肿瘤科护士对临终照护的态度及影响因素的调查

[目的]调查肿瘤科护士对临终照护的态度及影响因素。[方法]应用修订的中文版临终照护的态度调查量表(FATCOD)对全国137所肿瘤专科医院及综合医院肿瘤科265名注册护士进行问卷调查。[结果]肿瘤科护士的FATCOD总分为108.97分±10.23分,肿瘤科护士对癌症病人临终照护的态度与护士的年龄、照顾临终病人的经历及是否接受过培训与教育有关。[结论]肿瘤科护士对癌症病人临终照护态度得分不高,提示肿瘤护理教育仍有待加强;同时,需根据影响因素提供有针对性的教育,有效提高护士为临终病人提供照护的能力。     

肿瘤科新入职护士工作压力的质性研究

目的了解肿瘤科新入职护士工作初期的工作压力,为护理管理者更好的了解肿瘤科新入护士,满足其工作需要提供依据。方法采用质性研究中的现象学研究法,对2所三级甲等医院肿瘤科2017年9月～12月新入职12名护士进行深入访谈,运用Colaizzi现象学研究法对资料进行分析、归纳。结果对12份访谈资料进行反复提炼、分析、归纳,最终提炼为3大主题:负性情绪体验、缺乏沟通技巧、生死观念的缺失。结论通过了解新入职护士的工作压力,建议加强对护士负性情绪的排解,沟通技巧的培训,临终护理的掌握,引导肿瘤科护士正确面对人生。     

护士在护理临终病人中的真实体验

目的了解和理解护士护理临终病人的真实体验。方法质性描述。运用Edmund Husserl观点构成的质性研究,深入访问4家三甲医院护理临终病人的10名注册护士,使用Colaizzi的分析程序进行分析。结果由于受临终病人疾病特点影响及病人家属对临终护理工作的干预,从事临终护理的护士承受着紧张、恐惧等一系列情绪变化,并存在人生观的改变。结论有必要对从事临终护理的护士实行统一的培训和指导,并给她们提供足够的关心和支持。     

夜班护士应对肿瘤病人临终抢救心理体验的质性研究

目的:了解夜班护士面对肿瘤病人临终抢救后的内心体验.方法:采用现象学的研究方法选择某三级甲等医院肿瘤中心的18名值夜班护士进行半结构式访谈,将获得资料运用Colaizzi 7步分析法进行整理分析.结果:经过分析总结提炼出护士心理体验的4个主题:缺乏安全感、抢救后产生负性情绪、自我认知的转变、职业价值感增强,各主题之间存在一定的关联性.结论:夜班护士工作中缺乏安全感,医护人员应主动做好肿瘤临终病人的死亡教育.医院管理层要健全医疗安全应对方案,保障工作安全,重视肿瘤科夜班护士临终抢救后的内心感受,夯实夜班护士的专业技能,提升其综合抢救能力,提升其职业获益感和价值感,采取针对性措施,确保护士身心健康,保持护理队伍健康稳定发展.     

肿瘤科护士的情绪体验及其影响因素的研究

目的探讨肿瘤科护士在护理患者过程中的内心感受及产生原因。方法采用定性研究方法,对16名三级甲等医院肿瘤科护士进行半结构式的开放性访谈,运用定性资料的内容分析法进行资料分析。结果在情绪方面,有些护士表现出轻松、稳定、平静等正性情绪,有些护士表现出难受、伤感、无奈、郁闷、委屈、害怕等负性情绪;在对患者的态度方面,有些护士采取尊重、敬佩、同情、换位、理解的态度;有些护士则表现为情感淡漠;护士缓解负性情绪的方式有:角色转换、转移注意力和倾诉。结论综合医院肿瘤科护士在工作中的情绪复杂多样,护理管理者需针对其产生的原因,采取积极有效的措施,避免或减少护士负性情绪,保证临床护理工作质量。     

362 关于护士对晚期癌症病人临终过程观察能力的调查

研究目的　确定什么资历的护士能描述癌症晚期病人的临终过程。方法　选择威斯康辛州大学医学院肿瘤科及当地临终关怀医院中有护理癌症晚期病人经验的护士 ,参与对癌症晚期病人几周到几个月的临终过程观察。观察前研究者需与参与者进行 4～ 2 0 min单独面谈 ,并完成问卷调查。调查内容包括有关临终病人机体的、社会心理学的、情绪的、精神方面的问题 ,主要有 1 0个 :( 1 )如何描述临终过程 ?( 2 )你能否感到何时死亡逼近病人 ?( 3)死亡逼近病人时你的感觉如何 ?( 4 )你遇到多少次病人死亡 ?( 5)描述死亡出乎意料地来临的情况。 ( 6 )病人的…     

