CAJ | 학술논문

目的应用SHEL模式对精神科与综合科护理不良事件发生的原因进行分析比较,为管理者制订有针对性的防范措施提供依据.方法用SHEL模式对某三级甲等医院2007年至2009年发生的136例护理不良事件原因进行分析,并对精神科、综合科发生不良事件进行分类、发生率进行对比分析.结果精神科发生护理不良事件位于前3位的是:用药错误、外走、自杀与自伤,综合科发生护理不良事件位于前3位的是:用药错误、操作不当与管道脱落.发生护理不良事件与护士业务素质有关占91.18%,与护理工作场所有关占43.38%,与临床环境有关的占41.18%,与当事人及他人有关的占57.35%.精神科较综合科护理不良事件的发生率高.结论采用SHEL模式分析精神科与综合科护理不良事件,能客观、全面地分析其发生的原因,并提示护理管理者根据不同的专科特点采取相应的管理策略,制订最佳的防范风险的应对措施.
목적 응용SHEL모식대정신과여종합과호리불량사건발생적원인진행분석비교,위관리자제정유침대성적방범조시제공의거.방법 용SHEL모식대모삼급갑등의원2007년지2009년발생적136례호리불량사건원인진행분석,병대정신과、종합과발생불량사건진행분류、발생솔진행대비분석.결과 정신과발생호리불량사건위우전3위적시:용약착오、외주、자살여자상,종합과발생호리불량사건위우전3위적시:용약착오、조작불당여관도탈락.발생호리불량사건여호사업무소질유관점91.18%,여호리공작장소유관점43.38%,여림상배경유관적점41.18%,여당사인급타인유관적점57.35%.정신과교종합과호리불량사건적발생솔고.결론 채용SHEL모식분석정신과여종합과호리불량사건,능객관、전면지분석기발생적원인,병제시호리관리자근거불동적전과특점채취상응적관리책략,제정최가적방범풍험적응대조시.
Objective To compare and analyze the causes that occurred in psychiatric and general department using SHEL models, in order to provide evidence of preventing nursing adverse events.Methods We analyzed causes of 136 nursing adverse events using SHEL models, and compared the classification, causes, incidence of nursing adverse events between psychiatric and general departments. Results The first three nursing adverse events in psychiatric department were medication error,going outside, suicide and self harm, and those in general department were medication errors, specimens being wrong, improper operation and pipeline off. 91.18% of nursing adverse events accounted for quality of nursing services, 43.38% accounted for nursing environment, 41.18% accounted for clinical environment,and 57.35% accounted for parties and others. Incidence of nursing adverse events in psychiatric department were higher than that in general department. Conclusions SHEL model can objectively and comprehensively analyze the causes of nursing adverse events, and make nursing managers take the appropriate management strategy and the best safeguard against the risk of development of response.