保护性约束对精神病患者家属心理影响调查分析

目的了解医护人员对精神病患者实施保护性约束时家属的心理反应。方法采用自拟精神病患者受保护性约束家属心理反应调查表对93例精神病患者家属进行相关调查分析。结果80．95％的家属对保护性约束持接受态度,14．28％认为是对患者的惩罚．19．05％认为会加重患者的病情,28．57％担心患者会受到意外伤害,47．62％认为约束患者必须征得家属同意,4．70％的家属对凋查内容不发表意见。结论对精神病患者实施保护性约束治疗时必须征得患者或监护人的知情同意,掌握适应证,规范保护性约束操作,防止意外伤害。     

保护性约束带使用过程中护理风险的防范

为减少护理意外拔管事件，保证治疗的连续性及安全性，减少护理纠纷，我院在神经外科无陪护ICU对有拔管危险的患者使用自行研制的手一腕一体保护性约束带，并与传统的腕部约束带配合使用，同时应用保护性约束知情同意签字书，临床运用效果满意。     

保护性约束对首发精神分裂症患者家属心理影响调查分析

目的:了解对首发精神分裂症患者实施保护性约束后家属的心理反应。方法:采用自编问卷对200例首发精神分裂症家属进行保护性约束心理反应进行调查。结果:74.00%的家属对患者接受保护性约束无心理准备,21.00%的家属持不理解态度;19.00%的家属认为保护性约束是不人道的,是在惩罚患者;37.00%的家属认为保护性约束会更刺激患者不健康的心理,会加重病情;17%的家属害怕患者受到意外伤害;36.00%的家属担心患者在保护期间基本生活得不到保障;79.50%的家属认为约束患者必须要征得家属同意。结论:保护性约束是精神科常用的一项行为治疗,但在对精神疾病患者进行保护性约束前要对患者或家属做到知情告知,严格掌握应用的适应证,规范操作流程,提高家属对保护性约束的认识并取得其理解,为患者提供有力的家庭支持。     

新型上肢约束带的制作及使用

临床工作中我们常会接触到全身麻醉未清醒病人或全身麻醉术后精神异常者、精神病病人,脑部疾患导致意识障碍、躁动者.为了防止病人发生坠床、抓伤、拔管和病情加重等情况.护理人员在征得家属的知情同意后常使用约束具对病人实施保护性约束.     

新型上肢约束带的制作及使用

临床工作中我们常会接触到全身麻醉未清醒病人或全身麻醉术后精神异常者、精神病病人；脑部疾患导致意识障碍、躁动者。为了防止病人发生坠床、抓伤、拔管和病情加重等情况，护理人员在征得家属的知情同意后常使用约束具对病人实施保护性约束。由于传统约束带易导致病人皮肤破损、肢体末梢循环受阻、肢体神经受压致感觉异常、四肢关节功能障碍等弊端，     

知情同意引发医疗纠纷的探讨

综述了知情同意引发医疗纠纷的问题,主要包括知情同意引发医疗纠纷的原因、完善知情同意的建议。认为研究患者的知情同意权问题,严格执行知情同意,有助于保障患者的合法权益,缓解医患矛盾,减少医疗纠纷的发生,进而推进医学事业的发展。     

尊重患者自主性原则及其实践方式知情同意的临床伦理分析

法律及伦理层面对医疗知情同意的要求日益严格,本文从伦理学角度剖析尊重患者自主性和医疗知情同意原则,以期为临床实践和临床伦理学相关研究和教学提供参考。首先分析尊重患者自主性的伦理学概念,在此基础上论述知情同意是落实尊重患者自主性原则的实践应用,梳理国内外关于医疗知情同意原则的确立历史和目前公认的知情同意实施过程,并由此得出如下结论:临床医疗知情同意存在共识尚待完善、培训不足、规范形成落后于新技术应用等挑战,未来应加强培训、开展相关研究并形成指南/共识,以帮助医务工作者在临床诊疗中更好地实施知情同意。     

