基层医院两种护理工作模式的效果比较

目的比较责任包干制和床边工作制相结合的个人负责制护理工作模式与层级护理模式的效果，以探讨群众满意、患者安全的临床护理工作模式。方法采用抽签法选择神经外科、骨外科、心内科、妇科4个病房作为试点病房设为研究组，实行责任包干制和床边工作制相结合的个人负责制护理工作模式，以相同方法选择4个非试点病房作为对照组，继续实施层级护理模式。比较该护理模式实施6个月后研究组与对照组患者满意度及护理不良事件发生率。结果研究组不能自理患者对护理服务的总体满意度为96．1％，对照组患者为81．0％，两组在服务态度[（3．57±0．89）分比（3．17±0．76）分]等5个维度方面得分比较，差异有统计学意义（t分别为1．30，0．72，0．25；P〈0．05）；研究组能自理患者满意度为94．9％，对照组为83．9％，两组在基础护理[（3．70±0．64）分比（3．37±0．65）分]等3个维度方面得分比较，差异有统计学意义（t=5．23，P〈0．01）；研究组患者总体满意度为95．2％，对照组患者总体满意度为83．3％，两组比较差异有统计学意义（x2=22．28，P〈0．01）；研究组发生不良事件2例，对照组发生9例，两组比较差异有统计学意义（x2=4．01，P〈0．05）。结论实行责任包干制和床边工作制相结合的个人负责制护理工作模式有利于提高患者满意度和降低护理不良事件的发生率。

Objective To explore the nursing model which can improve the satisfaction degree and reduce adverse event. Methods Selected 4 trial wards of neurosurgery, cardiovascular medicine, orthopedics and gynaecology department in research group by lots, practiced individual responsibility nursing mode including responsibility system and bedside work, selected 4 non-trial wards in control group and practiced the nursing model of stratified care. To survey and compare the satisfaction degree of patients and the quantity of adverse events of nursing between the two groups after six months since the mode used. Results The satisfaction degree of the patients who could not cared by themselves in experimental group was 96.1% and 81.0% in control group, service attitude score were （ 3.57 ± 0.89 ） and （ 3.17 ± 0.76 ） independently, also scores in the other 4 dimensionswere significantly different（t = 1.30,P 〈0. 05 ）. The satisfaction degree of the patients who could cared by themselves in experimental group was 94.9%, and 83.9% in control group, basic nursing score were （3.70 ± 0.64） and （ 3. 37 ± 0. 65 ） independently, also scores in the other 2 dimensions were significantly different（t = 5. 23,P 〈 0. 01 ）. The satisfaction degree of patients in experimental group was 95.2% and 83.30%in control group, the difference was significant（x2 =22.28,P 〈0. 01 ）. Adverse events of nursing was two in experimental group and 9 in control group, the difference was significant （ X2 = 4.01, P 〈 0. 05 ）. Conclusions Individual responsibility nursing mode including responsibility system and bedside work increase the satisfaction degree of patients and reduce the adverse events of nursing.