特需病房临终患者实施舒适护理的体会

目的探讨舒适护理在特需病房临终患者中的运用.方法结合特需病房工作特点时27例临终患者按照舒适护理模式实施护理.结果临终患者疼痛症状有效缓解;平稳渡过心理反应期,接受死亡现实;家属对护理的满意度达98%以上.结论舒适护理在特需病房临终患者中的运用提高了护理质量、服务质量,提高了患者的依从性、舒适度及满意度,充分体现了"以人为本"的整体护理内涵.     

人文护理在特需病房的应用

目的探讨人文护理在特需病房患者中的运用。方法结合特需病房的工作特点对住院患者按照人文护理模式实施护理。结果患者及家属对护理的满意度明显提高。结论人文护理在特需病房的应用提高了护理服务质量，并充分发挥了护士的主观能动性。     

特需病房的临终关怀服务

目的提高临终病人及家属的生活质量。方法建立家庭式临终关怀病房,控制癌症晚期病人的疼痛,制定个性化临终护理计划,做好基础护理和心理护理,给予临终病人家属心理支持,尊重其民族习俗和宗教信仰,遵照病人生前愿望进行尸体料理,帮助家属办理后续事宜。结果提高了临终病人生命质量,满足了病人的心理需要,病人及家属满意度较高。结论在特需病房实施的临终护理模式提高了服务质量和特需医疗服务信任度,扩大了特需医疗服务的影响力。     

护理层级管理在产科特需病房的应用研究

[目的]探讨护理层级管理在产科特需病房护理人员中的应用效果.[方法]选择2008年1月-2009年12月在产科特需病房全体护士,实施护理层级管理.比较实施护士层级管理前、后1年产科特需病房护理终末质量及各级护士满意度.[结果]产科特需病房实施护理层级管理前后基础护理、特级和1级护理、健康教育质量及病人满意度与实施前差异有统计学意义;成长中护士和高年资护士满意度与实施前比较差异均有统计学意义.[结论]分层级管理有利于提高护理质量,提高病人满意度,增强护士职业成就感,提高护士满意度.     

精神科特需病房的安全隐患及管理对策

目的：分析精神科特需病房存在的安全隐患,并探讨针对性地、适合精神科特需患者住院的安全管理对策,以最大限度地保障患者的人身安全。方法将2009年4月至2011年3月入住特需病房患者217例作为对照组,给予精神科常规护理,将2011年4月至2012年3月入住特需病房患者113例作为研究组,制定和实施特需病房管理制度,比较两组间意外事件发生率和满意度。结果研究组意外事件发生总数较对照组显著减少;制定和实施特需病房管理制度后,患者满意度显著提高（ P＜0.05）。结论通过对精神科特需病房安全隐患的分析,制定特需病房的管理制度和实施措施,能提高患者对护理工作的满意度,同时有效确保护理安全。     

舒适护理在晚期癌症患者临终护理中的实施效果评价

目的探讨舒适护理在晚期癌症患者临终护理中的实施效果。方法选取在我院住院的104例晚期癌症临终患者，分为实验组和对照组每组52例。对照组按护理常规护理，实验组在常规护理基础上实施舒适护理。结果两组患者疼痛疗效、心理状态、护理工作满意度等方面差异有显著意义( P<0.05)。结论舒适护理在晚期癌症患者临终护理中的应用提高了护理质量，服务质量，提高了患者的舒适度及满意度，充分体现了“以人为本的整体护理内涵。     

专科护士在护理层级管理中对护理影响力的研究

目的 探讨专科护士在护理层级管理模式中对护理的影响力.方法 选择2009年1月～2011年7月产科特需病房全体在职护士为研究对象,特需病房11病区实施护理层级管理模式,特需病房12区实施传统整体护理.比较两种不同护理模式下病区护理终末质量、病人满意度、各级护士满意度及专科护士专业地位对各级护士职业成长的影响.结果 产科特需病房11区实施护理层级管理模式后与对照病区护理质量比较：基础护理质量（P＜0.001）、特Ⅰ级护理质量（P ＜0.005）、健康教育质量、患者满意度、各级护士满意度均有统计学意义（均P＜0.05）,专科护士专业地位对各级护士职业成长的影响显著.结论 分层级管理有利于提高护理质量,提高患者满意度,专科护士专业地位的确立增强了护士的职业成就感,提高了护士工作满意度,促进护士提高学历并努力向专科护士发展.     

