目的 调查医疗文书填写现状并探讨其对患者满意度之间的影响。 方法 2012年10月－12月以呼吸内科住院的患者为调查对象，调查其医疗文书完成情况，统计医疗文书缺项数目。同时参考国内外患者满意度研究，自制满意度调查表，调查患者对医务人员满意度；分析医疗文书缺项数目对患者满意度的影响。 结果 研究共纳入151例患者，共有126份医疗文书存在不同程度填写缺陷，占83.44%，平均缺项（11.58 ± 11.63）条。总体患者就医满意度为6.85分，与医疗文书缺项数目呈现负相关性（R=?0.602，P=0.001）。患者性别、年龄、文化程度、付费方式和住院天数与患者满意度无相关性。 结论 医疗文书缺项数目较多、完成质量不高。需要加强医务人员对于医疗文书完成质量的重视程度。
ObjectiveTo explore the application of discharge planning model in Respiratory Department. MethodWe developed discharge planning model in the Respiratory Department and performed standardized management on inpatients by assessing, planning, implementing and following up the whole process. A total of 716 discharged patients before the implementation of the planning model (January to March 2014) were designated as the control group, and 739 discharged patients after the model implementation (April to June 2014) were regarded as the observation group. Then, we compared such indexes as the rate of discharge planning, average length of hospital stay, retention rate of discharged patients, the number of new hospital admissions and medical orders during the time of weak nurse strength, and inpatient satisfaction before and after the model implementation. ResultsAfter implementation of discharge planning model, all observed indicators were significantly better in the observation group (P<0.05). ConclusionsImplementation of discharge planning model can effectively promote physician-nurse cooperation, plan health guidance for discharged patients, make them be ready to return to society and family, improve patients' satisfaction, and achieve the aim of patient-oriented high quality care. Meanwhile, it also can shorten the average length of hospital stay, reduce orders during the time of weak strength. It can not only ensure the ward medical indexes, but is helpful to manage nursing schedule.
ObjectiveTo explore the effect of closed-loop group nursing model on the makeshift intensive care unit (ICU) in a hospital specialized for coronavirus disease 2019 (COVID-19).MethodsSeveral fever wards had been shifted into ICUs and ran by the first medical team from Sichuan Province from January 30th to March 19th, 2020. Closed-loop group nursing model was utilized. The nursing model activated the nurses in management by empowerment and nursing group establishment. To ensure standard of care, measures were carried out in this model, namely, improving the physical work environment, nurse training, optimizing composition of nursing manpower, fine and standardized management of medical resources, “double-chain” medical supply system, “3S” management on first aid kit, protecting patient safety and dignity, and developing emergency nursing workforce deployment plan.ResultsThe implementation of closed-loop group nursing model showed good results in treating severe to critically ill COVID-19 patients regardless of shortages in nursing workforce and facilities. The rescue work was carried out successfully in the makeshift ICUs. All the nurses showed great teamwork and were really involved in the management of the wards. ConclusionsAs the current ICUs were not adequate for the increasing number of critically ill patients during the epidemic, it was unavoidable to transform other wards into ICUs. Closed-loop group nursing model was utilized to break the hierarchy. As a result, all nurses were empowered to participate in nursing management and their potential was fully inspired. Furthermore, this working model presented a clear working framework in multidisciplinary teamwork in a limited time, which also provided patients with dignity and safety.
Objective we want to construct a rating scale for the key technique using the inhaler device for patients with chronic airway disorder and to provide a reference tool for the scientific evaluation of patients’ techniques in the use of inhaler devices. MethodsThrough literature review and Delphi expert consultation, the items of the rating scale were determined, and the weights and assignments of the items were determined through the analytic hierarchy process. The resulting evaluation form was used for clinical assessment of patients, and the differentiation of each item was tested by the critical ratio method.ResultsAfter the two rounds of consultation, the positive coefficients of experts were 95.24% and 100%, the expert authority coefficients were 0.988 and 0.990, and the Kendall-W coefficients were 0.371 (P<0.001) and 0.654 (P<0.001), respectively. The final form, consisting of 10 operational items for evaluating key inhaler techniques for patients with chronic airway disorder, was finalized. The results of the hierarchical analysis showed that the consistency ratio CR was 0.088<0.10, which satisfied the consistency test. The top 5 key operational steps were medication preparation, exhalation, holding the mouthpiece, inhalation, and breathholding. Used for clinical patient assessment showed better discrimination of items (t ≥ 3, P<0.05).ConclusionThe rating scale for the technique using the inhaler device for chronic airway disorder constructed in this study is scientifically reliable, convenient, and practical, which can be used as an objective evaluation tool to assess patients’ skill in inhaler device use.