加强临床护理告知 推进优质护理服务示范工程

随着优质护理示范工程的推进、《医疗事故处理条例》的出台及病人的自我保护意识不断增强,对医疗护理质量、安全有了更新的要求。这就要求护士在护理工作过程中必须很好地履行护理告知义务。告知的过程也就是护患沟通的过程,在临床工作中能否履行好护理告知义务,将直接影响到护理质量及护患关系。因此,有必要了解护士对护理告知程序的理解程度,为提高护理告知效果、减少医疗纠纷提供依据。     

心内科护理工作中获得患者知情同意的实践

目的探索建立适用于心内科护理工作的护患知情同意程序。方法①加强护士法律意识的培养,使之依法施护;②强化护士的服务理念、沟通技巧,真实告知患者与护理相关的信息,并征得其理解和同意;③建立护理告知制度,规范护理记录,真实记录有关信息。结果护理服务实现规范化,体现了对患者人格和个性化权利的尊重,提高了患者的满意度。结论知情同意是患者的权利和护士的责任,建立并实施临床护理工作中知情同意程序,是依法施护,保护护患双方的合法权益,减少医疗纠纷,提高护理服务质量,开展人性化护理的关键。     

对护士进行护理告知系统培训的实践与效果

目的探讨护理人员履行告知中存在的问题，开展护理告知培训的方法及效果。方法制定系统培训护理告知计划，通过院内、科内进行讲座、讨论、经验介绍等各种形式对护士进行告知知识培训。结果对告知培训前与培训后护理人员的告知技巧与能力、法律意识，护理告知有效率、病人及家属对护士告知满意度进行比较，具有统计学意义（p〈0.01）。结论护理告知知识培训，提高了护士告知技巧与能力，增强了工作责任心、法律意识，加强了护患沟通，提高了告知有效率、病人及家属满意度，有效减少了护患纠纷的发生。     

告知、签字制度在防范护患纠纷中的运用

目的减少临床护理工作中护患纠纷的发生。方法针对发生纠纷的原因,建立、健全相应的告知、签字制度,以减少护理缺陷。结果护士的工作责任心、法律意识增强,加强了护患沟通,保证了病人的知情权,有效减少护患纠纷的发生。结论告知、签字制度可以减少护患纠纷的发生,提高病人对医院的满意度,在临床上可以推广运用。     

知情同意在临床护理操作告知中的应用进展

护理操作是临床护士实施的与病人治疗和护理密切相关的技术性操作,是临床医疗工作的重要组成部分,通常医生对病人的医嘱和部分治疗性操作须由护士来实施.然而,对病人实施的治疗措施的意义、风险与后果一般人难以知悉,因未履行告知义务或履行不当侵犯病人知情同意权引起的纠纷呈逐年上升趋势[1],为此,护理界对知情同意的关注和研究已形成国际化趋势[2].当前,在护理操作中规范知情同意,履行全面告知,可以减少护患纠纷已成为护理界的共识.现综述如下.……     

加强临床护理告知 推进优质护理服务示范工程

随着优质护理示范工程的推进、《医疗事故处理条例》的出台及病人的自我保护意识不断增强,对医疗护理质量、安全有了更新的要求。这就要求护士在护理工作过程中必须很好地履行护理告知义务。告知的过程也就是护患沟通的过程,在临床工     

影响护患关系的因素及对策

护患关系是护士与病人为了医疗护理的共同目标而发生的多元化的互动关系.在医院,护患关系是护士所面临的最重要的关系,建立护患关系的目的是帮助病人确认并满足其需要.在护理实践中,护患关系与护理效果密切相关.近年来,随着病人及家属维权意识的提高,对护士的要求逐步提高,护患纠纷的发生率也日趋增多.分析影响护患关系的因素,采取相应的对策,建立和谐护患关系,对提高护理服务质量至关重要.     

病人的“知情同意权”与护士的义务

随着社会的发展，医学的进步，医学界逐渐强调尊重病人的自主权，医患之间也从传统的主动——被动型关系模式发展成共同参与型关系模式，共同参与医疗决定和实施。病人对自己的病情、诊疗方案、预后、潜在危害等有知情同意的权利，护士有充分的告知义务，让病人知道住院时的规章制度、检查及手术目的、医疗费用、康复知识等，以使病人能更好的配合治疗护理，促进病人康复。但在告知过程中应注意处理好病人知情权与医疗保护的关系以及医护告知内容的一致性，以增加病人对医生护士的信任，促进医总和护患关系融洽，有利于病人恢复健康。     

外科护士在履行告知义务中需注意的问题

随着社会的进步、法制的健全,病人知情同意意识逐渐增强,对医疗护理工作提出了越来越高的要求[1]。根据《医疗事故处理条例》第十一条规定:“在医疗活动中,医务人员应将病人的病情、医疗措施、医疗风险如实告知病人,及时解答其咨询”[2],外科护士在工作中就如何做好告知,是每一位外科护士必须注意的问题,工作中需注意以下几点。1病人的入院告知内容1.1一般病人的入院告知内容值班护士应诚挚、热情地接待病人:①介绍病区环境及设施如盥洗室、卫生间的位置、用餐、开水供应时间、床单元管理要求、呼叫系统的使用方法等;②人员介绍:介绍病区护…     

