搞好护患关系 提高护理服务满意度

近年来随着环境污染的日益加重，恶性肿瘤发病率逐年上升，从2000年至2004年我科收治病人1632例，其中初治者648例，复治者有984例。复治病人的增加与医学科学不断发展，医疗护理技术水平不断提高，病人生存期不断延长有关。随着患者维权意识的增强，临床上常出现一螳医疗纠纷，往往许多纠纷的切人点是护理不到位。笔者从事肿瘤内科临床护理工作多年，得出如下经验：加强护患关系是减少护患纠纷、提高社会效益及提高中晚期肿瘤患者生存质量的非常重要的环节。     

构建和谐护患关系对减少护理纠纷的意义

随着人类社会的进步、人们文化生活水平的提高及健康观念的转变,患者的自我保护意识也不断增强。因此,护患纠纷在临床上有上升趋势。许多纠纷与护患沟通不够、护患沟通障碍等存在直接或间接的关系,真正属于护理差错或护理事故的纠纷是微乎其微的。因此,加强护患沟通,建立良好的护患关系,可增强患者对医务人员的信任感,营造相互信任、相互尊重、相互了解的氛围,减少或避免护患间的心理隔阂,营造和谐的护患关系,减少医疗纠纷发生[1]。1重视护患之间的沟通1.1掌握护患沟通技巧临床上80%的护患纠纷都是由于护士与患者沟通不良或沟通障碍所引起[2…     

良好的沟通对护理工作的重要性

<正>随着医学模式的转变以及心理护理学的不断发展,沟通在护理工作中发挥越来越重要的作用。良好的医护沟通不仅可以提高工作效率还可以提高工作质量,尤其是随着社会不断进步患者的自我保护意识不断增强,护患关系十分紧张,护理纠纷也不断上升,调查显示,良好的护患沟通对提高患者满意度,防止护患纠纷的发生具有很重要的意义。     

临床常见护理纠纷的原因分析及对策

随着医疗体制的改革及《医疗事故处理条例》的颁布实施,法律、法规的普及,人们法制观念和维权意识普遍增强。在临床工作中,由于护理缺陷、差错、护患关系紧张而引发的护患纠纷也越来越多[1]。护患纠纷是指因护士原因或属于护理工作的因素与患者及家属发生的纠纷,属于医患纠纷中的一个分支。在临床工作中如何加强优质服务,优化护患关系,提高护理质量,杜绝差错、事故的发生,以减少护患纠纷、     

浅谈如何建立护患关系,减少临床护理纠纷

目的 探讨临床护理纠纷的防范对策,提高护士防范护理纠纷的能力.护理工作是整个医疗卫生工作的重要组成部分,实践证明,护患关系的好坏直接影响患者疾病的疗效.结果 护理工作中不安全因素,护士法律意识淡薄,责任心不强,技术水平不过硬,病历书写不规范,护患沟通不够,是引发护理纠纷的原因.结论 提高护理人员法律意识,加强职业道德、职业素质的培养,不断提高护理人员技术水平,重视并规范护理文件书写,建立良好的护患沟通关系,杜绝护患纠纷的发生.     

现代医疗环境下护患纠纷的原因及防范措施

随着人们生活水平的不断提高,患者对护理质量、护理安全提出了更高的要求,用法律衡量护理行为和后果的意识不断增强.护理人员一旦侵犯了患者的权利,不管其行为是故意还是过失,都有可能引起护患纠纷.因此,如何正确防范纠纷是每位护理人员都应关注的问题. 1 护患纠纷的概述 护患纠纷是指在临床诊疗过程中护理人员与患者及家属发生的各类矛盾,是医疗纠纷中的一种重要形式和特殊类型.实际临床工作中,许多纠纷的发生都直接或间接地由护患沟通障碍引起,真正属于护理差错或护理事故的纠纷却是微乎其微.因此,护患沟通是不容忽视的一个方面.     

护患沟通障碍的原因分析及应对

护患关系是患者与护士在护理过程中形成和建立起来的人际关系,它直接影响着患者的心理变化,与患者的康复有着密切的联系[1]。随着社会文化生活水平的不断提高,患者健康观念的进一步加强,需要我们护理人员与患者进行良好的沟通。护患沟通是指护士与患者及其家属、陪护人员之间的沟通。是处理护患之间人际关系的主要内容,没有护患沟通,就不能建立良好的护患关系。有效的沟通能减少护患纠纷的发生。但往往在临床护理工作中,许多的护士与病人之间仍存在许多的沟通欠缺问题,因此而引发的纠纷与投诉仍时有发生,作者结合临床工作,对护患沟通障碍的…     

护患沟通在临床护理中的应用

目的 随着人们物质文化生活水平的提高及健康观念的转变,患者及家属的保护意识不断增强,对护理工作的要求也越来越高,因而护理纠纷的发生呈上升趋势.在临床护理工作中许多纠纷发生的原因均与护患沟通不够有着直接或间接的关系,而真正属于护理差错或护理事故的纠纷却微乎其微.为此,如何预防护理纠纷的发生做好护患之间的沟通就显得极为重要.护患沟通是护患双方沟通的过程,是双方对医疗护理活动的一种信息传递过程,它使双方能充分有效地表达对医疗护理活动的理解、意愿和要求.随着医学模式的转变,护患沟通越来越被更多的人们所关注.所以认识和理解护患沟通的内涵显得很重要,良好的护患沟通是减轻患者身心痛苦的需要,是促进护患之间理解和支持,是提高护理效果的需要,更是构建和谐社会的需要.[1]     

护士长在改善和协调护患关系中的管理作用

随着社会经济的发展和医学护理模式的不断转变,人们的法律意识和对医疗护理水平的需求的提高,导致护患关系紧张和纠纷发生率不断呈上升趋势.护士长作为临床最基层的管理者,不仅是患者利益的保护者,又是护士的代言人,在改善和协调护患关系中起着不可替代的作用,良好、有效地协调2者之间的关系,可以显著减少护患纠纷,提高护理质量.     

护患沟通技巧在临床护理中的应用

目的探讨护患沟通在临床医疗中的作用,总结新时代的护患关系对医院护理工作的效果及体会。方法自2008年起,我院根据护患沟通的时代特征,通过统一思想认识、加强组织领导、健全规章制度和狠抓落实,共对358例患者进行了加强护患关系沟通的实践研究。结果护患关系得到极大的改善,护患纠纷由2007年的6.32%下降到2008年的2.57%。2008年11月我院在接受上级机关的住院患者满意度抽查中,患者对住院护理满意率达98%,患者投诉及护理纠纷发生率为0。结论倡导正确的服务理念,掌握护患沟通技巧,提供精益求精的护理技术,是构建温馨和谐的护患关系的根本保证,是提高患者满意度的重要措施。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.