应用临床路径对抑郁症患者实施健康教育的实践与体会

目的:探讨抑郁症患者最有效的健康教育方法,提高患者依从性和患者满意度,增强患者治愈的信心,和谐医患关系。方法:选择60例抑郁症患者,随机分为观察组(30例)和对照组(30例),对照组实施常规健康教育,观察组应用临床路径实施健康教育,出院前进行患者依从性比较及满意度调查。结果:观察组患者依从性、满意度明显高于对照组,差异有显著性差异(P<0·01)。结论:应用临床路径对抑郁症患者实施健康教育可提高患者依从性和满意度,探讨有效的健康教育方式对和谐医患关系、提高患者治愈率具有积极意义。     

The meaning of suicidal psychiatric in-patients'' experiences of being cared for by mental health nurses

Twenty-one psychiatric in-patients who had thought about, expressed the wish or even attempted to commit suicide narrated their experiences of receiving care from mental health nurses. The interview texts were transcribed and interpreted using a phenomenological-hermeneutic method, inspired by Ricoeur's philosophy. Two main themes with subthemes were found: Confirming: attending to patients' basic needs; seeing patient; having time for patient; being with patient; listening to patient without prejudice; being open to patient; accepting patient's feelings; communicating hope to patient; and Lack of confirming: overlooking patient's basic needs; not seeing patient; not having time for patient; leaving patient to herself or himself; listening to patient with prejudice; not being open to patient; denying patient her or his feelings; communicating hopelessness to patient. These findings were interpreted in the light of Hegel's philosophy of mutual recognition and confirmation. When relating episodes of good or bad nursing care suicidal patients emphasized their need for confirmation during their interaction with nurses when in hospital after suicide attempts.     

Nursing care of the mechanically ventilated patient: What does the evidence say?: Part one

The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.     

国外患者安全屏障系统研究进展及对我国的启示

近年来随着患者自主意识的提高,患者安全已成为国际社会高度重视的课题。关注患者安全,共创医患关系双赢的局面,是现代医疗服务模式所追求的目标。文章在阐述患者安全和屏障概念的基础上,介绍了国外患者安全屏障系统的研究方向,为我国患者安全屏障系统的改进和完善提供了指导。     

'Knowing the patient': a review of research on an emerging concept

Knowing the patient is an important concept emerging from recent studies of nursing practice The concept is relevant to therapeutic decision-making Also, knowing the patient actualizes a cherished value in nursing the treatment of persons as unique individuals Investigators described that knowing the patient comprises two components the nurse's understanding of the patient and the selection of individualized interventions In addition, the nurse's experience with caring for patients, chronological time and a sense of closeness between the patient and nurse, are three factors consistently related to knowing the patient The concept has implications for practice, including that knowing the patient may result m positive patient outcomes Also, expert nurse decision-making may be characterized by knowing the patient Recommendations for further research in this area include the clarification and refinement of the concept, as well as the examination of relationships between knowing the patient and outcomes of care     

The quality of patient education evaluated by the health personnel

Scand J Caring Sci; 2010; 24; 548–556
The quality of patient education evaluated by the health personnel The purpose of the study was to describe the quality of patient education evaluated by health personnel. The sample consisted of 916 nurses and physicians working in one hospital in Finland. The data were gathered with a questionnaire developed specifically for this study. The questionnaire measured patient education quality as two dimensions: patient education resources and implementation. The data were analysed using basic and multivariate methods. The overall resources of patient education were quite good. The problems were related to the possibilities for patient education, such as the lack of time, the unsuitability of conditions and the shortage of equipment. In addition, 54% had inadequate knowledge of patients’ posttreatment condition and 29% of the impact the illness had on patients’ everyday lives. Furthermore, 47% were less skilled in supporting self‐care. On the other hand, health personnel’s attitudes towards patient education were positive. They were able to use verbal and individual patient education very well, whilst other methods of patient education were used less well and more infrequently. The patient education was implemented largely as patient‐centred and interactive. However, the patient was not always taken into account in the planning and evaluation of patient education. Several background variables of the health personnel had a statistically significant connection to patient education resources and implementation. These findings indicate that patient education is largely well implemented, although the resources need to be developed somewhat further.     

Supporting self-management in patients with chronic illness

Support of patient self-management is a key component of effective chronic illness care and improved patient outcomes. Self-management support goes beyond traditional knowledge-based patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support application of knowledge in real-life situations that matter to patients. This approach also encompasses system-focused changes in the primary care environment. Family physicians can support patient self-management by structuring patient-physician interactions to identify problems from the patient perspective, making office environment changes that remove self-management barriers, and providing education individually and through available community self-management resources. The emerging evidence supports the implementation of practice strategies that are conducive to patient self-management and improved patient outcomes among chronically ill patients.     

