本文關(guān)鍵詞： 責(zé)任制整體護理 系統(tǒng)評價 認(rèn)知 行為 現(xiàn)狀　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1.系統(tǒng)評價我國責(zé)任制整體護理的相關(guān)研究,為我國醫(yī)院如何建立責(zé)任制整體護理的長效機制提供循證依據(jù)和建議。2.調(diào)查了解重慶市二、三級醫(yī)院臨床責(zé)任護士對責(zé)任制整體護理的認(rèn)知、態(tài)度及行為情況;了解重慶市二、三級醫(yī)院在開展責(zé)任制整體護理過程中取得的成效和存在的問題;探討目前影響深入開展責(zé)任制整體護理的主要因素,為持續(xù)深入開展責(zé)任制整體護理提供參考依據(jù)。方法:1.計算機檢索CMB、VIP、CNKI、Wan Fang Data數(shù)據(jù)庫,根據(jù)預(yù)先制定的納入和排除標(biāo)準(zhǔn)篩選文獻、提取數(shù)據(jù),采用Cochrane Handbook 5.0和Combieg工具評價納入研究質(zhì)量,采用定性研究方法綜合分析資料。2.采用問卷調(diào)查法,運用自行設(shè)計的半結(jié)構(gòu)式問卷,對隨機抽取的1674名重慶市二、三級醫(yī)院臨床護士的一般人口社會學(xué)情況、關(guān)于責(zé)任制整體護理的認(rèn)知、態(tài)度及行為情況、開展責(zé)任制整體護理的效果及影響因素等進行調(diào)查分析。結(jié)果:1.系統(tǒng)評價共納入33篇文獻,均為橫斷面調(diào)查研究。定性結(jié)果顯示:我國責(zé)任制整體護理的認(rèn)知程度較好;10篇文獻從業(yè)務(wù)范圍、組織形式、強化管理及建立制度方面闡述了我國責(zé)任制整體護理的實施方式;開展責(zé)任制整體護理以來,我國取得了一定的成效同時仍存在著一些問題,通過循證的方法探討和解決問題是其未來發(fā)展的方向。2.問卷調(diào)查提示:(1)臨床責(zé)任護士對責(zé)任制整體護理內(nèi)涵的認(rèn)知正確率在90%以上;三級醫(yī)院護士責(zé)任制整體護理的認(rèn)知得分高于二級醫(yī)院護士(P0.01);本科及以上學(xué)歷護士責(zé)任制整體護理的認(rèn)知得分高于�？萍耙韵聦W(xué)歷護士(P0.05);(2)100%的受調(diào)查護士所在科室排班方式體現(xiàn)了責(zé)任制整體護理模式,57.3%的護士所在科室開展責(zé)任制整體護理達5年以上;責(zé)任護士關(guān)于責(zé)任制整體護理行為總的落實率在70%以上,但各具體行為的落實率存在差異;三級醫(yī)院護士責(zé)任制整體護理的行為得分高于二級醫(yī)院護士(P0.01);本科及以上學(xué)歷護士責(zé)任制整體護理的行為得分高于�？萍耙韵聦W(xué)歷護士(P0.05);不同科室護士責(zé)任制整體護理的行為得分比較有統(tǒng)計學(xué)差異(P0.01),其中監(jiān)護室護士的行為得分最高,而急診科護士的行為得分最低;(3)90%以上的護士認(rèn)為責(zé)任制整體護理工作模式使患者得到了更好的照護,患者對護理工作滿意度提高,而護士自身的能力也得到提升;90.1%的臨床責(zé)任護士參與過延續(xù)護理實施,但延續(xù)護理的開展形式主要為電話隨訪(96.9%)和知識講座(67.8%);79.7%的護士贊同持續(xù)、長久開展責(zé)任制整體護理;80%以上的護士認(rèn)為人力不足和護士薪酬偏低是影響責(zé)任制整體護理開展的主要因素。結(jié)論:1.目前關(guān)于責(zé)任制整體護理的研究缺乏高質(zhì)量的隨機對照試驗,多為問卷形式的橫斷面調(diào)查研究,但其研究內(nèi)容廣范,分析了我國開展責(zé)任制整體護理的現(xiàn)狀和效果,總結(jié)了現(xiàn)有的有效經(jīng)驗和存在的問題,對促進我國醫(yī)院建立責(zé)任制整體護理的長效機制有一定的啟示作用。2.重慶市二、三級醫(yī)院已廣泛開展責(zé)任制整體護理,并取得了明顯的成效。臨床責(zé)任護士對責(zé)任制整體護理的內(nèi)涵具有正確的認(rèn)識,并持積極的態(tài)度,責(zé)任制整體護理行為落實情況較好。護理管理部門還需進一步保障護士人力配置和后勤支持,降低護士勞動強度,提高護士薪酬,健全績效考核制度,簡化護理文書,完善質(zhì)量控制體系,以更好地推動責(zé)任制整體護理持續(xù)深入開展。同時,應(yīng)進一步推動延續(xù)護理的實踐和研究,將責(zé)任制整體護理模式延伸到基層醫(yī)院、社區(qū)及居家護理中。
[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.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R47

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