三级医院分级护理制度实施现状的调查分析

Investigation on Implementation of Grading Nursing Care in Top-notched Hospitals

目的了解三级医院临床实践中分级护理制度实施现状,结合临床实际及专家提出的指导性建议,进一步完善分级护理制度。方法抽取2所三级医院6个病区的患者为调查对象,通过直接观察法,记录每个病区每日接受各级护理的患者数量、巡视时间间隔及未及时更改护理级别的情况。采用Delphi法就分级护理有关内容对30名护理专家进行咨询。结果调查患者283例,其中一级护理47.0%,二级护理51.9%,三级护理1.1%;5.3%未及时更改护理级别。巡视时间间隔一级护理平均55.67min,二级护理220.10min,三级护理233.54min。30名专家认为一级护理需要30～60min巡视1次,病情危重及不稳定者随时巡视;二级护理2～4h巡视1次;三级护理每天巡视3～4次。结论原分级护理制度在临床实践中难以执行,应根据临床实践及专家建议确定合适的分级护理巡视间隔时间。

Objective To investigate the implementation of grading nursing care in clinical settings, and to provide information for further perfection of the protocol. Methods Patients admitted to 6 wards of 2 top-notched hospitals were recruited with stratified sampling method. Such data as daily patient count receiving a specific grade of nursing care, intervals of nurses＇ making their rounds, whether the grading of nursing care was changed timely in accordance with doctors＇ order, were collected under direct observation. After that, 30 nursing specialists were consulted in terms of the contents of grading of nursing care. Results A total of 283 patients were investigated, among whom, 133（47.0%） received grade I nursing care, 147（51.9%） grade II and 3（1. 1%） grade III; the level of nursing care which was received by 15 （5.3%） patients, was not changed timely. The interval of nurses＇ making their rounds averaged 55.67 min for grade I nursing care, 220.10 min for grade II, and 233.54 min for grade IIL All the specialists agreed that nurses should make their rounds every 30-60 min, or at anytime when patients were critically ill, for grade I nursing care, every 2-4 h for grade II, and 3-4 times a day for grade III. Conclusion It is difficult to implement the previous grading of nursing care in clinical practice. So the results of the investigation and expert consultation is consistent with clinical practice and easy to operate.