护士履行告知义务与患者知情同意权的探讨

目的：护士在护理活动中正确履行告知义务，以维护护患双方的合法权益，提高护理质量。方法：加强护士告知的意识和告知能力的培养，具体在患者入院时、治疗护理过程中和出院时履行告知义务。结果：护士在工作中充分地履行告知义务，保障了患者的知情同意权，建立了互相信任、互相理解的护患关系。结论：医护人员的告知义务与患者的知情权在医患关系中是对应的权利义务关系，履行告知义务，对于提高护理质量，减少护患纠纷有着至关重要的意义。     

医患双方对医疗知情同意书意见的调查

目的探讨医患双方对医疗知情同意书的意见,以期为修改医疗知情同意书提供参考依据。方法收集不同等级医院的医疗知情同意书进行分析。采用自制的调查问卷对某医院100名医生和100名患者进行医疗知情同意书意见的调查。结果医患双方在医疗知情同意书的性质、过程、签署及改进方面的差异均有统计学意义(均P<0.05)。结论临床现行医疗知情同意书仍有许多方面不能达到医生及患者的要求,且绝大部分的医生及患者均认同知情同意书应采取全国统一格式。     

Informed consent: a study of the OR consenting process in New Zealand

The outcome of the informed consenting process should be that patients are knowledgeable about their future procedure, but there is no guarantee that signing the informed consent form means that patients have understood the information that their health care providers have given to them. To evaluate the informed consenting process in an OR direct admissions department of a city hospital in New Zealand, we interviewed 18 surgical patients. We transcribed the audiotaped interviews and analyzed the data using a general inductive approach derived from Grounded Theory. Our analysis indicated that educational information was not always based on patients' previous knowledge or understanding, although most patients understood the surgical consenting process to be complete after they met with the physician and signed the form. Our study highlights that although patients spoke with their physicians and nurses, there was still a lack of understanding. Perioperative nurses are in a prime position to reinforce informed consent. They should actively support the consenting process and be proactive in collaborating with patients and physicians to ultimately ensure that the patient has every opportunity to make an informed decision.     

Regarding Abortion: Informed Consent or Selective Disclosure?

Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost anything that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommodates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the independent voice in nursing, presents here the voice who elects to enter the dialogue, but who does so "in another way."     

The Research on Community Consultation: An Annotated Bibliography

Community consultation is a required element of research studies that use a waiver of or exception from informed consent. Its intent is to provide an additional patient safeguard in emergency research circumstances when prospective informed consent is not possible. Investigators have reported that community consultation may be the most difficult aspect in implementing research trials using a wavier of or exception from informed consent. This article presents a brief overview of the sparse literature available on the process of community consultation since the inception of the current emergency research regulations. To determine if the process is meeting its goals, more research will be required.     

Impact of detailed informed consent on research subjects' participation: a prospective, randomized trial

This study was undertaken to measure potential research subjects' participation in a survey research design, based on level and type of informed consent required before enrollment. In this prospective, randomized trial, 300 eligible Emergency Department participants were randomized to one of three groups: verbal consent (n = 100), limited written consent (n = 100), and detailed written consent with signature (n = 100). The consent was related to a self-administered patient satisfaction survey. The primary outcome was level of participation, where participation was categorized as full, limited, or refusal. Ninety-five percent confidence intervals (CI) constructed about proportions were used to assess differences in participation rates between the three consent groups. Among 300 participants, no demographic differences were found between groups for age or gender. Participants who were randomized to complete the detailed written consent had a significantly lower rate of full participation (72%) when compared to those randomized to verbal consent (85%; mean difference between groups 13%, 95% CI 2% to 24%) and to those with limited written consent (84%; mean difference between groups 12%, 95% CI 1% to 23%). Participants randomized to detailed written consent also had a significantly higher refusal rate (23%) when compared to those in the limited written group (12%; mean difference between groups -11%, 95% CI -21% to -1%). The length and type of informed consent required affected potential research subject participation in a survey research design. Participants who were asked to sign a detailed written informed consent document had a lower rate of participation compared to those with verbal or limited written consent.     

