疑难重症患者多专科护理协作查房的组织与实践  

Organization and practice of the multi-specialty nursing collaborative rounds for critical illness patients

作　　者：冯洁惠[1] 徐建宁[2] 朱旭菁 李少玲 陈霞[1] 应金萍[1] 王华芬 FENG Jiehui;XU Jianning;ZHU Xujing;LI Shaoling;CHEN Xia;YING Jinping;WANG Huafen

机构地区：[1]浙江大学医学院附属第一医院,杭州市311000 [2]浙江中医药大学,杭州市310053

出　　处：《中华护理教育》2025年第1期78-84,共7页Chinese Journal of Nursing Education

基　　金：浙江省医药卫生科技计划项目(2024KY1191);浙江省医药卫生科技计划项目(2022KY764)。

摘　　要：目的探索专科护士主导的疑难重症患者多专科护理协作查房模式,以期通过团队协同合作解决护理问题,培养临床思维和提升团队合作水平。方法修订护理多专科协作管理制度,实施护理部-专科组-护理单元3级管理架构,保障多专科协作护理的顺利进行。融和多学科团队协作(multi disciplinary treatment,MDT)及EDIPT框架[共情(empathize)、定义(define)、创想(ideate)、原型(prototype)、测试(test)],建构“多专科融合、跨专业联合”的协作查房步骤。2023年,采用线上线下整合的形式开展12次多专科护理协作查房。在开展多专科护理协作查房前、后,采用问卷调查对参加查房讨论的36名专科护士进行协作能力比较;采用问卷对参与查房学习的212名专科护士进行满意度调查,内容包括查房对临床思维提升和解决护理问题的帮助等。结果2023年通过查房解决了疑难重症器官移植护理、复杂创面护理、血管通路建立等问题,根据相关案例发表学术论文9篇。开展多专科护理协作查房后,36名参加讨论的专科护士跨专业团队合作得分高于查房前(103.86±7.15比98.06±13.32,t=2.481,P=0.018)。线上线下累计超过2000人次参与查房,其中212名参与学习的专科护士总体满意度得分均数为4.68分。结论多专科护理协作查房实现了优质专科护理资源的院内共享,解决了疑难重症患者的护理问题,为提升团队协同合作解决问题和培养护士临床思维提供了借鉴。Objective Through developing the model of multi-specialty nursing collaborative rounds for critical illness patients led by specialty nurses,to solve nursing problems through teamwork and enhancing the levels of clinical thinking and cooperation ability of specialty nurses.Methods By revising the management system of multi-specialty nursing collaboration,a three-level management structure comprising the nursing department,specialty groups,and nursing units was established to ensure the smooth execution of multi-specialty collaborative nursing.Besides,through combining multi-disciplinary treatment(MDT)and the EDIPT framework(empathize,define,ideate,prototype,test),a collaborative nursing rounds procedure of“multi-specialty integration and interdisciplinary collaboration”was developed.In the year 2023,a total of 12 multi-specialty nursing collaborative rounds were conducted using an integrated approach of online and offline methods.Pre and post the rounds,a questionnaire was administered to collect feedback from the 36 specialty nurses participated.Another satisfaction survey was conducted using a questionnaire among 212 specialty nurses who learned in the rounds,focusing on the benefits of such rounds for clinical thinking practice.Results In 2023,the study successfully addressed challenges related to critical organ transplantation care,complex wound care,and vascular access establishment through the implementation of collaborative rounds.Moreover,these efforts led to the publication of nine high-level academic papers on relevant cases.After implementation,the interprofessional teamwork scores of the 36 participating specialty nurses were significantly higher compared to their scores prior to such rounds(103.86±7.15 vs 98.06±13.32,t=2.481,P=0.018).In the end,over 2000 participants engaged in the rounds,either online or offline.Among them,212 specialty nurses who learned in the rounds reported an average satisfaction score of 4.68.Conclusion The multi-specialty nursing collaborative rounds model facilitate th

关 键 词：专科护士 危重症 团队协作 临床思维 护理实践模式 

分 类 号：R47[医药卫生—护理学]