新医改背景下护理柔性流程构建及临床实践效果研究 Research on the Construction of NursingFlexible Process and the Effect of Clinical Practice under the Background of New Medical Reform
目的：本研究选取某三级公立医院为案例，基于新医改和ERAS背景与文献综述分析，了解医院护理核心服务流程中的主要问题，探讨、实践行之有效的柔性流程优化措施。为护理柔性流程构建及相关研究提供借鉴。方法：1) 项目调研：采用电话回访和发放问卷收集患者1000例和护士120名对医院护理核心服务流程中的意见和需求。2) 构建柔性流程:运用ESIA(流程优化)基本原则、5W1H提问技术、鱼骨图法等，并根据中华医学会外科学分会血管外科学组2013版《深静脉血栓形成的诊断和治疗指南》，依据流程再造理论创始人：迈克尔？哈默教授创造的理论平台，完成了66项护理柔性流程构建和优化。3) 优化前后对比研究：设立多个不同内容的实验组和对照组进行优化前后临床实践效果对比研究。结果：优化后实验组患者对护士和对护理工作流程满意度均明显高于对照组；实验组护士非增殖活动时间明显减少(P < 0.05)；实验组比对照组护士柔性流程接受度、护士满意度提升和不良事件发生率下降(P < 0.01)；围术期患者禁食禁饮时间缩短。术后副反应的发生次数明显减少，实验组显著少于对照组，P < 0.05；实施后患者满意度和护士的满意度均高于实施前(P < 0.05)。结论：柔性流程在临床实践取得初步成效，实验组护士非增殖活动时间明显减少，患者平均住院日缩短、术后离床时间短、患者和护士满意度提高，患者营养主观体验提升，患者舒适度增加，住院体验感增强，值得临床推广应用。
Objective: This study selects a third-level public hospital as a case. Based on the background of the new medical reform and ERAS and literature review and analysis, it understands the main prob-lems in the core nursing service process of the hospital, and discusses and implements effective flexible process optimization measures to provide reference for the construction of nursing flexible process and related research. Methods: 1) Project investigation: Telephone interviews and questionnaires were used to collect the opinions and needs of 1000 patients and 120 nurses on the core nursing service process of the hospital. 2) Constructing a flexible process: applying the basic principles of ESIA (process optimization), 5W1H questioning techniques, fishbone diagram method, etc., and according to the 2013 edition of the “Guidelines for the Diagnosis and Treatment of Deep Vein Thrombosis” by the Vascular Surgery Group of the Chinese Medical Association Surgery Branch According to the founder of process reengineering theory: the theoretical platform created by Professor Michael Hammer, completed 66 nursing flexible process construction and optimization. 3) Comparative study before and after optimization: Set up multiple experimental groups and control groups with different contents to conduct a comparative study of clinical practice effects before and after optimization. Results: After the optimization, patients in the experimental group were significantly more satisfied with the nurses and nursing work processes than in the control group; the non-proliferative activity time of the experimental group nurses was significantly reduced (P < 0.05); and the experimental group was more flexible than the control group in the acceptance of flexible procedures. Nurse satisfaction increased and the incidence of adverse events decreased (P < 0.01); the fasting and drinking
