层级全责一体化护理模式在血液净化中心的应用

The Application of Nursing Mode of Five-class Full-responsibility Integration in the Blood Purification Center

目的探讨层级全责一体化护理模式在血液净化中心的应用效果,提高透析护理质量。方法对血液净化中心的维持性血液透析患者实施层级全责一体化护理模式,将血液净化中心护理人员根据职称、学历和能力水平的不同实行结构岗位职责分层,即在病区实行"护士长→护理组长→责任护士→辅助护士→助理护士"的5级层级管理结构。根据维持性规律血液透析患者隔日上午或下午透析的治疗特点,按照区域设置8个层级责任制护理小组,每组各由1名责任护士、1名辅助护士、1名助理护士组成,其中责任护士的工作班次与本组透析患者的透析时间安排相同,固定为隔日早班及下午班。层级责任制护理小组中责任护士和助理护士班次固定3个月,辅助护士班次相对固定。对实施前(2005年)及实施后(2006年)的病房护理管理质量、护理质量结果及患者、护士满意度进行比较。结果实施层级全责一体化护理模式后,病区管理检查分数由实施前(2005年)的93分提高到了实施后(2006年)的97分;消毒隔离检查分数由实施前的96分提高到了实施后的99分;患者满意度由实施前的82%提高到了实施后的92%,护士满意度由实施前的80%提高到了90%。护理质量(患者内瘘穿刺成功率、透析中患者不适症状发生率、护理缺陷发生率)比较差异有统计学意义(P<0.05)。结论血液净化中心实施层级全责一体化护理模式可以有效提高透析护理质量,实现了一体化、系统的透析护理服务,使血液净化中心的护理管理质量更加系统和深入,促进了血液净化护理队伍自身的健全与发展。

Objective To explore the effect of nursing mode of five-class full-responsibility integration in the blood purification center so as to improve the quality of dialysis care. Methods The nurses in the blood purification center were classified based on their academic title, education background, practical ability. A management system of five-level full-responsibility, e.g. head nurse-nursing group leader - nurse on duty - auxiliary nurse - assistant nurse, was formed. 8 nursing groups were organized based on the characteristics of dialysis every another morning or afternoon among patients with retaining dialysis. Each group was made of one nurse on duty, one assistant nurse and one auxiliary nurse, among whom the nurse on duty went to work every another morning or afternoon and the other two members changed their shifts every three months. Then a comparison was conducted between before the execution （2005） and after the execution of the nursing mode （2006） according to the seasonal check-up results in terms of nursing management quality, nursing service quality and satisfaction rate of patient and nurse. Results After execution of the new nursing mode, the nursing management quality was significantly increased （P〈0.05）, the satisfaction rate of patient and nurse was also increased significantly （P〈0.05） and so it was with nursing service quality （including puncturing rate, incidence of patient＇s complaints during dialysis and times for finding flaws at nursing care）（P〈0.05）. Conclusion The nursing mode of five-class full-responsibility integration helps improve the nursing quality of dialysis and realize the integrated and systematic nursing service at dialysis. Therefore, it promotes the completion and development of the nursing team for blood purification.