Evaluation of innovations in nursing practice: report and discussion

AIM: To assess whether a pilot study conducted in the UK achieved its objective to reduce admissions to hospital and bed days in patients identified as suitable recipients of case management by community matrons. BACKGROUND: The Department of Health has advocated the use of nurse-led case management to improve the coordination of care and prevent inappropriate hospital admissions. METHOD: 66 patients and another 66 controls were identified for the 'Evercare' caseload according to criteria set by United Healthcare. Admissions data for the six months after entry into the study were collected from the hospital information system. FINDINGS: admission rates in both the control and intervention group decreased over time and there was no significant difference in rates between the two groups at six months. There was no demonstrable effect on length of stay either. Users were satisfied with the service and nurses cited several clinical stories implying benefits for individual patients.     

Primary nursing: staff perception of changes in ward atmosphere and role

The value of a primary nursing care delivery structure remains undecided. This study was carried out on an acute psychiatric admissions unit as it changed its care delivery system to that of primary nursing. A review of the literature highlights the inconclusive nature of previous investigations. The principle of evidence-based practice raises the need for further research to put this issue to rest. The staff perception of this change on both the atmosphere of the ward and on the role of the nurses themselves was analysed. A general reduction in satisfaction with role was discovered, as was a reduction in eight out of 10 subscales of the Ward Atmosphere Scale (Moos 1989). As primary nursing generally receives favourable reviews by nurses, and was in fact positively received by the staff in this study at the time of initiation, this negative result is surprising. It is conjectured that primary nursing may be an ideal philosophy of nursing that is difficult to realize due to constraints surrounding contemporary nursing practice.     

聘请院外护理专家实施以问题为本的示范查房及效果评价

目的 探讨院外护理专家以问题为本(Problem Based Managing,PBM)现场查房的实践模式及其在临床护理管理实践中的积极作用,加强临床护理管理质量的持续改进.方法 采用客观、开放的态度,聘请院外护理专家来院进行PBM现场查房,建立类似企业电信系统"零缺陷"管理的护理质量"旁路控制"科学评价机制,客观真实地反映医院临床护理工作中存在的问题和隐患,并运用根因分析查找系统原因,进行及时改良,数月或1年后请专家再来医院"回头看",对问题的整改情况进行持续评价.结果 通过聘请院外护理专家来院进行以问题为本的现场示范查房,能帮助各科室护理管理者更好地及早发现问题、排查隐患,学习问题解决的方法和经验,从而培养年轻管理者发现问题、解决问题、对问题进行分级归类的能力,使以问题为本的管理理念落到实处.结论 聘请院外专家来院进行以问题为本的现场示范查房,能够提高护理管理者发现问题、解决问题、防范问题发生的能力,在一定程度上保证了临床护理质量的可持续改进.     

Attempts at innovations in the practice of teaching and practicing psychiatric nursing

In the context of recent changes that are taking place in the field of mental health care in Brazil, the University has the responsibility to redimensioning human resources qualification of mental health workers. At the Mental Health Care and Educational Program of the University of S?o Paulo and S?o Paulo Health Office (S?o Paulo/Brazil), an experience still in course, the nursing students attending to psychiatric nurse training evaluated that theoretical-practical education dealing with health care issue in the field of Psychosocial Rehabilitation purpose, at the same time that directly interferes in the qualification of practices, simultaneously develops the students attitudes and knowledge that qualify them to perform coherent practices in accordance with rehabilitation models of care.     

Custody and caring: innovations in Australian correctional mental health nursing practice

The challenges of delivering quality nursing care to incarcerated offender populations are diverse, complex and pressing. Correctional nursing in prison health facilities is a highly specialized area of mental health care. Research findings have identified contextual influences on the nature of practice and practice arrangements in the correctional environment. Implications for practice innovation and role development are explored through milieu factors.     

产科病房实行人性化护理的新举措

目的探讨在产科病房实行人性化护理的新举措。方法开展全程无缝隙服务、导乐分娩和陪护分娩、创造温馨舒适的环境、构建健康交流平台-孕妇之家。结果护患关系更加融洽,病人满意度从70%上升到98%以上,两个效益增长跃居全院之首。结论人性化护理是提高病人满意度和赢得医疗市场的重要保证。     

Changing managed care to care management: innovations in nursing practice

This article describes ways to develop a Case Management System that includes the principles of care planning by using an interdisciplinary team across the continuum of health services.     