临终照护培训对护士照顾晚期癌症患者知识水平及态度的影响研究

目的探讨临终照护为主的护理培训对提高肿瘤科护士照护晚期癌症患者知识和照顾临终癌症患者态度的效果。方法由临床护理专家、医生及小组成员根据住院癌症患者临终照护模式的护士培训课程对250名临床护士进行专业能力培训。培训分为8个模块内容,共40个学时,每个模块内容分为理论授课、情景模拟和小组讨论。培训前后,采用临终癌症患者照护知识问卷及照顾临终患者态度问卷进行评价。结果培训后,肿瘤科护士的临终照护知识总分、心理护理、丧亲家属照护、死亡准备和精神支持与希望维护维度得分均提高,与培训前比较,差异有统计学意义(P0.05)。照顾临终患者态度总分、照顾态度和照顾意识维度均提高,培训前后,差异有统计学意义(P0.05)。结论临终照护相关培训可有效提高肿瘤科护士的临终照护知识水平,改善照顾临终癌症患者的态度。临终照护培训可使护士更好地照护临终癌症患者应对死亡,有利于肿瘤科护士专业能力的提高。     

用爱温暖你

我是肿瘤科病房的一名普通的护士。在刚开始踏入护理这一行时,每天重复着打针、换水、发药等这些枯燥乏味的活时,曾让我感觉到护理的简单和低级,但在肿瘤科几年的历练,让我对护理,对病人,对生命有了一个全新的认识与感悟。曾有很多人问我,怕不怕面对那么多的死亡,很奇怪,从我第一次接触临终病人到现在,我没怕过,因为我亲身经历了一个个癌症病人,从最初的放化疗,到复发、转移,以至到最后临终所经历的种种痛苦的折磨,我感受更深的是无奈和沉重。     

210名肿瘤科护士专业生活品质现状及影响因素分析

目的 调查肿瘤科护士专业生活品质的现状,分析其影响因素。方法 采用便利取样的方法,使用一般情况调查表、中文版护士专业生活品质量表、护士版健康促进生活方式量表对广州市3家肿瘤专科医院工作的210名护士进行问卷调查。采用多元线性回归分析肿瘤科护士专业生活品质的影响因素。结果 肿瘤科护士专业生活品质中共情满足、倦怠和二次创伤应激的原始分分别为（31.69±5.71）分、（26.87±4.32）分和（25.45±4.18）分,处于中高度共情满足水平、中高度倦怠水平和中高度二次创伤应激水平的肿瘤科护士分别占80.0%、77.7%和83.8%;肿瘤科护士健康促进生活方式总分为（60.00±14.21）分,处于中等水平。多元线性回归结果显示：自我实现、是否愿意护理临终患者、护士层级/职务进入共情满足维度的回归方程（P<0.05）,共解释总变异的42.0%;自我实现、人际支持发展、是否愿意护理临终患者、所在医院是否有举办关于护士心理支持活动或讲座进入倦怠维度的回归方程（P<0.05）,共解释总变异的37.8%;自我实现进入二次创伤应激维度的回归方程（P<0.05）,解释总变异的1.6%。结论 本组肿瘤科护士共情满足水平较高,共情疲劳水平也较高,总体专业生活品质有待提高;自我实现、是否愿意照顾临终患者、护士层级/职务是肿瘤科护士共情满足的影响因素,自我实现、人际支持发展、是否愿意护理临终患者、所在医院是否有举办关于护士心理支持活动或讲座是肿瘤科护士倦怠的影响因素,自我实现是肿瘤科护士二次创伤应激的影响因素。建议护理管理者关注肿瘤科护士的专业生活品质,及时识别改善可控的因素,采取相应的干预策略,例如改革薪酬、晋升、进修等制度,建立积极、健康、支持性的工作环境以及定期开展相关培训,提高护士的职业价值观,促进护士自我实现和人际支持发展,进而保持良好的专业生活品质。     

急诊科护士对临终病人死亡事件真实体验的质性研究

[目的]了解急诊科护士经历临终病人死亡事件的真实体验,为医院制定临终病人的护理方案或临床路径提供依据。[方法]采用质性研究中的现象学研究方法,利用目的抽样法对3所三级甲等综合医院的14名急诊科护士进行半结构式深入访谈,采用Colaizzi 7步分析法进行资料分析。[结果]提炼4大主题:身心反应(紧张与恐惧、疲乏与无奈、悲伤与失落)、应对方式(发泄情绪、转移注意力、反思工作、寻找社会支持、逃避相关刺激、致使工作压力)、对临终关怀的理解(缺乏临终关怀的照护体验、保证临终病人的对关怀的基本需求、加强对家属的临终关怀延伸服务)、人生观和价值观的改变(尊重生命与珍惜现在、职业认同感与工作责任感)。[结论]急诊科护士经历临终病人死亡事件承受身心压力,多采取积极的应对方式,但缺乏对临终关怀的照护知识与技能,医院应多关注急诊科护士的身心健康,同时加强临终护理关怀相关培训,重视临终病人及其家属的临终关怀,以更好地开展急诊临终病人关怀护理工作。     

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

Background

People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness.

