目的

探讨医护一体化管理模式在乳腺癌日间化疗病房中的应用效果。

方法

本研究为自身前后对照研究,按照纳入和排除标准选取2014 年10 月至2015 年3 月第三军医大学第一附属医院收治的乳腺癌术后化疗患者123 例,拟接受EC-T 方案(表柔比星+环磷酰胺序贯紫杉醇)化疗,2014 年10 ～12 月已完成4 次化疗,2015 年1 ～3 月需再完成4 次化疗;从2015 年1 月起,在乳腺癌日间化疗病房实施医护一体化管理,改进住院流程。 在实施前后,采用SERVQUAL 调查问卷评价患者满意度,同时抽取同时期医护人员25 名,采用童俐俐等制定的问卷评价医务人员的满意度,并采用配对χ² 检验(McNemar 法)比较满意度之间的差异,用配对t 检验比较患者等待治疗时间。

结果

收集患者满意度有效问卷114 份,回收率92.7%(114/123);医护人员满意度有效问卷23 份,回收率92.0%(23/25)。医护一体化管理实施后,患者对医护服务态度、健康教育及住院流程的满意度升高(P 均＜0.001);医护人员对化疗药物输注安全、医护配合和劳动强度的满意度都得到提升(P 均＜0.001)。 患者等待治疗时间在实施医护一体化管理前为(4.92±0.66)h,实施后为(1.45±0.12)h,患者等待治疗时间明显缩短(t=54.397,P＜0.001)。

结论

在乳腺癌日间化疗病房开展医护一体化管理是一种安全、有效的模式,明显提高了患者和医护人员的满意度。

Objective

To study the efficacy of integrated management model of medical treatment and nursing in day-care chemotherapy unit for breast cancer patients.

Methods

This was a before-after control study. According to the inclusion and exclusion criteria, 123 breast cancer patients were enrolled in the First Affiliated Hospital of the Third Military Medical University from October 2014 to March 2015. They had undergone 4 cycles of postoperative chemotherapy (EC-T regimen: epirubicin + cyclophosphamide followed by paclitaxel) from October to December 2014, and they would complete another 4 cycles of postoperative chemotherapy from January to March 2015. Since January 2015, we implemented integrated management of medical treatment and nursing in day-care chemotherapy unit for breast cancer patients in order to improve the hospitalization process. Before and after the implementation, SERVQUAL questionnaire was used to evaluate the patients' satisfaction. Twenty-five doctors and nurses were surveyed by the questionnaire developed by Tong et al to evaluate the satisfaction of the medical staff. The paired χ² test (McNemar method) was used to compare the satisfaction of patients and medical staff before and after the implementation. The waiting time of patients was compared by paired t test.

Results

A total of 114 valid questionnaires from patients were collected and the recovery rate was 92.7% (114/123). Twenty-three valid questionnaires from medical staff was collected and the recovery rate was 92.0%(23/25).After the implementation of integrated management, the patients' satisfactions with medical service, health education and hospitalization process were increased (all P＜0.001); the satisfactions of medical staff with chemotherapy drug infusion safety, doctor-nurse cooperation and workload were also increased (all P ＜0.001). The waiting time of patients was (1.45±0.12) h after implementation, significantly lower than (4.92±0.66) h before implementation(t=54.397,P ＜0.001).

Conclusion

Integrated management of medical treatment and nursing in day-care chemotherapy unit for breast cancer patients can improve the satisfaction of both patients and medical staff, regarded as a safe and efficient model.