保护性约束在精神科病房的合理应用

目的探讨在精神科病房科学合理使用保护性约束,同时实施人性化护理的优点、方法和意义。方法将70例在精神科男科住院治疗、需要实施保护性约束的精神病患者,按随机数字表法分为观察组和对照组,每组35例。对照组采用传统方法实施约束并予以常规护理;观察组实施科学的保护性约束方法,并采取人性化的护理模式（约束前做好与患者及家属的沟通,实施科学的保护性约束方法,讲究约束技巧,加强约束期间心理护理及生活护理,满足其合理要求,并做好解除约束后的心理安抚工作）。对2组患者实施约束后自伤及他伤、心理反应状态、躯体影响、治疗依从性、护患纠纷及投诉等情况进行比较。结果观察组心理反应状态、治疗依从性、家属满意度均明显高于对照组,约束后躯体影响、自伤及他伤、护患纠纷及投诉明显低于对照组（均P〈0.05）。结论对需要实施保护性约束的精神病患者实施科学保护性约束及制定人性化护理模式,可以保证护理工作的顺利进行,加强了护士在保护性约束过程中的责任心,提高了患者及家属满意度,很大程度地降低了护患矛盾及纠纷的发生。     

精神科护士保护性约束态度、行为与伦理氛围认知的现状及相关性分析

目的了解精神科护士保护性约束态度、行为与伦理氛围认知的现状并分析其相关性。方法采取便利取样的方法,对湖南长沙2所精神病专科医院、1所三级甲等综合医院的330名精神科护士,采用精神科护士保护性约束态度、行为问卷和伦理氛围认知量表进行问卷调查,采用Pearson相关分析法分析两者之间的相关性。结果精神科护士保护性约束态度总分为(30.47±4.83)分,保护性约束行为总分为(31.67±3.17)分,精神科护士伦理氛围认知总分为(88.15±11.82)分。330名精神科护士在临床工作年限、性别、学历、职位、婚姻状况、所在病房保护性约束态度得分比较,差异有统计学意义(P<0.05),精神科护士在年龄、性别、是否接受过医学伦理教育培训保护性约束行为得分比较,差异有统计学意义(P<0.05),精神科护士在性别、有无精神心理专科护士证、是否接受过医学伦理教育培训伦理氛围认知得分比较,差异有统计学意义(P<0.05)。精神科护士保护性约束态度与伦理氛围认知呈正相关(r=0.242,P<0.001)。结论精神科护士保护性约束态度和伦理氛围认知均处于中等水平,精神科护士保护性约...     

精神科患者保护性约束中知情同意的相关问题及对策

本文分析了精神科患者保护性约束中知情同意存在的问题和原因,并对我院实践方法进行了介绍,提出在保护性约束中只有遵循患者充分知情、理解、同意的原则,才能保证知情同意的实现。     

保护性约束在精神科护理中的应用和观察

目的：探讨保护性约束措施在精神科护理中的应用效果。方法：将2013年1月—2013年12月78例具有精神疾病,并且需要保护性约束的患者随机分为观察组和对照组,每组39例。对照组仅采用保护性措施;观察组采用人性化措施进行护理。对两组患者的护理效果进行比较。结果：与对照组比较,观察组患者的心理反应良好,治疗依从性、患者及家属满意度提高,自伤及他伤、躯体影响下降（P〈0.05）。结论：人性化措施在保护性约束中的应用更符合现代人性化护理模式,可以满足患者的身心需求,促进治疗的顺利进行,提高患者及家属满意度,降低了护患纠纷的发生。     

精神科实施约束中的问题与对策

目的：探索对精神病患者使用约束过程中的存在问题，以提高其使用的安全性。方法：对2003～2005年50例使用保护性约束过程中的潜在或出现的问题进行分析、查找原因，提出防范措施。结果：提出并实施防范措施后，安全性大有提高。结论：制定相对统一的保护性约束制度，规范约束的护理行为，是精神科约束带使用安全的有利保证。     

