构建和谐医患关系的几点建议

医患关系是社会中最重要的人际关系之一，医患之间是相互依存、密不可分的关系。患者是医生的“衣食父母”，医生是维护患者健康的卫士。医患关系应该成为社会中最合谐的人际关系。当前医患关系中出现一些问题，是在特定环境下产生的不正常现象，医患关系紧张将直接影响医疗服务质量、患者的健康和安全以及医生技术和才能的发挥，直接损害医患双方利益。正因为如此，医患关系才为大家所关注，才需要我们着力去解决。     

从医患关系看当前医患沟通教育

和谐的医患关系不仅是提高医疗质量的前提和基础,也是促进医疗事业发展的关键。当前,全国范围内不断发生伤医、辱医等暴力事件,对于医生和医院的正常工作造成了很大的冲击。良好的医患关系不仅需要有负责心的医生以及高超医疗技术的保障,更需要医生和患者之间的沟通和交流,正确的沟通方式和技巧是连接患者和医生的桥梁和纽带,是促进问题解决的最佳方式。本文以紧张的医患关系为缘起,试图通过分析医患沟通的重要性以及当前医患沟通存在的问题,提出有针对性的医患沟通策略,缓和医患关系,为促进我国医疗事业的发展提出些许建议。     

从构建和谐医患关系谈医生的责任与义务

医患关系是医疗实践中最重要的、最基本的人际关系。和谐的医患关系是维系良好的医疗秩序和环境的基本保证，是减少医疗纠纷，提高医疗质量的重要环节。加强医患沟通，努力提高医疗服务质量，是构建和谐医患关系的关键所在；加强正面宣传，正确引导舆论，是构建和谐医患关系的根本措施；正确认识和谐医患关系、医生的责任与义务是构建和谐医患关系的重要手段。     

医患关系的多重面向

1引言 医患关系是整个医疗实践的核心，医疗实践的开展都建立在医患关系的正确处理上，医患关系的和谐是医疗实践成功的一大标志。随着我国由计划经济转向市场经济，传统的医疗体制也发生了改变，“公费医疗”逐渐被个人支付和医疗保险所取代。传统医疗体制的瓦解并没有导致新型医疗体制的顺利建立，加上医疗市场的混乱、管理制度的落后使得近期社会上屡次出现医患冲突事件，医疗纠纷、天价药单、患者报复医生等情况时有发生，因此，正确认识医患关系的实质，以及正确处理医患关系就显得尤为必要。     

关于五官科的医患关系

医患关系是医疗实践过程中建立起来的医务人员与患者之间的人际关系，良好的医患关系是创造人性化医疗服务的基础。本文从平等对待患者、尊重患者人格、与患者交流沟通的技巧、对待病人的态度，及加强医务人员自身职业道德修养等几个方面论述了五官科医生如何建立良好的医患关系问题。     

重建医院伦理的制度因素建议——原则谈判法在医患关系分析中的应用

根据原则谈判的原理,医患关系紧张是医患利益冲突的立场表现,医患关系和谐化的出路在于通过制度调整,实现医患利益的相容。在医患关系的相关利益主体中,医生和患者是利益直接冲突的双方,而医院和政府则是利益关系的主导者。当制度能够保障医生的职业安全和应得利益,并且医生的职业安全和应得利益主要取决于患者的治疗疾病、可接受的医疗成本、受到应有的尊重等利益满足,那么医患关系和谐就会实现。达成这种局面的制度包括:提高医务人员与医院方的谈判地位、提供医务人员避免医疗风险的制度安排、加强对医生的执业水平和职业伦理的评价机制建设等方面的内容。     

关怀互动促进医患关系和谐

近年,各地医务人员赔偿巨额医疗费用的消息时有耳闻,患者殴打医生致伤致残的事件时有发生。医患关系如此紧张,致使一些地方出现“医者不敢行医,患者不敢就医”的现象。其矛头指现行医疗体制,构建和谐的医疗市场与医疗秩序已成当务之急。为什么医患关系越来越紧张?原因应该是多方面的。既有医疗体制的问题,也有医院管理的问题;既有医学问题,也有社会问题;既有属于医务人员的问题,也有患者方面的问题。但从总体上看,要解开医患矛盾的“结”,缓和乃至消除日益紧张的医患关系,营造和谐的医疗秩序,必须从医患双方寻找原因,和谐医患关系。1医生需…     

应注重培养实习医生的医患沟通能力

现代医学发展突飞猛进 ,许多以前的不治之症今天已能治愈。虽然医生诊治疾病的水平有了显著提高 ,患者却对医生抱着怀疑、不信任、甚且敌对的态度 ,患者与医生的隔阂也到了前所未有的程度 ,突出表现在医患纠纷日益增多。我们认为 ,大部分医患纠纷不是医疗技术水平、医疗质量方面的问题 ,而是医患沟通不够 ,医者服务不到位引起的。医患关系是医疗活动中一对主要的矛盾体。正常健康的医患关系应当是建立在相互理解、相互信任基础上的平等、合作的关系 ,而不是有求于人的关系 ,更不是冲突和敌对的关系。正常有序的医疗活动是以医生和患者良好的…     

