分级护理新标准的制定及评价

Establishment of new standard of progressive patient care and evaluation

目的:制定分级护理新标准。方法:通过2次自制调查表,对3所三级甲等医院22个疾病系统237种疾病的5391名住院病人的实际护理情况进行了2次问卷调查,第一次采用开放式提问调查,分析总结其结果将病情监测间隔时间分为15～30min、1～2h、3～6h、>6h;病人活动能力分5度:即绝对卧床休息、床上活动、床周自行活动、室内活动、院内活动;生活辅助项目分为饮食、排泄、全身清洁,辅助程度分为完全协助、部分协助、自理3个等级;依此内容进行第二次封闭式提问调查并制定出分级护理新标准;用新标准进行临床试用。结果:随护理级别的下降,监测病人病情间隔时间延长,病人生活辅助程度随亚级别的下降能自理的人数呈增多趋势;80%以上病人对饮食指导、心理护理、健康指导的护理有需求,且贯穿于病人整个护理服务之中。结论:①不同的病人护理需求不同,同种疾病的病人护理需求也不同;②目前分级护理的内容不完善、欠严谨,不能完全适应病人的需求;③分级护理新标准与临床实践更相符,更具实用性。

Objective： To establish new standard of progressive patient care. Methods： The actual nursing condition of 5391 inpatients with 237 kinds of diseases from 22 disease systems in three level three grade one hospitals were investigated twice by self-designed questionnaire. The first investigation was carded out using open questions. According to the first investigation results, the interval of observation time of patients＇ conditions was divided into 15min-30min, 1h-2h, 3h-6h and 〉6h; the level of activity was divided into 5 levels： strict bed rest, activity in bed, activity around bed, activity in room and activity outdoor; life-assisted items included feeding, toilet and hygiene; the level of life-assisted divided into whole assisted, part assisted and serf-care. According to these results, the second investigation was carded out using closed-questions. New standard of progressive patient care was established according to the second investigation results and it was tested in clinical practice. Results： With the declining of patient care level, the interval of observation time of patients＇ conditions was extended and the number of self-care patients increased; more than 80% patients had demands of feeding direction, psychological nursing and health education, and those ran through the whole nursing service. Conclusion： （1） different patients had different nursing demands and patients with same disease had different nursing demands. （2） the content of current progressive patient care was not perfect and compact, couldn＇t satisfy patients＇ demands perfectly. （3） the new standard of progressive patient care corresponded to clinical practice more and had more practicable than the old one.