学生区病房在护生临床实习中的应用

[目的]了解实习护生对学生区病房实习模式的认可度。[方法]采用问卷法对50名护生进行行为表现自评。[结果]90.0%的护生对学生区病房的临床实习模式持赞成态度,实习结束时护生对学生区病房模式的评价均高于进入病区时。[结论]实习护生对学生区病房临床实习模式的认同度较高。     

医护联合查房在精神科临床实践中的应用

目的探讨医护联合查房在精神科的临床应用效果。方法自2005年以来在我院开展了医护联合查房,并对患者满意度、意外事件、患者或家属投诉3个方面进行了开展前后的对比。结果开展医护联合查房后患者满意度提高（X2=85．369,P=0．000）,各类意外事件发生率、投诉率下降。结论医护联合查房促进了“交流-协作-互补”型医护关系的建立,提高了患者满意度,减少了意外事件发生,提升了护士自身价值感。     

无陪伴病房患者安全护理评价指标体系的建立

目的 初步构建一套科学、客观、全面地无陪伴病房患者安全护理评价指标体系。 方法 在三维质量结构理论基础上,采用文献检索法、专家小组讨论、 Delphi 专家函询法,筛选指标,建立无陪伴病房患者安全护理评价指标体系。 结果 两轮函询中问卷回收率分别为 88.2% 、 100% , 权威系数分别为 0.865 、 0.873 , 协调系数分别为 0.178 、0.330 ,构建了包含 12 项一级指标, 47 项二级指标的无陪伴病房患者安全护理评价指标体系。 结论 构建的无陪伴病房患者安全护理评价指标体系具有较高的科学性和可靠性,为护理管理者进行病房患者安全管理提供客观、可量化的依据。     

Representing nursing practice: evaluating the effectiveness of a nursing classification system.

The purpose of this study was to examine the effectiveness of the International Classification for Nursing Practice (ICNP) in representing the contributions of nursing to health-care outcomes in Canada.The ICNP BetaVersion was used to code retrospective nursing data extracted from patient records originating in acute care, in-patient mental health care, home care, and long-term-care practice settings. In spite of wide variation in documentation practices, ICNP achieved matches with the majority of nursing data.The study revealed areas for improvement in the ICNP BetaVersion, specifically with regard to granularity related to the use of natural language terms and professional terms. Recommendations for further development through research in nursing-sensitive outcomes are discussed.     

老年骨科无陪护病房护士班次管理的探索与实践

自2010年6月以来,我院老年骨科运行无陪护护理服务,根据病人需求及护理工作特点,积极探索,以"AN"(白班、夜班)二班制护士排班替代传统的"APN"(白班、小夜、夜班)三班制护士排班,细化工作职责,重新修订工作流程,基础护理质量和专科护理质量显著提高.现介绍如下.     

精神科心身病房创建优质护理试点病房护理实践

2010年全国护理工作会议上提出以"夯实基础护理,提供满意服务"为主题的"优质护理服务示范工程"活动[1]。我科积极响应卫生部的号召,在医院的统筹安排下,积极参与各项工作。自2010年2月起开始筹备,7月加入优质护理试点病房的行列。经过5个月的试点工作,护士工作责任感、护理工作质     

医护合作型责任制护理模式在妇科病区的实践

目的探讨医护合作型责任制护理模式对医疗护理质量和病区相关满意度的影响。方法选取该院妇科2014年1月~6月收治的患者为对照组（实施医护合作型责任制护理模式前）,2014年7月~12月收治的患者为实验组。对照组采用传统的查房模式,实验组采用医护合作型责任制护理模式,比较医护合作型责任制护理模式实施前后医疗护理质量和病区相关满意度的情况。结果实施医护合作型责任制护理模式后, 患者的住院天数、甲级病历病案率、患者满意度均优于实施前（P < 0.01）。结论医护合作型责任制护理模式改善了医护患沟通,提高了工作效率,改进医疗护理质量,有利于深化优质护理服务,强化专科护理内涵。