尊重患者自主性原则及其实践方式知情同意的临床伦理分析

法律及伦理层面对医疗知情同意的要求日益严格,本文从伦理学角度剖析尊重患者自主性和医疗知情同意原则,以期为临床实践和临床伦理学相关研究和教学提供参考。首先分析尊重患者自主性的伦理学概念,在此基础上论述知情同意是落实尊重患者自主性原则的实践应用,梳理国内外关于医疗知情同意原则的确立历史和目前公认的知情同意实施过程,并由此得出如下结论:临床医疗知情同意存在共识尚待完善、培训不足、规范形成落后于新技术应用等挑战,未来应加强培训、开展相关研究并形成指南/共识,以帮助医务工作者在临床诊疗中更好地实施知情同意。     

知情同意在护理工作中的应用

患者在就医诊疗过程中应享有知情同意权。不管是从医德伦理,还是法律上,护士无疑与医生同样负有责任。实践中人们认识不一,做法也各不相同。本文在参阅大量相关资料的基础上,重点从什么是知情同意、知情同意在国内外进展状况、知情同意与护理工作的关系、知情同意在临床护理中存在的问题以及知情同意在实践中应注意的问题和技巧等方面进行了综述,认为不断提高法律意识和自身修养,明确职责范围和法律责任,对提高医护质量,减少医护纠纷有着重要的意义。     

精神障碍患者麻醉知情同意的临床伦理分析

在临床实践中，麻醉技术的知情同意仍是麻醉学科的独特领域，但麻醉科医生轻视精神障碍患者的知情同意成为临床工作的薄弱环节。在人类原始道德本能的加持下，基于对精神障碍患者同情的道德关怀，代理同意被认为有利于患者，但现实中存在多种因素制约患者在麻醉知情同意上享有权利。在医患共同决策医学模式下，应尽可能让轻症精神障碍患者参与知情同意过程，其提供信息的深度和广度取决于患者的自知力。获取精神障碍患者麻醉知情同意的路径尚待优化，可通过多学科合作等多种方式，达到患者真正知情同意，保障精神障碍患者的合法权益。     

Applying the principles of informed consent to patient care. Legal and ethical considerations for physical therapy

This paper presents legal and ethical considerations regarding informed consent for the evaluation and treatment of patients in physical therapy practice. Therapists traditionally think of informed consent in relation to clinical research, but as the trend toward independent practice and private practice increases in physical therapy, the physical therapist must understand the process of informed consent in relation to patient care. Legal concepts of battery, self-determination, and the fiduciary relationship create a legal foundation for informed consent. The patient's moral right to self-determination and the corresponding duty of health professionals to "do no harm" create a strong moral basis for gaining a patient's informed consent. Practical suggestions are offered to physical therapists to help them assess their need for obtaining informed consent.     

破伤风抗毒素脱敏注射知情同意书的应用及效果

目的探讨破伤风抗毒素脱敏注射知情同意书的应用及效果。方法对门诊注射室破伤风抗毒素皮试阳性患者,签署破伤风抗毒素脱敏注射知情同意书并进行健康教育。结果应用破伤风抗毒素知情同意书后无纠纷、投诉发生。结论在行破伤风抗毒素脱敏注射中应用破伤风抗毒素脱敏注射知情同意书,维护了患者和护士自身的合法权益,有效降低了脱敏注射的风险,防范了护患纠纷的发生。     

Informed choice and consent for cervical spine manipulation

Informed consent is essential in ethical health care practice. Information and advice regarding choices is a precondition of informed consent. Autonomy, truthfulness and ethical decision making are all relevant to the informed choice and consent process. The purpose of this paper is firstly to discuss these topics. Following this, a case of informed choice and consent for cervical spine manipulation is examined. This case illustrates ethical problems that can arise in the informed choice and consent process. The moral reasoning in the case is clarified with the assistance of an ethical grid. The conclusion is that autonomy, a patient's right to self determination, is paramount in the informed choice and consent process. Autonomy enhancing informed consent requires more than a mechanical recitation of procedures, hazards and options. In order to uphold a patient's right to self determination, patients need to be included in the decision making process by allowing them to make treatment choices based on accurate information and advice from the physiotherapist.     

