25所三级甲等综合医院脑卒中患者个案管理护理服务现状的调查

Current status of case management for stroke in 25 tertiary general hospitals in China

目的 了解我国三级甲等综合医院脑卒中患者个案管理护理服务的现状,为构建并完善脑卒中患者个案管理模式提供参考依据。方法 采用便利取样法,2020年9月至10月,选取我国25所三级甲等综合医院在神经内、外科病房工作护理人员168名,对其所在医院脑卒中患者个案管理护理服务开展的基本情况、效果评价和阻滞因素进行调查。结果 168名护理人员中,有31.0%(52/168)护理人员开展了脑卒中个案护理服务。脑卒中患者个案管理护理服务实施场所主要为神经内科及外科病房(88.5%)、卒中专科护理门诊(38.5%);实施的主要人员为护士(53.8%)、卒中个案管理师(44.2%);个案管理服务周期1年占比为78.8%;服务内容开展形式为建立个人档案(92.3%)和电话随访(96.2%)为主。最常用的评价工具及评价指标分别为美国国立卫生院神经功能缺损评分表(National Institute of Health Stroke Scale, NIHSS)(98.1%)和患者满意度(96.2%)。阻滞因素主要为未建立成熟的运行机制及信息系统(61.2%)、卒中个案管理工作流程不完善(58.6%)、政策支持不足(44.8%)。结论 我国三级甲等综合医院脑卒中个案管理护理服务开展情况不理想,脑卒中患者专科护理门诊开展较少;个案管理护理服务开展内容较为传统及项目评价尚不全面;未发挥卒中个案管理师在个案管理中的独特优势。需进一步完善各项护理服务项目,加强脑卒中个案管理师岗位资质和角色职责的科学规划,发挥个案管理师在个案管理的独特优势,从而促进个案管理护理服务的发展。

Objective To investigate the current status of case management for stroke patients in tertiary general hospitals in China so as to provide references for establishment of a complete case management model for patients with stroke. Methods Convenient sampling method was employed to select 168 nurses specialised in neurology from 25 tertiary general hospitals in China to investigate the status and evaluate the effect and the retardation factors in case management for stroke patients. Results A total of 31.0%(52/168) nurses conducted case management for stroke patients. Case management services were provided predominantly in the neurological wards(88.5%) and stroke clinics(38.5%). The staff who involved in the case management for stroke were nurses(53.8%)and case managers for stroke(44.2%).The period of case management service within 1 year accounted for 78.8%. Setting-up personal file accounted for 92.3% in the contents and forms of case management services while telephone reviews accounted for 96.2%. The commonly used evaluation tools and evaluation indicators were the National Institute of Health Stroke Scale(NIHSS)(98.1%) and scale of patient satisfaction(96.2%). It was founded that the main factors of retardation were in completion of a proper operational mechanism and information system(61.2%), imperfect workflow incase management for stroke(58.6%) and insufficient support in policies(44.8%). Conclusions The current case management for stroke in general hospitals in China is not ideal: there exists only a few specialised stroke nursing clinics, the specific specialities of the case managers in the case management for stroke are not yet fully employed, the contents of the case management for stroke are not updated and the evaluations of the delivery of case management for stroke is not comprehensive. It is necessary to further improve the content of nursing services, strengthen the scientific planning for career qualification and responsibilities of the case managers, and establish a unified and standardised nursing procedures and effective evaluation mechanism. Then it would give full play to the unique advantages of the case managers in the case management for stroke, so as to promote the continuous improvement of the nursing services in case management for stroke.