肺结核患者的心理特征和护理

目的:了解肺结核患者的心理特征,从而有针对性地进行心理护理,使肺结核患者愉快的接受抗结核治疗。方法:经过护理人员细心周全的观察,分析肺结核患者的心理特征,在临床工作中对患者进行针对性的心理护理。结果:肺结核患者的心理主要表现为恐惧及焦虑、自卑、悲观绝望、麻痹侥幸、求助、发泄。结论:观察患者的心理特征,并给予相应的心理护理,能减轻患者的不良心理,使患者的身心早日康复。     

Assessing learning styles: practical tips for patient education

Nurses must facilitate and support patient and family decision-making and improvement in health outcomes using instructional skills. Complex patient needs and nursing responsibilities necessitate thoughtful consideration for maximizing the effectiveness of patient teaching encounters. This article reviews assessment of patient learning styles in combination with context for an individualized approach, as well as motivation for adult learners as a framework for organization of patient teaching. Methods and modes of patient teaching are discussed as well as tips for overcoming barriers to planning and implementing patient teaching.     

重症肝炎患者凝血功能检测分析

目的探讨利用血凝仪检测凝血四项功能对准确反映病毒性肝炎患者凝血功能状况及预后判断的价值。方法选择正常人和慢性肝炎重度（慢肝重度）、重型肝炎（重肝）、肝炎后肝硬化（肝硬化）患者，血凝仪检测凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）以及纤维蛋白原（Fbg）含量。结果除慢性肝炎严重肝损害患者外的所有患者上述四项指标的均值均明显高于正常组（P〈0．001）；其中慢肝重度和肝硬化患者Fbg含量的异常率明显高于其它二项或三项指标（P〈0．01或0．05）；重型肝炎死亡患者PT均数及APTT异常率均明显高于存活者（P〈0．05）。结论利用血凝仪检测凝血四项功能可以从多个角度更客观、准确地反映严重肝损害的肝炎患者凝血功能状况及其预后。     

Nurse practitioners' perceptions of their caring behaviors

PURPOSE: To explore nurse practitioners' (NPs) perceptions of their own caring behaviors, the relationship between sociodemographic variables, environmental factors, and NP's perceptions of their caring behaviors. DATA SOURCES: A mailed survey to a systematic random sample of 200 members of an Illinois NP group. CONCLUSIONS: The top ten caring behaviors in rank order were appreciating the patient as a human being, showing respect for the patient, being sensitive to the patient, talking with the patient, treating patient information confidentially, treating the patient as an individual, encouraging the patient to call with problems, being honest with the patient, and listening attentively to the patient. IMPLICATIONS FOR PRACTICE: The quality of instruction in the biomedical aspect of nursing education is relatively easily assessed. Caring is nurses' hidden work that may go unrecognized except when the caring behaviors are missed by the patients or their families.     

Patient transfers in Australia: implications for nursing workload and patient outcomes

blay n., duffield c.m. & gallagher r. (2012) Journal of Nursing Management 20, 302–310
Patient transfers in Australia: implications for nursing workload and patient outcomes Aim To discuss the impact of patient transfers on patient outcomes and nursing workload. Background Many patient transfers are essential and occur in response to patients’ clinical changes. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in ‘bed block’. Evaluation A discussion of the literature related to inpatient transfers, nursing workload and patient safety. Key issues Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. Conclusions The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. Implications for nursing management High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care.     

患者安全研究热点的共词聚类分析

目的分析PubMed数据库中2014-2018年患者安全研究的热点,了解该领域研究现状及发展趋势,以期为我国患者安全研究和实践提供参考依据。方法以“patient safety”为主题词,检索PubMed数据库,采用书目共现分析系统软件BICOMB统计高频主题词,并采用SPSS 21.0统计软件对主题词进行共词聚类分析。结果共检索相关文献11913篇。提取高频主题词26个。通过共词聚类分析总铸出2014-2018年患者安全研究的8个研究热点,即患者安全及医疗差错的现况、医务人员的临床能力、跨专业协作与有效沟通、清单工具、患者安全管理与实践的标准及医疗质量改进、患者安全及患者安全文化、用药错误的预防与控制、患者安全立法及法理学研究等。结论近5年患者安全研究热点分析有助于了解该领域的研究现状及发展趋势,为患者安全在我国的实践发展和研究提供参考和借鉴。     

The practices of expert psychiatric nurses: accompanying the patient to a calmer personal space

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.     

