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.