NICU危重患者家属需求与护士对家属需求的认知差异调查

目的：调查神经外科重症监护病房（Neurosurgical Intensive CareUnit,NICU）护士对家属需求的认知与NICU危重患者家属实际需求之间的差异。方法：使用中文改良版危重患者家属需求量表(Modified critical care family needs inventory,M-CCFNI)对复旦大学附属华山医院神经外科监护室（NICU）2021年1～9月收治的危重患者家属323人以及在职护士62人进行调查分析。结果：(1)NICU危重患者家属需求平均分为（128.52±15.62）分,各条目均分为（3.43±0.44）分,呈高需求状态;护士认知的患者需求平均分为（118.05±15.46）分,各条目均分为（3.15±0.41）分,评分差异具有统计学意义（P<0.01）。(2)NICU危重患者家属需求5个维度的得分排序中NICU护士与患者家属一致认为最重要的需求是“病情保证”,但双方在“亲近患者的需求” 和“医护人员的支持”两个维度存在着明显差异（P<0.01）。(3)M-CCFNI量表共有37条需求,NICU危重患者家属认为最重要10条需求中,护士与其吻合的有7条,但家属认为极为重要的“希望每天和医生进行交流(IS)”,“医护人员能如实回答我的问题(AS)”,“每天都能得到有关患者病情的相关消息(PS)”3条需求,护士的认知远低于患者家属的需求。(4) NICU危重患者家属与护士在得分后10条的需求中,危重患者家属将自身心理、精神方面的需求列为其最不重要的需求项目;而NICU护士则低估了危重患者家属想要了解患者病情的信息以及探视的需求。结论：神经外科重症患者家属需求呈高需求状态,远高于护士的对家属需求的认知,且护士对家属需求侧重点的认识存在着偏差。     

降阶梯思维模式在急诊危重患者院内安全转运中应用

目的探讨降阶梯思维模式在急诊危重患者院内安全转运中应用。方法2017年1~6月对急诊科18名护士实施降阶梯思维模式培训,分析培训前后急诊护士护理能力及院内转运危重患者过程中不良事件发生情况。结果培训后急诊护士理论考试评分、应急考试评分、危重病患转运能力评分均高于培训前,差异有统计学意义(均P<0.05),患者转运时间短于培训前,差异有统计学意义(均P<0.05)。培训后输液管脱落或堵塞、供氧中断、设备故障、患者血压波动等不良事件发生率显著低于培训前,差异均有统计学意义(均P<0.05),培训后患者满意度显著高于培训前,差异有统计学意义(P<0.05)。结论降阶梯思维模式能有效提高急诊护士护理技能及危重病患转运能力,从而降低危重病患转运过程中不良事件发生,提高患者满意度。     

责任护士对危重患者病情认知程度的调查研究

目的探讨责任护士对危重患者病情的认知程度及干预措施。方法针对40名责任护士开展关于病区危重患者"八知道"调查。结果分别有26名(65.0%)、29名(72.5%)、30名(75.0%)和26名(65.0%)的责任护士对危重患者的护理问题、意识状态、心理状态、排泄困难处理基本认知;3名(7.5%)责任护士对护理措施完全认知,20名(50.0%)责任护士对阳性体征未认知,29名(72.5%)责任护士对治疗方法部分认知;本科学历总分高于中专学历和大专学历,差异有统计学意义(P0.05);分管0~20个床位护士的认知程度均分高于21~30个和30个以上床位,差异有统计学意义(P0.05)。结论高学历的责任护士有助于提高危重病情的认知程度,合理的分配责任护士所分管的危重患者数,可以提高对患者的护理质量。     

护士分层管理运用于消化内科危重病人护理的效果研究

目的 探讨护士人力分层管理应用于危重病人护理的效果。方法 2012年11月—2015年5月入住消化内科的危重住院患者150例,设立A组和B组,A组实行首问负责制护理,即由床位分管责任护士完成该患者从入院到出院的所有护理评估、护理措施及病情观察、护理评价等连续的、全面的护理服务。B组患者以APACHE II评分为标准,若评分<15分,该患者的护理活动由N2a能级护士完成;若评分≥15分,该患者的护理活动由N2b能级护士完成。出院前一天,通过自行设计的调查表,调查责任护士对护理资源配置的满意度以及患者/家属对护理工作的满意度。结果 比较2组数据,结果如下：(1)2组护士工作时间的灵活性、安排周末工作补偿的满意度、家庭与工作的平衡感等方面差异有统计学意义(P＜0.05)。(2)2组护士在与共事者的关系、每月周末休息的机会、安排周末休假的灵活性方面差异没有统计学意义(P＞0.05)。(3)2组患者/家属对责任护士的责任心、及时主动满足需求等满意度调查方面差异有统计学意义(P＜0.05)。(4)2组患者/家属对护士的服务态度、沟通能力等满意度调查方面差异没有统计学意义(P＞0.05)。结论 通过护士的分层管理能使护理管理者合理分配护理人员,合理分配工作量,提高护理工作效率,减少不必要的人力浪费,提高患者满意度,值得在日常护理管理中推广和展开。     

