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1.
大中型综合医院护理安全管理系统的建立与应用研究   总被引:1,自引:0,他引:1  
[目的]探讨建立护理安全管理系统的关键要素,建立一种适用于我国大中型综合医院的护理安全管理系统,预防护理不良事件发生,为患者提供安全护理。[方法]以质性研究为核心,采用现象学研究法、扎根理论研究法,对2007年1月~2009年12月乐山市人民医院建立护理安全管理系统过程中的关键环节以及病区护士长、大科护士长的安全管理行为和临床护士的安全护理行为进行比较、分析、描述,归纳出建立护理安全管理系统的关键要素;辅以量性研究,收集3年全院各科室申报护理安全事件、护理差错及病人投诉等数据,推断护理安全管理系统运行效果。综合分析质性、量性研究的结果,描述护理安全管理系统的关键要素,建立护理安全管理系统的概念架构及流程图,指导临床安全护理实践。[结果]提出了护理安全文化的概念,建立大中型综合医院护理安全管理系统的8个关键要素是医院的护理安全文化、护理安全管理组织体系、护理安全管理规章制度及质量考核标准、开展全面全员全程护理安全活动、高危压疮及跌倒患者危险因素评估及预防管理规范流程、护理安全事件主动报告及处理规范流程、护理安全持续改进及可追溯机制、鼓励患者主动参与护理安全,其中护理安全文化是护理安全管理系统的核心要素。以8个关键要素为基础,描述了护理安全管理系统的概念架构及流程图。2007年1月~2009年12月该院出院病人共计86212人次、护理安全事件发生率0.21%、护理差错发生率0.04%、非难免性压疮发生率为0、护理投诉率0.02%;护理安全事件发生率、护理投诉率逐年降低,无护理事故发生,3年比较,P﹤0.01,有统计学差异;护理安全事件主动报告率逐年增加,2009年达100%,P﹤0.01,有统计学差异。护理安全系统运行良好。[结论]建立一种适用于我国大中型综合医院的护理安全管理系统,可以有效预防护理不良事件发生,为患者提供安全护理,实现"中国患者安全目标"。  相似文献
2.
How adults construct evening meals. Scripts for food choice   总被引:1,自引:1,他引:0  
3.
ABSTRACT: A grounded theory approach was used in an attempt to generate theory about client perceptions and experiences of a cardiac rehabilitation program conducted in a rural community. A series of interviews was conducted with a selection of people who had experienced a life-threatening cardiac event. The cohort was divided into two groups: those who attended a cardiac rehabilitation program and those who did not. The findings, though not generalisable, allowed the generation of a number of theories (which may come to be the genesis of future research) regarding the differences in the physiological, psychological, sociological and vocational well-being between the groups. The findings also suggested that location of the program, the times it was conducted, and the communication skills of significant healthcare workers who recruited participants were important factors affecting attendance.  相似文献
4.
Using data from an introspective ethnography, this paper proposes a modified theory of awareness among dying patients, their families and medical personnel. By incorporating the sociology of emotions, this modified theory provides a richer understanding of the complexity of relationships in death and dying than the previous literature which focuses on knowledge and the management of knowledge in social interactions in the context of dying. It is suggested that awareness based on knowledge and the cognitive processing of information not only obscures the emotional content of terminal illness, but also moves to the background the emotional work performed by dying patients and their families. The modified version of awareness theory recognises that emotion and cognition are intertwined and pays close attention to emotions within the social context.  相似文献
5.
Researchers argue that a number of assumptions have been made about the concepts of patient satisfaction and dissatisfaction that have compromised their validity. The aim of this study was to explore the meaning of 'dissatisfaction' with health care. Forty-one people who had experienced problems in health care were identified from a household survey of health service users. They were interviewed in depth using an unstructured schedule. A grounded theory approach was used to construct a framework inductively from their accounts. The results suggest that 'dissatisfaction' could not accommodate the range of feelings, beliefs and values people express when they encounter problems in health care. However, another concept, that of 'personal identity threat', was identified which offered additional insights into the meaning of untoward experiences in health care. This concept delineates the grounds for disappointment or dissatisfaction, and helped to capture the complexity of the feelings and views expressed. Personal identity was perceived as being challenged through experiences which were felt to be disempowering, dehumanising and devaluing. Gender, class and race differences also emerged in respondents' perceptions of identity threat.  相似文献
6.
