神经外科护理记录中存在的问题及对策

现将2012-01—12我院神经外科726份护理记录中存在的问题总结如下。1临床资料2012-01—12我院神经外科出院患者1 213份,其中护理记录726份。按照《医疗事故处理条例》和河南省卫生厅下发的《护理文书书写规范及管理规定》对护理记录进行质量评价。     

内科病危患者护理记录缺陷分析及对策

为了保证护理记录质量,提高护士书写护理记录水平,我院对内科危患者的护理记录进行质控检查,现对存在的缺陷分析如下.1 资料与方法1.1 一般资料 我院护理文书终末质量控制督查小组随机抽查2010-09-2011-05内科病危患者护理记录单186份,2次/月.结合本院护理记录书写规范,进行质控检查.     

神经外科护理记录缺陷分析及对策

随着人们法律意识的增强,医疗纠纷不断发生,根据2002-09月实施的《医疗事故处理条例》中规定,患者有权复印护理记录,在进行医疗事故技术鉴定时,护理记录是医疗机构向鉴定委员会必须提供的客观材料之一[1];同时护理记录是否规范、及时、完整、准确,影响到整份病历的质量,也是护理工作质量优劣的充分体现.为全面了解我科护理记录质量情况,对我科2006-01-12,603份神经外科护理记录进行分析,对存在的缺陷及对策总结如下.     

精神科应用整体护理的效果观察

为观察在精神科实施整体护理后的效果，促进整体护理在精神科更深入的应用，对精神科实施整体护理前2年（1995年－1996年）与后2年（1998年－1999年）院内感染率、平均住院日、护理质量合格率、服务态度满意率及信任度进行分析比较。结果，精神科实施整体护理后2年与前2年相比，院内感染率明显下降，差异有显性（P＜0．05）；治愈出院平均住院日缩短6天，出院平均住院日缩短7天；护理质量检查三项合格率（基础护理、护理书、病区管理）依次提高2．55，2．65，5．35个百分点，服务态度满意率及信任度亦由原来90％提高到98％。说明精神科实施整体护理是精神医学发展及护理模式转变的需要，具有很好的临床效益、社会效益和经济效益。精神科实施整体护理不应在精神科护理诊断、新入院精神病人健康宣教技巧、简化改进精神科护理表格等方面进行进一步探讨，以深化整体护理在精神科的应用。     

俱乐部式人文关怀对老年慢性心衰患者的效果

目的 探讨俱乐部式人文关怀在老年慢性心衰患者心理护理中的运用效果。方法 选取我院2020年6月～2022年6月100例老年慢性心衰患者为研究对象,数字表法随机分为两组,对照组患者采用常规护理,观察组在对照组基础上采用俱乐部式人文关怀护理。评估两组护理前后汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、明尼苏达心力衰竭生活质量调查表（LiHFe）,检测护理前后左心室射血分数（LVEF）、记录6min步行距离（6MWD）。结果 两组护理后LiHFe评分、HAMA评分、HAMD评分均较护理前显著降低,且干预后观察组显著低于对照组（P<0.05）;两组护理后LVEF、6MWD均较护理前显著升高,且护理后观察组显著高于对照组（P<0.05）。结论俱乐部式人文关怀用于老年慢性心衰心理护理能够降低焦虑、抑郁情绪,改善心衰相关生活质量,并有助于提升心脏功能。     

静默疗法联合思维转换对肝癌术后患者的效果

目的 探讨静默疗法联合思维转换在肝癌术后患者护理中的运用效果。方法 本研究对象为2019年2月～2021年6月我院90例肝癌手术患者,采用数字表法随机分组。两组均进行常规术后护理,对照组采用常规心理护理,观察组采用静默疗法联合思维转换进行心理护理,均干预4周。干预前、后评价焦虑自评量表（SAS）、抑郁自评量表（SDS）、癌症病人生活质量量表（EORTCQLQ-C30）以及Karnofsky功能状态（KPS）评分,记录并发症发生情况。结果 两组护理后SAS评分、SDS评分均较护理前降低,且护理后观察组显著低于对照组（P<0.05）;两组护理后EORTCQLQ-C30评分、KPS评分均较护理前升高,且护理后观察组显著高于对照组（P<0.05）;两组并发症发生率差异无统计学意义（P>0.05）。结论 静默疗法联合思维转能够降低肝癌术后患者的焦虑、抑郁情绪,提升其生活质量和功能状态。     

