摘要
目的了解临床护士应用Morse跌倒评估量表情况,为临床正确使用Morse跌倒评估量表提供依据。方法病区护士使用Morse跌倒评估量表对134例年龄≥65岁老年患者进行跌倒风险评估,并将跌倒高风险的患者上报至老年病专科护理小组,老年病专科护理小组派专科护士在24h内到病区对患者进行评估会诊,同时专科护士对会诊科室其他年龄≥65岁患者进行跌倒风险评估。结果病区护士上报跌倒高风险患者45例,而专科护士同期评估存在跌倒高风险患者62例,两者评估患者为跌倒高风险率比较,差异有统计学意义(P<0.05);病区护士的跌倒评估总分及行走辅助、步态、认知状态评分显著低于专科护士(P<0.05,P<0.01)。结论病区护士低估了患者发生跌倒的风险,且存在漏报跌倒风险患者的现象。护理管理者需加强对病区护士进行Morse跌倒评估量表使用的培训,以正确评估患者,保障患者安全,降低院内跌倒发生率。
Objective To investigate the application of Morse Fall Scale by clinical nurses,and to provide information for nurses to correctly use the scale. Methods Morse Fall Scale was used by clinical nurses to evaluate the fall risks of 134 patients aged ≥ 65 years. The evaluation results were reported to geriatric nursing group. Clinical nurse specialists were sent to reevaluate the fall risks for the same patients within 24 hours,and the fall risks of the other patients aged ≥65 were also assessed. Results A total of 45 cases were reported with high fall risk by clinical nurses,while 62 cases were found to have high fall risk by clinical nurse specialists during the reevaluation process,and the difference was significant （P0.05）. The total score of fall risk and the scores of ambulatory aid,gait,mental status evaluated by clinical nurses were significantly lower than those reevaluated by clinical nurse specialists （P0.05,P0.01）. Conclusion Clinical nurses underestimate the fall risk of senile patients and neglect some cases with high fall risk. In order to reduce unintentional falls of senile patients,clinical nurses should be given intensified training on the use of Morse Fall Scale.
