriate measures by analyzing results to guarantee safety of patients and nurses and improve nursing service quality by establishing the risk consciousness, settling reasonably patient-nurse disputes, improving the emergency response capacity of several contradictions, and standardizing the nursing infection management in the department emergency. It is important to reduce occurrence of the risk events of pediatric nursing, strengthen the following pediatric nursing risk management, risk control and risk assessment and other aspects, and safe- guard the legitimate rights and interests of the pediatric patients and nursing staff to provide a reference to improve the service quality of pediatric nursing.