精神科护士对保护性约束的态度和行为调查分析

[目的]了解精神科护士使用保护性约束的态度与行为状况。[方法]采用自行设计的问卷,对102名精神科护士使用保护性约束的态度和行为进行调查。[结果]精神科护士对使用保护性约束的态度得分为26.41分±2.78分,行为得分为30.41分±2.31分。[结论]精神科护士对保护性约束呈中性态度,能比较恰当地使用保护性约束。     

神经科护士有关身体约束知识、态度和行为的调查分析

[目的]了解神经科护士对身体约束使用知识、态度和行为的情况,分析神经科护士对身体约束使用知识、态度和行为的相关性.[方法]采用夏春红等设计的身体约束知识、态度和行为问卷对北京市4所三级甲等医院的147名神经科护士进行调查.[结果]神经科护士身体约束知识答对率为71.94％,身体约束态度得分为33.60分±3.01分,身体约束行为得分为49.82分±6.53分;身体约束知识得分与态度得分呈正相关(r=0.174,P＜0.05),而身体约束行为得分与身体约束知识、态度得分之间无相关性(P＞0.05);神经科护士工作年限与身体约束知识得分呈负相关(r=-0.203,P＜0.05).[结论]神经科护士对身体约束知识的掌握有待提高,对身体约束呈中性态度,有较恰当的身体约束行为;身体约束知识得分越高,态度越正向;影响神经科护士身体约束知识、行为的因素为年龄和工龄.     

对精神病患者实施约束中潜在问题的思考

目的 正确、规范地对精神病患者使用保护性约束，以切实保护患者、患者家属及护士的合法权益。方法 对保护性约束过程中的潜在问题、可能会发生的差错、容易产生的医患纠纷进行分析。结果 提出进一步健全保护性约束制度，强化管理，在保护患者安全的同时，强调精神科护士也要实行各个方面的自我保护。结论 制定相对统一的保护性约束制度，规范保护性约束的护理行为，使精神科护士在对患者实施保护性约束时既有章可循，又责任分明。     

神经科护士有关身体约束知识、态度和行为的调查分析

[目的]了解神经科护士对身体约束使用知识、态度和行为的情况,分析神经科护士对身体约束使用知识、态度和行为的相关性。[方法]采用夏春红等设计的身体约束知识、态度和行为问卷对北京市4所三级甲等医院的147名神经科护士进行调查。[结果]神经科护士身体约束知识答对率为71．94％,身体约束态度得分为33．60分±3．01分,身体约束行为得分为49．82分±6．53分;身体约束知识得分与态度得分呈正相关（r=0．174,P〈0．05）,而身体约束行为得分与身体约束知识、态度得分之间无相关性（P〉o．05）;神经科护士工作年限与身体约束知识得分呈负相关（r=-0．203,P〈o．05）。[结论]神经科护士对身体约束知识的掌握有待提高,对身体约束呈中性态度,有较恰当的身体约束行为;身体约束知识得分越高,态度越正向;影响神经科护士身体约束知识、行为的因素为年龄和工龄。     

精神科护士对住院患者实施保护性约束体验的质性研究

目的:深入了解护士对精神科住院患者实施保护性约束的心理体验,为规范保护性约束的合理使用提供参考。方法:采用质性研究的现象学方法为指导,对11名精神科护士进行深入访谈,根据Colaizzi的7步分析法分析资料。结果:共提炼出认知体验、情感体验、护士使用保护性约束的影响因素3个主题。结论:临床工作中精神科护士在实施保护性约束时多感压力大,为确保患者及周边环境安全,护士对保护性约束常过多依赖。护理管理者需要建立完善的循证指南,规范保护性约束的合理使用,鼓励护士积极寻找其他方法替代,保障患者安全。     

护士身体约束知信行研究进展

身体约束是临床上用以保证患者安全的重要措施,评估护士身体约束的知识、态度和行为有助于了解约束的实施现状及存在的问题,从而不断提高使用约束的科学性与合理性。文章对目前护士使用身体约束的知信行现状、评估工具及影响因素进行了综述,在此基础上,对身体约束质量控制的改进措施进行了展望,包括建立专家共识、加强护士培训和医院管理、完善量表构建,为身体约束相关护理研究及临床实践提供依据和参考。     

