急诊留观室病人家属需求的调查与分析

目的通过对急诊留观室家属的调查,了解急诊留观室家属的需求,从而改进急诊就医的环境与质量。方法采用方便抽样的方法,应用自行设计的问卷对100例急诊留观室病人家属进行调查。结果急诊留观室病人家属的各项需求中,从高到低依次为：对医生护士的需求,对急诊设施及管理的需求,对健康教育的需求。结论护士对病人家属需求的准确把握,是提高病人及家属满意度的前提。     

急诊留观病人家属需求的调查

社会支持是病人应对疾病和治疗过程中最有潜力的资源之一 ,而病人家属是病人的重要社会支持来源[1] ,也是干预措施实施过程的监督者与支持者。在实际工作中 ,护理人员常忽视与病人家属的交流 ,使其需求不能得到及时满足 ,造成医护人员—病人—家属之间协调不佳 ,从而影响急诊病人的救治及康复 ,甚至引发医疗纠纷。为此 ,我院对 5 0例急诊留观病人家属进行了问卷调查 ,以了解他们在留观室陪护病人期间的有关需求情况 ,为提高急诊护理质量提供依据。1　对象和方法1.1　对象　 2 0 0 4年 1月— 2 0 0 4年 2月 ,愿意参与调查的 5 0位急诊留观病…     

急诊留观病人的健康教育

[目的]探讨健康教育在急诊留观病人中的应用效果。[方法]针对100例急诊留观病人的不同疾病,采取有目的性的健康教育形式进行持续健康教育。[结果]对留观病人及其家属实施健康教育可提高病人对护士的满意度,缩短了留观天数,减少了医疗纠纷,提高了护理质量。[结论]对急诊留观病人开展健康教育、进行人性化的高水平护理,可以提高病人对医院、护士的满意度,增进护患关系,使病人有效的恢复。     

急诊留观病人的健康教育

[目的]探讨健康教育在急诊留观病人中的应用效果。[方法]针对100例急诊留观病人的不同疾病,采取有目的性的健康教育形式进行持续健康教育。[结果]对留观病人及其家属实施健康教育可提高病人对护士的满意度,缩短了留观天数,减少了医疗纠纷,提高了护理质量。[结论]对急诊留观病人开展健康教育、进行人性化的高水平护理,可以提高病人对医院、护士的满意度,增进护患关系,使病人有效的恢复。     

急诊留观病人家属需求的调查

社会支持是病人应对疾病和治疗过程中最有潜力的资源之一，而病人家属是病人的重要社会支持来源，也是干预措施实施过程的监督者与支持者。在实际工作中，护理人员常忽视与病人家属的交流，使其需求不能得到及时满足，造成医护人员—病人—家属之间协调不佳，从而影响急诊病人的救治及康复，甚至引发医疗纠纷。为此，我院对50例急诊留观病人家属进行了问卷调查，以了解他们在留观室陪护病人期间的有关需求情况，为提高急诊护理质量提供依据。     

压疮督查小组在急诊危重留观病人压疮防治中的作用

目的 降低急诊危重留观病人压疮发生率.提高带入压疮好转及治愈率.方法 成立以急诊护士长和业务骨干为成员的“压疮督查小组”,制定管理制度及职责,建立管理流程,进行相关理论培训,对压疮进行积极预防和治疗.结果 急诊护士预防压疮意识增强,压疮护理知识不断更新,急诊留观室压疮发生率明显降低,带入压疮好转率及治愈率提高,同时也提高了患者及家属对压疮的自护能力.结论 成立“压疮督查小组”,能有效降低压疮发生率,提高带入压疮好转及治愈率,提升急诊护理质量.     

