关怀日记在ICU患者人文护理中的应用

目的探讨关怀日记在ICU患者人文关怀中的实施效果。方法将2018年综合ICU收治的患者按时间顺序分为对照组318例和干预组403例。对照组接受ICU常规护理,干预组在此基础上,聚焦人文关怀护理,将ICU日记调整为ICU关怀日记并应用。比较两组入ICU 24 h内及转出ICU时焦虑、抑郁发生率,并收集干预组患者及家属对ICU关怀日记实施的满意度。结果干预组转出ICU时,焦虑、抑郁发生率显著低于对照组(P<0.05,P<0.01);干预组患者及家属对ICU关怀日记满意度得分8.75±0.56。结论记录ICU关怀日记能帮助危重患者及家属降低焦虑、抑郁发生率,提升对危重护理工作满意度。     

早期活动对ICU患者焦虑抑郁情绪的影响

目的探讨早期活动对ICU患者焦虑抑郁情绪的影响。方法便利抽取162例ICU患者根据时间先后分为对照组85例和干预组77例。对照组接受常规护理,干预组在常规护理基础上进行早期活动干预,以床上主动锻炼为主,每日2次;制定早期活动安全准入指标和过程监测指标保障患者活动安全性。使用医院焦虑抑郁量表评估两组患者入住ICU 24h内和转出ICU时焦虑抑郁情绪发生情况。结果入住ICU 24h内两组焦虑抑郁得分及发生率无统计学差异(均P0.05);转出ICU时干预组焦虑抑郁得分及发生率显著低于对照组(均P0.01);活动期间干预组未发生严重不良事件。结论早期活动安全可行,能有效改善ICU患者焦虑抑郁情绪。     

痴呆照顾健康管理对照顾者负担及心理状态的影响

目的 研制手机App用于痴呆照顾健康管理，并探讨对照顾者照顾负担、焦虑抑郁及自我效能的影响。 方法 选取90名轻度认知功能障碍及老年期痴呆患者的照顾者为研究对象，实施基于手机App的痴呆照顾健康管理，进行线上线下联合干预。干预前及干预6个月后采用Zarit护理者负担量表、广泛性焦虑量表-7、病人健康问卷抑郁量表及一般自我效能感量表评价干预效果。 结果 干预后，照顾者的照顾负担、焦虑、抑郁及一般自我效能感得分与干预前比较，差异有统计学意义（均P＜0.05）。 结论 基于手机App的痴呆照顾健康管理可降低照顾者负担，改善焦虑及抑郁情绪，提升自我效能。     

应用循证护理对ICU术后患者实施音乐干预的效果观察

目的 探讨ICU术后患者实袍膏乐干预的有效性。方法 将39例全麻手术后进入ICU的患者随机分为观察组（19例）和对照组（20倒）。对照组术后采用常规护理方法对患者进行护理干预。观察组应用循证护理的方法进行音乐干预,即提出临床问题，查找文献资料，寻找实证．评价相关实证，制订并实施音乐干预措施。于术前厦术后采用状态特质焦虑量表（STAI）和抑郁自评量表（SDS）及视觉模拟焦虑（VAS）法对两组患者进行评估。结果 术后第5天观察组STAI、SDS、VAS值与对照组比较，差异有显著性意义（均P〈0．05），且患者的焦虑、抑郁情绪显著改善。对照组出现幂同程度的焦虑，烦躁、抑郁等表现。结论 音乐干预可降低ICU患者的焦虑、抑都情绪厘视觉模拟焦虑水平。通过循证护理为ICU术后患者实施音乐干预．可显著降低患者的焦虑情绪。     

ADOPT问题解决模式护理对大面积烧伤患者创面愈合及心理状态的影响

目的：探究ADOPT问题解决模式护理对大面积烧伤患者伤残接受度、创面愈合及美观满意度的影响。方法：前瞻性选择2020年1月-2022年12月笔者医院收治的患者460例大面积烧伤患者为研究对象,将2020年1月-2021年3月收治的患者纳入对照组,2021年4月-2022年12月收治的纳入观察组,对照组采用大面积烧伤后常规护理,观察组采用ADOPT问题解决模式护理,持续护理3个月。分别于干预前和干预3个月后,采用伤残接受度量表（Acceptance of disability scale,AODS）评估患者伤残接受度,采用视觉模拟评分（Visual analogue scale,VAS）评估患者创面疼痛程度,采用简明烧伤健康量表（Burn specific health scale,BSHS-A）评估患者生活质量;干预4周后,计算创面愈合率;干预3个月后,采用（Vancouver scar scale,VSS）评估患者创面愈合后瘢痕增生情况,采用美观满意度评分表评估患者美观满意度;记录创面愈合时间。结果：干预后,观察组患者AODS评分、创面覆盖率、美观满意度、BSHS-A评分均明显高于对...     

