急诊急救常见隐患及防范措施

随着医学科学的发展,院前急救作为抢救患者的第一环节尤为重要,我们对4年来出诊前准备、现场急救、转送中常出现的隐患进行分析总结,并提出相应防范措施,以减少护理差错及护患纠纷,提高院前急救效果。现报告如下。1常见隐患1.1出诊前①呼救电话接听不详:对急救患者的病情、发病时间、地点及对方联系方式询问不详细,导致救护车空跑或延时到达,延误患者抢救。②出诊不及时:部分医护人员及司     

院前急救的护理风险识别与防范

急救医疗的核心是争取时间与抢救生命。院前急救是急救医学的首要环节和重要基础,院前急救时间短、风险大、病种复杂多变,为提高急救时效性,本文探讨了院前急救的风险及防范。1院前急救的风险1.1时间因素院前急救成功的关键是时间。文献报道,急、危、重症患者死于原发病的不到10%,多由于抢救时机延误、并发症加重而死亡。由于交通状况、呼叫电话接听不祥、出诊速度慢等原因,延长了院前急救反应时间,使急救车辆不能在最短的时间到达急救现场,医护人员不能及时有效的判断、救治,均可延误抢救时机,“无治疗期”的延长直接影响院前急救的效果。1.2急救效果院前急救的目的是早期、有效救治患者,提高生存率和最佳生活状态,减少后遗症。急救车是流动的ICU室,出诊抢救物资准备不充分、不齐全、不适用,会直接影响抢救效果。在急救过程中各种操作不规范,病情判断处置失误,急救技术操作不熟练或速度慢,都直接影响院前急救的质量,也会导致医患纠纷的发生。1.3开放性急救环境院前急救处于开放性的环境,是对现场医护人员急救技术、态度、速度等多方面的考验。医护人员对患者实施的急救、治疗、护理等,家属均亲眼目睹。任何一点疏忽、说话不当,极易引发纠纷。转运途中病情交待不祥...     

院前急救的护理

院前急救是指各种遭受危及生命的急症，包括创伤、中毒、灾难事故、内科急症等患者需要及时抢救，患者或家属拨打“120”急救电话，急救中心收到信息后立即组派医护人员迅速到达患者所在现场施行的急救。该种治疗为挽救患者生命和减少伤残进行的初步处理为患者进一步的诊治创造条件。我院从开通“120”急救电话后1a多时间，对患者的抢救率90％以上，现将我院实施的院前急救的护理体会报告如下。     

院前急救出诊工作中常见隐患及防范措施

目的探讨院前急救出诊工作中常见的问题及可能出现的隐患,并提出相应的防范措施,来提高院前急救效果,减少医患纠纷。方法结合我院十余年来院前急救工作中的经验和教训来分析探讨院前急救工作中的隐患,并采取相应的防范措施。结果通过分析发现出诊前常见隐患,如:呼救电话接听不详细、出诊速度偏慢、出诊物资准备不齐全等。现场急救过程中常见隐患,如:急救人员技术不熟练、现场处理不当以及与患者家属沟通不够等。转运途中交通堵塞、监护不严、是否对患者进行妥善固定等。院前医疗文书书写不规范、记录不准也是院前急救出诊工作中常见问题及隐患。结论通过采取相应的防范措施:加强管理、完善规章制度、通畅通讯联络、扎实地学习急救知识、刻苦训练掌握急救技术、备齐必备的抢救设备、药品以及规范院前文书书写,可使院前急救速度加快、院前急救的效率及急救成功率提高,减少医患纠纷。另外加强相关法律知识、传染病知识的学习,外语培训以及不断更新急救领域的知识等十分必要。     

对患者家属普及院前急救常识的效果观察

目的了解患者家属对急救常识的需求并开展院前急救常识普及活动,以提高患者家属急救意识,普及院前急救常识。方法在培训前进行的患者家属对急救知识与技能培训需求调查中,100％认为参加院前急救常识培训很有必要。针对此,在院内15个科室20个病区组织133名患者家属参加院前急救常识普及活动。由护理人员对培训者讲授院前急救常识,包括展示现场急救知识展版,给每位培训者发放现场急救知识图片1套,理论讲授知识点,如现代救护观念、幼儿烫伤现场急救、中风的自救互救、心肺复苏、气道梗阻;演示急救技能;采用体验式教学,分组练习,手把手教,一对一指导练习。结果通过培训,全部对象操作合格。1次操作通过率6．8％（9人）,2次操作通过率47．4％（63人）,3次操作通过率31．5％（42人）,4次操作通过率14.3％（19人）。结论对患者家属进行院前急救常识普及,可提高急救医疗服务系统到达前的抢救水平。     

