综合标准病例考核模式在老年科护士跌倒风险评估能力客观测评中的应用

Application of comprehensive standard case examination mode in objective assessment of geriatric nurses' ability of fall risk assessment

目的探讨综合标准病例考核模式在老年科护士跌倒风险评估能力测评中的作用,以客观评价老年科护士跌倒风险评估能力情况。方法选择来自6个省(市)8家医院的825名老年科护士,采用综合标准病例考核模式对其跌倒风险评估能力进行客观测评,并分析不同特征老年科护士跌倒风险评估能力的差异。结果老年科护士跌倒风险总体识别准确率为34.9%(288/825),不同学历、职称护士跌倒风险总体识别正确率比较,差异均有统计学意义(P<0.05),且职称越高正确率越高。不同学历护士对是否使用"认知状态"识别正确率比较,差异有统计学意义(P<0.05);不同职称的护士对"超过一个医学诊断"、"使用行走辅助器具"、"步态"、"认知状态"4项风险因子识别正确率比较,差异均有统计学意义(P<0.05)。结论老年科护士对跌倒风险识别情况令人堪忧,而且不同职称、学历护士对跌倒风险评估能力不一。为预防老年科患者跌倒的发生,需对老年科护士进行规范化管理,合理安排不同职称护士岗位职责,同时对跌倒风险评估表进行细化说明,加强年轻护士的跌倒相关知识的培训力度,以提高护士跌倒风险识别能力水平。

Objective To study the effect of comprehensive standard case assessment mode in assessing the clinical nurses＇ ability to assess the fall risk. Method 825 geriatric nurses from eight hospitals in six cities were engaged in the study to evaluate their ability in fall risk assessment in the geriatric departments using comprehensive standard case assessment model. Results The overall accurate rate in geriatric nurses＇ recognition of fall risk was 34.9%（288/825）. There were significant differences in the overall accurate rate of recognition of falls risk across different academic qualifications and professional titles （P〈0.05）, and the higher the professional titles, the higher the accurate rate was. There was a significant difference between the nurses with different academic qualifications for the use of ＂cognitive state＂ （P 〈0.05）. Different professional titles of nurses had statistically significant differences in the correct identification of four risk factors of ＂more than one medical diagnosis＂, ＂use of walking aids＂, ＂gait＂ and ＂cognitive state＂ （P〈0.05）. There were statistically significant differences in the accuracy of recognition of ＂gait＂ and ＂cognitive state＂ between the nurses who had accepted and unaccepted fall risk training （P〈0.05）. Conclusions The recognition of falls risk by geriatric nurses is not satisfactory. Moreover, nurses with different titles and degrees had different ability to fall risk assessment. To prevent falls in geriatric patients, standardized management should be carried out among geriatric nurses along with reasonably arranging the post responsibilities of nurses with different professional titles, at the same time. Meansures should be taken to make a detailed description of the fall risk assessment form and strengthen the training of young nurses to improve the ability of nurses to identify the fall risk.