精神科护理和管理工作中涉及的法律问题

随着精神卫生事业的发展,保障精神病人的合法权益日趋备受重视,《上海市精神卫生条例》自2002年4月1日在上海市实施,《医疗事故处理条例》自2002年9月1日在全国实施。相关法律的实施,有利于正确处理医疗事故,保护病人和医疗机构及其医务人员的合法权益,维护医疗秩序,保障医疗安全,促进医学科学的发展。随着各相关条例颁布的实施,人们的法律意识在不断提高,自我保护意识在不断加强。那么,精神科护理和管理工作中涉及有哪些法律问题呢?众所周知,精神病人是一个特殊的弱势群体,常常用幻想或妄想代替现实,用错觉、幻觉代替真实的感知觉,以致影响了对现实的判断能力,而且缺乏自知力,故有的病人不得不住院治疗,住院期间除了医生查房,其余时间都有护士陪伴。在护理过程中存在特殊性、艰巨性和复杂性的特点,这就要求我们每一位护士,应该熟悉国家的法律法规,了解工作中涉及的法律性问题,认真履行职责,为病人提供优质的服务。现就精神科护理中涉及的相关法律问题叙述如下：     

如何规范书写护理记录单

护理记录单的内容是指根据医嘱和病情,对患者住院期间护理过程的客观记录,是护理教学、科研工作的重要资料之一,也是维护护患双方在护理活动中的合法权益的法律性文件[1]。而在《医疗事故处理条例》中规定,护理记录单是患者可以复印的病历内容之一。因此护理记录单的书写质量至     

《上海市精神卫生条例》简介

《上海市精神卫生条例》(以下简称《条例》)已于2 0 0 1年 1 2月 2 8日经上海市第十一届人民代表大会常务委员会第三十五次会议通过 ,于 2 0 0 2年 4月 7日正式实施。作为我国第一部精神卫生地方法规 ,理所当然地受到各方面包括专业同道的关注。为此 ,简作介绍。一、《条例》的主要内容《条例》共有七章四十九条 ,主要内容包括以下内容。1 总则。立法的目的和依据 ,适用范围 ,政府和各部门职责 ,患者合法权益保障 ,机构设置与人员要求 ,倡导社会参与等。2 心理健康咨询和精神疾病的预防。鼓励相关研究 ,非精神科的精神卫生服务 ,学校、公…     

精神科病房开展优质护理服务的效果评价

目的探讨精神科病房改变护理管理模式,实施优质护理服务对护理效果的影响。方法选取我院优质护理服务示范病区为实验组,普通病区为对照组。自2010-04~12,实验组按要求制定服务标准,并改变护理管理模式;对照组采用传统服务标准及护理管理模式对患者实施护理干预。结果通过对2组患者的满意度和护理质量考核成绩等评价指标进行对比,差异有统计学意义(P<0.01或P<0.05)。结论改变护理管理模式、实施优质护理服务,患者满意度提高,护患关系和谐;护理质量明显提高。     

森田疗法对精神分裂症患者生活质量的影响

目的：观察森田疗法对长期住院精神分裂症患者辅助治疗作用以及对生活质量的影响；方法：对100例精神分裂症患者平分成森田组和对照组，治疗8周，分别以生活质量量表(QOLS)、住院精神病人康复疗效量表(IPROS)、阴性症状量表(SANS)等评定疗效；结果：森田组治疗前、治疗后QOLS、IPROS、SANS自身比较有显著差异；各种量表的减分率两组有显著差异：结论：森田疗法对长期住院精神分裂症病人能改善阴性症状，并能提高康复水平及生活质量。     

OEC管理模式对衰退期住院精神疾病患者自护能力的影响

目的 研究OEC管理模式对衰退期住院精神疾病患者自护能力的影响.方法 选择2006年7月～2008年6月实施OEC管理模式前衰退期住院精神患者100例为对照组;2008年7月～2010年6月实施OEC管理模式后衰退期住院精神患者100例为观察组.比较OEC管理模式前后患者的自护能力,采用日常生活能力评定Barthel指数量表进行评价.结果 OEC管理模式让每位护士的工作业绩一目了然,促进了优质护理,使衰退期住院精神患者在进食、洗澡、穿衣、修饰、如厕、日常活动等方面自理能力得到很大提高,两组比较差异有统计学意义（P＜0.05）.结论 OEC管理模式对衰退期住院精神疾病患者的自护能力有明显提高作用.     

