PDCA循环运用于心肺复苏教学的效果观察

Effect observation of Plan-Do-Check-Act cycle applied to cardiopulmonary resuscitation teaching

目的 观察计划-执行-检查-处理(PDCA)循环对心肺复苏(CPR)教学效果的影响.方法 选择2016年7月至2017年6月在上海中医药大学附属普陀医院实习的未接受过CPR培训的上海中医药大学实习医师70名,按随机数字表法分为常规教学组(34名)和PDCA循环组(36名).常规教学组按统一备课时确定的方案对实习医师进行CPR培训;PDCA循环组按PDCA循环的调整方案进行培训.比较两组CPR考试成绩的差异;并观察教学中存在的问题.结果 随时间延长,两组CPR考试成绩逐渐提高,均明显高于第1次的成绩;且PDCA循环组第2次和第3次CPR考试成绩均明显高于常规教学组〔第2次(分):92.0±5.1比89.5±4.6,第3次(分):98.3±4.3比96.3±3.8,均P<0.05〕.两组实习医师3次考试中存在的问题如下:培训前实习医师CPR操作问题集中在呼吸判断漏判、延迟或错误、未启动或延迟启动急救系统、按压位置错误或中途移动、按压幅度过浅、简易呼吸器使用手法错误等方面,这些是CPR技能培训的重点;在两轮CPR培训后,未启动或延迟启动急救系统、未调整或延迟调整患者体位、按压速率过快或过慢、按压幅度过浅、胸廓回弹不充分、口对口人工呼吸错误等问题尚存在,这些是CPR技能培训的难点.结论 PDCA循环运用于CPR教学可帮助实习医师更好地掌握CPR技能.

Objective To observe the effect of Plan-Do-Check-Act(PDCA)cycle applied to cardiopulmonary resuscitation(CPR)teaching.Methods The 70 interns at the Affiliated Putuo Hospital of Shanghai University of Traditional Chinese Medicine from July 2016 to June 2017 who had not received CPR training from Shanghai University of Traditional Chinese Medicine were selected.They were divided into routine teaching group(34)and PDCA cycle group(36)according to the random number table method.The routine teaching group was given CPR training according to the scheme determined in the unified course preparation.The PDCA cycle group was trained according to the plan adjusted by PDCA cycle.The CPR tests scores of the two groups were compared and the problems about the training were looked for.Results Over time,the CPR scores of both groups were improved gradually by training.The scores of the 2nd and 3rd tests were significantly higher than those of the 1st test.The scores of the 2nd and 3rd CPR tests in the PDCA cycle group were significantly higher than those in the routine teaching group(the 2nd test scores:92.0±5.1 vs.89.5±4.6,the 3rd test scores:98.3±4.3 vs.96.3±3.8,both P<0.05).The problems found in the 3 tests of the two groups were as follows:issues were focused on missed/delayed/wrong breath judgement,omitted or delayed emergency system activation,incorrect pressing position or moving halfway,not enough depth of cardiac compression,and wrong use of simple breathing apparatus before CPR training.They were the important points of CPR skills training.After 2 turns of CPR training,problems such as omitted or delayed emergency system activation,missed or delayed patient's body position adjustment,incorrect cardiac compression rate,too shallow compression range,insufficient thoracic rebound,and mouth-to-mouth artificial respiratory error still existed.They were the difficulties of CPR training.Conclusion PDCA cycle applied to CPR teaching can help interns better master CPR skills.