THE PRACTICES OF EXPERT PSYCHIATRIC NURSES: ACCOMPANYING THE PATIENT TO A CALMER PERSONAL SPACE

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.     

Patient outcomes in the field of nursing: A concept analysis

PurposeThis paper reports an analysis of the concept of patient outcomes.MethodsThe Walker and Avant concept analysis approach was applied.ResultsThe attributes of patient outcomes include (1) patient functional status (maintained or improved), (2) patient safety (protected or unharmed), and (3) patient satisfaction (patient reporting of comfort and contentment). These attributes are influenced by the antecedents of individual patient characteristics and health problems, the structure of healthcare organizations and received health interventions. Additionally, patient outcomes do significantly impact the quality of nursing care, the cost of effective care and healthcare policy making formulation.ConclusionProviding good nursing care to all patients is a central goal of nursing. Patient outcomes in nursing are primarily about the results for the patient receiving nursing care. This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.     

Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for Patient Care?

PURPOSE: To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics. DESIGN AND METHODS: Secondary data analysis of a convenience sample of 481 patient ratings from adult and pediatric critical and noncritical medical surgical patients. FINDINGS: Combining dichotomous patient acuity indicators into multilevel categorical variables allowed evaluation of linear relationships between acuity and patient characteristics indicators. Of the 8 patient characteristics, only participation in care exhibited meaningful correlations with the acuity indicators. According to these findings, acuity indicators should not be substituted for the Synergy Model patient characteristics.     

Factors associated with the patient privacy protection behaviours of nursing interns in China: A cross-sectional study

AimTo explore the associated factors of patient privacy protection behaviours among nursing interns.BackgroundThe patient privacy protection behaviours of nursing interns are closely related to information security incidents and the quality of clinical practice. However, little is known about the associated factors of patient privacy protection behaviours among nursing interns.DesignA cross-sectional study.SettingA comprehensive hospital in Hunan Province, China.ParticipantsNursing interns in a comprehensive hospital from 30 different nursing schools were recruited using convenience sampling.MethodsData on general information, patient privacy protection cognition, moral sensitivity, empathy and patient privacy protection behaviours were collected with a general information questionnaire and corresponding scales with good psychometric properties. U-test, spearman correlation analysis and multiple linear regression were used to determine the associated factors of patient privacy protection behaviours among nursing interns.ResultsThis study showed that nursing interns in a college programme had better patient privacy protection behaviours than those nursing interns in a baccalaureate programme. Nursing interns who have more knowledge of privacy laws and whose clinical nursing teachers excelled in patient privacy protection might show better patient privacy protection behaviours. Nursing interns with better patient privacy protection cognition, higher moral sensitivity and greater empathy might have better patient privacy protection behaviours.ConclusionStrengthening nursing interns’ knowledge of privacy laws and patient privacy protection cognition, improving their moral sensitivity and empathy and standardising the patient privacy protection behaviours of clinical nursing teachers may can improve the patient privacy protection behaviours of nursing interns. Also, clinical teachers should pay close attention to nursing interns in baccalaureate programmes who are likely to have a lower level of patient privacy protection behaviours and act as role models for them in protecting patient privacy in clinical nursing education.     

Perceptions of caring among patients with cancer and their staff. Differences and disagreements

The current dyadic study investigated (a) patient and staff perceptions of the importance of caring behaviors, patient health, quality of life, and greatest health-related concern; (b) patient anxiety and depression (Hospital Anxiety and Depression Scale); and (c) staff views of patient perceptions of the importance of caring behaviors. The study included 21 matched patient-staff dyads. Three questionnaire versions of the Caring Assessment Instrument were used to tap patient (CARE-P) and staff (CARE-S) perceptions, and staff views of patient perceptions (CARE-SP). There were no correlations between patient and staff perceptions of the importance of caring behaviors, patient health, quality of life, or greatest health-related concern. However, staff views of patient perceptions about the importance of caring behaviors were strongly correlated with their own perceptions. Staff ratings of the importance of caring behaviors were not related to patient anxiety, depression, health, and/or quality of life. Patient depression was negatively correlated with three CARE-Q subscales. The results indicate that staff are not successful in judging the importance of caring behaviors, health, quality of life, and greatest health-related concern for individual patients. The major implication is that staff must be open to patient perceptions of what caring behaviors are important, and must validate their own perceptions of patient needs and concerns.