实施病区护士长一日五查房的效果评价

目的 探讨病区护士长一日五查房的实施效果.方法 护士长于晨会交班前、晨间护理后、上午下班前、下午上班后和下午下班前分别进行护理质量查房.结果 病区护理质量、患者满意度均提高,护理不良事件发生率下降(P＜ 0.01或P＜0.05).结论 护士长一日五查房对护理质量的提高有着重要的促进作用,有助于加强病房管理、融洽护患关系.     

Nursing management of urinary incontinence in geriatric inpatients

The management and treatment of incontinence represent two interrelated areas--providing enough providers of care and describing the types of management and treatment options available to the incontinent patient. This article has stressed that adequate staffing underlies any successful program of continence management and treatment. In addition, many options for the management and treatment of incontinence in the elderly have been presented. Of importance are the specific nursing implications that will make many continence protocols successful. These guidelines can provide the basis for planning patient care through the nursing process. This article has also addressed management and treatment strategies for incontinence that not only improve incontinence in patients but may cure it. These include behavioral management strategies which nurses should be encouraged to use in treating incontinent patients in the community. These same behavioral management strategies are being studied in inpatient settings, and the results indicate that nurses in inpatient settings and long-term care facilities should implement behavioral treatment programs for incontinent patients.     

Chronic pain in elderly nursing home residents: the need for nursing leadership

The incidence of chronic pain amongst elderly people in nursing homes is very high, making pain in this population a serious problem for aged care facilities. Research studies reveal a pattern of poor pain management in this setting despite the high incidence of pain suggesting that the management of pain in nursing homes is limited in scope and only partially effective. What is not fully appreciated by health professionals is the impact pain has on the lives of elderly people who live in nursing homes. In the study reported here a phenomenological method was used involving several in depth interviews with elderly people over a period of 9 months. Field notes of observations were also recorded as the participants went about their everyday lives in the nursing home. The discussion focuses on some of the themes drawn from the study with an emphasis on a key theme 'being constantly pained'. The findings of the study highlight what it is like to experience pain and how this impacts on everyday lives of elderly people. The paper concludes with some suggestions for health professional for improving care in this area.     

151例无陪护住院老年患者围手术期的护理管理

对医院外科系统9个科室需要手术的151例无陪护住院老年患者实施了围手术期无陪护护理管理.包括护理安全评估、护理照顾分级、设定无陪护患者围手术期临床路经、建立护理小组、进行护理质量控制等.解决了无陪护住院老年患者围手术期的安全与舒适问题,提高了患者及其家属的满意度.     

高龄患者人工髋关节置换术后并发症的观察与护理

目的探讨高龄患者行人工髋关节置换术后并发症的观察与护理。方法回顾性分析43例行人工髋关节置换术的高龄患者的病例资料及并发症观察情况。结果43例患者术后经系统康复护理,均治愈出院,经4～8周电话随访,髋关节功能恢复良好。高龄患者人工髋关节置换术后并发症发生率高,但经过及时规范的观察和护理治疗,康复效果良好。结论高龄患者人工髋关节置换术后,护理人员应加强术后观察,及时做好评估,预防早期并发症,采取积极措施,能提高手术成功率,也提高患者的生活质量。     

城市社区高龄老人生存现状调查

目的 了解杭州市部分社区高龄老人的生存现状,为政府及社区制定依托家庭护理和社区护理的养老服务政策提供参考依据.方法 采用便利抽样法选取杭州5个社区80岁及以上的老人为调查对象,使用调查问卷进行面对面调查,实际调查454名,调查率为71.2％.结果 高龄老人文化程度低,女性低于男性(P＜0.05);73.1％的老人与配偶或子女孙辈居住,20.7％的老人独居;高龄老人慢性病患病率高,为87.2％,失能比例高.结论 社区高龄老人慢性病患病率高,失能比例高,政府与社区应加强社区高龄老人的慢性病管理和老年护理工作,有针对性地增加家庭护理内容,给予女性高龄老人、独居老人及失能老人更多的关注与护理,以整体改善社区高龄老人的生存质量.     