养老院临终老人护理质量的研究

目的 探讨提高临终老人护理质量的方法。 方法 将2008年10月-2010年3月的60例临终老人设为对照组,按常规方法进行护理,2010年4月-2011年3月的35例临终老人设为实验组,根据老人生理、心理特点在临终病房进行护理。 结果 实验组患者基础护理达标率、护理记录及护理操作合格率、家属满意度均高于对照组。 结论 成立临终病房,将人文关怀融入临床工作,可以提高临终老人的护理质量,减少患者痛苦,使老人安宁、舒适地走完人生的最后阶段。     

舒适护理模式在特需病房的护理效果分析

目的：探讨舒适护理模式用于特需病房的临床护理效果。方法分析2013年5月至2015年2月在我院特需病房住院的350例患者的临床资料,结合患者需求按照舒适护理模式给予相应护理,同时随机选取240例在普通病房住院的接受传统护理的临床患者作为对照,护理结束后统计两组患者对护理的满意程度及护理临床效果。结果对病房环境、睡眠安静、饮食、医护人员护理态度、护理技巧和整体护理质量的评价结果,观察组患者整体满意程度均优于对照组(P<0.05)。观察组患者家属对护理普遍较满意,同对照组患者家属满意程度比较差异有统计学意义(P<0.05)。结论舒适护理用于特需病房患者提高了护理质量,提高患者临床治疗效果。     

特需病房与普通病房护患满意度的比较调查

目的探讨特需与普通病房护患关系现状,比较其差异。方法应用护士工作满意度量表[1]对普通病房30名和特需病房35名护理人员进行问卷调查。自编患者满意度量表问卷对普通和特需病房各30名患者进行问卷调查。结果特需病房住院患者的满意度显著高于普通病房。特需病房护理人员在家庭工作平衡和与共事者的关系高于普通病房。特需病房床护比显著低于普通病房。结论比较特需和普通病房的满意度,找出护理工作中存在的不足,并有针对性地改进护理工作。     

舒适护理在特诊病区的实施

目的 探讨舒适护理在特诊病区的实施措施及成效。方法选取住在不同特诊病室内的病人，对照组实施常规护理，实验组实施舒适护理，从病人满意度调查表中对整体护理质量的满意度进行评价。结果2组在健康教育、护患沟通、生活护理、被尊重、睡眠安静、服务热情、出院指导等方面有差异（P〈0．01）。结论实施舒适护理，提高了病人的满意度及护理服务质量，充分体现了“以人为本”的整体护理模式内涵。     

实施“护士岗位责任制”的方法与效果

目的 探讨实施“护士岗位责任制”的方法与效果.方法 选择骨科和消化内科两个病房实施“护士岗位责任制”,选拔高级责任护士,要求责任护士管床包干,对所管患者的全部护理负责,并对其实施前后主要护理项目护理时数、患者满意度、陪护率进行比较.结果 增加了对患者的生活护理、健康教育时间,缩短了治疗时间,提高了患者满意度,降低了陪护...     

Quality of dying in the ICU: is it worse for patients admitted from the hospital ward compared to those admitted from the emergency department?

Objective

Although most intensive care unit (ICU) admissions originate in the emergency department (ED), a substantial number of admissions arrive from hospital wards. Patients transferred from the hospital ward often share clinical characteristics with those admitted from the ED, but family expectations may differ. An understanding of the impact of ICU admission source on family perceptions of end-of-life care may help improve patient and family outcomes by identifying those at risk for poor outcomes.

Design and setting

This was a cohort study of patients with chronic illness and acute respiratory failure requiring mechanical ventilation who died after admission to an ICU in any of the 14 participating hospitals in the Seattle-Tacoma area between 2003 and 2008 (n = 1,500).

Measurements

Using regression models adjusted for hospital site and patient-, nurse- and family-level characteristics, we examined associations between ICU admission source (hospital ward vs. ED) and (1) family ratings of satisfaction with ICU care; (2) family and nurse ratings of quality of dying; (3) chart-based indicators of palliative care.

Main results

Admission from the hospital ward was associated with lower family ratings of quality of dying [β ?0.90, 95 % confidence interval (CI) ?1.54, ?0.26, p = 0.006] and satisfaction (total score β ?3.97, 95 % CI ?7.89, ?0.05, p = 0.047; satisfaction with care domain score β ?5.40, 95 % CI ?9.44, ?1.36, p = 0.009). Nurses did not report differences in quality of dying. Patients from hospital wards were less likely to have family conferences [odds ratio (OR) 0.68, 95 % CI 0.52, 0.88, p = 0.004] or discussion of prognosis in the first 72 h after ICU admission (OR 0.72, 95 % CI 0.56, 0.91, p = 0.007) but were more likely to receive spiritual care (OR 1.48, 95 % CI 1.14, 1.93, p = 0.003) or have life support withdrawn (OR 1.38, 95 % CI 1.04, 1.82, p = 0.025).

Conclusion

Admission from the hospital ward is associated with family perceptions of a lower quality of dying and less satisfaction with ICU care. Differences in receipt of palliative care suggest that family of patients from the hospital ward receive less communication. Nurse ratings of quality of dying did not significantly differ by ICU admission source, suggesting dissimilarities between family and nurse perspectives. This study identifies a patient population at risk for poor quality palliative and end-of-life care. Future studies are needed to identify interventions to improve care for patients who deteriorate on the wards following hospital admission.     

Critical nursing behaviors in care for the dying

A beginning list of seven critical nursing behaviors in care for the dying was identified in a qualitative study. Ten experienced palliative care nurses and 10 nurse educators were asked to describe situations in which a student or graduate nurse had displayed very positive or very negative attitudes to care for the dying. Behaviors identified after content analysis of transcribed interviews were responding during death scene, providing comfort, responding to anger, enhancing personal growth, responding to colleagues, enhancing quality of life during dying, and responding to the family. Three of these behaviors were not well described in the nursing literature.     

