我国医院职业陪护管理现状探讨

目的探讨我国医院职业陪护管理现状，规范医院陪护管理。方法专访医院及查询杂志，对全国32家医院进行陪护管理现状调查。结果（1）医院对陪护需求量大，各种管理模式共存，管理结果差异大；（2）患者自愿、有偿聘请陪护，陪护管理经济投入小，管理投入大。（3）陪护管理体制不健全。结论（1）陪护已成为医院不可缺少的辅助行业，应从源头上规范陪护行业管理。（2）直接由医院构建陪护管理机构，将医院的服务延伸到陪护服务，与护理同步管理，有利于确保医院及患者的安全，达到患者、陪护、医院三赢的效果。     

新时期医院陪护管理模式探讨

<正>随着社会的发展,人口老龄化问题日益突出[1],以亲人为主的亲情式陪护将慢慢淡出医院。由于无陪护病房存在一定的法律及纠纷隐患[2],而且国内护士严重缺编将成为开展无陪护病房的制约瓶颈[3]。医院职业陪护便是新时期医疗市场出现的新生事物[4]。职业陪护管理模式全国各地医院也不尽相同,本文参阅近几年职业陪护管理模式发展的相关文献,现对其介绍如下。1职业陪护     

湖南省二级以上医院住院患者陪护需求的调查与分析

目的 调查并分析湖南省二级以上医院住院患者陪护需求的现状,为医疗机构向住院患者提供满意的陪护服务提供科学依据.方法 采用自制"住院患者对陪护需求及相关因素调查表",对湖南省60家二级以上医院1030名住院患者从陪护需求、对家属陪护和职业陪护的看法等方面进行问卷调查.结果 ①92%的住院患者希望有陪护;95%的患者有陪护.②住院患者需要家属陪护的原因排序依次是"看到家属心理踏实、有安全感"、"家属更能了解患者需求"、"需要家属安慰"、"家属照顾更周到"、"别人不能取代家属在患者心里的位置".③住院患者对职业陪护的看法各条目得分从高到低依次是"可以得到更精心、更专业的护理"、"家属太忙"、"可减轻家属的压力"、"增加经济负担"、"可减轻心理压力".72.3%的患者知道有职业陪护这个职业,76.8%的患者认为医院有必要提供职业陪护.④对家属陪护影响看法的条目得分最高的是"家属陪护有利于患者康复".结论 二级以上医院的陪护率高于卫生部制定标准及陪护需求,由此医疗机构应该适当考虑患者陪护需求,放宽陪护标准,采取家属陪护与职业陪护相结合的方式,以满足不同患者的需求.     

老年科职业陪护现状分析及应对对策

目的：分析老年科职业陪护现状，探索完善职业陪护的管理之路。方法：采用自行设计的问卷调查表随机对100名老年患者及其职业陪护进行调查。结果：63．0％的患者因情感需求而选择职业陪护，对职业陪护大多比较认同，但对职业陪护的满意率仅40％。结论：职业陪护符合老年患者实际需求，但必须加大专职陪护的综合素质培训力度，提高职业陪护管理效能。     

早期老年痴呆住院患者照顾者压力分析与护理干预

目的：对不同身份早期老年痴呆住院患者的照顾者压力进行调查，为照顾者护理干预提供依据，以减轻照顾者压力，提高照护质量。方法运用“Zarit护理负担量表”，自制照顾知识能力量表，对早期老年痴呆住院患者的100名不同身份照顾者进行问卷调查，识字能力较差的照顾者，采取问答式调查；文化程度初中及以上、视力较好、理解能力较强的照顾者，自行填阅问卷。结果发出问卷100份，收回问卷100份，有效问卷100份。其中家属40例，职业陪护60例。照顾者因身份不同，面临的压力有区别，中重度身心压力者家属比例75．0％，职业陪护66．70％，家属比例大于职业陪护；轻度压力家属比例22．5％，职业陪护33．3％，大于家属比例；极重度压力者家属比例2．5％，职业陪护0％；陪护轻度压力比例大于家属，没有极重度压力者。在发现患者安全隐患、防范走失、能否与患者进行有效沟通交流及一起娱乐方面，职业陪护比例＜50％，家属比例＞65％，陪护对安全照护病人方面压力大于家属。结论早期老年痴呆住院患者的照顾者因身份不同，面临不同压力，护理人员应针对性地给予护理干预，减轻照顾者压力，提高早期老年痴呆住院病人的照护质量。     

