摘要
目的 探讨以临床案例为导向的管理模式对护士综合能力、心理及评判性思维的影响.方法 2014年实施的＆quot;常规临床案例管理模式＆quot;为对照组,收集了97例临床案例;2015年实施的＆quot;以临床案例为导向的管理模式＆quot;为观察组,收集了110例临床案例,比较2种管理方法对提高护士管理理论知识、临床实践能力及处理案例技巧帮助的大小;当发现、发生临床特殊案例后对护士情绪,包括心理、从事护理工作意愿、工作积极性、独立处理相关案例能力及护士评判性思维能力等的影响.结果 在护士认为提高管理理论知识、临床实践能力及处理案例技巧帮助大、对案例分析满意度的比例中,观察组分别为98.79%（244/247）、99.19%（245/247）、98.79%（244/247）、99.60%（246/247）,对照组分别为88.57%（217/245）、87.35%（214/245）、87.76%（215/245）、90.61%（222/245）,2组比较差异有统计学意义（χ2=21.390~27.571,P〈0.01）;护士认为特殊案例对其心理、从事护理工作意愿及工作积极性影响大的比例,观察组分别为15.79%（39/247）、13.77%（34/247）、11.34%（28/247）,对照组分别为31.84%（78/245）、31.02%（76/245）、30.61%（75/245）,2组比较差异有统计学意义（χ2=17.475、21.097、27.611,P〈0.01）;发现、发生特殊案例后,观察组护士独立处理案例、求助他人、无所适从的比例分别为97.57%（241/247）、2.02%（5/247）、0.40%（1/247）,对照组分别为85.71%（210/245）、12.24%（30/245）、2.04%（5/245）,观察组独立处理案例的比例较对照组高,而在求助他人、无所适从的比例均较对照组低,差异有统计学意义（χ2=22.647,P〈0.01）;评判性思维量表得分方面,观察组护士在寻找真相、开放思想、分析能力、系统组织能力、评判思维自信心、求知欲、认知成熟度、总分分别为（43.24±4.01）、（43.03±4.12）、（47.66±4.23）、（44.21±3.92）、（44.00±4.97）、（52.13±4.44）、（48.23±4.85）、（319.00±14.57）分,对照组分别为（39.00±3.56）、（38.90±3.28）、（43.65±2.47）、（40.55±1.99）、（39.00±3.40）、（47.87±4.01）、（41.89±5.11）、（292.23±6.02）分,2组比较差异有统计学意义（t=12.15~24.19,P〈0.01）.结论 以临床案例为导向的管理模式能提升护士综合能力,降低特殊案例对护士的不良影响,提高临床护士的评判性思维能力,确保患者安全.
Objective To explore the effect of the clinical case oriented management model on nurses comprehensive ability, psychological and critical mind. Methods In 2014 on the implementation of＆quot;routine clinical case management model＆quot;as the control group, collected 97 cases of clinical cases. In 2015 on the implementation of＆quot;the clinical case oriented management model＆quot;as the observation group, collected 110 cases of clinical cases. Compared two methods of management to improve the nurse management theoretical knowledge, clinical practice ability and deal with the size of the case skills help. When/after clinical special case found the influence for nurses, including psychology, work in the nursing work will, enthusiasm, independent ability to deal with related cases and the nurse critical thinking ability, etc. Results The proportion of the nurses thought that it was helpful to improve the management of theoretical knowledge, clinical practice ability and deal with the size of the case skills and the case analysis of satisfaction were 98.79%（244/247）, 99.19%（245/247）, 98.79%（244/247）, 99.60%（246/247） in the observation group, and 88.57%（217/245）, 87.35%（214/245）, 87.76%（215/245）, 90.61%（222/245） in the control group. The differences were statistically significant （χ2=21.390-27.571, P 〈 0.01）. The proportion of the nurse considered that special case on the psychological effects of nursing work, engaged in the willingness and enthusiasm were the main factor were 15.79%（39/247）, 13.77%（34/247）, 11.34%（28/247） in the observation group, and 31.84%（78/245）, 31.02%（76/245）, 30.61%（75/245） in the control group. The differences were statistically significant （χ2=17.475, 21.097, 27.611, P 〈 0.01）. After special case, the percentage of nurses to independently handle the case, help others, loss rates were 97.57%（241/247）, 2.02% （5/247）, 0.40% （1/247） in the observation group, and 85.71% （210/245）, 12.24% （30/245）, 2.04% （5/245） in the control group. The proportion of nurses to independently handle the case in the observation group was higher than that in the control group, but the ratio of nurses to help others, loss rates in the observation group were lower than those in the control group, the differences were statistically significant （χ2=22.647, P〈0.01）.Critical thinking score, the observation group of nurses in the search for truth, open mind, analytical ability, system organization, judging thinking self-confidence, curiosity, cognitive maturity, such as total score were respectively （43.24±4.01）, （43.03±4.12）, （47.66±4.23）, （44.21± 3.92）, （44.00 ± 4.97）, （52.13 ± 4.44）, （48.23 ± 4.85）, （319 ± 14.57） points. The control group nurses were respectively （39.00±3.56）, （38.90±3.28）, （43.65±2.47）, （40.55±1.99）, （39.00±3.40）, （47.87±4.01）, （41.89± 5.11）, （292.23 ± 6.02） points. The differences were statistically significant（t =12.15-24.19, P 〈 0.01）. Conclusions The clinical case oriented management model can improve nurses comprehensive ability, reduce the adverse impact of the special case for nurses, improve the clinical nurses＆#39; critical thinking ability, to ensure patient safety.
出处
《中国实用护理杂志》
2017年第8期619-623,共5页
Chinese Journal of Practical Nursing
基金
广东省教育科研“十二五”规划2012年度研究项目（2012JK330）
广东省护理学会2015年基金项目（YH20150257）
关键词
临床案例
质量管理
模式
Clinical cases
Quality management
Model