实施责任制护理工作模式的效果评价

目的：探讨实施护士＂包＂病人优质护理工作模式的效果。方法：按照层级每位责任护士包3～5例病人,提供连续、规范、全程的护理服务。规范责任护士工作职责、流程及考核标准并将考核标准与护士的绩效挂钩。结果：病人满意度、基础护理、护士知晓病情、健康教育执行、病房环境、医师对护理工作的满意度及医护配合程度均有提高（P〈0.05）。结论：实行护士＂包＂病人优质护理工作模式能有效提高病人满意度、护士的工作主动性及护理质量。     

责任制护理下实施晚间三级查房模式交班的效果

目的:评价责任制护理下实施晚间三级查房模式交班的效果。方法:实行晚间护士长、护理组长、责任护士参与的三级查房交班模式,制定各级护士交班职责,比较实施前后患者对护理工作满意度和护士对患者病情知晓情况。结果:实施后患者对护理服务满意度、护士对患者病情的知晓度均优于传统交班模式。结论:利用晚间三级查房模式交班,可快速提高护士的业务水平,提高护理质量。     

舒适护理理论在晚期肝癌患者临终关怀的应用

笔报道舒适护理理论在16例晚期肝癌患临终阶段的应用，给予患生理舒适、心理舒适、社会舒适、灵魂舒适，减轻患及家属心理压力，患安静、平和地渡过了人生最后阶段，家属十分满意。认为舒适护理理论在临终关怀中的应用提高了晚期肝癌病人临终阶段的生命质量，患享受到优死，体现了临终关怀“人性化”的服务。     

Satisfaction with nursing care and work during a year of clinical supervision and individualized care. Comparison between two wards for the care of severely demented patients

An intervention study was set up to explore the effects of the implementation of planned individualized care and regular systematic clinical supervision regarding nurses' degree of satisfaction with nursing care and work. All nurses on two similar wards caring for severely demented patients participated as experimental ward (EW) (n = 19) and control ward (CW) (n = 20). Data were collected before intervention and at 6 months and 12 months during intervention, by means of a questionnaire developed in Sweden which assesses aspects of satisfaction with nursing care and work. Analysis was performed by means of principal component analysis, Wilcoxon rank sum test and Friedman two-way ANOVA. The baseline data showed no significant differences in the responses from the nurses on the two wards; they were found to be more satisfied than dissatisfied with their job although recognition from management was poor. During the intervention, the experimental ward nurses' experience of praise, professional growth, autonomy and quality of care, as well as their feeling of co-operation with colleagues and comfort improved significantly, while no changes occurred on the control ward. The quality of the written documentation on patients' needs and care improved significantly, and the experimental ward nurses also rejected significantly more strongly that their knowledge about patients and work was unsatisfactory. Their improved satisfaction with nursing care and work was believed to be related to the support they received in cognitive and emotional coping, the possibility of reflective learning and the change in management style associated with intervention.     

An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department

This study aimed to investigate the effectiveness of nurse practitioner services for minor injuries in an adult emergency department and to ascertain consumers' satisfaction with the care received. Nurse practitioner roles in Australia have been progressively developing since a pilot project in 1990 examined their feasibility. Currently, nurse practitioners in Australia practise in a variety of specialist areas including coronary care cardiology, adult and paediatric palliative care, emergency, diabetics, aged care and perinatal care. The reported study used a retrospective design that conducted case-note audits and explored patient satisfaction with after-care questionnaires. One hundred case notes of patients treated by the nurse practitioner were audited and 57 patients completed questionnaires exploring their satisfaction and perception of the care received. Analysis of the case-note data indicated that the majority of presenting complaints were minor injuries. Of these injuries, 96.3% of presentations triaged level 4 and 94.4% of those triaged level 5 were seen within the time frame recommended by the Australasian Triage Scale. Forty-six per cent of patients required X-rays and 2% required pathology tests during their emergency department stay. The majority of patients were satisfied with the treatment received from the nurse practitioner. Patients are satisfied with management of small injury presentations by nurse practitioners in the emergency department. Incidentally, it was noted that the flow of patients through the department was improved, resulting in medical resources concentrated to higher priority presentations.     

术前访视对预防心脏外科术后患者ICU综合征的效果观察

目的:通过ICU护士术前访视降低心脏外科手术患者ICU综合征的发生率。方法:将60例心脏外科手术患者随机分为试验组(30例)和对照组(30例),对照组患者由外科病房护士和手术室护士进行常规术前准备和宣教,试验组患者在此基础上由ICU护士进行术前访视。比较两组患者术后的谵妄值、焦虑值及护理满意度。结果:试验组患者的焦虑值和谵妄值均明显低于对照组(P<0.01)。试验组患者的护理满意度高于对照组(P<0.05)。结论:ICU护士术前访视能有效降低心脏外科术后患者ICU综合征的发生率,同时也可以使患者以积极的心态配合ICU治疗和护理,有助于提高ICU护理满意度。