对分级护理巡视时间的调查分析及改进

The analysis and exploration of the round time of grading nursing care

目的调查临床实践中分级护理巡视现况,以调查结果为依据应用Delphi法进行专家咨询,确定各级护理合理的巡视时间。方法首先采用分层抽样法,抽取广州市某三级甲等医院内、外科各4个病区的患者为调查对象,通过观察法调查各病区护士白天10h内对每位患者的巡视情况,各病区调查1周。然后应用Delphi法对全国14个省市27所三级甲等医院的护理专家就分级护理服务内容(包括巡视相关内容)进行咨询。结果共调查患者436例,一、二、三级护理患者分别占35.6%、63.8%、0.6%;各病区护士白天对患者(不分护理级别)巡视的平均间隔时间为35.7-57.7min;输液巡视是主要的巡视内容,但与护理巡视要求相差较远。专家咨询结果显示合理的巡视时间为:一级护理30-60min巡视1次,病危病重者随时巡视;二级护理2-4h巡视1次;三级护理则按照床头交接班次数,每天巡视患者3或4次。结论原分级护理巡视时间在临床实践中难以执行,输液巡视作为分级护理巡视的一种特殊形式有利有弊,它无法取代分级护理的巡视内容。根据调查结果并经专家咨询后确定的分级护理巡视时间立足实践,切合实际,可操作性较强。

Objective To investigate the current status of the round time of grading nursing care in practice, then to determine the rational round time for practice with Delphi method. Methods With stratified sampling, eight departments were chosen in a tertiary level 1st class general hospital in Guangzhou as studying subjects. Data about the round time of grading nursing system during the time 8am to 6pm were collected. Every department was investigated for a week. Then nursing specialists from 27 hospitals of 14 provinces and cities were consulted for determining the rational round time. Results Totally 436 patients were investigated, including 35.6%, 63.8% and 0.6% of nursing care Grade Ⅰ,Ⅱ and Ⅲ respectively. The shortest round time interval was 35.7min, and the longest was 57.7min, which all within one hour. The transfusion round time was the mainly method, but it had great disadvantage. The result of Delphi method consultation showed that it was suitable to round the inpatient every 30-60min for Grade I, 2-4h for Grade Ⅱ, and three or four times a day for Grade III. Conclusions It is difficult to implement the round time standards of grading nursing care in practice. As a specM kind of round time, transfusion round time could not be instead of the round content in the grading nursing care. So the result of Delphi method consultation is consistent with clinical practice and easy to operate.