院前急救护理的隐患与对策

总结了院前急救护理中的常见隐患与对策，包括出诊前呼救电话记录不详细，出诊不及时，急救物品及药品不完备；现场急救护士业务技术不熟练、专科知识欠缺、不能准确评估病情；转运途中未严密关注患者安全，责任心不强，仪器性能不稳定；急救记录时间与医生不一致，内容不详细等。认为建立一套完善的院前急救制度和流程，不断提高出诊护士的业务水平、法律意识和护理文件书写水平。加强急救物品器材管理，才能确保终末质量，最大限度抢救病人生命，杜绝差错事故的发生。     

呼救“晕厥”患者院前急救程序标准化效果观察

目的:探讨标准化院前急救程序在呼救"晕厥"患者院前急救中的效果。提高院前急救效率,规避院前急救风险。方法:对256例呼救"晕厥"的院前急救患者随机采取不同的院前急救程序急救,其中130例采取非标准化院前急救,126例进行标准化的院前急救。统计病种并对患者或家属进行院前急救满意度调查。结果:呼救"晕厥"患者病种复杂,心跳骤停占7.0%,昏迷占14.8%,晕厥占19.1%,癫痫状态占17.6%,死亡占23.8%,其他占17.6%。出车响应时间满意度评分非标准化组45.8%,标准化组87.3%;现场急救满意度非标准化组76.3%,标准化组85.1%;安全转运满意度非标准化组85.2%,标准化组95.5%,差异有统计学意义(P<0.01)。结论:呼救"晕厥"患者采取标准化的院前急救程序可以缩短出车响应时间,提高现场急救和转运成功率,减少医疗纠纷。     

院前急救中的风险因素分析及管理

目的了解院前急救中的风险因素,提出管理对策。方法自设院前急救风险问卷调查表,对浙江省内从事院前急救工作的137名医生和护士进行问卷调查。结果不同工作年限的医护人员均认为位居前3位的风险因素有2项:患者信息不准确;疾病的严重性、复杂性。另外,工作年限1～3年的医护人员较多地强调客观或他人因素带来的风险;4～6年及7年以上的医护人员有较多的共识,他们能意识到自身原因带来的风险。院前急救流程中的重点风险环节有:电话受理环节1项;现场救护环节6项;出车环节2项;管理环节6项。结论管理者要规范院前急救流程,加强重点风险环节管理;让院前急救人员学会识别风险,提高对风险的预见性,针对不同工作年限的医护人员分别组织学习培训,增强医护人员对重危患者病情的评估能力和预见性;主动与患者及家属沟通交流,及时履行告知义务,从而得到患者及家属的信任、理解与合作。     

172例高血压脑出血患者的院前急救与护理

目的探讨高血压脑出血的院前急救及护理措施。方法对172例高血压脑出血患者的院前急救进行回顾性分析，由急救车及医护人员现场接回121例，采取了现场急救及转运途中救护。由普通车辆运送家属陪同进院42例，由家属背入院9例，两种方式院前均未采取任何急救措施。结果急救车接入院121例中死亡2例，普通车或背入院51例中死亡8例，由急救车接入院患者的死亡率明显低于家属用普通车辆运送或背入院者。结论积极开展现场急救、转送途中救护为缓解患者入院前的危险性、提高抢救成功率提供了有力保障。     

院前急救中常见隐患及防范措施

现将我院开通 12 0急救系统 3年来 ,对常见的急救隐患及防范措施总结如下 ,供同行们参考。1　常见隐患1.1　出诊不及时。由于医护人员及司机急救意识不强 ,时间观念淡漠 ,不能及时、整齐地赶到集合点 ,未能在规定时间内出诊 ,延迟抢救时间 ,而导致纠纷[1 ] 。1.2　呼救电话接听不详。接听呼救电话的医护人员未详细询问清楚急救病人的病情、发病时间、地点 ,导致专科医生派错 ,救护车空跑 ,延误病人的抢救[1 ] 。1.3　抢救物资准备不充分。由于急救物品配备不足 ,出诊人员出发前又未仔细检查 ,导致急救人员到了现场才发现抢救物资该带的没有…     