急诊科护士对危重患者院内转运的态度和认知水平调查

目的调查急诊科护士对危重患者院内转运的认知状况及相关态度,为优化院内转运相关流程提供真实可靠的依据。方法利用自制问卷对160例急诊科护士进行调查。问卷包括3个部分,分别为人口学基本信息、危重患者院内转运相关态度及危重患者院内转运相关知识。结果急诊科护士的转运相关知识得分为(13.34±1.37)分,优秀率为5.0%。急诊科护士对危重患者院内转运的认知情况不受性别、年龄、受教育程度、工作年限、职称、职务、是否具有急诊专科护士资格等因素的影响(P0.05)。急诊科护士对危重患者院内转运相关的态度得分为(4.12±0.48)分,与认知得分呈正相关(r=0.221,P0.05)。结论急诊科护士院内转运知识水平有待提高,同时其对待转运的态度决定了认知情况,在加强专业知识方面培训的同时,应加强转运的重要意义及风险方面的培训,最终提高危重患者院内转运护理安全度。     

ICU护士对患者家属需求的认知及相关因素调查

目的 调查ICU护士对家属需求的认知程度及相关因素,以便对护理人员进行有针对性的培养,从而提高ICU的护理质量.方法 采用方便抽样的方法对上海市2所三级甲等医院中的60名ICU护士进行问卷调查.结果 ICU护士对家属需求的认知程度最高的3项为:在第一次进入ICU时,能向家属主动介绍ICU的规章制度,能保证给患者最好的照顾,能用通俗易懂的话向家属解释有关患者的病情;在对探视需求的认识上比较不同学历和不同工作年限的护士均有统计学意义(P<0.05),其中本科及本科在读学历和4年以上的认识程度最高;在对于患者病情信息的需求的认识上不同学历和不同工作年限均有差异,本科及本科在读学历和4年以上的认识程度最高(P<0.05);在对于患者家属对ICU条件与环境需求认识程度上仅不同工作年限有统计学意义4年以上的认识程度最高(P<0.05).结论 提高了对不同年龄段及学历层次的ICU护士的针对性培养、完善相关的配套服务措施.     

儿科急诊危重患儿家属对复苏陪伴的态度及相关因素研究

目的:调查急诊危重患儿家属对复苏陪伴的态度和相关影响因素。方法:横断面研究纳入297名急诊危重症患儿家属,采用中文(家属版)复苏时家属在场利弊衡量表进行调查,分析量表总分、利益风险项得分、对各条目认同度和不同认同态度的相关因素。结果:287名(96.6%)家属支持复苏陪伴。不同性别、学历、家庭收入、患儿病程、病情危急程度家属量表总分比较差异无统计学意义(P>0.05),有无复苏经历家属量表总分比较差异有统计学意义(P=0.032)。结论:绝大多数家属赞同复苏陪伴,但对利益及风险相关条目的认同度有明显的倾向性。     

急诊危重患者家属需求的满足情况调查

目的了解急诊危重患者家属需求的满足情况。方法在中文版危重患者家属需求量表（critical care family needs inventory,CCFNI）的基础上应用自行设计的需求满足量表,采取分层整群抽样的方法,对下“病危”或“病重”医嘱后24h内的急诊患者家属进行调查。结果急诊危重患者家属需求的满足程度较低,满足较好的是病情保证的需求和与探视有关的需求,满足较差的是希望在医院能进行特殊宗教信仰活动和有人协助解决经济问题;不同健康状况组家属之间的需求满足得分差异有统计学意义（P〈0．05）。结论急诊医护人员应重视评估和满足急诊危重患者家属的需求,提高这一特殊群体的身心健康和家庭满意度。     

急诊重症监护患者家属的需求现状及其影响因素

目的了解急诊重症监护患者家属的需求现状,分析其影响因素,以期为制定相关宣教措施提供现实依据。方法 2015年1月至2016年6年,便利抽样法选择海军军医大学附属长海医院急诊重症监护患者家属248名为研究对象。采用危重患者家属需求量表(critical care family needs inventory,CCFNI)对其进行调查。结果患者家属CCFNI总分为(142.65±22.95)分,病情保证、接近患者、获取信息、自身舒适、获取支持等维度评分为(24.92±2.59)、(30.15±3.78)、(26.08±3.60)、(15.36±3.12)、(46.65±6.75)分。与患者关系不同的家属,其CCFNI评分差异无统计学意义(P0.05);不同性别、年龄、学历、家庭经济收入水平的家属,其CCFNI评分差异均有统计学意义(均P0.01)。无陪护经验家属的CCFNI评分高于有陪护经验家属,差异有统计学意义(P0.01)。在所有家属需求中,排在首位的是"保证患者得到及时救治",为(3.65±0.28)分,其次是"对病情得到如实回答",为(3.62±0.30)分。多因素Logistic回归分析表明,性别、年龄、文化程度、经济状况、陪护经验均是急诊重症监护患者家属需求的影响因素(均P0.01)。结论急诊重症监护患者的家属对保证患者得到及时救治需求最为迫切。护理人员应重视急诊危重患者家属的需求状况,并采取有针对性的措施,提高急诊危重症患者的治疗与护理质量。     

ICU患者家属、护士及医生对家属需求认知的差异

目的 了解ICU患者家属、护士及医生对ICU患者家属需求的认知状况及差异.方法 便利选取符合人选标准的家属35人、护士37人、医生21人,在患者入院48 h后采用危重患者家属需求量表(CCFNI)进行调查.结果 患者入院48h后,护士、医生在信息、接近及保证因子上的评分低于家属的评分,差异有显著性意义(P<0.05);家属最重要的需求是保证需求.结论 ICU医护人员对患者家属一些需求重视不足,医护人员应加强对家属需求、沟通技巧等方面知识的学习,帮助家属及患者度过急性应激期.     