Process consent: a model for enhancing informed consent in mental health nursing

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting.     

Intensive care patients' evaluations of the informed consent process.

This study examines the informed consent process from the perspective of intensive care patients. Using the largest single-method database of patient-derived information in the United States, we systematically outlined and tested several key factors that influence patient evaluations of the intensive care unit (ICU) informed consent process. Measures of information, understanding, and decision-making involvement were found to predict overall patient satisfaction and patient loyalty intentions. Specific actions supportive of ICU informed consent, such as giving patients information on advance directives, patient's rights, and organ donation, resulted in significantly higher patient evaluation scores with large effect sizes. This research suggests that the effectiveness of the informed consent process in the ICU from the patient's perspective can be measured and evaluated and that ICU patients place a high value on the elements of the informed consent process.     

儿童药物临床试验研究知情同意的伦理审查

由于儿童的生理、药理、心理及认知和自主权与成人有较大的差异,且各年龄段儿童又呈现不同的特点,儿童药物临床试验研究的知情同意除需遵循一般临床试验研究知情同意的基本原则外,在知情告知的信息、知情同意过程和同意的决定等各个环节又有其特殊要求。文章对儿童药物临床试验研究知情同意的伦理学和特殊性进行了辨析,以更好地指导开展儿童药物临床试验研究知情同意的伦理审查。     

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration

Informed consent is a reflection of patients' autonomy in health decision-making. The main responsibility lies with the doctor. In practice, the nurses' contributions matter as well. This paper presents a case study that explored physicians' perceptions of the existing informed consent process, their suggestions for improvement and their views on the nurses' roles in this process. A two-phase approach was conducted. First, six physicians with different expertise were interviewed. Second, after attending presentations about informed consent and physician–patient relationship principles, 32 physicians were asked to complete an open-ended questionnaire. Data were analyzed by two independent coders and emerging themes were compared. The results of the questionnaires and the interviews were triangulated. Of 32 physicians attending the presentations, 24 (75%) completed the questionnaire. The results indicate that physicians perceive patients, physicians and the hospital as main factors influencing the process of informed consent. Physicians' misinterpretation of informed consent principles, (mis)perceptions regarding patients and their family, and deficient hospital policy and support challenge the informed consent process. Physicians value nurses' roles, provided nurses have sufficient clinical knowledge, sound comprehension of informed consent principles and effective communication skills.     

生物样本库知情同意书规范化设计

知情同意书的签署是生物样本库伦理建设的核心, 其结构包括"知情告知"和"自主同意"两部分主体内容。本文依据现阶段生物样本库的特点, 提出生物样本库知情同意书的规范化设计, 具体描述从"生物样本库完备告知"到"捐赠者充分知情"两部分核心内容和要求, 以供生物样本库实践者参考和借鉴。     

Patient or physician safety? Physicians' views of informed consent and nurses' roles in an Indonesian setting

Informed consent is a reflection of patients' autonomy in health decision-making. The main responsibility lies with the doctor. In practice, the nurses' contributions matter as well. This paper presents a case study that explored physicians' perceptions of the existing informed consent process, their suggestions for improvement and their views on the nurses' roles in this process. A two-phase approach was conducted. First, six physicians with different expertise were interviewed. Second, after attending presentations about informed consent and physician-patient relationship principles, 32 physicians were asked to complete an open-ended questionnaire. Data were analyzed by two independent coders and emerging themes were compared. The results of the questionnaires and the interviews were triangulated. Of 32 physicians attending the presentations, 24 (75%) completed the questionnaire. The results indicate that physicians perceive patients, physicians and the hospital as main factors influencing the process of informed consent. Physicians' misinterpretation of informed consent principles, (mis)perceptions regarding patients and their family, and deficient hospital policy and support challenge the informed consent process. Physicians value nurses' roles, provided nurses have sufficient clinical knowledge, sound comprehension of informed consent principles and effective communication skills.