分层管理模式在高血压脑卒中长期卧床患者临床管理中的应用

Application of hierarchical management model in the clinical management of the medium and long-term bedridden patients with hypertension and stroke

目的探讨分层管理模式在高血压脑卒中长期卧床患者临床管理中的应用效果。方法本科于2013年5月起实施分层管理模式，通过制定合理的分层管理机制，以学历、职称、工作能力来划分为高级护士、中级护士、初级护士3级等级，以此来规范不同等级护士的岗位职责以及规范工作具体内容。将该模式应用于50例高血压脑卒中长期卧床患者，并以此作为实验组。同时选择2013年5月以前还未实施分层管理模式的50例高血压脑卒中长期卧床患者作为对照组。在分层管理模式实施前9个月和后9个月，分别对两组的基础护理、健康教育、专科护理、护理不良事件等指标的测评结果以及患者满意度进行比较。结果对照组患者实施分层管理后，护理工作质量和患者满意度均有明显提高，差异具有统计学意义（P〈0．01）。结论分层管理措施的实施有利于优化护理人力资源，大大调动了护士工作的积极性与主动性，不仅能提高高级别护士的综合管理质量，还能提高中、初级护士的护理水平，使各级别护士的工作及协调能力能达到有效发挥，提升了护士的护理理论知识、护理技术操作，从而提升了高血压脑卒中患者管理的整体水平。

Objective To discuss the application effect of hierarchical management model agement of the medium and long-term bedridden patients with hypertension and stroke. Methods in the clinical man- Hierarchical man- agement model had been implemented from May 2013. The rational hierarchical management mechanism was set up to divided the nursing staff into 3 categories, namely, the senior-level nurses, mid-level nurses and junior-level nurses according to their education, job titles and working abilities, in order to standardize the job responsibilities and the con- crete working contents. 50 bedridden patients with hypertension and stroke were selected as experimental group adopting the hierarchical management model. While another 50 patients of medium-term and long-term bedridden patients with hypertension and stroke who didn＇t adopt the hierarchical management model before May 2013 were selected as control group. Before and after the 9 months of the implementation of the hierarchical management model, the results of the two groups＂ primary care, health education, special care, bad nursing cases and other indicators and patients＂ satisfaction were compared respectively. Results After the implementation of the hierarchical management in experimental group patients, both the quality of nursing and the satisfaction of the patients were significantly improved （P 〈 0. 01 ） . Conclusions The implementation of hierarchical management mechanism is helpful for optimizing the human resources of nursing staff, which stimulates the enthusiasm and initiative of the nursing staff. It can not only improve the compre- hensive management abilities of the high-level nurses, but also enhance the nursing abilities of the senior, secondary and junior nurses, so working and coordination of different level nursing staff has achieved an effective results. The the- oretical nursing knowledge and operating skills are improved as well and at the same time, the overall management level for hypertensive oatients with stroke is also enhanced.