When the unreal becomes real: family members' experiences of cardiac arrest

The aim of this study was to provide insight into family members' experiences related to cardiac arrest. Data were collected through semi-structured interviews with 17 family members approximately 5-34 months after the cardiac arrest of a relative. As the focus was on the family members' experiences seen from a holistic perspective, content analysis was chosen for the study. When the event occurred to the patient, family members realized the need for assistance and managed to initiate first actions. When the emergency medical service arrived, family members responded to stress and forgot their own needs. When the staff took over at the hospital, family members not only received sympathy but also encountered professional distancing. Because their experiences vary widely, the encounter has to be developed through a comforting, sympathetic and respectful dialogue in consideration for individuals' preferences.     

The attitudes of cardiac arrest survivors and their family members towards CPR courses

OBJECTIVES: to evaluate self-assessment of first aid knowledge, readiness to make use of it in case of a medical emergency and judgement of a 1-day CPR course by cardiac arrest survivors, their family members and friends as compared to the general public. BACKGROUND: the recurrence rate of a cardiac arrest after successful resuscitation is high and most of out-of-hospital cardiac arrests occur at the patient's home. METHODS: medical students trained in basic and advanced life support provided 101 members of the target group and 94 of a sex and age matched control group with a 1-day course in CPR. RESULTS: after the course, half of the participants in both groups considered their knowledge of first aid to be very good or good. The readiness to perform first aid in a medical emergency increased significantly. Of the target group 96% of the participants as compared with the control group where 91% felt confident to recognise a cardiac arrest; 79 versus 68% considered themselves capable to perform CPR if needed. The course was judged as very good in 71 versus 69% and as good in 25 versus 27% with no differences between groups. CONCLUSION: one-day CPR courses are well accepted by cardiac arrest survivors, their family members and friends and help to reduce fears of reacting in medical emergencies. They seem to be more motivated to gain and use first aid knowledge than others.     

Interaction between adult patients' family members and nursing staff on a hospital ward

The purpose of this study was to generate knowledge of the interaction between an adult patient's family members and nursing staff from the staff's perspective. Data were collected from nursing staff (n = 155) working on the wards and out-patient departments for pulmonary, rheumatic, neurological and gastroenterological diseases at a university hospital by using a new questionnaire based on earlier research and the literature. The questions explored the staff's views of interaction with the adult patient's family members. In this study, interaction is seen as an umbrella concept which encompasses giving information to relatives, discussion, contacts between staff and significant others and working together. The instrument included questions about personal and telephone discussions, the provision of written instructions and factors facilitating and complicating interaction. The response rate was 55%. The data were analysed using SPSS software and examined using frequency and percentage distributions and cross-tabulation. The open-ended questions were analysed using qualitative content analysis by reducing, grouping and abstracting the data inductively. Discussions with relatives while they visited the patient in hospital were the commonest form of interaction. The majority of respondents perceived the interaction with the patient and knowing his or her family members as important. Less than one-fourth of the respondents started discussion with family members, while the majority expected family members to initiate interaction. The majority of respondents perceived the patient's presence in discussion as important, but sometimes they thought it was necessary to discuss with family members without the patient. The staff discussed with family members mainly in the ward office or in patient rooms, which were, however, not perceived as peaceful. Discussions primarily pertained to the patient's condition, discharge from hospital and planning of continued treatment. The majority of respondents reported that the opportunity for discussion offered by staff, the patient's positive attitude towards discussion with the family and family members' own interest facilitated interaction. The staff's haste and shift-work, family members' shyness of approaching the staff and the absence of a peaceful place for discussion serve to complicate interaction. Family members are primarily seen as informants and recipients of information. The staff's ability to recognize the importance of family members to successful patient care is relatively adequate. However, insufficient attention is paid to family members and their need for support.     