ISO9000质量认证标准在急诊留观室病房化管理中的应用

医院急诊管理既有一般科室的共性，也有其特殊性，特别是医疗保险制度改革后，急诊就诊与留观医疗保险费支付的比例不同，病人对急诊留观室的需求也在不断变化。按病情需要观察1d～3d的急诊病人被安排在临时输液室观察，而患多科合并疾病和无入院指证或有入院指证暂时无法收入院的重症病人被收治在急诊留观室内。实现急诊留观室病房化管理是急诊绿色通道的延伸和发展。     

ISO9000质量认证标准在急诊留观室病房化管理中的应用

医院急诊管理既有一般科室的共性 ,也有其特殊性 ,特别是医疗保险制度改革后 ,急诊就诊与留观医疗保险费支付的比例不同 ,病人对急诊留观室的需求也在不断变化。按病情需要观察 1d～ 3d的急诊病人被安排在临时输液室观察 ,而患多科合并疾病和无入院指证或有入院指证暂时无法收入院的重症病人被收治在急诊留观室内。实现急诊留观室病房化管理是急诊绿色通道的延伸和发展。近 1年多来 ,随着我院进行ISO90 0 0质量标准认证 ,逐步在急诊留观室实行病房化管理 ,护理服务质量有大幅度的提升。现将急诊留观室病房化管理的实践体会如下。1　编制和…     

急诊留观病人一体化健康教育效果观察

[目的]建立有急诊特色的一体化健康教育模式,观察其在急诊科留观病人中的健康教育效果.[方法]选择2010年1月急诊留观的100例病人,随机分为观察组和对照组,每组50例.对照组按常规方法实施健康教育,观察组运用医护一体化,急救留观一体化,病人家属一体化的健康教育模式.在病人留观期间,采用量化评分表,调查病人及家属对疾病相关知识了解程度、遵医依从性和对医护工作的满意度情况.[结果]与对照组相比,观察组对疾病相关知识了解程度和对医护工作的满意度显著提高(P＜0.01),遵医行为加强(P＜0.05).[结论]对急诊科留观病人进行一体化健康教育,可有效提高健康教育效果.     

急诊留观患者的健康教育

目的：探讨健康教育在急诊留观患者中的应用效果。方法：对165例急诊留观患者针对患者不同疾病的不同健康需要，采取目的性明确的健康教育形式进行持续的健康教育，使健康教育融会贯通于患者的整个留观过程。结果：对急诊患者及家属实施健康教育可提高患者对护士的满意度。缩短了留观天数，减少了医疗纠纷，提高了护理质量。结论：在急诊科开展健康教育、进行人性化的高水平护理，可以提高患者对护士的满意度。     

改进ICU患者家属探视管理的探讨

ICU传统封闭的管理模式,在护理实践中存在着护士与患者及家属沟通不利,影响患者及家属的知情权、选择权,护患关系紧张,不利于患者身心康复等一系列问题。文章从医学模式转变和发展需要、预防医疗纠纷、改善医患关系等方面探讨ICU向患者家属开放的必要性及存在的问题,论证了ICU向患者家属开放的可行性。     

尿毒症患者家属负性心理反应调查与护理干预

目的探讨对尿毒症患者家属负性心理反应的相关因素及护理干预的作用。方法采用组间对照,将57例尿毒症患者分成观察组和对照组,观察组给予健康教育及心理辅导等护理干预,对照组实施常规护理;运用心理健康状况自评量表（SCL-90）进行2组家属心理健康状况的评估。结果尿毒症家属负性心理反应与疾病知识缺乏,昂贵的医疗费用、长期的治疗及各种并发症的出现等关系密切,采用护理干预后观察组家属的抑郁、焦虑、恐惧心理明显低于对照组（P〈0.05）。结论针对尿毒症患者家属负性心理进行护理干预,不仅可以减少家属的抑郁、焦虑及恐惧心理,而且可以提高家属及患者的生活质量。     

