无惩罚上报制度在神经科护理安全管理中的价值探讨
Application value of no punishment report system in nursing safety management of department of neurology
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摘要: 目的：探讨无惩罚上报制度在神经科护理安全管理中的应用价值。方法：于2014年9月至2015年8月对神经科病人2879例和医护人员68名实施常规护理管理制度，在此基础上，于2015年9月至2016年9月对神经科病人2988例和医护人员68名在实施无惩罚上报制度，采用简化版护士职业倦怠量表（NBS）评估护士工作积极性，采用焦虑自评量表（SAS）评估护士焦虑情绪，采用自制《神经科病人护理满意量表》评估病人满意度，采用logistic回归分析病人满意度和不良护理事件发生的独立危险因素，统计分析所有病人满意度、护士工作积极性、焦虑和不良护理事件上报、发生情况。结果：实施后，护士的各项NBS得分和总得分均明显高于实施前（P<0.01），护士焦虑发生率和SAS得分均低于实施前（P<0.05和P<0.01），病人满意率和满意度得分明显高于实施前（P<0.01），不良护理事件上报率明显高于实施前（P<0.01），不良护理事件总发生率明显低于实施前（P<0.01）。logistic回归分析显示，护士工作积极性低、焦虑和不良护理事件不上报是病人不满意和不良护理事件发生的独立危险因素（P<0.01）。结论：实施无惩罚上报制度有利于提高神经科的护理安全管理质量，值得临床进一步推广。Abstract: Objective:To discuss the application value of no punishment report system in nursing safety management of department of neurology.Methods:The routine nursing management system was implemented in 2 879 patients and 68 medical staff in the Department of Neurology from September 2014 to August 2015,and the no punishment report system was additionally implemented in 2 988 patients and 68 medical staff in the Department of Neurology from September 2015 to September 2016 based on the routine nursing management system.The work enthusiasm and anxiety of nurses,and satisfaction of patients were assessed using the nurse job burnout scale(NBS),self-evaluation of anxiety scale(SAS) and self-made 'neurologist patient care satisfaction questionnaire',respectively.The patients' satisfaction and independent risk factors of adverse nursing were analyzed using logistic regression analysis method.All patients' satisfaction,work enthusiasm and anxiety of nurses,and adverse events report were analyzed.Results:After implementing,the item score and total score of NBS in nurses were significantly higher than those before implementing(P<0.01),the incidence rate of anxiety and SAS score in nurses were lower than those before implementing(P<0.05 and P<0.01),the scores of satisfaction rate and degree in patients were significantly higher than those before implementing(P<0.01),the report rate of adverse nursing events was significantly higher than that before implementing(P<0.01),and the total incidence rate of adverse nursing events was significantly lower than that before implementing(P<0.01).Logistic regression analysis showed that the low motivation and anxiety of nurses,and no report of adverse nursing events were the independent risk factors of the adverse nursing events and poor satisfaction of patients(P<0.01).Conclusions:No punishment report system can effectively improve the nursing safety management in Department of Neurology,which is worthy of further clinical promotion.
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