脑卒中患者家属康复知识水平与患者康复效果的关系研究

目的了解脑卒中患者家属康复知识的掌握情况与患者康复训练效果的关系。方法将200名患者及家属随机分为对照组和宣教组,每组包括患者和家属各50人。对照组只进行常规治疗和简单的康复说明;宣教组除常规指导外,还逐个进行有针对性的康复知识宣教及具体的康复训练指导,强调家属的积极参与作用。对比分析干预前后两组患者肢体功能改善情况和对应患者家属康复知识的掌握情况,并分析患者肢体功能改善情况及患者家属康复知识掌握的相关性。结果宣教组患者功能恢复情况好于对照组,尤其在上肢功能、下肢功能及平衡功能恢复方面,2组之间的差异有统计学意义（均P〈0.05）。脑卒中患者家属康复护理知识掌握情况与患者肢体功能的恢复情况之间存在正相关关系。结论对患者家属进行康复护理知识与技能宣教可促进患者功能恢复。     

晚期肿瘤患者家属对压疮认知的调查分析

目的探讨肿瘤患者家属压疮认知程度的影响因素。方法对2005年5月至2008年12月由院外带来的74例晚期肿瘤压疮患者家属共240人进行护理干预前后压疮认知程度的对照分析。结果文化程度和年龄是家属对压疮认知程度的主要影响因素,护理干预后家属认知程度均有提高,与干预前比较差异有统计学意义（P〈0．05）。结论针对文化程度、年龄等影响因素对家属采取针对性护理干预可以有效减少晚期肿瘤患者压疮的发生率,改善患者生活质量。     

外科监护室病人家属需求和心理状况调查

目的 :了解外科监护室 (SICU )病人家属的需求和心理状况。方法 :对87例病人家属进行问卷调查。结果 :家属对SICU的各项需求值在 3.88分～ 4.72分 (总分 5分 ) ,对SICU各方面满意值在4.5 2分～ 4.72 (总分 5分 ) ,焦虑值比常人高 ,焦虑值与家属认为亲人的病情严重程度呈正相关 ,与家属对访客制度的满意程度呈负相关。结论 :家属对SICU有较高需求 ,他们比常人焦虑 ,医护人员应尽量满足家属合理需求 ,减轻其焦虑心理 ,以更好地发挥家属对SICU病人的正性支持作用。     

222名颅内肿瘤患者家属决策冲突现状及影响因素分析

目的 调查颅内肿瘤患者家属决策冲突现状,分析其影响因素。方法 采用便利抽样法,于2021年9月—2022年2月选取乌鲁木齐市3所三级甲等医院符合纳入标准的222名颅内肿瘤患者家属作为研究对象。采用一般资料调查表、决策冲突量表、领悟社会支持量表和自我效能量表进行调查。采用多重线性回归分析颅内肿瘤患者家属决策冲突的影响因素。结果 本组颅内肿瘤患者家属决策冲突总分为（34.74±14.38）分,多重线性回归分析结果显示,患者肿瘤类型及患者家属经济压力、与医护讨论患者病情频率、领悟社会支持和自我效能进入回归方程（P<0.05）,共解释总变异的33.5%。结论 本组颅内肿瘤患者家属决策冲突处于中等偏下水平,患者肿瘤类型及患者家属经济压力、与医护讨论患者病情频率、领悟社会支持和自我效能是决策冲突的影响因素。医护人员应借助个性化、针对性的医疗决策辅助工具,改善患者家属的决策信心,降低其决策冲突水平。     

PDCA循环法在重危患者家属管理中的应用

目的：探讨PDCA循环法在重危患者家属管理中的应用方法及效果,深化优质护理服务,提高家属满意度。方法建立PDCA循环法家属管理模式,根据重危患者家属管理的现状分析,发现问题,分析原因及影响因素,制定计划并实施,评价效果,跟进检查,提高计划落实的有效性,分析结果,对未解决的问题转入下一个PDCA循环。结果与传统家属管理模式比较,PDCA循环法家属管理模式患者家属滞留和投诉显著减少,表扬显著增加(均P<0.01)。结论 PDCA循环法家属管理模式将管理与人文关怀相结合,深化了优质护理服务,提高了家属满意度。     

心脏疾病患者家属院外心脏急救知识调查及分析

目的通过对心脏疾病患者家属心脏急救知识的认知情况及需求程度的调查,探讨如何对其进行心脏急救知识的普及教育。方法采取问卷调查法对200例心脏疾病患者家属进行调查,内容包括一般资料,院外心脏急救知识掌握情况和院外心脏急救知识获得途径。结果患者家属整体认知水平较差,居住于城镇者认知水平高于居住于农村者;文化水平越高,对于心脏急救术的知晓度越高;居住于城镇者对培训的需求高于居住于农村者。结论加强心脏疾病患者家属对于心脏急救技能的培训教育,可充分运用社区、医院的有利条件,结合多媒体开展培训活动。在患者家属中建立正确的健康观念,提高其急救知识与技能。