Communicating with Communities about Emergency Research

The challenge of effectively communicating with communities about research is particularly salient for investigators who are conducting emergency research with an exception from informed consent. The authors discuss the ethical basis for the community consultation requirement and describe the nature and extent of the consultative process required to achieve these ethical purposes. The findings of the consensus conference are summarized as follows. 1) The requirements for community consultation and public disclosure for exception from informed consent studies serve important ethical purposes and should be retained. 2) Community consultation allows investigators and institutional review boards to obtain input from the community regarding planned research. The process serves to facilitate understanding, promote trust, ensure justice, and protect research participants. 3) Community consultation is a process that requires active participation by community members; however, it does not require their approval, consent, or consensus. The practical challenges involved in conducting meaningful community consultation are also discussed: defining the community and its appropriate representatives, methods to actively engage the community, the lack of uniformity among institutional review boards in required community consultation activities, and the lack of measures to evaluate the adequacy and appropriateness of community consultation. The recommendations of the consensus conference regarding future research about community consultation are summarized. Priorities include identifying best practices; defining effectiveness and developing measures to evaluate community consultation; evaluating alternative models and potential infrastructures to facilitate, conduct, and/or oversee effective community consultation processes; and developing educational modules for community members to empower their active participation in discussions about emergency research in their communities.     

Research without Consent: Community Perspectives from the Community VOICES Study

Objective: To explore community attitudes toward the federal regulations that allow investigators to conduct emergency research without obtaining informed consent from participants. Methods: Focus‐group participants were recruited from residential sites in New York City that were enrolled in the Public Access Defibrillation (PAD) Trial. The PAD Trial, a National Institutes of Health–funded, randomized trial in which laypersons were trained to treat cardiac arrest, was granted an exception from informed consent under these rules. Community residents and those who had been trained as lay responders in the PAD Trial were asked about the ethical issues raised by the conduct of research without consent (RWC), their definition of community, and appropriate methods of community consultation regarding RWC studies. Grounded theory content analyses were conducted on focus‐group data. Results: Seventeen (40%) men and 25 (60%) women from 15 buildings participated in six focus groups: four in English; two in Spanish. Definitions of “community” varied widely among and across groups; no strategy for community consultation was consistently endorsed by the participants. There were significant support and occasional adamant opposition to conducting RWC; participants often recounted specific personal experiences as the basis for both positive and negative opinions. Individuals with negative attitudes toward RWC often voiced strong support for specific RWC scenarios. Conclusions: There is no consensus regarding the definition of “community” or appropriate methods of consultation. Community members' attitudes toward RWC are often shaped by their personal experiences, and their general attitudes often differ from their reactions to specific RWC protocols.     

Using the Exception from Informed Consent Regulations in Research

This article reflects the proceedings of a breakout session, “Using the Regulations in Research” at the 2005 Academic Emergency Medicine Consensus Conference, “Ethical Conduct of Resuscitation Research.” There have been two organized studies, and a number of anecdotal reports, describing the decline in cardiac arrest resuscitation research in the United States since the implementation of the Final Rule. Paradis and colleagues found that the volume of human cardiac arrest research published in the United States was significantly less in a four‐year period after the Final Rule was adopted as compared to the earlier period. Nichol and colleagues reported that both the absolute number of US‐based randomized cardiac arrest trials and the proportion of US‐based trials (vs. foreign trials, based on the mailing address of the first author) decreased by about 15% annually. Despite the concern about a negative impact, there are at least five published trials, one in progress and one in planning that have been or are being conducted under the regulations. Those completed include the Diaspirin Cross‐Linked Hemoglobin, Public Access Defibrillation, Multicenter Vest CPR, Brain‐CPR, and Pre‐Hospital Treatment of Status Epilepticus trials. Reports of how investigators met the regulations and their experience in doing so are reviewed. A summary table of the federal regulations is provided. Participants discussed what additional information and research about using the regulations would be helpful for the promotion of quality resuscitation and emergency care research in the United States. Areas suggested for further investigation include: impact on the quality as well as quantity of such research; current level of understanding of the regulations by investigators, regulatory/IRB personnel and potential subjects (the general public); costs incurred: additional time required for preparation, approval and conducting community consultation and public disclosure; impact on research on non–life‐threatening conditions; value and cost of a registry; use of a standard reporting template for issues regarding meeting the requirements in individual clinical trials; whether more specific guidance would be helpful or restrictive; what constitutes effective community consultation and public disclosure; and whether titration of community consultation and public disclosure based on the risk of the proposed intervention to subjects is feasible and acceptable.     

Informed Consent: An Ethical Dilemma

Health care today involves complex decisions. How these decisions are made and by whom are the concerns of consumers, healthcare providers, ethicists, third-party payers, and the legal community. The authors explore the question of whether hospitalized clients participate in informed decision making and they use a case study to demonstrate application of Curtin's model for ethical decision making.     

An Ethical Analysis of Exception from Informed Consent Regulations

Federal regulations enacted in 1996 allow clinical research with an exception from informed consent in select emergency circumstances. Such research is only permitted when the therapy may directly benefit the research participant and it is not possible to conduct the research with informed consent. Among others, protective mechanisms include a process of community consultation and public disclosure and the establishment of a mandatory data safety monitoring board. Although the regulations do not preserve the right of self‐determination of the research participant, the author argues that they do provide an ethical means to advance the science of resuscitation.