林平娇

[摘要] 目的 探讨层级责任制护理模式在儿科临床工作中的应用。方法 将儿科病区13名护士进行分层级管理责任于人进行管床，设立护士长-高位责任护士-初级责任护士，按岗位分管床位，全面负责患儿的病情观察、治疗、护理、病区安全及家属沟通，使患儿得到及时、最适合的治疗和护理措施。结果 基础知识技能、专业技能、急救技能、综合能力、病区安全管理、护理质量、护理文书等项目，实施层级责任制后显著优先实施前（P<0.05），患者对护理服务满意度差异有统计学意义（P<0.05）；护士压力感降低。 结论 护理人员分层级管理，充分调动护士工作积极性，加强工作责任感，护士的综合素质和护理质量得到提升，充分利用现有护理人力资源，能提高工作质量和效率，使患儿得到更好更全面的照料，患者满意度提高，进一步提高了儿科优质护理服务的内涵。

[关键词] 层级责任制；护理模式；儿科

[中图分类号] R47 [文献标识码] C [文章编号] 1673-9701（2014）23-0093-03

[Abstract] Objective To explore the application of nursing mode of responsibility system guided by hierarchical management in pediatrics. Methods Thirteen nurses were arranged to take care of patients under the nursing mode of responsibility system guided by hierarchical management. They were graded into one head nurse， advanced responsible nurses and primary responsible nurses， and they were assigned with different duty according to their grades. They were responsible to observe the change of the illness， treatment， nursing， safety of the wards and communication with patients family members， to make sure patients can get prompt as well as suitable treatment and nursing. Results After the implement of responsibility system guided by hierarchical management， there were obvious improvements on basic knowledge， specialty skill， first aid， comprehensive ability， management of wards safety nursing quality， nursing document， and so on（P<0.05）. There was statistical significance in patients satisfaction to nursing（P<0.05）. Nurses also felt less pressure. Conclusion With the implement of responsibility system guided by hierarchical management， nurses are encouraged to work hard， work duty is strengthened， and comprehensive ability of nurses and nursing quality are enhanced. It could also make full use of current nursing resource， increase the efficiency， quality and patients satisfaction. Therefore， it could provide the patients with the best nursing and care.

[Key words] Hierarchy responsibility system； Nursing mode； Pediatrics

随着社会的进步，人们服务观念的改变，社会对护理的需求越来越高，为了适应医学模式的转变，提高护理质量[1]，我科在2012年启动了优质护理服务示范工程活动，开展优质护理服务五制推动，按护士队伍分层分级管理，建立和完善护理工作管床制，为患儿提供连续、全程、无缝隙的护理服务。儿科通过此活动的开展，取得满意效果。现报道如下。

1资料与方法

1.1一般资料

儿科共有护理人员13名，含护士长1人，护士12名，主管护士3名，护师4名，护士6名，床位35张，每人分管3名患儿，将2012年600例患儿分为对照组和实验组，每组300例，实施护士层级管床责任前后护士的综合素质及患儿护理质量与满意度进行对比分析。两组患儿及家属在性别、年龄、病情等基本资料方面比较差异无统计学意义（P>0.05），具有可比性。

1.2实施方法

对照组实施传统功能制护理模式，采用轮班制度，观察组采用层级管理法进行管理，采用连续责任制科学定岗，具体方法如下。根……