探讨以"问题导向"的交接班模式在急诊科床旁交接班的应用及效果评价。

以2019年6月至11月北京市门头沟区医院急诊科进行的304例次床旁交接班事件资料为研究对象进行回顾性对照研究，其中男性155例，女性149例；年龄20～84岁，平均(50.13±5.12)岁。神经系统77例，消化系统58例，呼吸系统55例，心血管系统78例，外伤例36例。对比普通床旁交接班模式和"问题导向"的床旁交接班模式中，责任护士对患者病情掌握、患者/家属满意度、接班护士满意度与不良事件发生率的差异。

采用了以"问题为导向"的床旁交接班模式后，责任护士对患者病情掌握度[(50.46±6.99)分比(38.98±4.76)分]、患者/家属满意度[(52.64±2.13)分比(40.77±3.26)分]、接班护士的满意度[(54.16±2.35)分比(44.22±2.12)分]均有所提高，护理不良事件发生率有所降低[0.16%(3/1 800)比2.66%(36/1 350)]，差异均有统计学意义(P<0.05)。

应用"问题导向"的床旁交接班模式对比普通床旁交接班，责任护士对患者病情掌握度、患者/家属满意度、接班护士的满意度均有所提高，护理不良事件发生率有所降低。

To explore the application and effect of "problem oriented" shift change mode in emergency department.

A retrospective control study was carried out on 304 cases of bedside shift events in the Emergency Department of Mentougou District Hospital, Beijing from June to November 2019, including 155 males and 149 females, aged 20-84 years with an average of (50.13±5.12) years. There were 77 cases of nervous system diseases, 58 cases of digestive diseases, 55 cases of respiratory diseases, 78 cases of cardiovascular diseases and 36 cases of trauma. Between the common bedside shift mode and the "problem oriented" bedside shift mode, the difference of patients’ condition control, patients’/family members’ satisfaction, nurses’ satisfaction and the incidence of adverse events was compared.

After adopting the "problem oriented" bedside shift mode, the nurses’ mastery of patients’ condition [(50.46±6.99) score (38.98±4.76) score], patients’ and family members’ satisfaction [(52.64±2.13) score (40.77±3.26) score], nurses’ satisfaction [(54.16±2.35) score (44.22±2.12) score] were improved, and the incidence of nursing adverse events was reduced [0.16%]. The difference was statistically significant (P < 0.05).

Compared with the common bedside shift, the degree of mastery of patients’ condition, the satisfaction of patients/family members and the satisfaction of the nurses who take over the shift are improved, and the incidence of nursing adverse events is reduced.