Transmission of NOTCH4 and GRIK2 in a population of Han Chinese with schizophrenia and affective disorder*★

BACKGROUND： Increasing evidence suggests overlapped genetic susceptibility across traditional classification systems that divided psychotic disorders into schizophrenia or affective disorder. OBJECTIVE： This study aimed to explore whether schizophrenia and affective disorder share genetic susceptibility in NOTCH4 and GRIK2 loci in a population of Han Chinese. DESIGN： Repetitive measurements. SETTING： The experiment was carried out at Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. PARTICIPANTS： Sixty-five mixed pedigrees （suffering from various diseases, in combination with schizophrenia and affective disorder）, composed of 45 completed trios and 20 single-parent families, were selected from Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. Probands received clinical diagnosis according to ICD-10; an independent clinician used identical criteria to review all diagnoses. All subjects were Han Chinese in origin and provided informed consent. There were 65 probands and 110 parents among the subjects. The probands comprised 30 males and 35 females： 33 with schizophrenia, 32 with affective disorder, mean age of （30.9 ± 9.8） years, mean age of onset （24.3 ± 8.8） years, mean duration （6.6 ± 7.0） years, and mean age of parents （58.8 ±10.9） years. METHODS： DNA samples from probands and their biological parents were extracted from peripheral blood according to standard methods. Four polymorphisms, -1725T/G and -25T/C in NOTCH4, rs6922753T/C and rs2227283G/A in GRIK2, were amplified and genotyped with PCR-RFLP techniques. MAIN OUTCOME MEASURES： Association between NOTCH4, GRIK2 polymorphism, and schizophrenia was analyzed by transmission disequilibrium test （TDT）. RESULTS： Sixty-five probands and 110 parents were included in the result analysis, with no dropouts. The results showed that the -25T/C polymorphism of NOTCH4 associated significantly with affecti     

Use of PASRR programs to assess serious mental illness and service access in nursing homes

OBJECTIVE: This study assessed the implementation of state Preadmission Screening and Resident Review (PASRR) programs with respect to identification of serious mental illness among nursing facility applicants and residents and access to mental health services. METHODS: A national survey was conducted with representatives from agencies that implement PASRR in all 50 states and the District of Columbia. Also, 44 states sent PASRR data for review. Four states were selected for an in-depth study; six nursing homes per state were selected and one staff member from each facility was interviewed (N=24). Medical records were reviewed for 30 to 40 residents from each facility who met criteria for potentially having a disabling serious mental illness (N=786). RESULTS: Medical records showed that 50 percent of patients at the time of admission and 68 percent of patients at the time of the record review had a psychiatric diagnosis, typically a diagnosis of depressive disorder. At the time of admission, fewer records identified individuals with a serious mental illness (9 to 20 percent) or a primary diagnosis of any psychiatric illness (5 to 12 percent). Many records indicated that in-depth, required PASRR screens were not performed. Ninety percent of the states reported that Medicaid covers only basic psychiatric consultation services, such as medication monitoring, in nursing facilities. Between 30 and 32 percent of national survey respondents also characterized access to facilities that provide mental health services as limited and of variable quality. Although all 24 nursing facilities reported providing psychiatric consultation services, access to other mental health services, such as psychosocial rehabilitation or individual counseling, varied considerably. CONCLUSIONS: Nursing facility compliance with administration and documentation of PASRR screens appears problematic. Nevertheless, there do not appear to be excessively high numbers of residents with serious mental illness, suggesting that state PASRR programs may contribute positively to the identification of people with serious mental illness. However, many nursing facility residents have some type of psychiatric illness, and PASRR legislation does not appear to have enhanced their ability to gain access to mental health services beyond standard psychiatric consultation and medication therapy.     

住院精神疾病患者中自杀行为的调查

目的 调查上海市市级、区级精神卫生中心住院患者中的自杀行为。方法 使用自制调查表、阳性阴性症状量表(PANSS),汉密尔顿17项抑郁量表(HAMD-17),临床总体印象量表(CGI)调查2001年1月至2002年2月上海市精神卫生中心和上海市5家区级精神卫生中心住院患者中的自杀行为。结果 上海市精神卫生中心住院患者中自杀行为出现比例为10.13％,区级精神卫生中心该比例为5.52％,平均为7.26％;出现自杀行为患者集中于35～54岁年龄段,病程多5～30年;女性患者自杀比例高于男性患者;自杀方式前三位为:服用药物和各种物品、尖锐物自杀、高处跳下;自杀1次者为多(62.1％),最多者自杀11次;诊断构成比以精神分裂症和情感性障碍为主(两者合计占87.5％)。结论 上海市精神卫生中心与区级精神卫生中心住院患者中出现自杀行为比例上存在的差异,可能与收治患者病情相对严重和复杂程度有关,服用药物和各种物品为第一位的自杀方式,不容忽视。     

