护理路径体系的建立与实施

目的 探讨护理路径体系的建立及其在护理工作中的实施与应用效果.方法 开展临床护理路径、健康教育路径、临床护理教学路径及服务路径,努力将临床诸多繁杂琐碎的护理工作程序化,以达到护理工作科学、规范、有序,降低护理人员工作量,确保医疗质量和安全.结果 护理路径体系的建立与实施,不仅缩短了患者的住院时间、降低了患者的住院费用、增强了患者的遵医行为,还使其掌握了疾病相关知识.同时实习护生的理论、操作、综合素质、带教满意度及带教管理质量等明显升高,护理人员和患者的满意度亦均有提高.结论 建立护理路径体系有利于临床各项工作规范化、程序化,并对质量、安全、满意度的提高有积极作用.     

临床护理路径在乳腺癌手术患者中的应用效果

目的 讨论临床护理路径在乳腺癌手术患者中的应用.方法 通过采取临床护理路径的应用,回顾分析68例乳腺癌手术患者的平均住院费用、平均住院时间、护理质量满意度等.结果 临床护理路径在整体护理的基础上注重有价值的内容,可以促进康复,缩短平均住院日期,降低医疗费用,提高护理质量满意度.结论 临床护理路径是一种工作模式,乳腺癌改良根治术的患者,通过临床护理路径的应用,让患者知道了自己的病情发展与转归,增强了战胜疾病的信心,加强了护理人员的责任感,可以更好的为患者提供个性化的医疗服务.     

临床护理路径表单的设计和应用

实施临床护理路径管理是规范临床诊疗行为,提高医疗质量,保障医疗安全的重要举措,是医院改革的重要内容之一。我院将临床路径与临床护理路径有机结合,积极探索各种入径病种的护理路径,使用自行设计的护理路径表单,进一步丰富护理工作内涵,规范临床护理工作.     

临床路径护理管理实践

目的探讨运用临床路径加强护理管理提高护理质量。方法加强护理人员对临床路径的学习和认识,严格按临床路径进行临床护理工作。加强对实行临床路径过程中的监督和管理,依据临床路径进行护理过程中的质量检查和评价。结果通过临床路径的实施,使护理管理系统化,提高了护理质量。结论运用临床路径进行护理工作,减少了护理差错,保障了患者的安全,有利于提高护理质量。     

临床护理路径在气管、支气管异物患者手术前后护理中的初步应用

目的探讨临床护理路径(C.N.P,Clinical nursing path)在气管、支气管异物患者手术前后护理中的应用价值.方法建立气管、支气管异物临床护理路径,并对55例气管、支气管异物患者实施护理.结果应用临床护理路径护理组患者的医疗护理质量明显提高、平均住院日和医疗费用明显降低,患者和家属对疾病知识测试的优良率和对护理服务满意率也显著增加,与对照组相比差异有显著性.结论在临床护理工作中应用护理路径可缩短平均住院日、减低医疗成本、减少医疗资源的浪费,并使患者获得最佳的医疗护理服务.     

临床护理路径在普外科病人的应用

在医疗市场竞争激烈的今天,护理工作的质量和服务水平已成为病人选择就医最直接、最重要的指标之一.判定护理质量和服务水平的优劣,除医院的自我监测外,病人的满意度也列入了考核内容.为适应医疗服务的新形势,满足病人的需求,提高护理质量.我科选择临床路径的医疗服务模式.临床路径的实施,达到了降低成本、缩短住院天数,提高了病人的满意度和服务质量的效果[1].现就我科应用临床护理路径的情况介绍如下.……     

临床护理路径与护士层级管理在神经内科的应用

目的 探讨临床护理路径与护士分层级管理在神经内科应用的效果.方法 利用现有资源,将科室常见病做出临床护理路径表格,重新制定各层级护士的工作职责,将临床护理路径表与护理记录单同时使用,实现护理活动的程序化和标准化.采用自行设计的问卷进行患者、医生、护士满意程度调查,统计平均住院天数.结果 将临床护理路径与护士层级管理在神经内科联合应用后,患者平均住院天数下降,护士、医生、患者满意度均显著提高.结论 将临床护理路径与护士层级管理联合应用,能有效控制医疗成本,提高护理质量,提升护士核心能力,有利于护理人才的培养,达到最佳的护理管理目标.     

运用临床路径加强护理管理提高护理质量

目的探讨运用临床路径加强护理管理提高护理质量。方法加强护理人员对临床路径的学习和认识，严格按临床路径进行临床护理工作。加强对实行临床路径过程中的监督和管理，依据临床路径进行护理过程中的质量检查和评价。结果通过临床路径的实施，使护理管理系统化，提高了护理质量。结论运用临床路径进行护理工作，减少了护理差错，保障了病人的安全，有利于提高护理质量。     

临床护理路径在急性心肌梗死介入治疗中的应用

临床护理路径(CNP)是一种跨学科的、综合的、深化整体护理的整体医疗护理工作模式[1],是一种既能降低单病种住院日和医疗费用,又可达到预期效果的治疗标准化模式,以减少康复的延迟及资源浪费,使服务对象获得最佳的医疗护理服务质量.为更好地配合医疗工作,提高护理工作质量.我科将临床护理路径引入到急性心肌梗死介入治疗中,效果较好,现报告如下.     