精神科病人及家属对静脉输液实施保护性约束态度的调查

目的 探讨精神科病人及家属对静脉输液过程中实施保护性约束的态度,为提高护理工作质量提供理论依据.方法 采用自制问卷调查对96例精神科病人及87位家属进行调查.结果 51.3％的病人和47.1％的家属能接受保护性约束;37.9％家属担心保护性约束会造成病人心理伤害;分别有27.1％病人和33.3％家属认为输液时进行保护会使病人感到不适;68.7％病人和55.1％家属认为进行保护性约束需要经过他们同意.结论 病人和家属对输液实施保护性约束的态度存在一些问题,护士应向病人和家属做好解释工作,在操作过程中及时满足病人的生理和心理需求,从而保证护理工作安全与质量,提高病人及家属满意度.     

精神科护士对保护性约束的态度和行为调查分析

[目的]了解精神科护士使用保护性约束的态度与行为状况。[方法]采用自行设计的问卷,对102名精神科护士使用保护性约束的态度和行为进行调查。[结果]精神科护士对使用保护性约束的态度得分为26.41分±2.78分,行为得分为30.41分±2.31分。[结论]精神科护士对保护性约束呈中性态度,能比较恰当地使用保护性约束。     

临床分析精神病患者保护性约束不安全因素及解决对策

目的:探讨精神病患者保护性约束不安全因素及解决对策。方法:采用回顾性方法分析,选取本院自2015年1月至2018年12月收治的312例实施保护性约束精神病患者的临床资料,分析实施保护性约束存在的不安全因素及解决对策。结果:精神病患者实施保护性约束原因中,主要由于精神分裂症(64.42%)、心理障碍(10.90%)需要保护性约束。沟通不畅(57.05%)是导致保护性约束的主要不安全因素。结论:针对精神病患者保护性约束前、约束中及其约束后存在的不安全因素,提出解决性对策,可保证护理安全。     

改良后肢体约束带在精神科的应用

目的探讨肢体约束带经改良后应用于临床的效果观察。方法将改良后的肢体约束带应用于75例患者,观察约束不良反应如关节疼痛、皮肤勒伤、肢体肿胀,自行松解率及约束后舒适度的评价,与传统的双套结约束法(82例)相比较。结果改良后的肢体约束带不良反应及自行松解率较传统组明显降低,舒适度提高,与传统组比较,差异有统计学意义(P0.05)。结论改良后肢体约束带应用于临床,减少了不良反应,舒适度高,更安全、有效。     

心理干预联合保护性约束管理对降低精神科患者暴力行为的影响观察

目的 探讨心理干预联合保护性约束管理对降低精神科患者暴力行为的影响。方法 选取收治的精神科患者200例,根据随机数字表法分为对照组和观察组各100例,两组均行常规治疗,在此基础上,对照组实施常规护理干预,观察组在对照组基础上进行心理干预联合保护性约束管理。于护理前、后,比较两组精神症状程度[阳性及阴性综合征量表（PANSS）]、躁狂发作程度[Young躁狂评定量表（YMRS）]、行为及病情改变[住院患者护士观察量表（NOSIE）];并比较护理期间两组暴力行为发生情况。结果 护理后,两组PANSS、YMRS、NOSIE评分均低于护理前,且观察组低于对照组（P<0.05）;观察组暴力行为发生率低于对照组（P<0.05）。结论 心理干预联合保护性约束管理能减轻精神科患者精神症状及躁狂程度,改善其行为,降低暴力行为发生率。     

Ethical dilemmas in curriculum planning

This paper delivers a discussion regarding the ethical dilemmas currently facing curriculum planners when designing nurse training programmes. The paper acknowledges the ideal of curriculum planning in nurse education and sets against it the worsening picture of nurse staffing levels facing many hospitals at present. It attempts to consider the esteem needs of the students and the legal requirements for care in relation to this dilemma. Whilst appearing to take a rather pessimistic view, the paper reflects the realities of the staffing problems currently being faced by some Liverpool hospitals.     

