责任制整体护理的系统评价及现状调查研究

发布时间：2018-02-05 00:33

本文关键词： 责任制整体护理系统评价认知行为现状　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.系统评价我国责任制整体护理的相关研究,为我国医院如何建立责任制整体护理的长效机制提供循证依据和建议。2.调查了解重庆市二、三级医院临床责任护士对责任制整体护理的认知、态度及行为情况;了解重庆市二、三级医院在开展责任制整体护理过程中取得的成效和存在的问题;探讨目前影响深入开展责任制整体护理的主要因素,为持续深入开展责任制整体护理提供参考依据。方法:1.计算机检索CMB、VIP、CNKI、Wan Fang Data数据库,根据预先制定的纳入和排除标准筛选文献、提取数据,采用Cochrane Handbook 5.0和Combieg工具评价纳入研究质量,采用定性研究方法综合分析资料。2.采用问卷调查法,运用自行设计的半结构式问卷,对随机抽取的1674名重庆市二、三级医院临床护士的一般人口社会学情况、关于责任制整体护理的认知、态度及行为情况、开展责任制整体护理的效果及影响因素等进行调查分析。结果:1.系统评价共纳入33篇文献,均为横断面调查研究。定性结果显示:我国责任制整体护理的认知程度较好;10篇文献从业务范围、组织形式、强化管理及建立制度方面阐述了我国责任制整体护理的实施方式;开展责任制整体护理以来,我国取得了一定的成效同时仍存在着一些问题,通过循证的方法探讨和解决问题是其未来发展的方向。2.问卷调查提示:(1)临床责任护士对责任制整体护理内涵的认知正确率在90%以上;三级医院护士责任制整体护理的认知得分高于二级医院护士(P0.01);本科及以上学历护士责任制整体护理的认知得分高于专科及以下学历护士(P0.05);(2)100%的受调查护士所在科室排班方式体现了责任制整体护理模式,57.3%的护士所在科室开展责任制整体护理达5年以上;责任护士关于责任制整体护理行为总的落实率在70%以上,但各具体行为的落实率存在差异;三级医院护士责任制整体护理的行为得分高于二级医院护士(P0.01);本科及以上学历护士责任制整体护理的行为得分高于专科及以下学历护士(P0.05);不同科室护士责任制整体护理的行为得分比较有统计学差异(P0.01),其中监护室护士的行为得分最高,而急诊科护士的行为得分最低;(3)90%以上的护士认为责任制整体护理工作模式使患者得到了更好的照护,患者对护理工作满意度提高,而护士自身的能力也得到提升;90.1%的临床责任护士参与过延续护理实施,但延续护理的开展形式主要为电话随访(96.9%)和知识讲座(67.8%);79.7%的护士赞同持续、长久开展责任制整体护理;80%以上的护士认为人力不足和护士薪酬偏低是影响责任制整体护理开展的主要因素。结论:1.目前关于责任制整体护理的研究缺乏高质量的随机对照试验,多为问卷形式的横断面调查研究,但其研究内容广范,分析了我国开展责任制整体护理的现状和效果,总结了现有的有效经验和存在的问题,对促进我国医院建立责任制整体护理的长效机制有一定的启示作用。2.重庆市二、三级医院已广泛开展责任制整体护理,并取得了明显的成效。临床责任护士对责任制整体护理的内涵具有正确的认识,并持积极的态度,责任制整体护理行为落实情况较好。护理管理部门还需进一步保障护士人力配置和后勤支持,降低护士劳动强度,提高护士薪酬,健全绩效考核制度,简化护理文书,完善质量控制体系,以更好地推动责任制整体护理持续深入开展。同时,应进一步推动延续护理的实践和研究,将责任制整体护理模式延伸到基层医院、社区及居家护理中。
[Abstract]:Objective: To study the 1. system evaluation of China's responsibility of holistic nursing care, to provide evidence and suggestions for.2. investigation in Chongqing city in two to establish long-term mechanism for the responsibility of holistic nursing care in our hospital, awareness of responsibility holistic nursing clinical nurses of three hospitals, attitude and behavior; to understand the Chongqing City two, three hospitals in holistic nursing in the process of effectiveness and problems; carry out the main factors of the influence of holistic nursing, to continue to carry out the responsibility of holistic nursing care to provide reference. Methods: 1. databases of CMB, VIP, CNKI, Wan Fang Data database, extract the data according to the the inclusion and exclusion criteria, literature, evaluation by Cochrane Handbook 5 and Combieg tools, the quality of the included studies using qualitative research methods, comprehensive analysis of data using.2. The investigation method of the questionnaire, using semi-structured questionnaire, randomly selected sample of 1674 Chongqing city two, demographic information of clinical nurses in three grade hospitals, about the responsibility system nursing cognition, attitude and behavior, effect and influence factors of carrying out the responsibility system nursing were investigated and analyzed. Results: 1. the evaluation system included a total of 33 papers, is a cross-sectional study. The qualitative results showed that better cognitive degree of our responsibility overall care; 10 articles from the scope of business, form of organization, strengthen management and establish the system aspects of the implementation of responsibility in our country since the development of holistic nursing care; responsibility holistic nursing, China has made some achievements but there are still some problems, through the methods of evidence-based study and solve the problem is that the future