医疗护理路径在婴幼儿先天性心脏病中的实施与效果评价

目的 :评价医疗护理路径在婴儿先天性心脏病中的实施效果 ,探讨以低廉的医疗费用提供优质服务 ,提高医疗护理质量的方法。方法 :制定婴幼儿先天性心脏病的医疗护理路径 ,术前、术后医疗护理细则 ,统一出院标准 ,认真执行。通过比较实施医疗护理路径前后患者的住院时间、医疗费用及满意度以评价效果。结果 :通过规范术前、术后医疗护理路径 ,有效地保证了医疗护理工作及外科手术的顺利进行 ,缩短了住院时间 ,降低了医疗费用 ,提高了患者的满意度。结论 :认真做好医疗护理路径工作是保证和提高医疗和护理质量的关键环节。在临床工作中具有可行性和实用价值 ,值得推广     

临床护理路径与护士分层级管理联合应用的效果

目的探讨将临床护理路径与护士分层级管理联合应用,推动临床路径顺利实施。方法利用现有资源,将临床护理路径流程任务制定到各层级护士的工作职责中,采取量化评价流程质量的方式,与护士绩效挂钩,实现护理活动的程序化和标准化。结果临床护理路径与分层级管理联合应用前后患者满意度比较,差异有统计学意义（P〈0.01）;实行临床护理路径后各单病种的平均住院日下降,差异有统计学意义（P〈0．05）。结论实施临床护理路径与护士分层级管理联合应用,有效控制了医疗成本,提高了护理质量,达到最佳的护理管理目标。     

Reconceptualising clinical pathway system design

Increased patient throughput and patient acuity resulting from the introduction of prospective funding mechanisms, such as Case Mix (based on the Diagnosis Related Groups) for in-patient acute care, raised serious concerns about compromising quality of care delivered to patients. The paper clinical pathway has been introduced as a tool to streamline documentation, implement standardised clinical management protocols and improve quality of care provided to patients. However, the checklist format and its lack of connection to clinical data reflecting changes in patient status have imposed severe limitations on the ability of clinical pathway to be used as an effective information management and decision support tool. This is the first of two papers reporting on a research effort that was undertaken to identify, validate and address the limitations of paper clinical pathways. A set of functional specifications and a functional model were developed following the initial exploratory study. The work led to a set of reconceptualised system (CCPMS) design guidelines for the development of a robust computerised clinical pathway management system that could provide dynamic information management and decision support to clinicians in response to changing patient clinical status. The second paper will report on the features and benefits demonstrated by the CCPMS prototype. Implications to nursing brought about by the introduction of such a tool will also be explored.     

Trayectoria clínica para mujer con cáncer de mama localmente avanzado en tratamiento con quimioterapia neoadyuvante

Breast cancer is a very important public health issue, due its high incidence and mortality. Neoadjuvant chemotherapy has proven to be a valid option in the treatment of operable breast cancer and a better aesthetic result if breast- tumour ratio is unfavourable.The administration of the therapy itself is complicated, but the difficulty lies mainly in the management of side effects or adverse effects of the treatment.The emergence of a new therapeutic applications need to be constantly reviewed, which combined with the high work loads in the oncology day hospital requires easily managed, standardised and updated methodologies. A method of choice would be the use of clinical pathways that are just emerging in Spain, but could be helpful in managing this disease.The aim of this publication is to share the design of a clinical path for this specific disease with the scientific community. The process of preparing this document has been work of reflection, literature review and unification of criteria that may be used to facilitate work within the Oncology Day Hospital, improving the records of the work involved, especially those related to nursing practice. Their evaluation would enable proposals to be defined for improving and facilitating evidence-based practice.     

图像存储与传输系统和消毒隔离制度在防治SARS中的应用

目的 总结图像存储与传输系统和消毒隔离制度在重症急性呼吸综合征(SARS)防治中的应用经验。方法 在隔离区铺设网络，配备移动式X线摄影机，数字化影像设备(CR)，专用数字化胶片扫描仪，干式激光打印机，普通扫描仪和打印机，拍摄X线胸片后，将图像上传到服务器；利用清洁区内诊断工作站及时进行软读片和书写电子诊断报告；在隔离区和清洁区均可打印胶片和诊断报告。结果 摄片图像质量良好，系统运行平稳，可满足SARS病房的要求，避免了医院内交叉感染。结论 图像存储与传输系统和消毒隔离制度在重症急性呼吸综合征诊治工作中应用取得良好效果。     

骨科健康教育临床路径内容的研究

目的 提高骨科健康教育的有效性,使骨科患者早日康复。方法 通过成立骨科健康教育临床路径小组,采取书写、修改、临床应用、再修改、定稿的方式完成了共性与专病健康教育临床路径表及落实检查登记单。结果 经临床试用,每种疾病的路径表针对性强,既有文字又有图片,有利于患者的学习,也对护士的工作起指导作用,一方面提高教育的知晓率,另一方面提高护士的工作效率。结论 研制科学、统一的骨科健康教育临床路径内容,能够为护士提供一条有效的教育途径,为骨科患者提供更优质的服务。     