基于扎根理论的心理护理对面部烧伤患者自我残障接受度及创伤后成长的影响

目的：探讨基于扎根理论的心理护理对面部烧伤患者自我残障接受度、创伤后成长的影响。方法：选取82例面部烧伤患者，采用随机数字表法随机分为对照组和观察组，每组41例。对照组采取常规护理干预；观察组在对照组基础上给予基于扎根理论的心理护理。比较两组干预前后的负性情绪[焦虑自评量表(Self-ratomganxietyseale,SAS)和抑郁自评量表(Selfratingdepressionscale,SDS)]、体像障碍程度（体像障碍自评量表）、创伤后应激障碍[创伤后应激障碍自评量表(PTSD checklist-civilian version,PCL-C)]、自我残障接受度[伤残接受度量表(Acceptance of disability scale,AODS)]以及创伤后自我成长[中文版创伤后成长评定量表(Chinesepost-traumaticgrowthinventory,C-PTGI)]变化。结果：干预后，观察组SAS、SDS、体像障碍自评量表及PCL-C评分均低于对照组（P<0.05）,AODS、C-PTGI评分均高于对照组（P<0.05）。结论：基于扎根理论的...     

心理护理对改善ICU机械通气清醒患者负面情绪及预后的效果

目的探讨心理护理对改善ICU机械通气清醒患者负面情绪及预后的效果。方法将60例ICU行机械通气且神志清醒的患者,随机分为2组,每组30例。对照组予以常规护理,观察组在对照组基础上联合心理干预。观察2组患者干预前后的焦虑评分(SAS评分)、抑郁评分(SDS评分)。统计2组机械通气时间、机械通气撤机成功率及对护理工作的满意度。结果 2组干预前的SDS、SAS评分差异无统计学意义(P0.05);干预后2组患者的SAS、SDS评分均较干预前明显改善,且观察组患者的SDS、SAS评分明显高于对照组,差异有统计学意义(P0.05)。观察组的机械通气时间、机械通气撤机成功率及对护理工作的满意度均优于对照组,差异有统计学意义(P0.05)。结论对ICU机械通气清醒患者在规范常规护理的前提下,加强心理护理,可明显缓解患者负面情绪,减少机械通气时间,改善预后。     

音乐治疗对ICU术后患者焦虑抑郁的影响

目的 探讨音乐治疗对全麻手术后进入ICU患者焦虑、抑郁状态的影响。方法 将39例全麻手术后进入ICU的患者随机分为观察组19例和对照组20例。对照组实施常规护理；观察组在此基础上于术前晚及术后1～5d进行音乐治疗。采用状态特质焦虑量表（STAI）、抑郁自评量表（SDS）及视觉模拟焦虑（VAS）方法比较两组焦虑、抑郁程度。结果 观察组术后第5天STAI、SDS、VAS值均显著低于对照组（均P＜0．05）。结论 音乐干预可降低ICU患者的焦虑、抑郁情绪，且使护理更加人性化。     

优质护理辅助整形美容清创缝合术对颌面部外伤患者应激反应及效果满意度的影响

目的：分析优质护理辅助整形美容清创缝合术对颌面部外伤患者应激反应及效果满意度的影响。方法：选取2019年2月-2021年10月笔者科室收治的98例颌面部外伤患者为研究对象，按护理干预方案不同分为对照组47例（常规护理）、观察组51例（优质护理）。比较两组焦虑自评量表（Self rating anxiety scale,SAS）、抑郁自评量表（Self rating depression scale,SDS）、自我感觉负担量表（Self perceived burden scale,SPBS）、平均动脉压（Mean arterial pressure,MAP）、心率值（Heart rate,HR）、双向瘢痕评分量表（Patient and observer scar assessment scale,POSAS）、温哥华瘢痕评分量表（Vancouver scar score,VSS）及美学效果满意度。结果：观察组患者SAS、SDS、SPBS评分均低于对照组（P<0.05）。两组干预后MAP、HR均有所下降，且观察组MAP、HR低于对照组，差异均有统计学意义（P<0.05）。干...     

