Study on the Co-Ordinating Function of Nurses in the Day Surgery

首先，我做了参考文献综述研究，以澄清背景和原因，为什么日间手术（DS）已经在领先的国家，如美国蔓延得如此之快。其次，我做了一个学习之旅，在澳大利亚，有一个不同的医疗系统。从这两项研究中，我发现了原因;a。由于医疗保险在国民生产总值中所占比例过高和预算紧张的状况，美国于20世纪70年代初开发了DRG/ PPS（诊断相关组/预期支付系统）。医疗机构为了生存，引入并推广了DS模式，其主要目的是保证医疗机构的高效管理、优质服务和消费者满意度;为了提高医疗机构的管理效率，提出了“健康病人”的理念和健康病人的选择标准。此外，本研究采用以病房为中心的管理制度，并导入关键路径，以提升护理品质。作为DS单位的工作人员，在那里协调的同事是必要的，主要是护士承担了这一角色。第三，我调查了DS在日本的情况。对50家医疗机构进行问卷调查。此外，本人亦曾到访一个牙科服务单位，观察其工作协调、分析工作流程及进行病人满意度问卷调查。DS协调人员应具备良好的观察能力、医学和护理知识的深度和广度以及良好的护理技能b。应给予病人充分的知情同意c。尽管住院时间较短，但通过良好的沟通技巧，患者感到他们得到了足够的照顾和保证。在紧急情况下，良好的协调技能是必不可少的。

First of all, I have done the study on reference review for clarifying the background and the reasons why Day Surgery (DS) has been spread so rapidly in the leading countries such as USA.Secondly, I have done a Study Tour in Australia where there is a different medical system. From the two studies I found the reasons that ;a. Too high percentage of medicare towards GNP and the tight budget condition in USA, DRG/ PPS (Diagnosis Related Groups/Prospective Payment System) has been developed in the early years of 1970.b. DS has been introduced and spread for the survival of medical institutions which is accountable for the efficient manasement, warranty of quality care and consumer satisfaction.For the efficient of management, the idea of "healthy patient" and the selecting criteria of healthy patient, are developed. In addition, centered ward management system was adopted for DS.For the quality care, Critical Pathways have been introduced. As the personnel of DS unit, where co-ordinating of co-workers is necessary, mainly nurses have taken this role.Thirdly, I have investigated the situation of DS in Japan. A questionnaire survey was sent to 50 medical institutions . In addition, I visited one DS unit to observe the work co-ordination, analysis of work flow and conducted a patient satisfaction questionnaire.The following conclusions were obtained ;a. the DS co-ordinating stuff should possess qualities such as good observation skills, depth and breadth of medical and nursing knowledge and good nursing skillsb. adequate informed consent should be given to patientsc. despite of short time in DS, patients feel that they have adequate care and assurance through good communication skills of DS stuffd. In emergency situations, good co-ordinating skills are essential.