住院病人跌倒管理中护士自我评价与真实世界跌倒事件的反思与启示  

Reflection and enlightenment on nurses′ self-evaluation and real-world fall events in inpatient fall management

作　　者：谢美莲 张志云[1] 张立娟[1] XIE Meilian;ZHANG Zhiyun;ZHANG Lijuan(Beijing Ditan Hospital,Capital Medical University,Beijing 100015 China)

机构地区：[1]首都医科大学附属北京地坛医院,100015

出　　处：《全科护理》2022年第4期457-462,共6页Chinese General Practice Nursing

基　　金：北京市医院管理中心“培育计划”项目,编号:PG2020032。

摘　　要：目的:通过传染病专科医院护理人员对于跌倒管理现状的自评及以往跌倒事件的回顾性梳理与分析,挖掘现有跌倒管理体系中的问题,剖析并思考,为今后建立针对不同医疗机构特点的跌倒管理路径的深入研究提供思路。方法:本研究采用横断面研究设计与回顾性分析,于2019年7月1日—2019年8月31日选择在北京地区某传染病专科医院研究期间工作的所有在岗注册护士展开调研,采用《住院病人跌倒预防之临床护士工作自评量表》进行数据收集。同时针对过去5年间该医院发生的41例跌倒事件展开回顾性分析,发现现存问题,探讨管理新思路。结果:参与自评调查的342名护理人员自我评价得分为(242.06±16.21)分,显示出较好的认知水平及预防跌倒的执行力。不同人事编制的护士对陪侍人的宣教工作、不同岗位护士对跌倒标识的管理能力、不同学历护士对病人提供生活用具的意识与能力、不同年龄段护士对后勤部门的协作能力比较差异均存在统计学意义(P<0.05)。结合过去几年间院内发生的41例跌倒事件进行分析,跌倒病人年龄为29~86岁,其中男性27例,女性14例,ADL评分≥60分者30例,事件发生前的最近跌倒风险评分显示无风险者或轻度风险者36例,无视力障碍者39例,无意识障碍者38例,有陪护者27例。病人自理能力、跌倒风险评估均为较好状态下发生的跌倒事件与护士对自我工作评测的高分值之间出现了巨大的差异。结论:护理人员对于跌倒防范管理自我执行力评价的高分值与目前各级医疗机构对于跌倒预防管理工作的重视性相关,但是跌倒事件依然发生的事实以及尤其是在身体状况较好、跌倒风险低的人群中发生的真实情况。临床症状观察与评估的科学化开发、跌倒评估系统个性化的改进、多学科合作及病人的共同参与、护理人员管理中的合理分工、健康宣教策略的Objective:To explore the problems in the existing fall management system,analyze,and think through the self-assessment of the status quo of fall management by nurses in infectious disease specialist hospitals and the retrospective sorting and analysis of past fall incidents,so as to provide ideas for the establishment of fall management pathways for different medical institutions in the future.Methods:This study adopted a cross-sectional study design and retrospective analysis.From July 1,2019,to August 31,2019,all on-the-job registered nurses who worked in an infectious disease specialist hospital in Beijing during the research period were assessed by the Clinical Nurse Self-Assessment Scale for Inpatient Fall Prevention.At the same time,a retrospective analysis was carried out on 41 falls events that occurred in the hospital in the past 5 years,finding the existing problems and discussing the new management ideas.Results:The average self-evaluation score of 342 nurses who participated in the self-assessment survey was(242.06±16.21),which showed an excellent cognition level and executive ability to prevent falls.Nurses with different personnel establishments had differences in the propaganda and education work for their escorts;nurses in different positions had differences in the management ability of fall signs;nurses with different educational backgrounds had differences in the awareness and ability to provide patients with living appliances;different ages of nurses had differences in the cooperation ability with the logistics department;all the differences above were statistically significant(P<0.05).Combined with the analysis of 41 cases of falls in the hospital in the past few years,the patients aged from 29 to 86 years old,including 27 men,14 women,and 30 cases with Activities of Daily Living(ADL)score≥60 points.Before the event,the latest fall risk score showed 36 cases with no risk or mild risk,39 cases without visual impairment,38 cases with unconscious impairment,and 27 cases with accompanying perso

关 键 词：跌倒 不良事件 医院管理 护理 病人安全 

分 类 号：R47[医药卫生—护理学]