针对性系统护理对上睑下垂手术患者术后效果及外观满意度的影响

目的：探讨针对性系统护理对上睑下垂手术患者术后效果及外观满意度的影响。方法：选取医院2018年3月-2021年4月收治的104例上睑下垂手术患者为研究对象，将其按照随机数表法分为对照组（n=52）和观察组（n=52），对照组给予常规术后护理，观察组在对照组基础上给予针对性系统护理，两组患者均连续干预1周，比较两组患者心理状况、术后效果、外观满意度、生活质量。结果：干预前，两组患者焦虑自评量表（Selfratinganxietyscale,SAS）、抑郁自评量表（Selfratingdepressionscale,SDS）评分比较无统计学意义（P>0.05），干预后，两组上述评分均下降，且观察组低于对照组（P<0.05）；观察组上睑轮廓、双眼睑对称情况、双眼睑高度对称情况评分均高于对照组，外观满意度（92.31%）较对照组（71.15%）显著升高，且差异有统计学意义（P<0.05）；干预前，两组躯体功能、认知功能、社会功能、角色功能评分均无明显差异（P>0.05），干预后，两组上述评分均明显改善，且观察组高于对照组，差异有统计学意义（P<0.05）。结论：上...     

实习医学生沟通技能评估及相关因素分析

目的 了解实习医学生沟通技能现状并探索其相关因素.方法 采用自行设计的一般资料问卷及沟通行为自我评价量表对260名医学生进行问卷调查.结果 医学生在与患者的沟通、对特定疾病或具体健康问题指导、与医务人员的沟通三方面的得分分别为3.26±0.55、3.00±0.69、3.43±0.64.医学生对受虐待/暴力及艾滋病患者的...     

Importance of positive interaction in the initial meeting between plastic surgeons and patients: A survey

The aesthetic plastic surgery patient represents a particularly sensitive and highly demanding client within the whole patient population. There is no doubt that a kind and understanding response to his problems and needs, which are often rather complex, contributes decisively to the establishment of a basis of confidence and it predominantly determines the further course of any interpersonal relationship with the surgeon. A kind response, i.e., positive interaction, signifies the complete acceptance of the patient, both verbally and nonverbally. The surgeon must be all ears to the requests and concerns and must attentively concern himself with all the patient's physical impairments that have grown into a problem. Positive interaction also means assessment and understanding of the patient's personality, including his self-image, his view of reality, and his present condition in order to choose correctly the suitable level of communication. Finally, positive interaction means the precise analysis of the patient's rational and irrational fears and his conceptions and expectations. There must be discussion of his wishes and the therapeutic and surgical possibilities in order to map out an acceptable path of treatment.Presented at the annual meeting of the Austrian Society of Plastic Surgery, 4–6 October 1990, Feldkirch, Austria Address reprint requests to G.M. Beer, M.D., Plastic, Aesthetic and Reconstructive Surgery Unit, Landeskrankenhaus Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria     

基于SEGUE框架的儿科护患沟通教学模式的构建与效果评价

目的 基于SEGUE框架构建儿科护患沟通教学模式并进行效果评价。方法 设计包含准备（Set the stage）、信息收集（Elicit information）、信息给予（Give information）、理解患者（Understand the patient′s perspective）、结束（End the encounter）5个环节的结构化儿科护患沟通教学模式,应用理论学习、案例分析、情境模拟及临床实践等教学方式,对2018、2019级共98名护理本科生（试验组）进行教学实践,并与采用常规方法教学的55名2016级护理本科生（对照组）进行教学效果比较,采用哈佛医学院沟通量表及美国内科协会病人满意度量表进行评价。结果 试验组沟通评估总分及标准化病人满意度总分显著高于对照组（均P＜0.05）。结论 基于SEGUE框架的儿科护患沟通教学模式有利于提高学生的临床沟通能力,改善沟通效果。     

基于认知学徒制的高职护患沟通课程教学改革研究

目的探讨基于认知学徒制的高职护患沟通课程教学改革的效果。方法将2014级三年制高职护理专业2个班级设为对照组(94人),《护患沟通》课程采用传统授课方式;2015级2个班级设为观察组(103人),以认知学徒制理论为指导实施《护患沟通》课程教学。结果观察组护生护患沟通技能考核成绩、自评沟通能力得分显著高于对照组(P0.05,P0.01);对教学改革评价得分(4.26±0.93)~(4.53±0.67)分。结论实施基于认知学徒制的高职护患沟通课程教学改革,有助于培养护生护患沟通能力和沟通技能,提高护理教育教学质量。     