Nursing assessments in the inpatient geriatric population

Thorough assessment is essential in caring for the institutionalized elderly who have difficulty with urine control. The assessment should include a physical examination, a functional assessment, and an evaluation of the environment. The physical examination should be completed in a timely fashion after incontinence develops in order to rule out treatable causes of urine loss. The examination includes a health history and physical examination, with special attention being given to the genitourinary system. A urine specimen should be obtained during the examination to rule out bladder infection. The functional assessment of the patient is one of the most important aspects of the patient assessment. This is particularly true for elderly inpatients because much of the incontinence found in nursing homes is attributable to functional deficits. The functional assessment should address the history of the patient's incontinence, the patient's cognitive abilities and potential for participating in continence care, the patient's mobility, and the patient's abilities related to activities of daily living. Deficits in any of these areas may contribute to or cause urinary incontinence. In addition to the physical examination and functional assessment of the patient, the environment should be evaluated. The visibility, location, and structure of the toileting facilities can serve to either promote or impair urine control. In addition to the physical facilities provided, the overall nursing care approach may foster or hinder the patient's ability to maintain urinary continence. Nursing assessment that addresses these three areas will provide information that is needed to develop a nursing care plan that will maximize the patient's potential for urine control.     

医养结合老年科患者自理能力与分级护理、护理时间的相关性研究

目的：定量了解医养结合老年科患者每日所需的护理时间,探讨其与分级护理、患者日常生活自理能力（ADL）之间的关系,为科学完善老年分级护理标准提供参考。方法：采用现场记录法对安徽省某大型综合医院医养结合老年科进行了连续7天、以满足232名老年患者全部护理需要为目的的护理操作内容和时间的调查和分析。结果：不同护理级别、相同ADL分级的老年患者每日所需直接护理时间无统计学差异（P〉0.05）;同一护理级别、不同ADL分级的老年患者每日所需要的直接护理时间及总护理时间差异有统计学意义（P〈0.05）。结论：ADL评分能直接反映老年患者对直接护理的需求,能有效提示老年患者生活自理能力和相应的实际护理需求。建议在老年科由医生确定老年患者分级护理的I、II、III级,再由临床经验丰富的护士应用ADL量表进行A、B、C分级,即将老年患者划分为IA、IB、IC、IIA、IIB、IIC、IIIA、IIIB、IIIC 9项护理等级。     

Nursing needs of hospitalized older adults. Consumer and nurse perceptions

The proportion of older adults is increasing in Australia, and the proportion of older adults requiring medical care is expected to increase in the future. At the same time, budget restrictions are a reality for Australia's health system. Increasing need and decreasing resources suggest the need to focus on the quality aspect of treatment and care for older adults. Little research has been conducted in the area of perceived nursing needs of elderly patients during hospitalization. This is an important area of research because it is increasingly recognized that elderly patients have specialized needs and are the major consumers of health care. Even less research has compared patient and carer perceptions with those of nursing staff. This article is a literature review and an investigation of the quality of care elderly patients receive, and of patient and nurse perceptions of the importance of various nursing activities. Quality of care is reviewed in terms of perceptions of nursing care priorities and elderly patients' satisfaction with the quality of nursing care they receive. Research examining nurses' perceptions related to why they are unable to consistently provide quality nursing care to all elderly patients is also reviewed. By identifying the nursing needs of elderly patients and educating nursing staff about these needs, professional practice can be guided and improvements in quality of care, patient satisfaction, and patient outcomes may occur.     