品管圈活动对精神科危险物品带入率的影响

目的探讨品管圈活动在精神科危险物品管理中的应用效果。方法于2014年2月由天水市第三人民医院五病区10名护理人员组成品管圈并开展以"降低危险物品带入率"为主题的活动,运用品管工具及方法,在现状调查、原因分析的基础上,制定目标,确定对策并落实质量改进措施。分别将2014年3月-4月及6月-7月来院探视家属作为对照组和研究组,比较两组的危险物品带入率。结果开展品管圈活动后探视家属危险物品带入率由活动前的58%下降至活动后的25%,差异有统计学意义(P0.01)。结论开展品管圈活动激发了护士的主观能动性,增强了护理团队的凝聚力,通过主题活动,提高了家属对危险物品的认识,病区危险物品带入率降低。     

Australia's National Mental Health Strategy and deinstitutionalization: some empirical results

OBJECTIVE: To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland. METHOD: Regression analysis (using the maximum likelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953-54 to the present, although data are presented from 1883-84. RESULTS: These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953-54 to 1973-74, followed by the period 1974-75 to 1984-85. CONCLUSIONS: In large part, the two policies associated with deinstitutionalization, namely a discharge policy ('opening the back door') and an admission policy ('closing the front door') had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at a much slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.     

Reducing transfers of psychiatric inpatients to emergency rooms of general hospitals in Singapore: a clinical practice improvement project

Objective: Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this.

Methods: Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes.

Results: During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue.

Conclusions: Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.     

A proposal of a patient psychiatric treatment and hospitalisation consent form

The Polish medical law has accepted the rule of equivalence in the doctor-patient relationship. In this way it gave up on the medical paternalism". To a large extent, the newly passed or renewed Rules and Regulations were responsible for this. All Polish hospitals, the psychiatric ones amongst them, must abide the rules on patients' agreement to being hospitalised, examined and treated in accordance with the regulations on: the profession of the doctor and the dentist (passed on the 5th December 1996); on the patient's laws and the Speaker of Patient's Laws (passed on the 6th November 2008) and the Minister of Health Regulation on the type and range of medical records kept in the health care centres and the means of dealing with those records (from the 21st December 2006). Many hospitals have use their own adapted records, which are in accordance with those rules and regulations. There is no universal forms concerning the patient's consent to being admitted and treated in a psychiatric hospital. The problem that is taken on by the psychiatrists about the difference and specificity of psychiatric treatment and the situation of the patient being admitted onto a psychiatric ward, proves the general consent forms to be inadequate. The article shows the current and running regulations on the patient's consent to hospital admission, an agreement to receiving health care and receiving medical information and insight into medical records. The character, scope, types of patient's agreement and their forms have been discussed here. Appropriate form types and outlines are presented.     

Physician don't heal thyself: a descriptive study of impaired older doctors

BACKGROUND: The growing and welcome interest in the issues leading to distress and impairment in younger doctors has not been mirrored by a focus on the similar issues in older doctors which is surprising given the aging medical workforce. OBJECTIVES: To improve understanding of impairment in older doctors and to facilitate the planning of primary prevention strategies. METHOD: Consecutive case records of notifications to the Impaired Registrants Program of the New South Wales Medical Board, Australia, of doctors over 60 years from January 2000 to January 2006 (N = 41) were examined. Details of demographics, type of practice, nature of referral, medical morbidity, cognitive examination, psychiatric diagnosis and outcome of assessment were recorded. RESULTS: Impaired older doctors suffered cognitive impairment (54%), substance abuse (29%) and depression (22%) and 17% had two comorbid psychiatric conditions. Twelve percent had frank dementia. Two work patterns--the "workhorse" and the "dabbler"--were observed, as was a culture of postponed retirement due to a sense of obligation and working "until you drop." Impaired older doctors were found to have higher chronic illness burden compared with community norms. Almost half were the subject of patient complaints or of poor performance within ten years of presentation. CONCLUSION: To our knowledge there has been no other comprehensive examination of patterns of impairment in older doctors. Older doctors are prone to suffer "the four Ds": dementia, drugs, drink and depression. We need to encourage mature doctors to adapt to age-related changes and illness and validate their right to timely and appropriate retirement.