浅谈病房职业陪护的管理

随着社会经济发展，生活节奏加快，一些病人家属因各种原因不能亲自照顾病人，于是一个新的职业一陪护员应运而生。但常出现病人及家属对陪护的不满意和抱怨，甚至发生纠纷。另一方面，陪护缺乏管理，人员多而乱，严重影响医院的环境及工作秩序。为了提高陪护人员的整体素质，减轻家属负担，促进病人早日康复；同时减少陪护在医院随意流动，预防医院交叉感染。我院于2005年9月创建了“职业陪护中心”。在医院职业陪护中心的领导下，我科于2005年10月--2006年9月对病房陪护进行规范化培训与管理探讨，取得了良好的效果，受到了病人、家属及社会的赞誉。现将管理方法及体会介绍如下。     

住院患儿陪护探视需求的调查

目的：了解儿童医院患儿住院陪护探视状况,分析其影响因素,为制定科学合理的陪护探视制度提供参考依据。方法：采取问卷式调查,对600名患儿家属进行调查,内容包括陪护需求、探视原因及探视方式等。结果：住院患儿家属对陪护探视需求明显高于我院实际控制的陪护探视率。结论：从实际出发,遵循以人为本的原则,适当提高陪护探视率,同时加强管理和引导,对提高医疗质量,促进患儿身体尽快康复,维护医院正常医疗秩序,塑造良好医院形象,有重要而现实的意义。     

住院患儿陪护探视需求的调查

目的：了解儿童医院患儿住院陪护探视状况,分析其影响因素,为制定科学合理的陪护探视制度提供参考依据。方法：采取问卷式调查,对600名患儿家属进行调查,内容包括陪护需求、探视原因及探视方式等。结果：住院患儿家属对陪护探视需求明显高于我院实际控制的陪护探视率。结论：从实际出发,遵循以人为本的原则,适当提高陪护探视率,同时加强管理和引导,对提高医疗质量,促进患儿身体尽快康复,维护医院正常医疗秩序,塑造良好医院形象,有重要而现实的意义。     

医院专职陪护人员的培训与规范化管理

目的 为提高医院专职陪护人员的职业素质，更好地服务患者。方法 把陪护人员纳入医院管理范畴，制定陪护工职责、管理制度，由专职护理人员对陪护工进行岗前指导、生活护理技能等的培训；加强自我防护、减少医院外来人员的流动，预防医院交叉感染。结果 专职陪护人员的整体素质及生活护理能力得到提高，促进患者早日康复，减轻家属的负担。结论 医院对专职陪护人员的培训和规范化管理，能提高专职陪护人员的整体素质和生活护理能力，达到患者、医院、陪护工三方多赢的结果。     

不同等级医院护士生存质量测评研究

目的 了解不同等级医院护士的生存质量现状与差异，探讨影响不同等级医院护士生存质量的因素。方法 应用WHOQOL-BREF量表中文版，采取整群抽样的方法，对不同等级规模医院的在职护士进行调查。结果 三级医院护士生存质量的整体得分，高于二级医院护士生存质量的整体得分高于一级医院护士生存质量的整体得分。结论 不同等级医院护士的生存质量总体得分存在着差异；家庭和睦程度、饮食是否规律、每月总收入是影响不同等级医院护士生存质量的共同因素。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Voluntary breath-holding in the morning and in the evening

The aim of the present study was to determine whether or not voluntary breath-holding time (BHT) changes with the time of the day. BHT with airways closed at end-expiration was measured in six male subjects in the sitting position during the morning (08.00-12.00 hours, on days 1, 6, 7 and 8) and evening (20.00-24.00 hours, on days 2 and 4). BHT increased with the number of days of testing and, at day 8, the morning values averaged 160% of those on day 1. Also, Delta P ACO2 [the difference between end-tidal partial pressure of CO2 ( P CO2) and alveolar P CO2 ( P ACO2) at the breaking point] increased in proportion to BHT. Hence the BHT/Delta P ACO2 ratio remained nearly constant. Voluntary hyperventilation prolonged BHT and increased Delta P ACO2. Conversely, in hypoxia (13% O2 for 1-2 h), BHT and Delta P ACO2 were reduced proportionally. During the evening sessions, most of the BHT/Delta P ACO2 ratios in normoxia, hypoxia or after hyperventilation were higher than the corresponding morning values, with the group difference reaching statistical significance for the measurements in normoxia and hypoxia. In conclusion, voluntary BHT varies in both duration and its relationship with Delta P ACO2 between the morning and evening hours. The results should also imply that, with an interruption of breathing, changes in alveolar and arterial gases are not the same at different times of the day.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.