分级护理医护决策主体差异性分析  

Analysis of the Difference of the Decision Maker in Grading Nursing Care

作　　者：柏亚妹[1] 宋玉磊[1] 倪冬梅 王慕然[1] 杜世正[1] 王丹丹[1] 徐玮[1] 钟琴 朱静[1] 王迪 徐桂华[1] BAI Ya-mei;SONG Yu-lei;NI Dong-mei(Nanjing University of Chinese Medicine,Nanjing,Jiangsu,210023,China)

机构地区：[1]南京中医药大学,江苏南京210023 [2]常州市中医院,江苏常州213003

出　　处：《中国医院管理》2018年第7期70-72,共3页Chinese Hospital Management

基　　金：国家自然科学基金资助项目(71573140);江苏省医院管理协会医院管理创新研究课题(YSYJY-3-2017-177);江苏省优势学科二期项目南京中医药大学护理学一级学科指令性课题(YSHL2016-007)

摘　　要：目的探讨分级护理决策主体对分级护理等级划分的影响。方法采用多中心分层随机抽样调查法调查6家公立医院6 073例普通成年住院病人,分别由医生、护士对纳入病人进行分级决策,调查该病人24小时直接护理工时,通过病人等级、工时与其病情、自理能力的相关性分析,验证不同决策主体下护理等级划分的准确性和客观性。结果 6 073例病人APACHEⅡ等级以病情较轻和病情比较危重为主,自理能力等级分布较均匀,医生、护士作为决策主体,不同病人等级之间24小时护理工时差异均有统计学意义,分别为P<0.05和P<0.01,医嘱护理等级和护嘱护理等级均与APACHEⅡ评分显著负相关(P<0.01),与Barthel指数显著正相关(P<0.01)。护嘱护理等级与自理能力的相关性较医嘱护理等级更强。结论护士在病人病情判断上与医生一致,在病人自理能力判断上较医生准确,由护士来决策病人的自理能力等级更为合适,加强医护合作,将有助于提高分级护理决策的准确性及护理服务的质量。Objective To explore the influence of grading nursing decision maker on grading nursing classification.Methods A total of 6 073 patients in 6 public hospitals were surveyed by multi-center stratified random sampling survey. Patients were graded into decision making by doctors and nurses respectively. In the investigation of the patient24 h direct nursing time,the accuracy and objectivity of nursing class division under different decision makers were verified by analyzing the correlation between patients grades,nursing hours and patients＇ disease severity,self-care ability. Results 6 073 patients＇ APACHEⅡgrades are mainly lighter or critical. Self-care ability level distribution is more uniform. There is significant difference in 24 h direct nursing time between patients with different grades when doctors and nurses are the decision-maker respectively（P〈0.05,P〈0.01）. Both doctor＇s degree of care and degree of nursing care are negatively correlated with APACHE II score（P〈0.01）,and they were significantly positively correlated with Barthel index（P〈0.01）. The correlation between degree of nursing care and self-care ability is stronger than that of doctor＇s degree of care. Conclusion The nurses agree with doctors on the patients＇ disease severity,but the judgment of patients self-care ability is more accurate than doctors. So It is more appropriate to make patients self-care ability grades by nurses and it will help to improve the accuracy of grading nursing decision-making and the quality of nursing service through strengthening the medical cooperation.

关 键 词：病人医护管理 分级护理 决策主体 

分 类 号：R47[医药卫生—护理学]