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目的探讨六西格玛中DMAIC理论在提高临床吞咽评估技术中的应用效果。方法选择2015年3—9月广州医科大学附属第一医院161名内科护士为研究对象,基于DMAIC理论中的定义、测量、分析、改进、控制五步法,确立提高护士床旁吞咽评估的关键因素,对影响质量的根本原因进行分析并制定整改措施:建立项目共识,加强培训,制定流程指引,提高护士依从性,持续质量控制。比较应用DMAIC理论前后,护士床旁吞咽评估技术掌握率、临床护理能力,分析应用该理论在提高吞咽评估技术中的作用。结果护士床旁吞咽评估技术干预前得分为(1.95±1.12)分,干预后为(2.59±1.00)分,差异有统计学意义(t=-5.339,P<0.001)。护士临床护理能力提高,主要为重视对家属喂食技巧的评估(t=-2.324,P=0.021);关注患者摄食前的全身状态、意识水平、高级脑功能(t=-3.834,P<0.001);关注进食体位、方式、内容、时间、进食量(t=2.313,P=0.021);观察进食后出现噎食、咳嗽、清喉咙情况(t=4.884,P<0.001);观察口腔的食物残留,胸口食物堵塞感(t=2.588,P=0.010);关注咽部异样感、唾液分泌(t=-2.839,P=0.005);关注返流及返流物(t=4.671,P<0.001)。结论应用DMAIC理论能显著提高护士床旁吞咽评估技术,降低高风险患者误吸发生率,保障患者进食安全,值得在临床中推广应用。
Objective To explore the application of DMAIC theory in Six Sigma to improve the clinical evaluation of swallowing. Methods A total of 161 nurses from the First Affiliated Hospital of Guangzhou Medical University from March to September 2015 were selected as the research objects. Based on the definition in DMAIC theory, the five-step method of measurement, analysis, improvement and control was established to establish the key to improve the bedside swallowing assessment of nurses Factors, analyze the root causes of the impact on quality and formulate corrective measures: establish project consensus, strengthen training, develop process guidelines, improve nurse compliance, and continue quality control. The application of DMAIC theory before and after the comparison, swallowing evaluation of nurses bed evaluation techniques, clinical nursing ability, analysis and application of the theory in improving the role of swallowing assessment techniques. Results The nurse bedside swallowing assessment technique before the intervention score (1.95 ± 1.12) points, after intervention (2.59 ± 1.00) points, the difference was statistically significant (t = -5.339, P <0.001). The nurses’ ability of clinical nursing improved mainly on the assessment of family feeding skills (t = -2.324, P = 0.021). Concerned about the status of the whole body before the food intake, the level of consciousness and the advanced brain function (t = -3.834, (T = 4.884, P <0.001); observe the food residues in the oral cavity (t = 4.884, P <0.001); observe the food intake, cough, (T = -2.839, P = 0.005); attention was given to reflux and reflux (t = 4.671, P <0.001) . Conclusion The application of DMAIC theory can significantly improve the bedside swallowing assessment of nurses, reduce the incidence of aspiration in high-risk patients, and ensure the safety of patients. It is worth popularizing and applying in clinic.