development direction of the.2. questionnaire: (1) clinical nursing responsibility 'attitude towards responsibility holistic nursing connotation of the correct rate is above 90%; cognitive score level three hospital nurse responsibility system holistic nursing care was higher than that of the nurses of two hospitals (P0.01); cognitive score bachelor degree nurse responsibility system holistic nursing care and education higher than junior nurses (P0.05); (2) 100% of the surveyed the nurse department scheduling reflects the responsibility of holistic nursing model, the nurse 57.3% departments to carry out holistic nursing for 5 years; the responsibility of nurses on the implementation of holistic nursing responsibility system of the total rate of more than 70%, but the specific behavior of the implementation rate of existence difference; three hospital nurse responsibility system nursing behavior the nurses scored higher than grade two hospitals (P0.01); Bachelor degree nurse responsibility overall care behavior score higher than junior and less educated nurses (P0.05); responsibility of nurses in different department of overall nursing The behavior scores were statistically significant difference (P0.01), in which the behavior of ICU nurses and nurses in the emergency department of the highest score, the lowest score of behavior; (3) more than 90% of the nurses believed that the responsibility system of the whole nursing model so that patients get better care of patients, nursing job satisfaction, and the ability of nurses have been improved; the 90.1% clinical nurses participated in the implementation of continuing nursing care, but continuing nursing was mainly in the form of telephone follow-up (96.9%) and lectures (67.8%); 79.7% of the nurses with continuous, long development responsibility overall care; more than 80% of the nurses believed that the lack of manpower and low pay is the main effect of nurses the factors to carry out the responsibility system nursing. Conclusion: 1. the current research on the responsibility system nursing lack of randomized controlled trials of high quality, for the cross sectional study of questionnaire investigation, but its research The wide range of content, analyzes the status and effect of the responsibility system for the development of holistic nursing in China, summarizes the existing experience and problems, to establish a long-term mechanism to promote the responsibility of holistic nursing care in our hospital have implications.2. some two Chongqing City, three hospitals have been widely carry out the responsibility of holistic nursing care, and achieved remarkable results. The connotation of clinical nurses on the responsibility of holistic nursing care has a correct understanding and a positive attitude, the overall implementation of the responsibility system nursing behavior better. Nursing administrators need to further protect the nurse human allocation and logistical support, reduce the labor intensity of the nurse, improve the nurse salary, and improve the performance the examination system, simplifying nursing documents, perfect quality control system, in order to better promote the responsibility of holistic nursing care continued to carry out. At the same time, we should further promote the continuation of nursing practice and research, The overall care model of the responsibility system is extended to the grass-roots hospitals, community and home care.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

【参考文献】