Educating nurses to care for the incontinent patient

Urinary incontinence among nursing home patients is a very common problem. Until quite recently, incontinence was believed to be impossible or unnecessary to treat except through the use of absorbent pads and diapers. The cost of this type of management to the facility in terms of laundry, labor, and supplies, as well as to patients' well-being, is very high. Recent data suggest that at least some incontinent nursing home patients can benefit from treatment programs that can be taught to the nurse's aide staff and that, at the very least, will reduce laundry and supply costs. The significance of an improvement in patient morale or a decrease in the incidence of complications resulting from incontinence has yet to be assessed, but should be considered. In addition, even a partially successful treatment program may be helpful to the nurses caring for these patients as the nurses' sense of hopelessness and frustration about managing incontinent patients may be reduced. Finally, an active treatment program for continence, instituted by nurses, advances the nursing care of these patients from custodial nursing care to therapeutic nursing care.     

合肥市空巢老人慢性病患病情况及社区护理需求的调查

目的 了解合肥市空巢老人的慢性病患病情况及社区护理需求,为空巢老人的社区健康管理提供依据.方法 自行设计调查问卷,由经过系统培训的调查员在社区卫生服务站或人户对1 016名空巢老人进行问卷调查.结果 空巢老人慢性病患病率为67.52％,患病居前5位的慢性病依次是高血压、冠心病、糖尿病、脑血管病、慢性支气管炎.在社区护理...     

卫生棉条在神经外科大便失禁护理中的应用

[目的]探讨卫生棉条在神经外科大便失禁病人中的应用效果。[方法]将56例神经外科大便失禁病人随机分为实验组和对照组,实验组使用卫生棉条,对照组使用传统方法进行护理。观察两组每天排便次数、皮肤并发症、每天护理时间、护理满意度等情况。[结果]实验组每天排便次数少于对照组,皮肤并发症发生率低于对照组,每天护理时间短于对照组,满意度高于对照组（P〈0.05）。[结论]应用卫生棉条对神经外科大便失禁病人进行肛周皮肤护理,是一种理想的护理方法。     

Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements.

INTRODUCTION: An identification system utilizing the therapeutic intervention scoring system (TISS) was developed to differentiate between intensive care and high-dependency unit (HDU) patients. OBJECTIVE: To overcome the staff recruitment and retention problem, ward nursing staff were recruited into the unit. To ensure patient care requirements did not exceed nursing skill level, TISS was utilized to differentiate ICU from HDU patients and to identify nursing skill requirements. METHOD: All patients admitted to the unit over a 23-month period were concurrently TISS scored utilizing TISS -76 on admission (O/A), at 4-6 hours, day 1, day 2 and on discharge. Concurrent data on age, medical history, type of surgery and length of stay were collected. RESULTS: There were a total of 450 patients. Interventions utilized were mainly 1-, 2- and 3-point TISS values. The study identified the HDU patient group as being older, having a higher incidence of cardiac history and a shorter length of stay. The ICU patient group was identified as having undergone more major surgery. CONCLUSION: TISS is an effective triage tool for differentiating between ICU and HDU patients and identifying nursing skill requirements to care for the ICU and HDU patient groups.     

The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: A longitudinal correlational study

BackgroundWith the rapid increase in the number of long-term care hospitals in Korea, care quality has become an important issue. Urinary incontinence is an important condition affecting many residents’ quality of life. Thus, it is important that urinary incontinence be amenable to improving conditions with appropriate interventions, since a change in urinary incontinence status can reflect care quality in long-term care facilities if patient level factors are adjusted.ObjectivesWe aim to examine the impact of organizational factors on urinary incontinence care quality defined as the improvement of urinary incontinence status or maintenance of continent status post-admission to Korean long-term care hospitals.Design and dataThis is a longitudinal correlation study. Data came from two sources: monthly patient assessment reports using the Patient Assessment Instrument and the hospital information system from the Health Insurance Review and Assessment Services. The final analysis includes 5271 elderly adults without indwelling urinary catheter or urostomy who were admitted to 534 Korean long-term care hospitals in April 2008.MethodsMulti-level logistic analysis was used to explore the organizational factors that influence urinary incontinence care quality controlling for patient level factors.ResultsWith respect to the organizational factors, the findings showed that location and RN/total nursing staff ratio variables were statistically significant, controlling for risk factors at the patient level. The odds of urinary incontinence improvement from admission in urban long-term care hospitals were 1.28 times higher than rural long-term care hospitals. In addition, when a long-term care hospital increased one standard deviation (0.19) in the RN ratio, the odds of urinary incontinence status improvement or maintenance of continence status from admission increased about 1.8 times.ConclusionsThe most significant finding was that a higher RN to patient ratio and urban location were associated with better resident outcomes of urinary incontinence among organizational factors. For a better understanding of how these significant organizational factors influence positive care outcomes and provide more practical implications, studies should examine concrete care process measures as well as structure and outcome measures based on systematic conceptual models.     

老年慢性病患者连续护理小组的设立与效果

目的探讨老年慢性病患者连续护理小组的设立及效果。方法对自愿报名的163名护士进行评估考核,根据考核结果选择40名成绩优秀者组成连续护理小组,并对小组成员进行培训,对需要连续护理的老年慢性病患者实施连续护理。结果小组成员培训后考核成绩显著提高;连续护理实施后患者满意度提高(P0.01)。结论设立老年慢性病患者连续护理小组能提高护士业务水平及操作技能;保障出院患者能得到连续护理,提高其满意度。     

加强薄弱环节管理提高老年患者护理质量

目的加强薄弱环节管理,提高老年患者护理服务质量。．方法查找老年患者护理管理的薄弱环节有重点时段（重大节假日,双休日、早中晚时间段,危重患者抢救、出入院患者周转高峰期,治疗护理工作量大、护士人数减少的时段）;重点患者（危重、长期卧床、行动不便、静脉输液、手术及留置各种管道等易发生安全问题的患者）;重点护士（基本功不够扎实、服务意识不够强的护理人员）;重点环节（指交接班、医嘱执行和查对、患者特殊用药及治疗护理操作等环节）。针对这些薄弱环节制定有效的管理措施：按照工作量和患者情况合理调配人力资源,实行弹性排班;在重点时段和重点环节增加查房次数,加大检查指导力度;组织对重点患者进行安全评估,加强护理安全管理;加强基础护理质量管理。结果2006年在危重患者数量增加、护理人员不增加的情况下,基础护理质量合格率、操作考试达标率、患者满意度均较上年同期提高;不安全事件的发生数量减少。结论加强薄弱环节管理,有利于减少护理风险,提高老年患者护理服务质量。     

Nurses’ Opinions of Pain and the Assessed Need for Pain Medication for the Elderly

The undertreatment of pain in the elderly living in nursing homes is a significant problem. In Swedish nursing homes, the registered nurse on duty is often responsible for 20-40 patients during the day with no daily contact from attending physicians. The aim of this study was to investigate the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients using patient scenarios. Two patient scenarios were used in this study; a questionnaire and background information was provided. The scenarios consisted of one smiling patient and one grimacing patient, both with the same numeric rating scale value of pain, blood pressure, pulse rate, and respiration rate. Three questions regarding pain assessment and management followed the scenarios. The questionnaire was sent to all 128 registered nurses working daytime in elderly care in both municipal nursing homes and municipal home care in the mid-Sweden region. A total of 56 nurses participated, providing an answering frequency of 45%. Results showed that registered nurses with more experience did not have the same opinion about pain as the smiling patient and gave inadequate medication, which was not in accordance with recommendations from the county hospital and the World Health Organization.     

Quality standards for choosing an adult incontinence product

Urinary incontinence (UI) is the leading cause for institutionalization of the elderly. According to the Agency for Health Care Policy and Research (AHCPR), over 50% of the elderly resident population living in nursing homes are considered to be incontinent. In long term care facilities, 33% of medical supplies purchased are incontinence products. This 33% represents the number one item for this classification of expenses.