Book Reviews     
K. Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America
S. Sinclair, Making Doctors. An Institutional Apprenticeship
P. Caplan (ed), Food, Health and Identity
C. Counihan and P.Van Estrik (eds), Food and Culture. A Reader
H.D. Holder, Alcohol and the Community: A Systems Approach to Prevention
B. Salter, The Politics of Change in the Health Service
B.H. Natelson, Facing and Fighting Fatigue. A Practical Approach
J. Hafkeens, Rituals of Silence. Long-term Tranquilliser Abuse by Women in the Netherlands
J. Woodward and R. Jütte (eds), Coping with Sickness. Health Care, Past and Present
P. Lydon, A Catalogue of Records Retained by Hospices and Related Organisations in the UK and the Republic of Ireland
R. Means and R. Smith, Community Care. Policy and Practice . 2nd Edition  相似文献
7.
In North America, health care providers are facing an increasingly complex health care system with an increasingly culturally diverse client population. Therefore, it is imperative that care providers are able to work with interpreters who are able to interpret both language and culture. A grounded theory study of nurses' experiences (N = 27) in working with Vietnamese clients provided evidence of the shared brokering concept. Nurses in four major cities in North America were interviewed for approximately 1.5 hours using a semistructured guide. Data were analyzed using dimensional analysis and the constant comparative method. Shared brokering was one concept that emerged within a larger theory of cultural discovery. The shared brokering concept, as described by nurses, provided a framework for providing complex, effective, and efficient care for clients who speak Vietnamese and live within the Vietnamese cultural worldview. Criteria necessary for the development of a shared brokering relationship are described. Further research is needed to develop the conditions and criteria for shared brokering.  相似文献
8.
Objective  To explore the patient's experience of venous ulceration and how it is shaped within primary care.
Design  Qualitative grounded theory study.
Participants and setting  Thirty-nine patients, 33 nurses and 14 general practitioners in a major health district in England.
Results  The findings indicate that patients with the chronic condition of venous hypertension are handled in an anomalous way within primary care when they present with ulcers on their lower limbs. The trajectory projections for the patients are not developed from the usual basis of a medically defined condition-specific diagnosis but from a symptom-specific diagnosis. This leads to an unusual context of care where there is a serious but unrecognized conflict of focus between the nurses and their patients. The nurses in this study tended to set priorities related to the ulcer and to the underlying pathology, whereas the patients wanted help in pain management and in normalizing their lives. The patients eventually came to a position of 'guarded alliance' 2 that in this study took one of three forms: adapting and enduring, emphasizing the positive, or negotiating for comfort.
Conclusion  The acute care approach applied to patients with this chronic condition led to a situation where the professionals usurped the self-care potential of the patients and navigated rather than piloted them through an acute phase of an underlying chronic illness. This in turn, led to poor quality of life for many of the patients and to frustration for the nurses who were failing to achieve the outcomes they desired. Both perspectives need to be encapsulated into the treatment approach for patients with this condition: healing the ulcer and normalizing the patients' lives can and should form the basis of care.  相似文献
9.
OBJECTIVE: The aim of this qualitative study was to elucidate the life situation and psychosocial processes of living with chronic pain in children suffering from juvenile chronic arthritis (JCA). METHODS: Taped open qualitative interviews with 22 children (aged 6-17 years) were transcribed verbatim and analysed using the comparative method for grounded theory. RESULTS: A core category, labelled oscillating between hope and despair, was identified and related to four additional categories labelled disturbed order, dependency, ambivalence and uncertainty about the future. There were relationships between the children's subjective experience of pain and their experiences of disturbed order in daily life, dependency on treatment, health care and significant others, ambivalence related to environmental reactions and uncertainty about the future. Chronic pain and disease control the children's lives and lead to restricted participation in social life. CONCLUSIONS: Chronic pain is a substantial problem for children with JCA, which must be considered in health care. The pain affected and disturbed the children's ordinary way of life. It blocked a number of goals. Psychological and physiological processes interact in the phenomenological experience of pain, and the response of the environment elicits, maintains or decreases the experience of pain. Hopefully,the findings contribute to a deeper understanding of the life situation of children suffering from JCA and can be of importance in developing rehabilitation programmes for these children.  相似文献
10.
The purpose of this paper is to achieve a deeper understanding of the learning processes that occur within a regular health dialogue between pupils and school health nurse from the school health nurse's perspective. The study used a grounded theory approach for the data collection and analysis. Eight experienced school health nurses were interviewed using a semistructured 'interview guide'. The interviews were audio recorded and transcribed verbatim. A detailed analysis presented the processes involved and the core category emerged as creating a communicative room to learn about health. The core category contained factors related to competencies, authenticity, reflective openness and environmental support, which was the basis for learning processes and a successful health dialogue. This paper adds to our understanding of the processes in school health nursing and the learning about health which takes place within a health dialogue.  相似文献
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