急诊危重患者家属需求的满足情况调查

目的了解急诊危重患者家属需求的满足情况。方法在中文版危重患者家属需求量表（critical care family needs inventory,CCFNI）的基础上应用自行设计的需求满足量表,采取分层整群抽样的方法,对下“病危”或“病重”医嘱后24h内的急诊患者家属进行调查。结果急诊危重患者家属需求的满足程度较低,满足较好的是病情保证的需求和与探视有关的需求,满足较差的是希望在医院能进行特殊宗教信仰活动和有人协助解决经济问题;不同健康状况组家属之间的需求满足得分差异有统计学意义（P〈0．05）。结论急诊医护人员应重视评估和满足急诊危重患者家属的需求,提高这一特殊群体的身心健康和家庭满意度。     

Patient-family-nurse interactions in the trauma-resuscitation room.

BACKGROUND: Controversy about the presence of patients' family members in the emergency department has centered on the trauma-resuscitation room. Little is known about interactions of patients' family members with the patients and with nurses or about the ramifications of the presence of patients' family members at the bedside. OBJECTIVES: To describe behavioral responses offamily members of patients and the interactions of thefamily members with nurses and the patient in the trauma room. METHODS: A secondary analysis was done of 193 videotapes of trauma room care. Of these, 88 tapes showed the presence of patients' family members, for a total of 42 hours. Qualitative ethology and a model of suffering as a scaffold were used to analyze verbal and nonverbal interactions between nurses, patients' family members, and patients. Behaviors and verbal interactions of patients and their families were coded as to persons who were enduring and persons who were emotionally suffering. Categories were described. RESULTS: Whether a patient's family members entered the trauma room depended on the patients condition, the patient's behavioral state, and the nature of the treatments. Categories of interactions were families learning to endure, patients failing to endure, family emotionally suffering and patient enduring, patient and family enduring, and resolution of enduring. The interaction style of the nurses involved was particular to each of these states. Two instances of inappropriate interactions occurred. CONCLUSIONS: Nurses can use the Model of Suffering as a framework to assess behavioral and emotional states and to select appropriate strategies to comfort patients' family members.     

重症监护室患者家属需求调查分析

目的研究重症监护室（ICU）患者家属需求。方法采用重危患者家属需求量表（CCFIN）调查80名ICU患者家属需求情况。结果家属需求排名前10的条目中有6条是对患者病情的保证;不同教育程度、ICU经历、医疗费用支付方式对家属需求的侧重有一定影响;有ICU经历的家属对于获取信息和病情保证的需求比无ICU经历家属的需求强烈（P〈0.01）;自费患者家属对自身的舒适需求高于公费和医保患者家属（P〈0.01）。结论 ICU患者家属存在不同程度的需求,ICU护士应加强与患者家属的沟通,建立合作、信任的交流渠道,采取人性化管理,最大程度地满足患者家属的需求,提高护理质量。     

The Last Frontier: Rural Emergency Nurses' Perceptions of End-of-Life Care Obstacles

Introduction: Caring for dying patients is part of working in a rural emergency department. Rural emergency nurses are prepared to provide life-saving treatments but find there are barriers or obstacles to providing end-of-life (EOL) care. This study was completed to discover the size, frequency, and magnitude of obstacles in providing EOL care in rural emergency departments as perceived by rural emergency nurses. Methods: A 57-item questionnaire was sent to 52 rural hospitals in Idaho, Wyoming, Utah, Nevada, and Alaska. Respondents were asked to rate items on size and frequency of perceived obstacles to providing EOL care in rural emergency departments. Results were compared with results from 2 previous emergency nurses' studies to determine if rural nurses had different obstacles to providing EOL care. Results: The top 3 perceived obstacles by rural emergency nurses were: (1) family and friends who continually call the nurse for an update on the patient's condition rather than calling the designated family member; (2) knowing the patient or family members personally; and (3) the poor design of emergency departments that does not allow for privacy of dying patients or grieving family members. The results of this study differed from the other 2 previous studies of emergency nurses' perceptions of EOL care. Discussion: Nurses in rural emergency settings often work in an environment without many support personnel. Answering numerous phone calls removes the nurse from the bedside of the dying patient and is seen as a large and frequent obstacle. Personally knowing either the patient or members of the family is a common obstacle to providing EOL care in rural communities. Rural nurses often describe their patients as family members or friends. Caring for a dying friend or family member can be intensely rewarding but also can be very distressing. Conclusion: Rural emergency nurses live and work on the frontier. Little EOL research has been conducted using the perceptions of rural emergency nurses possibly because of the difficulty in accurately accessing this special population of nurses. Rural emergency nurses report experiencing both similar and different obstacles compared with their counterparts working in predominately non-rural emergency departments. By understanding the obstacles faced by emergency nurses in the rural setting, changes can be implemented to help decrease the largest obstacles to EOL care, which will improve care of the dying patient in rural emergency departments. Further research is needed in the area of rural emergency nursing and in EOL care for rural patients.     

