助产士分级管理模式应用效果观察

Clinical Application of Midwife Hierarchical Management Mode

目的探讨实行助产士分级管理模式对提高产科质量与护理质量、促进产房管理、保证助产安全的可行性。方法从2007年11月开始实施助产士分级管理模式,实行护士长—责任组长—责任助产士分级管理。2007年11月—2008年8月执行助产士分级管理模式,在产房工作10年以下的助产士接生的阴道顺产初产妇1 544例,与2006年11月—2007年10月未执行助产士分级管理模式的10年以下年资助产士接生的阴道顺产初产妇1 029例的产科质量各项指标、护理质量及产妇满意度方面进行比较。结果施行助产士分级管理模式后的产妇会阴伤口感染率、会阴侧切率、宫颈裂伤率明显减少(P<0.05),护理投诉案例显著降低(P<0.05),护理缺陷发生率也显著降低(P<0.05),总体产科质量提高;同时,让年轻助产士增强安全感,高年资助产士得到满足感,医护关系得到改善,产妇及家属的满意度提高。结论实行助产士分级管理模式,设置助产组长,进行过程控制,提升服务质量,有助于实现护理工作的持续改进,并且尝试和探讨培养助产专科护士和临床护理专家。

Objective To explore the feasibility of midwife hierarchical management mode in improving the job quality, including the nursing quality, in the obstetrical department, thus promoting the delivery room management and ensuring the midwifery security. Methods The hierarchical management was initiated in Nov., 2007, with the head nurse - group head - charge midwife system being adopted. 1 544 primiparas with vaginal natural labor by midwives under the hierarchical management system who had worked in the obstetrical department for less than 10,years were included in the observation group, and 1 029 primiparas with vaginal natural labor by mid-wives who ＇had less-than-ten-year work experience in the obstetrical department but who had not been included in the hierarchical management system, in the control group. A comparison was made of both groups＇ various obstetrical indexes, nursing quality and the parturients＇ satisfaction. Results The perineum cut infection rate, side cut rate and cervical laceration rate among the observation group were all lower than those of the control group （P〈0.05）; the number of nursing complaints of the former, markedly fewer （P〈0.05）. Nurses had derived greater sense of security or satisfaction, the medical-patient relation was improved, and the parturients＇ and dependents＇ satisfaction was increased. Conclusion The midwife hierarchical management system, with its process control, improves the nursing service quality, facilitates the sustainable improvement of nursing, and helps cultivating specialized mid-wives and clinical nursing specialist on the trial basis.