护患沟通中沉默行为应对模型的构建

目的针对护患沟通中出现的沉默行为,构建具有可操作性的应对模型。方法根据有效沟通的6个步骤,以沟通前、沟通中、沟通后为阶段,初步制定护患沟通中沉默行为的应对流程。采用德尔菲专家咨询法对14名专家进行2轮函询。结果专家权威程度0.8,2轮函询后结果趋于一致。最终形成护患沟通中7个主题、3种类型沉默的应对流程。结论沉默应对模型的建立,有利于护理人员正确识别护患沟通中的沉默行为,依据应对模型采取有效的沟通方法,减少护患沟通不良导致的护患纠纷。     

The ‘go‐between’ study: a simulation study comparing the ‘Traffic Lights’ and ‘SBAR’ tools as a means of communication between anaesthetic staff

Communicating non‐urgent, urgent and frank emergency requests for assistance between anaesthetists in theatre often requires a ‘go‐between’ – frequently a non‐anaesthetic healthcare professional – to transmit information. We compared the currently recommended situation, background, assessment, recommendation (SBAR) tool with a newly devised Traffic Lights tool (‘red alert’, ‘amber assist’ and ‘green query’) in a simulation study to assess communication quality using 12 validated clinical scenarios of varying urgency. Compared to SBAR, Traffic Lights was used more consistently (‘very clear’ or ‘clear’ Traffic Lights 94% vs SBAR 69%); transferred information better (two or three pieces of information correctly transferred Traffic Lights 85%, SBAR 44%; and was judged to lead to greater clarity (all p < 0.0001). Message delivery time was significantly reduced (Traffic Lights 20.5 s vs SBAR 45.5 s, median (95% CI) difference 25 (19–30) s, p < 0.001). Users rated the Traffic Lights system as significantly more useful than SBAR, with 96% of participants preferring the Traffic Lights tool. Results were independent of go‐between training. We recommend the adoption of this communication tool as standard practice for anaesthetic teams.     

Adaptation and validation of the SEGUE checklist to assess osteopathy students' clinical communication skills

ObjectiveThis paper explores the adaptation and validation of the SEGUE checklist as a tool to assess clinical communication skills in undergraduate osteopathy students in Australia.MethodsA literature review guided instrument selection of the SEGUE tool for the learning, teaching and assessment of clinical communication skills in undergraduate osteopathy students. The SEGUE framework checklist was modified and adapted to meet the practises of undergraduate osteopathy students and a subsequent study was conducted to assess its validity; intra-rater and inter-rater reliability over three time points.ResultsA modified SEGUE checklist was developed and validated. Statistical analysis revealed acceptable inter-rater reliability at two time points six weeks apart. Intra-rater reliability revealed moderate to good reliability between the two time points six weeks apart. Testing also revealed scope for further sub-element refinement.ConclusionThe SEGUE checklist has the potential to be suitably adapted for both teaching and assessing clinical communication skills in undergraduate osteopathy students. Further work across a number of universities is needed to add and refine sub-elements of the checklist.     

Readability and quality of online patient materials in the websites of the Japanese Orthopaedic Association and related orthopaedic societies

BackgroundThe purpose of this study was to quantify the readability and quality of patient materials on the websites of the Japanese Orthopaedic Association and related orthopaedic societies.MethodsWe analyzed 143 online patient materials of seven societies, including the Japanese Orthopaedic Association and related six societies. The readability of the text in the material was quantified using two web-based programs (“Obi-3” and “Readability Research Lab”) and lexical density. The materials with a difficulty level ≤ second grade of junior high school were classified as “average difficulty,” and those ≤ sixth grade of elementary school were classified as “easy to read.” The quality of the materials was quantified using the validated Clear Communication Index, DISCERN, and Journal of American Medical Association benchmark criteria scores. The proportion of materials classified as sufficient quality was determined. The measurement values were compared among societies using Kruskal–Wallis tests.ResultsThe median difficulty level of the overall materials was the third grade of junior high school using the Obi-3 program. Only 44 (31%) were classified as average difficulty, and none were classified as easy to read. Based on lexical density, 31 (22%) materials were classified as average difficulty. The median Clear Communication Index score was 18 points out of 100. The median DISCERN and Journal of American Medical Association benchmark criteria scores were 27 (out of 75) and 0 (out of 4), respectively. Only one material met the criteria as having sufficient quality. There were significant differences among societies in the lexical density, Clear Communication Index, and DISCERN scores.ConclusionsThe patient materials on the Japanese Orthopaedic Association and related society websites were too difficult to understand. Furthermore, the quality of the materials was not sufficient. Improvement in readability and quality may be necessary to enhance patient-physician communication.