中文摘要：

目的：探讨PBL教学模式应用于护士层级培训中，对护士工作满意度、出院患者满意度和护士离职率的影响。方法：按照层级把护士分为不同护理组，每个护理组包括不同层级护士，由1名三级护士作为带教老师。统一进行评判性思维知识的培养、PBL教学模式培训，以组为单位应用PBL教学模式进行案例学习、教学查房、书写个案管理报告等实例训练。采用我院自己设计的患者满意度调查问卷，以科室为单位，按照10％的比例电脑随机抽取出院患者进行调查，取应用PBL教学模式前（2011年）出院患者满意度为基线对照。护士工作满意度采取MMSS（Mccloskey /Mueller Satisfaction Scale）量表，选择我院住院病区在岗护士，排除产假等休假人员，共纳入临床护士180人调查护士的工作满意度，取应用PBL教学模式前（2011年11月）住院病区护士工作满意度调查结果（180份）为基线对照。结果：2013年护士工作满意度总平均分3．3＆#177;0．27，高于2011年的2．9＆#177;0．50，改变有统计学意义（t值7．65，P＜0．05）；护士离职率呈逐年下降趋势，2011年为8．2％，2012年为2．9％，2013年为1．8％，改变有统计学意义（x2值13．04，P＜0．05）；2013年出院患者满意度平均分为90．5分，明显高于2011年77．5分，各条目除了护士收红包现象得分改变没有统计学意义外，其他改变均有统计学意义（ P＜0．05）。结论：PBL教学模式应用于临床护士的层级培训中，可以提高护士的综合素质，从而提高护士工作满意度和出院患者的满意度，降低护士离职率。

英文摘要：

Objective：To explore the PBL Teaching Mode＇s used in hierarchical training on Nurses＇Working Satisfaction, Discharged Patients＇Contentment, and the Rate of Nurses＇Resignation.Methods：The nurses were divided into different nursing teams, and each team consists of nurses of all levels and had one 3-level nurse as the supervisor .All the nurses had been provided with teachings on critical thinking, PBL model training, and applying PBL to case study, ward checking, writing history of individual cases etc.in teams.Reference groups of nurses, organized by the charge nurse, had checked wards and conventionally professional study twice one month according to the traditional procedure.Employ the patients＇satisfaction questionnaire designed by ourselves to examine any 10%discharged patients randomly selected by computers from each department in our hospital , and make as the reference the discharged pa-tients satisfaction before using PBL teaching mode .Nurses＇work satisfaction was examined through MMSS （ Mccloskey /Mueller Satis-faction Scale） , the proper data are drawn from our on-position-nurses in in-patient sections （ vocation-taking ones such as those on maternity-leave are excluded） , and 180 clinical nurses＇satisfactions are selected, with the referred comparison with the counter-parts （ ie., 180 samples） satisfaction before the application of PBL teaching mode .Results：Average nurses-working-contentment in 2013 was 3.3 ±0.27, which was higher than that （2.9 ±0.50） of 2011, and the change was of statistical significance （t=7.65, P〈0.05）;the rate of nurses＇resignation was yearly decreasing, with 8.2%in 2011, 2.9%in 2012, and 1.8%in 2013（χ2=13.04,P〈0.05）;the average satisfaction of discharged patients in 2013 is 90.5, obviously higher than 2011（77.5）, except that the item of nurses＇bribery displays no significant differences with its changes , all the other items in the questionnaire had shown the proper statisti-cal significance （ P〈0 .05 ） .Conclusio