老年癌症患者家属心理状况及相关因素调查

目的了解老年癌症患者家属的心理状况及相关影响因素。方法采用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对76名老年癌症患者家属进行问卷调查,分析其心理状况及影响因素。将患者家属的SAS和SDS评分与国内常模进行比较,进行t检验。结果老年癌症患者家属焦虑发生率为52．63％,抑郁发生率为46．05％,老年癌症患者家属SAS和SDS标准分均值均显著高于国内常模。家属性别、医疗费支付方式、疼痛程度、病情的不同,其SAS和SDS标准分均值均有显著不同。结论老年癌症患者家属存在不同程度的心理障碍,并与多种因素有关,医护人员不仅要重视癌症患者的心理状况,还要重视癌症患者家属的心理状况,同时采取相应的对策,减轻或消除家属的心理障碍,有利于减少患者家属焦虑与抑郁状态的发生。     

优化急诊观察室护理服务流程的方法及效果

目的:优化急诊观察室护理服务流程,提高病人满意度。方法:明确急诊观察室区域划分及功能布局,改变排班模式,对输液流程、后勤保障流程、交接班流程及与病人安全有关的流程进行优化。对优化前后的输液等待时间、病人满意度、护理差错与投诉次数进行比较。结果:实行护理服务流程优化后,病人输液等候时间缩短、病人满意度提高、护理差错和投诉减少。结论:优化护理服务流程为病人提供了优质、高效、及时、便捷、主动、安全的护理服务,提升了急诊护理服务品质,提高了护理质量,保障了护理安全。     

Surrogate Consent by Family Members for Out-of-hospital Cardiac Arrest Research

OBJECTIVES: To evaluate the availability of family members of potential subjects to provide consent for participation in out-of-hospital cardiac arrest (OOHCA) research and to estimate the time required to contact a family member. METHODS: This study was a prospective observational study of adult patients (>18 years old) with nontraumatic OOHCA treated by an urban emergency medical service. Emergency medicine resident physicians responded to each scene and noted the presence of family members. A subsequent convenience sample of family members answered standardized questions about their ability to provide consent for research participation on behalf of the patient. RESULTS: Physicians were present at 100 of the 112 adult medical cardiac arrests during the study period. A family member was present at 57% of the scenes (95% CI = 47% to 67%). Patients with family present were older and were less likely to have bystander cardiopulmonary resuscitation (CPR) or live in a nursing home. The mean time (+/-SE) from emergency dispatch to family contact was 24.40 (+/-2.60) minutes and from physician arrival to family contact was 2.45 (+/-0.87) minutes (n = 20). Eight of 13 family members were willing to enroll the patient into a resuscitation study, but five family members were unable to understand the explanation of informed consent. CONCLUSIONS: Family members were present for an unrepresentative subset of OOHCA cases, and were contacted after the therapeutic window for many interventions. The emotional nature of the emergency situation also limited the reliability of surrogate consent for OOHCA research.