医护一体模式下实施快速流程方案对护理工作环境的影响

The impact of fast track procedure in physician-nurse cooperation approach on nursing practice environment

目的探讨医护一体模式下实施快速流程方案对护理工作环境的影响,为医护一体模式的深入推广提供依据。方法 2012年6月至2013年6月由医生制订并实施快速流程方案,护士完成快速流程方案中医嘱的执行。2013年7月至2014年7月以亚专业为核心,构建结直肠外科快速流程医护一体团队,护士与医生共同制订并实施快速流程方案,护士在团队协调和管理方面起主导作用,包括培训和指导新进医生及实习医生,联络协调多科会诊等。本研究采用护理工作环境量表对研究对象进行调查,并将不同阶段的护理工作环境评分进行比较和分析。结果医护一体模式下实施快速流程方案能够提高医护合作维度评分(P=0.032),提高护理管理者的能力及领导方式维度评分(P=0.022),提高充足的人力及物力维度评分(P=0.041)。结论医护一体模式下,护士与医生共同评估、讨论、制订、实施快速流程方案,护士在团队合作中发挥其主导作用,能够显著改善护理人员工作环境,提升医疗服务质量。

Objective To evaluate the effect of fast track procedure in physician-nurse cooperation approach on nursing practice environment. Methods Before June 2013,nurses participated in fast track procedure project based on doctor＇s orders from July 2013,a muhidisciplinary team was built. Nurses participated in the ward rounds,han- dover,case discussion,decision of treatment and care plan together with doctors. The head nurse and team leader were responsible for the administration and supervision of the team together. Practice Environment Scale（PES） was used to investigate nurses before and after innovation. Results The dimension scores of physician-nurse cooperation （P=0.032）,leaders＇ ability and leadership style（P--0.022）,and abundant manpower and resources（P=0.041） increased significantly after implementation of fast track procedure in physiciannurse cooperation approach. Conclusion The physician-nurse cooperation approach enhances nurses＇ leading role,effectively improves nursing work environment and promotes the quality of health care. Further studies are needed to optimize the physician-nurse cooperation approach.