精神科护士保护性约束态度、行为与伦理氛围认知的现状及相关性分析

目的了解精神科护士保护性约束态度、行为与伦理氛围认知的现状并分析其相关性。方法采取便利取样的方法,对湖南长沙2所精神病专科医院、1所三级甲等综合医院的330名精神科护士,采用精神科护士保护性约束态度、行为问卷和伦理氛围认知量表进行问卷调查,采用Pearson相关分析法分析两者之间的相关性。结果精神科护士保护性约束态度总分为(30.47±4.83)分,保护性约束行为总分为(31.67±3.17)分,精神科护士伦理氛围认知总分为(88.15±11.82)分。330名精神科护士在临床工作年限、性别、学历、职位、婚姻状况、所在病房保护性约束态度得分比较,差异有统计学意义(P<0.05),精神科护士在年龄、性别、是否接受过医学伦理教育培训保护性约束行为得分比较,差异有统计学意义(P<0.05),精神科护士在性别、有无精神心理专科护士证、是否接受过医学伦理教育培训伦理氛围认知得分比较,差异有统计学意义(P<0.05)。精神科护士保护性约束态度与伦理氛围认知呈正相关(r=0.242,P<0.001)。结论精神科护士保护性约束态度和伦理氛围认知均处于中等水平,精神科护士保护性约...     

重症监护室护士对身体约束相关知识、态度和行为的调查分析

目的了解重症监护室护士对患者身体约束相关知识、态度、行为的状况。方法对北京市某三级甲等医院4个重症监护室的121名护士进行患者身体约束相关知识、态度、行为的调查。结果重症监护室护士身体约束知识得分为(12.69±1.84)分,答对率为79.29%,态度得分为(33.46±3.05)分,行为得分为(49.33±6.46)分。不同性别、科室及监护室工作年限的护士在身体约束知识、态度、行为得分差异具有统计学意义(P0.01或P0.05)。结论重症监护室护士身体约束知识整体呈中等偏上水平,但身体约束适应知识存在不足;对身体约束呈中性态度,且有较恰当的身体约束行为。     

ICU护士实施身体约束行为的现状及相关因素分析

目的了解ICU护士身体约束行为的状况,并探讨其相关影响因素。方法采用问卷调查法,对衡阳市5家三级医院150名ICU护士进行调查。结果ICU护士身体约束知识得分属于中上水平,总答对率为78．70％;对身体约束的使用呈中性态度;身体约束行为较恰当,其影响因素有：年龄、护龄、身体约束适应性知识、职称、身体约束的感受、ICU工作时间和接受约束教育的情况。结论护理管理及教育者可通过加强身体约束知识的继续教育,使护理人员建立正向地身体约束感受,从而采取适当的身体约束行为,提高照护质量。     

循证护理在精神疾病患者保护性约束中的应用

目的:探讨精神疾病患者在保护性约束中开展循证护理模式的临床效果,为临床护理提供经验。方法:将98例需要实施保护性约束治疗的精神疾病患者随机分为研究组和对照组各49例,对照组给予常规护理,研究组在对照组基础上实施循证护理。比较两组干预前后治疗依从性、护理满意度及NOSIE-30评分情况。结果:干预后研究组治疗依从性高于对照组(P0.05),护理满意度高于对照组(P0.05),NOSIE-30评分优于对照组(P0.05)。结论:循证护理模式能够有效改善精神疾病患者在保护性约束中的依从性及护理满意度,值得推广。     

Notes on narrative knowledge in psychiatric nursing

Notes on narrative knowledge in psychiatric nursing.
This paper reports briefly on one part of an empirical study of nurses' accounts of conversations with patients diagnosed as 'neurotic' and addresses issues related to narrative knowledge in psychiatric nursing. A rationale for analysing psychiatric nurses' narratives of practice is presented, and one framework for doing so is outlined. The form and grammar of nurses' narratives are sketched, and limitations of the present analysis are discussed. While the paper is based on research on practice in psychiatric hospital admission wards, the argument presented is relevant to psychiatric nursing practice generally.     

