1 data and methods
1. 1 general information
Fifty-two critically ill ICU patients admitted to our hospital from June 20 15 to June 20 16 were selected as the research objects and randomly divided into two groups. There were 26 cases in the observation group, including 65,438+05 males and 65,438+06,438+0 females, aged from 20 to 67 years, with an average age of (43.5 2.6) years. There were 26 cases in the control group, including 65,438+04 males and 65,438+02 females, aged from 25 to 70 years. There is no significant difference in age and sex between the two groups (P & gt0.05), which can be compared and analyzed.
1.2 method
The control group used routine nursing, and implemented corresponding nursing measures according to the specific conditions of patients, so as to maintain the stability of patients' vital signs and promote the improvement of patients' condition; The observation group took graded nursing management measures, the specific contents are as follows.
1.2. 1 Establish a graded nursing management team in ICU. First of all, in order to ensure the implementation effect of graded nursing management, ICU departments should set up a graded nursing management team according to their own conditions, with ICU director as the team leader, head nurse as the deputy team leader and other 6-8 nurses as the team members [2]. After the establishment of the group, a discussion should be held in the group to improve the existing ICU nursing management work and system according to the summarized clinical experience, formulate an effective grading nursing management system, put the responsibility into the individual, and put forward corresponding rectification measures according to the common problems.
1.2.2 Classification of ICU patients Generally speaking, ICU patients can be divided into four grades. Grade I: patients without vital signs can be transferred out of ICU. For such patients, special care is not needed, but the changes of their vital signs should be checked regularly to avoid abnormal situations; Grade II: The patient was treated in ICU, but did not need ICU intervention. For this kind of patients, 1 nurse should be in charge, or 1 nurse should be in charge of 2-3 patients, which can not only avoid the waste of human resources, but also ensure the quality and efficiency of nursing. Grade ⅲ: The patient's condition has been effectively controlled and needs 1 ICU intervention. For such patients, there should be 1 specialized nursing staff for nursing, and 2 can be equipped if necessary; Ⅳ: The patient's vital signs are unstable and his condition is critical, which requires two or more ICU intervention methods [3]. Such patients need 1 ~ 2 nurses to take care of them at the bedside to ensure timely rescue and avoid delaying the treatment opportunity.
1.2.3 Rational allocation of human resources ICU is different from other departments. Nursing work is very stressful, and nurses bear very important responsibilities and need to be vigilant at all times. In order to ensure the quality of nursing, we should reasonably arrange the allocation of human resources, change the ICU duty time to 12 h, optimize the shift scheduling time, and ensure that the number of nursing staff in each time period remains unchanged. It should be noted that nurses with different seniority and experience should be combined, which can not only help but also ensure the effective implementation of nursing work.
1.2.4 it is special to strengthen the training and assessment of ICU nursing work. Therefore, hospitals should regularly provide training opportunities for nursing staff, impart advanced nursing methods and concepts, and improve the professional quality of nursing staff. At the same time, strengthen ideological education, so that nurses can maintain a positive working attitude and a high degree of enthusiasm, actively participate in the work process, and reduce mistakes. In addition, daily supervision and assessment should be strengthened, and the assessment results should be included in the salary assessment standard, which can form a more favorable environment and promote the implementation of graded nursing management system.
1.3 observation index
The self-made nursing questionnaire was used to evaluate the quality of nursing, including ward management, drug management, ICU technology, nursing records, nursing safety, disinfection measures and infection prevention. The total score of each item 100, the higher the score, the higher the nursing quality. Statistics of adverse events during nursing; The total score of nursing satisfaction questionnaire is 100, with 85 points above being very satisfied, 70-85 points basically satisfied, and 70 points below being dissatisfied. Nursing satisfaction = very satisfaction rate+basic satisfaction rate [4].
1.4 statistical method
All the data obtained in this study are calculated and processed by SPSS 19.0 statistical software. Counting data is represented by [n(%)], measuring data is represented by (x s), and t test is adopted, P.
Two results
2. 1 nursing quality score
The scores of ward management, drug management, ICU technology, nursing records, nursing safety, disinfection measures and infection prevention in the observation group were (96.8 2.6), (97.4 2.5), (95.2 2.4), (96.6 2.3) and (97.4 2.3) respectively. The scores of ward management, drug management, ICU technology, nursing records, nursing safety, disinfection measures and infection prevention in the control group were (92. 1. 1.8), (93.0 2.0), (92.91.7) and (93) respectively. The results showed that the nursing quality index score of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant (t= 15.97, P < 0.05).
2.2 Incidence rate of nursing adverse events
There were 3 cases of nursing adverse events in the observation group, including ventilator-associated pneumonia (1), pressure sore (1) and accidental drainage tube falling off (1), and the incidence of nursing adverse events was1.54% (3/26). In the control group, there were 10 cases of nursing adverse events, including 2 cases of ventilator-associated pneumonia, 2 cases of pressure sore, 2 cases of accidental fall of drainage tube, 2 cases of transfusion extravasation, bed rest 1 case, and fall 1 case. The incidence of nursing adverse events was 38.46%( 10/26). The difference between the two groups was statistically significant (2=7.985 6, P
2.3 Nursing satisfaction
In the observation group, 15 patients were very satisfied with the nursing process and results, 10 patients were basically satisfied, 1 0 patients were dissatisfied, and the nursing satisfaction rate was 96. 15% (25/26). In the control group, 8 patients were very satisfied with the nursing process and results, 10 patients were basically satisfied, 8 patients were dissatisfied, and the nursing satisfaction rate was 69.23%( 18/26). The difference between the two groups was statistically significant (2=7.996 4, P
3 discussion
With the continuous improvement of health awareness, people have higher and higher requirements for nursing work. As the main place for hospitals to receive critically ill patients, ICU needs to strengthen the reform of nursing mode to ensure the efficiency and quality of nursing content. Graded nursing management is a nursing model based on efficient management [5]. Its goal is to optimize the allocation of human resources, improve the utilization efficiency of various medical resources, promote the improvement of nursing quality, reduce the number of risk factors and ensure the safety of patients. Through hierarchical management, patients can be divided into different groups, which is convenient for effective management. At the same time, the relevant nursing strategies are more flexible, which can ensure the scientificity of ICU nursing work and avoid the occurrence of adverse events, reflecting the principle of people-oriented. Clinical practice has proved that graded nursing management has obvious advantages and high clinical application value.
In this study, the graded nursing management of patients in the observation group can be more targeted. Classification of ICU patients can further clarify patients' condition, rationally allocate human resources, provide sufficient nursing staff support for ICU patients, strengthen training and assessment, analyze nursing management of nursing staff, and reasonably evaluate nursing staff's performance, so as to provide timely feedback and better follow-up nursing management. The results showed that the observation group scored higher in ward management, drug management, ICU technology, nursing records, nursing safety, disinfection measures and infection prevention than the control group, with statistical significance (P
To sum up, graded nursing management of ICU patients can effectively improve nursing quality and nursing satisfaction, and reduce the incidence of nursing adverse events. The effect is remarkable, and it is worth popularizing.
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