山西省某三级甲等医院临床医护合作存在问题的现状调查

Research on the existing problems of clinical doctor-nurse collaboration

目的探讨临床医护合作关键结合点及存在的问题，为改善医护合作，实现医护无缝隙合作提供依据。方法通过开放性问卷调查，找出医护合作内容及其存在的问题，编制医护合作存在问题调查问卷（医生卷、护士卷）。选取山西省某三级甲等医院的247名护士、211名医生进行问卷调查，以分析医护合作点间关系及存在问题的原因。结果8个医护合作内容得分率分别为护士卷30．35％-84．50％，医生卷31．30％-84．30％；护士卷与医生卷得分率最高的维度均为医师操作维度，分别为84．50％，84．30％；护士卷与医生卷得分最高的5个条目中病区管理条目均占40％；82．94％（得分≥3）的医生认为低年资护士的合作能力较差。结论医师操作时护士合作薄弱；病区管理维度问题最多；医嘱处理及执行的问题最棘手；低年资护士缺乏规范化培训和胜任力评价；建议制定合理流程和职责以改善医护合作。

Objective To investigate key bonding point and existing problems of clinical doctor-nurse collaboration, in order to improve the collaboration and provide reference for seamless cooperation between doctors and nurses. Methods Open questionnaires were used to find out the bonding point of doctor-nurse collaboration and its problems. Questionnaire on existing problems of doctor-nurse collaboration （ doctor volume and nurse volume） was also designed for further analysis. 247 nurses and 211 doctors in a third class A hospital in Shanxi province were included in this investigation, to work out the collaboration between nurses and doctors and the cause of existing problems. Results The score rates in 8 doctor - nurse bonding point were 30.35% ~ 84.5% in nurse volume and 31.3% - 84.3% in doctor volume. The highest score in both nurse and doctor volume was doctor＇s operating dimension, which accounted for 84.5% and 84.3%. Among 10 worst doctor- nurse collaboration items, people who scored more than or equal to 3 accounted for 63.97% ~ 100.00%. Among 5 items which were the highest in both nurse and doctor volume, ward management accounted for 40%. 82.94% doctors who scored more than or equal to 3 believed that junior nurses＇ ability to cooperate was poorer. Conclusions Nurse performed poorly in cooperation during doctors＇ operation. Most problems lie in ward management. Problems in medical order handling and execution are most intractable. And junior nurses lack standardized training and competence evaluation. Therefore, establishing reasonable flow path and responsibilities is necessary to improve doctor-nurse collaboration.