Entwicklung eines internetbasierten klinischen Pfads am Beispiel des Fibromyalgiesyndroms

Clinical pathways (CP) are considered to be a tool of clinical process management describing the optimal route for diagnostic and therapeutic medical treatment of a specified patient. Apart from economic aspects CPs can make a contribution to optimization of health quality management as well as to improvement of medical staff and both patient satisfaction and patient safety whereas the feasibility and acceptance of evidence-based medicine guidelines are often found to be low. In order to stimulate critical discussion by offering the opportunity to easily gain first practical experience, a free web-based clinical pathway system for diagnosis and treatment for patients with fibromyalgia syndrome (FMS) will be presented.     

Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis

In the United Kingdom, pharmacist and nurse independent prescribers are responsible for both the clinical assessment of and prescribing for patients. Prescribing is a complex skill that entails the application of knowledge, skills, and clinical reasoning to arrive at a clinically appropriate decision. Decision-making is influenced and informed by many factors. This study, the first of its kind, explores what factors influence pharmacist and nurse independent prescribers during the process of clinical reasoning. A think-aloud methodology immediately followed by a semi-structured interview was conducted with 11 active nurse and 10 pharmacist independent prescribers working in secondary care. Each participant was presented with validated clinical vignettes for the think-aloud stage. Participants chose the clinical therapeutic areas for the vignettes, based on their self-perceived competencies. Data were audio-recorded, transcribed verbatim, and a constant-comparative approach was used for analysis. Influences on clinical reasoning were broadly categorised into themes: social interaction, intrinsic, and contextual factors. These themes showed that intrinsic, sociocultural, and contextual aspects heavily influenced the clinical reasoning processes of prescribers. For example, prescribers were aware of treatment pathways, but chose to refer patient cases to avoid making the final prescribing decision. Exploration of this behaviour in the interviews revealed that previous experience and attitudes such as confidence and cautiousness associated with responsibility were strong influencers within the decision-making process. In addition, strengthening the professional identity of prescribers could be achieved through collaborative work with interprofessional healthcare teams to orient their professional practice from within the profession. Findings from this study can be used to inform the education, training, and practice of independent prescribers to improve healthcare services by improving their professional and interprofessional development.     

The role of ‘mediators’ of communication in health professionals' intersectoral collaboration: An ethnographically inspired study

Several studies describe intersectoral collaboration in Western healthcare as hampered by lack of coordination of care and treatment and incoherent patient pathways. We performed an ethnographic study following elderly patients from admission to an emergency unit (EMU) to discharge and further treatment and care at other facilities in the healthcare system. The aim was to explore how health professionals work together across sectors in the Danish healthcare system and how they create patient pathways for elderly patients (+65) with multiple chronic illnesses. Intersectoral collaboration was identified as distant relations between large numbers of health professionals, where communication was conveyed by electronic health record (EHR) formats which promoted information delivery that focused on patients’ immediate symptoms. Other significant ‘mediators’ of communication were the telephone that seemed to resemble face‐to‐face communication and the patient who delivered information from one professional to another. We suggest that the communication among professionals at various facilities interacts with the format and functionalities of the EHRs, which typically fall short in delivery of information across sectors, because the often complex needs of patients with multimorbidity do not fit in with the available functionalities of the EHR.     

循证医学—21世纪的临床医学

为促使临床医护人员按循证医学的要求解决临床问题,制订预防和治疗疾病的措施,重点从循证医学取舍依据的标准、评价方法、重要性及局限性方面进行阐述。循证医学要求临床医护人员对于病人疗效的评价宜采取大样本随机对照试验或Meta综合分析,才能获得更全面、更近真实的结论,才能指导制订某些疾病的治疗方案,帮助澄清某些困惑的问题。但在运用随机对照及Meta分析中,应尽量降低干扰因素,避免给结论造成偏差。     

Patient-individual care pathways in phase D neurological rehabilitation

The "patient-individual neurological care pathways" are a concept for qualified decision-making about rational rehabilitative strategies in the treatment of neurological diseases. Such clinical pathways include available scientific evidence and treatment guidelines. In neurological rehabilitation all treatments have a decidedly interdisciplinary character. All members of the team need highly specialized knowledge, a high potential for teamwork, as well as efficient organisation of work time. Here, computer aided decision-making tools such as the "patient-individual neurological care pathways" facilitate rational decisions and reduce the need for reorganization of therapies. In rehabilitation of neurological patients a symptom-oriented and function-related perspective of the individual treatment goals is indispensable for optimal choice of therapy approaches. This function-oriented classification of patients and creation of individual treatment plans are realized within the Excel-based care pathways. This system has been proved on the one hand as an instrument for streamlining and optimisation and, on the other, as a useful tutoring tool in the medical rehabilitation process.