Professional nursing support for culturally diverse family members of critically ill adults

Family members' perceptions of professional support expected of critical care nurses were examined for differences related to cultural affiliation using the "Professional Support Questionnaire for Critical Care Nurses Working with Family Members" (PSQ). The PSQ was administered face-to-face to family members waiting to visit a critically ill relative admitted to the intensive care unit. ANOVA and post hoc tests were computed to compare 90 family members' expectations for professional nursing support during a relative's critical illness across three cultural groups-African American, Hispanic, and White. There were significant differences in family members' responses on certain PSQ items across cultural groups. Despite these differences, family members' expectations of professional support from critical care nurses were generally universal-suggesting equitable care, dignity, and respect should be universal values. There is a need for critical care nurses to develop interventions that respect some cultural uniqueness as well as address the universal needs of family members coping with the ICU admission of a critically ill family member.     

Needs of families with a relative in a critical care unit in Hong Kong

The aim of this study is to explore family members' perceptions of their immediate needs following admission of a relative to a critical care unit in Hong Kong. A convenience sample of 30 family members was drawn from those available during the first 96 hours of hospitalization of their relative. Self-reported questionnaires, consisting of a demographic data sheet, a modified Chinese version of the 45-item Critical Care Family Needs Inventory (CCFNI) and semistructured interviews, are the instruments used to examine family members' perceptions of need importance and to ascertain whether or not these needs are met. Doctors and nurses are identified as the most suitable people to meet most immediate family needs. Conclusions are drawn as to the best focus of nursing interventions in order to provide quality care to patients and families.     

Needs of family members of intensive care unit patients.

To identify important needs of families of critically ill patients, and the degree to which these needs were being met, 64 family members and 58 nurses were asked to complete a modified version of the Critical Care Family Needs Inventory (Molter & Leske, 1983). Family members and nurses identified many similar important needs, such as the need to have questions answered honestly, the need to be called at home about changes in the patient's condition, and the need to know why things were done for the patient. However, family members indicated that some needs were both more important and less satisfactorily met than the nurses perceived: the need to know the occupational identity of staff members, directions as to what to do at the patient's bedside, and having friends for support.     

ICU病人亲属家庭需要的调查研究

应用Molter“急危重病人家庭需要量表”对 5 0例ICU病人亲属进行调查 ,以了解当病人在ICU接受监护时 ,其亲属对病人家庭需要的认识。结果显示ICU病人亲属认为能够保证病人的安全 ,了解病人的治疗与预后 ,了解病人护理的需要最重要 ,而与病人亲属身心相关的需求重要性得分则较低。某些需要在男女病人亲属之间存在显著性差异 ,部分需要与病人亲属的年龄、教育水平和家庭收入分别有显著相关。提示ICU护士必须正确认识病人家庭需要 ,并根据病人亲属的性别、年龄、教育水平和家庭收入等因素满足病人家庭需要 ,以帮助病人家庭应对病人病重时的危机状态 ,维持病人及亲属的身心健康     

Caring for families with a family history of cancer: why concerns about genetic predisposition are missing from the palliative agenda

Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.     

Life's final journey: the oncology nurse's role

Despite advances in technology and science, many people diagnosed with cancer are likely to die from the disease. Because of the long-term relationships that oncology nurses develop with patients and their families during lengthy treatment periods, they are the most appropriate clinicians to provide care across the continuum and through the final journey. Care of patients in the final days of life requires a comprehensive knowledge of common syndromes, skillful assessment, and adept clinical management. Nurses cannot focus solely on the needs of patients; family members often are unaware of the dying process. Oncology nurses are uniquely qualified to provide education and support to families at the bedside witnessing the final days and hours of their loved ones. Finally, oncology nurses involved in the care of dying patients are at risk for burnout and need to provide care for their own needs to find balance between their professional and personal lives.     

Expressed emotion and nursing the schizophrenic patient

The findings from the family studies of schizophrenic family members' readmission (which coined the term 'expressed emotion' to explain why some families have members who need readmission more often than others) are related to a variety of areas of psychiatric nursing research, including nurses' attitudes, nurses' behaviour, ward atmosphere, institutionalization, social therapy, and patient outcome. This follows the Berkowitz & Heinel report that psychiatric nurses at one hospital behave like the families that have lower readmission rates. A strategy for further research of psychiatric nurses 'expressed emotion' is proposed, in relation to the course and outcome of schizophrenic patients' hospitalization.