对在职护理本科生精神科护理临床实习需求的调查

目的了解在职护理本科生对精神科护理临床实习的需求。方法采用自行设计问卷,调查北京2所护理学院的在职护理本科二年级的204名学生对精神科护理临床实习的需求。结果89．7％的护生认为对在职护理本科生有必要开设精神科护理课程;91．2％的护生认为课程设置中应该安排精神科的临床实习,实习时间最好为1—2周。实习过程中希望采用临床观摩、亲自参与患者护理等形式,达到掌握沟通交流的技巧、患者的安全护理、典型症状的识别、精神科药物护理等目的。结论对在职护理本科生教学中有必要安排精神科护理课程,并在课程设置中增设临床实习内容,提高护生的综合能力。     

Forensic psychiatric nursing: skills and competencies: I role dimensions

This paper reports on an investigation into the skills and competencies of forensic psychiatric nurses from the perspective of three groups: (A) forensic psychiatric nurses; (B) non-forensic psychiatric nurses; and (C) other disciplines. A national survey of forensic psychiatric services in the UK was conducted, and information gathered on the perceived skills and competencies in this growing field of psychiatric practice. From 3360 questionnaires, 1172 were returned, making a response rate of 35%. The results indicate a small discrepancy between forensic nurses' and non-forensic nurses' perceptions of the role constructs of forensic practice. However, a larger difference was noted between nurses' perceptions and other disciplines' perceptions of the constituent parts to forensic psychiatric nursing. Nurses tended to focus on personal qualities both in relation to themselves and the patients, while the other disciplines focused on organizational structures both in defining the role and in the resolution of perceived deficits. The findings have implications for multidisciplinary working, as well as policy formulation and curriculum development in terms of the skills and competencies of forensic nurse training.     

Creating a space for recovery-focused psychiatric nursing care

Creating a space for recovery-focused psychiatric nursing care
Within contemporary mental health-care, power relationships are regularly played out between psychiatric nurses and service users. These power relationships are often imperceptible to the practicing nurse. For instance, in times of distress, service users often turn to or/and 'construct' discourses, beliefs and knowledge that are at odds with those which psychiatric nurses rely on to inform them of the mental status of the service user. The psychiatric nurse is in the position to impose knowledge onto service users, usually in concurrence with 'traditional or bio-psychiatry', without realizing or failing to acknowledge that the service user may have an alternative explanation of his/her mental health problems/experiences. In this paper, practice examples, based on the experiences of the four authors (from within and outside of services), are used to illustrate this 'hidden' power relationship. The authors use Foucault's ideas about: (i) government; (ii) the knowledge/power nexus and resistance; (iii) and his analytic tool of genealogy to help unravel this paradox within psychiatric nursing practice. The authors also use the emerging discourse of recovery as an alternative (and challenge) to 'traditional bio-psychiatry' and consider the implications for psychiatric nursing practice.     

Enhancing psychiatric nursing practice: role of an advanced practice nurse.

In response to demands for alternative health models that deliver cost-effective quality care, one large Midwestern medical center implemented a change in their nursing practice model. The change involved the introduction of unit-based nursing leadership teams that included advanced practice nurses (APNs). This article reports the findings from an investigation that employed a case study design to evaluate the process and outcomes of integrating an APN on a psychiatric unit with experienced nurses. Data collection methods included a nursing survey (n = 34), interviews with nine randomly selected nurses, and two multidisciplinary open forums. Consistent with the staff nurses' survey ratings of important advanced practice role functions, responses from the nursing interviews and open forums suggested nurses' professional development to be the most positive outcome. Role confusion was identified as a negative outcome. Recommendations for improved integration and use of APNs in today's psychiatric health environments were identified.     

Suicidal patients as experienced by psychiatric nurses in inpatient care

Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.     

Negotiating clinical knowledge: a field study of psychiatric nurses' everyday communication

Negotiating clinical knowledge: a field study of psychiatric nurses' everyday communication
Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced by the particular social relations on hospital wards. Empirical data stemming from an extended fieldwork at two Danish psychiatric hospital wards were interpreted using interactionistic theory and the metaphor: 'the game of clinical knowledge'. The results indicated that the nurses' production of clinical knowledge was highly dependent on the individual nurses' practical ability to participate in the game. Furthermore, the nurses colluded in their mutual communication to enable the collective display and sense of knowing that protected them against explicit signs of uncertainty about the clinic. The game of clinical knowledge influenced processes of clinical decision-making among the nurses as the game added to a distorted widening of a 'fictional distance' between patients and the representations produced by the nurses.     

'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.