Ethical dilemmas in antibiotic treatment

Patients with moderate to severe infections are given less than maximum empirical antibiotic treatment in order to reduce the rise in resistance. This practice involves two ethical dilemmas: whether the danger to a present patient should be increased (even if by a small degree) to benefit future, unidentified patients; and whether this should be done without the consent of the patient, disregarding the patient's autonomy. We argue that future patients have a right to come to no harm. Future patients being unidentified, practitioners of medicine have a duty to protect their rights and weigh them against the rights of the present patient. A decision on the collective (guidelines, decision support systems) is a convenient way to do that. Using a temporal discount rate to show that the life of present patients has pre-eminence, to some degree, over future patients does not solve the immediacy of the plight facing a present, identified patient with a very severe infection. We think there are good grounds to take into less account considerations of future resistance for such a patient, or in a formal analysis, to make the ratio of benefits to the present versus future patients dependent on the severity of disease of the present patient. None of these solve the problem of patients' autonomy. We see no other way but to argue that the right of future patients to come to less harm outweighs the right of the present patient to share in decisions on antibiotic treatment.     

Ethical dilemmas in trauma nursing

For someone seeking to understand the ethical dimensions of trauma nursing, it quickly becomes apparent that there is a uniquely complex set of issues to be examined in this context. Many of these issues are made more difficult by the fact that the provider/patient relationship that undergirds the moral dimension of patient care in other contexts is necessarily truncated or absent in the trauma unit. This article seeks to explore some of these issues and the moral ambivalence they create.     

Ethical dilemmas in driver reeducation

This article illustrates ethical dilemmas faced by therapists who provide driver reeducation. The dilemmas discussed are (a) accepting a wide range of referral sources and client disabilities versus the inability to know enough to anticipate all driver performance errors, (b) the client's safety versus the client's right to independence, (c) financial constraints versus advantages of technology, and (d) the reporting of poor driving risk versus client confidentiality. A method for determining one's pattern of resolving ethical dilemmas is discussed.     

Ethical dilemmas in hospice and palliative care

In order to understand some of the ethical dilemmas that face hospice programs in the United States, one must understand the Medicare Hospice Benefit, which is the model by which hospice programs provide palliative care to terminally ill patients in the United States. Unlike palliative care programs outside the United States, patients must have a prognosis of 6 months or less to receive hospice care under the Medicare Hospice Benefit. Care is reimbursed on a per diem basis, and inpatient care is restricted to pain and symptom management that cannot be managed in another setting. Ethical dilemmas that face physicians referring patients to hospice programs include the ability of clinicians to predict accurately a patient prognosis of 6 months or less, and to what extent hospice programs and clinicians are obligated to provide patients with full information about their illness, as the Medicare Hospice Benefit requires that patients sign an informed consent in order to elect the hospice benefit. There are ethical dilemmas that affect day-to-day patient management in palliative care programs including physician concern over the use of morphine because of possible respiratory depression in the advanced cancer patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat near the end of life, and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. By following current research dogma, and only considering patient-generated data as valid, the patient population that most needs to be studied is excluded. A new methodology specifically for palliative care research is needed to provide information on the patients who are cognitively or physically impaired and unable to provide input regarding their needs near the end of life.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Ethical dilemmas in organ donation and transplantation

Since the first successful organ transplantation in 1953, we have seen an explosive development in transplantation surgery, particularly during the 1980s. With it followed an abundance of legal controversies and ethical dilemmas. Optimal use of viable organs necessitated precise definition of brain death in heart-beating cadavers with artificially maintained ventilation and circulation. Viable organs must remain well perfused to be suitable for procurement and transplantation into carefully selected recipients on an equal-opportunity basis. Due consideration must be given to both medical and social indications. At present, homografts dominate the field of organ transplantation; however, because of the shortage of human organs, both artificial organs (especially hearts) and xenografts are expected to become increasingly common in the near future. No doubt, the use of such modern technology will introduce additional ethical problems.     

Ethical dilemmas in perioperative nursing practice

Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways.