浅谈非语言性沟通技巧

在临床实践中，医护人员常常需要应用适当的沟通技巧去收集病人生理、心理、精神、社会文化等方面的健康资料，认真制定诊疗计划并同时建立和发展良好的医护患关系。然而很多情况下，医护人员往往把重点只放在语言沟通技巧上而忽略了非语言沟通技巧的应用，从而使医护患间沟通的有效性大打折扣。由于非语言性沟通具有较强的表现力和吸引力，又可跨越语言不通的障碍，所以往往比语言性信息更富有感染力。因此，必须掌握一些非语言沟通技巧的知识并在临床工作中运用适当的非语言沟通技巧以增加医护患间沟通的有效性，从而提高医疗护理的水平。     

成年听力障碍女性生殖健康问题初探

目的 探索成年听力障碍女性在孕期、围生期保健及避孕方面可能存在的问题,为促进其生殖健康改善提供依据.方法 借助访谈导引共访谈12例符合条件的成年听障女性.访谈录像,转录音频资料,并对转录文本进行确认及内容分析.结果 共找出4个主题:知识有限、被动获取知识、完全家庭依赖及不愿回答某些避孕问题.其中,孕期、围生期及避孕方面均存在知识有限及被动获取知识,完全家庭依赖在孕期及围生期显著.结论 孕期、围生期及避孕方面,成年听力障碍女性的生殖健康更易受威胁,因此需要医护人员给予更多指导帮助.     

ICU人文关怀查检单的设计及应用

目的 通过设计一种符合ICU特色的人文关怀查检单,搭起医护人员-患者及家属之间的沟通桥梁,进一步指导医护人员在临床实践中进行更全面的与患者及家属沟通,以提高ICU护患沟通的准确性和有效性,更加精准地为患者提供人性化、个性化的优质护理服务,最终提升护理服务质量和患者住院的满意度.方法 参照相关文献并结合科室实际情况设计ICU人文关怀查检单,2016年4—6月将其应用于入住ICU的危重患者,对重症患者的基本信息、患者日常的需求信息、医护-家属沟通需求信息进行如实填写,每班进行交接,并动态的根据患者及家属需求的变化而进行调整,观察患者及家属的需求情况,以及在ICU住院期间(≥1 d)的满意度.结果 重症医护团队对人文关怀查检单进行100%实施,有效地指导医护人员与患者及家属之间的沟通,同2015年全年(4个季度)的住院满意度、2016年第1季度的住院满意度相比,2016年第2季度的患者住院满意度最高.结论 将人文关怀查检单应用于ICU重症患者,有助于更好地实现医护-患者及家属之间的沟通,提升ICU的护理服务质量和ICU患者住院满意度.     

重型颅脑创伤患者转出ICU后早期家属内心体验与需求的质性研究

【】 目的 探究家属在重型颅脑创伤患者转出ICU后早期的内心体验与需求,为制定针对性的护理干预措施提供参考依据。方法 采用描述性现象学研究法,目的抽样选取从ICU转出早期的重型颅脑创伤患者的直接照护者8名,进行面对面半结构式深度访谈,运用Colaizzi现象学研究法对访谈内容进行整理分析,提炼主题。结果 经过阅读、分析、反思、分类和提炼,总结出一级主题3个,包括:复杂的心理感受、心理压力的促进因素和多维度的需求;二级主题9个,包括:期待患者早日转出ICU、对患者转出后的安全存在焦虑、对照护工作感到压力、治疗环境和护理模式的改变、社会支持不足、心理和情感的支持、信息的及时提供、医护患的有效沟通、基础照护知识和技能的学习。结论? 医护人员应关注重型颅脑创伤患者转出ICU后早期家属的心理压力,并积极满足家属的需求,在患者转出ICU前、中、后,给予家属心理和情感支持、提供及时有效的信息、促进医护患的有效沟通和提升家属的照顾能力,帮助家属顺利过渡,减少迁移应激的发生。     

杭州市听力障碍患者就医体验现状调研

目的了解杭州市听力障碍患者的就医体验现状。方法基于PZB理论模型、运用问卷对156例患者进行就医期望与实际体验的调查,采用个案访谈方法对145例患者家属及57名医护人员进行访谈。结果听力障碍患者就医过程中,期望与实际体验差异最明显的维度为"沟通",实际得分最高为"防感染意识"。听力障碍患者家属期望与实际体验差异在医疗技术和诊疗态度这两个方面较小,而对沟通方面较不满意。医护人员期望与实际体验差异最显著的是沟通时间和沟通方式。结论听力障碍患者就医过程中体验与期望差距最大的方面为沟通,医护人员在提供服务的过程中需要注意沟通的方式和技巧,提高沟通效果。     

乳腺癌患者及家属对“患者自我报告睡眠障碍结局”的认知及参与意愿调查

目的描述乳腺癌患者及家属对患者自我报告睡眠障碍结局的认知和参与意愿。方法采用描述性研究,运用自行设计的认知现状及参与意愿调查问卷对279例乳腺癌患者及家属进行问卷调查。结果 28.7%的研究对象对患者自我报告非常了解,11.1%的研究对象认为患者自我报告结局能较大地改善患者疾病体验,12.2%的研究对象认为患者自我报告结局能较大地促进医患和护患沟通;35.5%的研究对象在实际就医中经常向医护人员自我报告睡眠障碍相关信息,49.8%的研究对象愿意考虑用"患者自我报告"的方式向医护人员反映睡眠障碍方面的相关信息。家庭月收入10 000元者更常向医护人员自我报告睡眠障碍相关信息,更愿意用患者自我报告向医护反映睡眠障碍相关信息。年龄越小,在未来就医中越打算用患者自我报告向医护反映睡眠障碍信息,也越认为身边病友及家属会认为患者自我报告睡眠障碍具备临床价值。患者对自我报告的认知越好,其参与意愿越高。结论乳腺癌患者及家属对自我报告的认知缺乏,参与意愿不高。不同年龄、收入水平和认知情况均会影响其对睡眠障碍自我报告结局的参与意愿。医护人员可以将睡眠障碍自我报告整合到乳腺癌患者的临床实践中,提高患者参与自我报告的意愿,以提升就医体验。     

专业差异性及规章制度对手术室团队合作影响的质性研究

目的探讨专业差异性及规章制度对手术室团队合作的影响,为提高手术室团队的合作能力提供依据。方法运用质性研究方法,对15名手术室医护人员进行深度访谈,按照现象学方法对资料进行整理和分析。结果得到了不同专业之间的差异导致团队内部的沟通合作不佳、不合理的规章制度导致团队内部的沟通合作不佳和通过教育可以提高手术室团队的沟通合作能力3个主题。结论医护间要尽量多交流共享信息,管理者需要不断完善原有的不利于团队团结合作的制度,加强对新进医护人员合作理念的教育培训。     

脑卒中吞咽障碍患者照顾者需求的质性研究

目的 了解脑卒中吞咽障碍患者照顾者的需求,为构建脑卒中吞咽障碍患者照顾者培训体系、减轻照顾者负担、促进脑卒中吞咽障碍患者康复提供参考.方法 采用质性研究中的现象学研究方法,选取11名脑卒中吞咽障碍患者照顾者进行半结构式访谈,对访谈资料进行转录、编码、分析、总结和归纳.结果 脑卒中吞咽障碍患者照顾者需求可提炼为4个主题:知识缺乏、渴望社会支持、心理负担过重和延续护理服务欠缺.结论 脑卒中吞咽障碍患者照顾者存在多方面的需求,医护人员应重视照顾者的需求,给予照顾者吞咽障碍知识指导、心理社会支持及延续性护理支持,提供专业且个性化的措施满足其合理需求,以提升照顾者的照顾能力,减轻其心身负担,促进患者康复.     

沟通流程标准化模式在医护沟通中的应用现状

介绍沟通流程标准化模式(SBAR沟通模式)在临床医护沟通中的应用形式和有效性,提出我国目前医护人员应用SBAR沟通模式需要提高依从性和沟通技巧,探索我国今后在临床和医学教育中提高医护人员对SBAR沟通模式的信息传递方式、范围和跨专业合作等方面的实践指导。     

心内科住院患者与医护人员沟通用药信息的主观障碍性因素的质性研究

目的 深入了解住院患者与医护人员沟通用药信息的主观障碍性因素.方法 采用Edmund Husserl & Heidegger的观点构成的质性研究对10例心内科住院患者进行深入访谈,现场录音和笔录,并运用Colaizzi的分析方法进行分析,了解心内科住院患者与医护人员沟通用药信息的主观障碍性因素.结果 内科住院患者与医护人员沟通用药信息存在着动机模糊或缺乏、“好患者”、对护士在用药信息的提供方面存在认识误区3个方面的主观障碍性因素.结论 患者与医护人员沟通用药信息的主观障碍因素严重影响着患者临床用药信息的掌握,从而影响着患者安全及有效用药,把握这些因素,可以促进药物安全和有效发挥药效.     

Preferences for communication in clinic from deaf people: a cross‐sectional study

Aims and objectives To explore the preferences of deaf people for communication in a hospital consultation. Methods Design – cross‐sectional survey, using a structured, postal questionnaire. Setting – survey of readers of two journals for deaf and hard of hearing people. Participants – 999 self‐selected individuals with hearing loss in the UK, including those who use sign language and those who use speech. Main outcome measures – preferred mode of communication. Results A total of 11% of participants preferred to use sign language within everyday life, 70% used speech and 17% used a mixture of sign and speech. Within a clinic setting, 50% of the sign language users preferred to have a consultation via a sign language interpreter and 43% indicated they would prefer to only have a consultation directly with a signing health professional; 7% would accept a consultation in speech as long as there was good deaf awareness from the health professional, indicated by a knowledge of lip‐reading/speech‐reading. Of the deaf speech users, 98% preferred to have a consultation in speech and of this group 71% indicated that they would only accept this if the health professional had good deaf awareness. Among the participants who used a mixture of sign language and speech, only 5% said they could cope with a consultation in speech with no deaf awareness whereas 46% were accepting of a spoken consultation as long as it was provided with good deaf awareness; 30% preferred to use an interpreter and 14% preferred to have a consultation directly with a signing health professional. Conclusions The hospital communication preferences for most people with deafness could be met by increasing deaf awareness training for health professionals, a greater provision of specialized sign language interpreters and of health professionals who can use fluent sign language directly with clients in areas where contact with deaf people is frequent.     

手语在门诊导诊中的应用与效果

目的探讨手语在门诊导诊中的应用与效果。方法组织门诊导诊护士学习手语,用手语与聋哑患者交流、导诊,就诊、检查、取药时充当翻译角色。结果导诊护士手语表达考核通过率达90.00%;聋哑患者对导诊服务满意度达100.00%。结论应用手语与聋哑患者交流可提高患者对导诊服务的满意度。     

护士随专家出诊对糖尿病患者进行健康教育的方法与效果

目的探讨新的全程糖尿病教育模式,满足门诊患者的需求。方法由随专家出诊的糖尿病教育护士接诊,对患者进行健康教育,并根据不同情况制订教育计划,实施个性化教育。结果实施后门诊患者的遵医行为优于实施前（P〈0．05或P〈0．01）。对就诊的满意度提高（P〈0．05）。实施后门诊人数增长至1464人次／年,患者复诊率增加。结论糖尿病教育护士随专家出诊的教育模式,有利于提高门诊患者对疾病的认知水平和依从性,提升糖尿病教育护士角色认同,优化就诊程序。     

门诊医生对护士素质要求的调查

目的 探讨门诊医生对护士的素质要求.方法 采用自设问卷调查316名门诊医生对护士的素质要求.结果 门诊医生对护士的年龄、学历有一定要求,对护士预先分诊、了解疾病的专科归属和诊断治疗知识掌握程度的要求较高;希望护士能掌握一些常见的化验检查结果,并对患者进行必要的解释;希望护士能定期培训,更新知识;希望护士的形象和语言规范...     

门诊老年慢性病患者健康信息来源与需求的调查研究

目的 调查门诊老年慢性病患者健康信息来源与需求现状,为开展门诊健康教育提供依据。方法 对2021年11月至12月上海市某三甲医院门诊老年慢性病患者进行问卷调查。 结果 门诊老年慢性病患者最重要的健康信息来源是门诊医生(94.3%),其次是门诊护士(80.2%)、其他患者(70.4%)、门诊健康讲座(59.0%)、医院免费健康读物(58.1%)、亲友(55.1%)；最信任的三个健康信息来源门诊医生(88.6%),门诊护士(39.2%)、门诊健康教育讲座(32.5%)；最信任以上三个健康信息来源的原因是信息内容权威性(88.9%)、发布者的权威性(85.0%)、传播媒介权威性(66.5%)；门诊老年慢性病患者健康信息需求最高的内容是可靠医生(96.0%)、合适的治疗手段(92.5%)、疾病预防(89.4%)；门诊老年慢性病患者最信任的获取健康信息的场所是医疗机构的门诊(94.7%)；门诊老年慢性病患者(83.1%)认为有必要在门诊设置固定场所帮助患者获取健康信息。结论 门诊老年慢性病患者的健康信息需求较大但来源较为局限。建议医护人员拓宽患者健康信息来源的途径,加强与患者的合作,同时应从患者的健康信息需求出发,提高门诊健康教育精准度。此外,医院管理者可设置门诊健康教育咨询点,便于老年慢性病患获取健康信息。     

Access to New Zealand Sign Language interpreters and quality of life for the deaf: a pilot study

Purpose.?This paper aims to: (1) explore usage and accessibility of sign language interpreters, (2) appraise the levels of quality of life (QOL) of deaf adults residing in New Zealand, and (3) consider the impact of access to and usage of sign language interpreters on QOL.

Method.?Sixty-eight deaf adults living in New Zealand participated in this study. Two questionnaires were employed: a 12-item instrument about access and use of New Zealand sign language interpreters and the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF).

Results.?The results showed that 39%% of this sample felt that they were unable to adequately access interpreting services. Moreover, this group scored significantly lower than a comparable hearing sample on all four WHOQOL-BREF domains. Finally, the findings revealed that access to good quality interpreters were associated with access to health services, transport issues, engagement in leisure activities, gaining more information, mobility and living in a healthy environment.

Conclusions.?These findings have consequences for policy makers and agencies interested in ensuring that there is an equitable distribution of essential services for all groups within New Zealand which inevitably has an impact on the health of the individual.     

A survey of the accessibility of chiropractic clinics to the disabled.

OBJECTIVE: To determine to what degree chiropractic clinics are complying with the Americans with Disabilities Act (ADA), which mandates that health care clinics be accessible to the disabled. METHODS: A survey was developed and mailed to 200 chiropractic clinics in Orange and Los Angeles counties. The survey asked about the essential necessities for health care clinics to be accessible to the wheelchair-bound, the blind, and the deaf. It also sought to discover how many disabled patients these clinics were treating and the attitudes of practitioners and staff toward this population. RESULTS: The response rate was 50.5%. Accessibility for the wheelchair-bound was high. Accessibility for the blind was limited by a lack of Braille signs. Accessibility to the deaf was limited by lack of telecommunications device for the deaf or use of sign language interpreters. Most clinics were treating few or no disabled patients and did not perceive a need to become more accessible. CONCLUSION: There appears to be poor compliance with the ADA in chiropractic clinics in Los Angeles and Orange counties. Although data are lacking, it appears likely that the disabled population is being underserved by the chiropractic profession. Education for chiropractors on the rights and needs of the disabled population is necessary to give this group equal access to chiropractic health care.     

Nursing interpreters? Interpreting nurses?

Swiss hospitals are characterized by an increasing diversity, in the sense of personal and social differences such as including origin, gender language, skills, age, lifestyles and social status. Diversity is a challenge for hospitals. It is crucial to language barriers and migration and their clinical consequences. In spite of a trend towards interpreter services "going professional", interpreters are only reluctantly used. This is surprising. In this article we deal with three questions: What are clinical consequences of language barriers? How can language barriers be overcome? Should nurses act as interpreters? The literature available clearly shows that due to insufficient flow of information patients speaking a foreign language tend to receive inadequate care. Also, there is a consensus that patients' relatives acting as ad hoc interpreters are ill-equipped or unsuited to overcome language barriers. Conversely, professional interpreters improve most evidently the quality of care of patients speaking a foreign language. However in clinical everyday life the consistent use of interpreters is not always feasible. Thus, the setting-up of a pool of hospital-based ("internal"), trained bilingual health professionals appears to be an acceptable alternative.     

专科护理会诊在腹膜透析病人护理中的应用

[目的]探讨非腹膜透析专科腹膜透析护理中专科护理会诊的方法及效果。[方法]分析2010年5月—2013年4月腹膜透析专科护士对在非腹膜透析专科住院的56例腹膜透析病人进行的专科护理会诊,总结专科护理会诊的成效。[结果]专科护理会诊的实施,提高了非腹膜透析专科护士腹膜透析相关知识及操作技能的掌握,建议请腹膜透析专科医生会诊协助治疗的有38例,纠正非腹膜透析专科护理人员对腹膜透析病人的不正确护理9例,提高了治疗及护理效果。[结论]建立非腹膜透析专科住院病人的护理会诊制度,解决了腹膜透析专科护理问题,使腹膜透析病人得到同质护理,提高了护理质量,体现了专科护士的价值。     

Communicating effectively with deaf patients

This article explores the communication needs of deaf patients who use British Sign Language as their first or preferred language. It would appear that these needs are not being met, particularly in acute hospital settings. Practical advice is provided for nurses to improve the quality of care that deaf patients receive.