疑难重症患者多专科护理协作查房的组织与实践
收稿日期: 2024-04-08
网络出版日期: 2025-01-16
基金资助
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)
Organization and practice of the multi-specialty nursing collaborative rounds for critical illness patients
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2 000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。
冯洁惠 , 徐建宁 , 朱旭菁 , 李少玲 , 陈霞 , 应金萍 , 王华芬 . 疑难重症患者多专科护理协作查房的组织与实践[J]. 中华护理教育, 2025 , 22(1) : 78 -84 . DOI: 10.3761/j.issn.1672-9234.2025.01.013
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 2 000 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 the sharing of high-quality specialty nursing resources within the hospital,and address nursing problems faced by critical illness patients effectively. This study provides valuable insights into the enhancement of teamwork ability and clinical thinking among specialty nurses.
| [1] | 丁炎明, 吴欣娟, 田君叶, 等. 我国31个省份三级医院专科护士培养及管理的现状调查[J]. 中华护理杂志, 2021, 56(9):1357-1362. |
| [1] | Ding YM, Wu XJ, Tian JY, et al. The current situation of the cultivation and development of specialty nurses in tertiary hospitals in China[J]. Chin J Nurs, 2021, 56(9):1357-1362. |
| [2] | 岳欣, 戴冬梅, 张美玲. 专科护士对病人结局影响的研究现状与思考[J]. 护理研究, 2018, 32(21):3342-3344. |
| [2] | Yue X, Dai DM, Zhang ML. Research status quo and consi-deration of effect of specialist nurses on patient outcomes[J]. Chin Nurs Res, 2018, 32(21):3342-3344. |
| [3] | 黄道花, 李娟, 查莹娟. 护理多专科团队协作查房的实践[J]. 中华护理教育, 2018, 15(6):441-444. |
| [3] | Huang DH, Li J, Zha YJ. The application of the multi-disci-plinary team to assist nursing rounds[J]. Chin J Nurs Educ, 2018, 15(6):441-444. |
| [4] | 和霞, 林梅, 杨清, 等. 多学科协作诊疗模式下专科护士参与策略的研究进展[J]. 中华急危重症护理杂志, 2020, 1(6):549-553. |
| [4] | He X, Lin M, Yang Q, et al. Review on strategy of specialist nurse’s participation in multidisciplinary team[J]. Chin J Emerg Crit Care Nurs, 2020, 1(6):549-553. |
| [5] | 周然, 尹万红, 杨吕, 等. 重症患者标准化查房:思考与探索[J]. 中华内科杂志, 2024, 63(5):434-438. |
| [5] | Zhou R, Yin WH, Yang L, et al. Reflections and prospects on standardized rounds for critical illness[J]. Chin J Intern Med, 2024, 63(5):434-438. |
| [6] | 李莎, 候丽红, 党永娇, 等. 多学科融合跨专业联合教学查房在中医住培中的探索和实践[J]. 中国毕业后医学教育, 2022, 6(3):253-256. |
| [6] | Li S, Hou LH, Dang YJ, et al. Exploration and practice of multi-disciplinary integration and cross-disciplinary joint teach-ing ward round in TCM residency training[J]. Chin J Gradu Med Educ, 2022, 6(3):253-256. |
| [7] | Novak E, Mulvey BK. Enhancing design thinking in instruc-tional technology students[J]. J Comput Assist Learn, 2021, 37(1):80-90. |
| [8] | 葛文双, 白浩, 马红亮. 设计思维融入混合课程的设计与教学干预效果[J]. 现代教育技术, 2020, 30(7):42-49. |
| [8] | Ge WS, Bai H, Ma HL. The design and teaching intervention effect of integrating design thinking into blended course[J]. Mod Educ Technol, 2020, 30(7):42-49. |
| [9] | Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death[J]. Eur Heart J,2022, 43(40):3997-4126. |
| [10] | Svane J, Nielsen JL, Stampe NK, et al. Nationwide study of mortality and sudden cardiac death in young persons diagnosed with chronic kidney disease[J]. Europace, 2022, 24(10):1599-1607. |
| [11] | Loutradis C, Sarafidis PA, Ferro CJ, et al. Volume overload in hemodialysis:diagnosis,cardiovascular consequences,and mana-gement[J]. Nephrol Dial Transplant, 2021, 36(12): 2182-2193. |
| [12] | 郭佳钰,侯惠如,张瑞芹,等. 维持性血液透析患者容量负荷评估与管理的最佳证据总结[J]. 中华护理杂志,2021, 56(10):1490-1497. |
| [12] | Guo JY, Hou HR, Zhang RQ, et al. Summary of the best evidence for the assessment and management of volume load in maintenance hemodialysis patients[J]. Chin J Nurs, 2021, 56(10):1490-1497. |
| [13] | 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409. |
| [13] | Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)[J]. Chin J Diabetes Mellit, 2021, 13(4):315-409. |
| [14] | 中国康复医学会器官移植康复专业委员会. 成人实体器官移植后糖尿病管理专家共识[J]. 中华糖尿病杂志, 2023, 15(7):593-610. |
| [14] | Organ Transplantation and Rehabilitation Committee of Chinese Medical Association of Rehabilitation. Expert consen-sus on diabetes mellitus after solid organ transplantation in adults[J]. Chin J Diabetes Mellit, 2023, 15(7):593-610. |
| [15] | 梅长林, 陈晓农, 郝传明, 等. 慢性肾脏病高钾血症风险评估及管理专家建议(2020版)[J]. 中华医学杂志, 2020, 100(44):3489-3493. |
| [15] | Mei CL, Chen XN, Hao CM, et al. Expert recommendations for risk assessment and management of hyperkalemia in chronic kidney disease(2020 edition)[J]. Natl Med J China, 2020, 100(44):3489-3493. |
| [16] | 王菲, 陈韵, 涂建鑫, 等. 心脏移植患者运动康复最佳证据总结[J]. 中国实用护理杂志, 2022, 38(33):2594-2599. |
| [16] | Wang F, Chen Y, Tu JX, et al. Evidence summary of exercise rehabilitation for heart transplantion patients[J]. Chin J Pract Nurs, 2022, 38(33):2594-2599. |
| [17] | Squires RW. Cardiac transplant and exercise cardiac rehabi-litation[J]. Heart Fail Rev, 2023, 28(6):1267-1275. |
| [18] | Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardio-vascular-kidney-metabolic(CKM) syndrome:a scientific state-ment from the American Heart Association[J]. Circulation, 2023, 148(20):1636-1664. |
| [19] | 崔锦, 陈香萍, 劳月文, 等. 简化版跨专业团队合作量表的汉化及信效度分析[J]. 护理与康复, 2019, 18(9):1-6. |
| [19] | Cui J, Chen XP, Lao YW, et al. Chinesization on simplified Assessment of Interprofessional Team Collaboration Scale and analysis on its reliability and validity[J]. J Nurs Rehabil, 2019, 18(9):1-6. |
| [20] | 国家卫生健康委,国家中医药局. 进一步改善护理服务行动计划(2023-2025年)[EB/OL].(2023-06-15)[2024-07-30]. https://www.gov.cn/zhengce/zhengceku/202306/content_6887303.htm. |
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