Objectives

To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers.

Setting

Community mental health facility in a large regional centre in Central Queensland, Australia.

Design/methods

Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers.

Results

Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.     

Mental Health Nurse Incentive Program: Facilitating physical health care for people with mental illness?

People with serious mental illness have increased rates of physical ill‐health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty‐eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health‐care provision in collaboration with general practitioners (GPs) and other health‐care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers’ physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.     

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.     

连续性排班模式对初级责任护士身心健康的影响

目的了解连续性排班模式对初级责任护士身心健康的影响。方法采用90项症状量表(SCL-90)对初级责任护士身心状况进行调查分析。结果初级责任护士的躯体化、人际关系敏感、抑郁、焦虑、敌对、偏执、精神病性等8项因子评分在实行连续性排班后,明显低于传统的排班模式(P0.01),差异有统计学意义。结论实行连续性排班模式,在保证护理质量的前提下,减轻了护士的工作压力,有利于维护护士的身心健康。     

Supplementary prescribing in mental health nursing

Nurse prescribing is now possible in mental health care settings since the introduction of supplementary prescribing. The impact that supplementary prescribing will have on mental health service users, mental health services, mental health nurses and their educational preparation needs to be addressed by service providers, higher education institutions and workforce development confederations.     

带负压式刷牙口腔护理法在口气管插管患者中的应用

目的 探讨带负压式刷牙口腔护理法在口气管插管患者中的应用效果。方法 将收治的80例带口气管插管的患者随机分成实验组和对照组,各40例,实验组采用带负压式刷牙口腔护理法,对照组采用棉球擦洗加冲洗口腔护理法,对两组患者口腔护理用物准备及操作时间,口腔清洁及并发症情况,患者对操作意愿及自觉舒适度进行观察和比较。结果 实验组的备物时间、口腔护理时间显著低于对照组（P〈0.05）;同时口腔残留物、口臭、溃疡斑的发生明显低于对照组（P〈0.05）;实验组患者的舒适度、乐意接受意愿比例均显著高于对照组。结论 带负压式刷牙口护法不仅能提高口气管插管患者口腔清洁度,还能缩短护士操作时间及减少耗材,增强患者舒适度及乐意接受意愿,值得临床推广。     

护士绩效考核标准的建立与实施

护士绩效考核是目前卫生部开展的“优质护理服务示范工程”活动中护理改革的重要内容之一。我院作为省级首批试点医院,在院领导的大力支持下,我们采用护理工作量、工作效率、护理技术难度和人员编配等多因素评价方法对护士工作进行综合评价,制定了护士绩效考核评价分配方案,为调动护理人员工作的积极性及主动性,提高护理工作效率及护理服务质量,推进护理改革及创新,打下了良好的基础,现将我们的做法介绍如下。     

The clinical nurse leader: helping psychiatric mental health nurses transform their practice

The national movement to transform the health care delivery systems must include a focus on mental health treatment. To address similar deficits across other practice domains, the Clinical Nurse Leader (CNL) role has been created. The CNL is a master's degree that prepares a nurse to use a systems perspective to improve outcomes for a cohort of patient, deliver care based on best practices, and coordinate care in a multidisciplinary team. Applying the CNL role to mental health care could help psychiatric mental health nursing be at the forefront in the transformation of mental health care delivery.     

The psychiatric consultation-liaison nurse: thriving in a general hospital setting

One outcome of mainstreaming of psychiatric services into the general health system is that nurses working in general hospitals now have increased contact with patients experiencing mental health problems. The literature suggests that general and comprehensive nurses do not believe they have the skills, confidence and knowledge to care adequately for patients in their care who have a mental health problems. The Psychiatric Consultation-Liaison Nurse (PCLN) can assist and educate general nurses in the care of patients with mental health problems who are receiving care in a medical/surgical setting. This study is based upon the findings of a Nurse Practitioner Pilot Study funded by the Department of Human Services (Victoria). In this paper the authors will present a brief overview of the role and model of practice of the PCLN, the means of referral, a profile of consultations and an overview of educational and policy development activity. The findings of the evaluation based on a combination of a Health Professional Satisfaction Survey and Focus Group Interviews will also be presented. The positive contribution of the PCLN to the confidence of nurses and how this might impact on patient outcomes will be highlighted. The value placed on the PCLN role by general hospital staff is evidence of psychiatric nursing not just surviving but thriving.