护士主导手术伤口管理模式的建立与实践

The establishment and clinical application of nurse-led surgical wound management model

目的:构建由护士主导的手术伤口管理模式并应用于临床。方法:建立由护士主导手术伤口管理的机制,组建手术伤口三级护理管理团队,制定科学的护理指引,明确伤口处理原则和各级人员职责,试行后在全院手术科室推广。统计该模式实施后护士对手术伤口护理指引依从率、医护患三方满意率、I类手术伤口感染率、护士理论知识与操作考核成绩。结果:该模式实施后护士对手术伤口护理指引依从率均≥90.0%;2015—2019年本院I类手术伤口感染率为0.19%~0.42%,均低于I类手术伤口感染率要求(≤1.5%)。医、护、患三方对护士主导手术伤口管理模式满意率分别为96.48%、80.01%、94.38%。培训后护士伤口管理的理论成绩显著提高(P<0.001),护士伤口换药操作合格率达100%。结论:由护士主导手术伤口管理模式能满足手术伤口管理的临床需求,可为患者提供安全、高质量的伤口护理,扩展护士的工作范畴,提升护理工作内涵。

Objective:To construct a nurse-led postoperative wound management model and apply it to the clinical practice.Methods:We established mechanisms for nurse-led surgical wound management and constructed a three-level nursing management team.We developed a scientific guideline,identified the principle of surgical wound management and the responsibilities of the personnel involved.The nurses'compliance rate to the guideline,the satisfaction of doctors,nurses and patients towards the model,infection rate of type I surgical wound,as well as the knowledge and wound dressing change skills of nurses were evaluated after the implementation of the model.Results:The annual nurses'compliance rates to the guideline between 2016 and 2019 were greater than 90.0%.From 2015 to 2019,the infection rates of type I surgical wounds were 0.19%-0.42%,respectively,which were lower than the national hospital infection control standard(≤1.5%).The satisfaction of doctors,nurses and patients towards nurse-led surgical wound management was 96.48%,80.01%,94.38%respectively.Nurses'knowledge of surgical wound management had improved significantly(P<0.001)after the training.One hundred percent nurses reached the standards of wound dressing change skills.Conclusion:The nurse-led surgical wound management model can meet the clinical needs of surgical wound management,provide patients with safe and high-quality wound care,expand the scope of nurses'work,and enhance the connotation of nursing work.