目的 探讨责任制助产护理模式配合体位管理对高龄产妇分娩方式及产程的影响。方法 选择2023年6月—12月医院接收的高龄产妇68例进行研究，按照护理方式分为两组各34例，对照组为常规助产护理，观察组为责任制助产护理模式配合体位管理，比较两组分娩方式、产程、疼痛程度及护理满意度。结果 观察组阴道分娩率为76.47%（26例），高于对照组52.94%（18例），剖宫产率为8.82%（3例），低于对照组29.41%（10例）（χ2分别为4.121、4.660，均P＜0.05）。观察组第一产程（6.25±0.50）h、第二产程（0.79±0.21）h、总产程（7.15±0.63）h、宫口开大3 cm、10 cm时的疼痛程度（4.12±1.08）分、（6.29±1.25）分明显低于对照组（7.01±0.62）h、（0.96±0.30）h、（8.11±1.07）h、（7.84±1.45）分、（9.09±0.74）分（t分别为5.563、2.706、4.508、11.997、11.239，均P＜0.05）。观察组的护理满意度为97.06%（33例），比对照组的76.47%（26例）高（χ2=4.610，P=0.031）。结论 高龄产妇展开责任制助产护理模式配合体位管理可促进自然分娩，并缩短产程，减轻产时疼痛程度，降低剖宫产率，提高护理满意度。

Objective To explore the effect of responsibility midwifery nursing model combined with position management on delivery mode and labor process of elderly parturient．Methods A total of 68 cases of elderly pregnant women admitted to the hospital from June to December 2023 were selected,and they were divided into two groups according to the nursing mode,34 cases in each group．The control group was given routine midwifery nursing,and the observation group was given responsible midwifery nursing mode combined with position management．The methods of delivery,labor process,pain degree and nursing satisfaction of the two groups were compared．Results The vaginal delivery rate was 76.47%（26 cases）in the observation group,which was higher than 52.94%（18 cases）in the control group,and the cesarean section rate was 8.82%（3 cases）in the observation group,which was lower than 29.41%（10 cases）in the control group（χ²=4.121 and 4.660,P=0.042 and 0.030）．The pain degree of the first stage of labor（6.25±0.50）h,the second stage of labor（0.79±0.21）h,the total stage of labor（7.15±0.63）h,the pain degree of the cervical dilation 3 cm,10 cm in the observation group were significantly lower than those in the control group[（7.01±0.62）h,（4.12±1.08）points,（6.29±1.25）points vs （0.96±0.30）h,（8.11±1.07）h,（7.84±1.45）score,（9.09±0.74）score（t=5.563,2.706,4.508,11.997,11.239,P<0.05）．The nursing satisfaction of the observation group was 97.06%（33 cases）,which was higher than 76.47%（26 cases）of the control group（χ²=4.610,P=0.031）．Conclusion sResponsibility midwifery nursing mode combined with position management can promote natural childbirth,shorten the labor process,reduce the pain during labor,reduce the rate of cesarean section,and improve nursing satisfaction in elderly women,which is worthy of promotion．

目的 探讨拔岗晋级结合激励机制在护士岗位管理的实践和体会。方法 在护士岗位管理中运用拔岗晋级结合激励机制,收集实施岗位管理前后1年护士满意度、患者满意度、护士职业获益感、护士职业投入、离职率资料,进行统计学分析。结果 实施后护士满意度、患者满意度、护士职业获益感、护士职业投入较实施前提高(P<0.05),离职率下降(P<0.05),差异有统计学意义。结论 建立在拔岗晋级及激励机制上的护士岗位管理能提高护士满意度,降低护士离职率,稳定护士队伍,能够提高护士职业获益感、护士职业投入,从而提高护士工作的主观能动性和工作积极性,为高质量护理服务和优质护理服务长效机制的建立奠定了基础,促进优质护理服务的可持续发展,提高护理管理效能。

Objective To explore the application and experience of job promotion combing with excitation mechanism in nurses position management. Methods We used job promotion combing with excitation mechanism in nurses position management to compare the satisfaction rate, perceived career benefit, work engagement and separation rate of nurses. Results After the application, the satisfaction rate, perceived career benefit and work engagement of nurses were increased, while separation rate of nurses was decreased(P<0.05), the difference has statistical significance. Conclusion The application may increase the satisfaction rate, perceived career benefit and work engagement of nurses, and decrease the separation rate of nurses, elevate the subjective initiative and work enthusiasm. Nursing quality is improved continuously. The management efficacy is promoted.