探讨总责任护士主导的医护一体化临床护理模式在创伤骨科的应用效果。

选择2016年7月至2017年6月在南京大学医学院附属鼓楼医院创伤骨科行手术治疗的骨折患者200例，按照入院先后顺序分为对照组90例(实施创伤骨科常规护理)和观察组110例(实施医护一体化工作模式，包括成立医护合作小组、实施总责任护士主导的医护一体化查房、个体化诊疗方案的共同决策、疼痛管理、早期出院计划与延续护理)。比较2组患者的术后护理效果和医护合作满意度。对数据行t检验和χ²检验。

总责任护士主导的医护一体化模式下，观察组患者术后72 h内数字评分法(NRS)评分为(4.09±1.64)分，疼痛干预有效率为77.57%，对照组术后72 h内NRS评分为(5.15±1.69)分，疼痛干预有效率为57.95%，2组比较差异均有统计学意义(P值均小于0.05)；观察组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为2、1、3，对照组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为9、7、11，两组比较差异均有统计学意义(χ²＝4.486、4.296、6.812，P＝0.027、0.036、0.009)。观察组术后康复开始时间为(21.48±6.41)h，术后住院时间为(11.08±2.19)d；对照组术后康复开始时间为(36.48±10.75)h，术后住院时间为(13.95±2.93)d，2组比较差异均有统计学意义(t＝11.670、－7.616，P值均小于0.05)。2组医护合作满意度结果显示，观察组患者信息的交流得分为(3.78±0.85)分，共同参与治疗或护理决策得分为(3.86±0.87)分，医师和护士的关系得分为(4.00±0.84)分，总分为(3.87±0.67)分；对照组患者信息的交流得分为(3.32±1.00)分，共同参与治疗或护理决策得分为(3.23±0.93)分，医师和护士的关系得分为(3.45±0.96)分，总分为(3.33±0.84)分，2组比较差异均有统计学意义(P值均小于0.05)。

总责任护士主导的医护一体化护理模式的应用，以亚专科为核心，重新整合医护资源，共同参与制订患者的诊疗护理方案，共同聚焦患者安全与质量，加强了医护间的配合，提高了医疗护理服务质量，提升医护合作满意度。

To explore the application effect of integrated clinical nursing mode led by general responsible nurses in department of orthopedics.

From July 2016 to June 2017, 200 patients with fractures who underwent surgical treatment in orthopedics trauma department of Drum Tower Hospital Clinical College of Nanjing University were selected and divided into two groups: control group (90 cases) and observation group (110 cases). The control group only accepted the conventional mode of nursing care, which was mainly carried out according to doctor′s orders. The observation group was given medical and nursing integration model on the basis of this including the establishment of a medical and nursing cooperation group, the implementation of the medical and nursing one led by the general responsible nurses, integrative ward rounds, joint decision-making of individualized diagnosis, treatment programs, pain management, early discharge plans and continuing care. The effect of nursing after operation and the satisfaction degree of cooperation between doctors and nurses in different periods were compared between the two groups. Data were processed with t test and chi-square test.

Under the integrated medical and nursing mode dominated by general responsible nurses within 72 hours after operation, the numerical rating scale(NRS) score of the observation group was (4.09±1.64) points, and the effective rate of pain intervention was 77.57%. The NRS score of the control group was (5.15±1.69) points, and the effective rate of pain intervention was 57.95%. There were significant differences between the two groups (with P values below 0.05). After application, the incidence of lower extremity deep venous thrombosis, urinary system infection and constipation in the observation group were 2, 1 and 3 respectively, and in the control group, the incidence of lower extremity deep venous thrombosis, urinary system infection and constipation were 9, 7 and 11 respectively. There were significant differences between the two groups (χ²=4.486, 4.296, 6.812; P=0.027, 0.036, 0.009). The starting time of rehabilitation exercise was (21.48±6.41) h in the observation group and the hospital stays after operation were (11.08±2.19) d; the starting time of rehabilitation exercise was (36.48±10.75) h in the control group and the hospital stays after operation were (13.95±2.93) d. There were significant differences between the two groups (t=11.670, -7.616, with P values below 0.05). The results of cooperation satisfaction between the two groups showed that in the observation group, the score of patients’ information exchange was (3.78±0.85) points, the score of co-participation in treatment or nursing decision-making was (3.86±0.87) points, the score of doctor-nurse relationship was (4.00±0.84) points, and the total score was (3.87±0.67) points; in the control group, the score of patients′ information exchange was (3.32±1.00) points, the score of co-participation was (3.86±0.87) points, the score of treatment or nursing decision-making was (3.23±0.93) points, the score of doctor-nurse relationship was (3.45±0.96) points and the total score was (3.33±0.84) points. There were significant differences between the two groups (with P values below 0.05).

The application of integrated nursing mode led by general responsible nurses regards sub-specialty as the core, re-integrates medical and nursing resources. Doctors and nurses can jointly participate in the formulation of patient′s diagnosis and treatment nursing program, and focuse on patients′ safety and quality, which strengthens the cooperation between doctors and nurses, improves the quality of medical and nursing services, and improves the satisfaction of medical and nursing cooperation.