医患沟通在临床工作中的应用

目的：临床工作中有效的医患沟通可防止医患纠纷的发生，提高医生的业务水平。方法：在院领导的指导下，采用多种形式进行沟通，包括预防性的沟通、集体沟通、书面沟通、统一沟通等。结果：医患沟通增加了医生的知识，满足了患者家属的需要，医疗纠纷明显下降，医院的经济效益有所提高。结论：医生是医疗活动中的主要成员，是医患沟通的桥梁，医生通过换位思考，提供优质的服务，可融洽医患关系，使医患沟通得到保证。然而要真正持久的改善医患关系，还需要社会各界的支持以及医、护、患的共同努力。     

广西乡镇患者对医患关系认知的调查分析

目的对广西乡镇患者的调查,以了解广西乡镇医患关系的现状及影响医患关系的原因。方法采取整群随机抽样方法,对广西各乡镇的患者采用自行设计的调查表进行问卷调查。结果在被调查的503名患者当中有54.47%的人与医生的关系一般,关系比较好的只占40.36%。医生的服务态度、技术水平、道德素养、医疗环境和医疗费用等是影响医患关系和谐发展的因素。结论目前广西乡镇医患关系处于紧张的局面,医疗费用和医生的服务态度是影响医患关系紧张的主要因素,患者和医生的相互信任、尊重、沟通和理解是改善乡镇医患关系的基础。     

介入诊疗中心安全目标管理

目的建立＂病情警示＂制度,提醒医护人员关注病人最危险的因素,做好紧急预案,确保医疗安全。方法护士通过术前访视,采集病人相关危险因素,以晨会交班形式告知各班次医护人员,并书写成卡片放在手术间警示架上,警示大家。结果＂病情警示＂临床应用,提高了医护人员工作警惕性,帮助大家主动发现潜在的医疗问题,减少医疗安全隐患,保证介入手术安全实施。结论＂病情警示＂在介入手术安全管理方面起到至关重要的作用。     

Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality

Although the US health care system is often touted as one of the best in the world, disparities exist in quality of care received by different populations, in different regions, and across different institutions and clinicians. Initiatives to provide access to health insurance have been a major policy tool to ensure that Americans receive high-quality health care. However, availability of insurance coverage does not automatically lead to high-quality care. This article explores points of vulnerability in the US health care system at which the potential to achieve high-quality care can be lost: (1) access to insurance coverage; (2) enrollment in available insurance plans; (3) access to covered services, clinicians, and health care institutions; (4) choice of plans, clinicians, and health care institutions; (5) access to a consistent source of primary care; (6) access to referral services; and (7) delivery of high-quality health care services. Ensuring high-quality health care requires that each of these "voltage drops" be recognized and addressed. JAMA. 2000;284:2100-2107.     

Consensus standards for the care of children and adolescents in Australian health services

The medical and psychosocial needs of children and adolescents differ from those of adults, and this should be reflected in the care they receive in all areas of a health service. Children and adolescents must be accommodated separately to adults to ensure that their unique needs are met and risks of harm are minimised. The Standards for the care of children and adolescents in health services have been developed by a working group of clinicians, health service providers and consumer advocates based on a combination of available research evidence, published best practice guidelines and multidisciplinary expert consensus. Stakeholder input was obtained through invitations to comment, and pilot testing of the Standards was conducted in six metropolitan, regional and rural hospitals. The Standards provide detailed recommendations in the areas of recognising rights; the provision of child-, adolescent- and family-friendly health service facilities; the availability of child- and adolescent-specific equipment; and the importance of appropriately trained staff. To facilitate implementation and allow ongoing performance monitoring, the Standards have been developed for use alongside the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program. The Standards provide a vehicle to ensure patient safety and to facilitate the provision of high-quality care for children and adolescents in Australian health services.     

EHR Safety: The Way Forward to Safe and Effective Systems

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.     

我国基层医疗卫生机构患者安全问题及其解决路径研究

基层医疗卫生机构作为国民“健康守门人”,其患者安全管理能力是衡量我国医疗卫生服务能力和健康促进能力的重要标准。基层医疗卫生机构患者安全问题具有基础性、客观性、双向性、相似性等特点。但基层患者安全问题并未得到重视,基层医疗卫生机构仍然存在着卫生服务能力低下、不良事件上报率低、用药安全难以保障、患者安全文化建设不足等问题,应当从制定基层患者安全目标、提升基层卫生服务能力、拓宽患者安全问题来源、加强基层用药监督、营造良好的患者安全文化氛围等方面提升基层患者安全保障体系,以更好地保障患者安全,促进国民健康发展。     

The Informatics Opportunities at the Intersection of Patient Safety and Clinical Informatics

Health care providers have a basic responsibility to protect patients from accidental harm. At the institutional level, creating safe health care organizations necessitates a systematic approach. Effective use of informatics to enhance safety requires the establishment and use of standards for concept definitions and for data exchange, development of acceptable models for knowledge representation, incentives for adoption of electronic health records, support for adverse event detection and reporting, and greater investment in research at the intersection of informatics and patient safety. Leading organizations have demonstrated that health care informatics approaches can improve safety. Nevertheless, significant obstacles today limit optimal application of health informatics to safety within most provider environments. The authors offer a series of recommendations for addressing these challenges.This position paper focuses on next steps in using health informatics to improve patient safety. The paper does not attempt to provide a comprehensive review of patient safety-related technical accomplishments, because recent Institute of Medicine (IOM) reports have done so. This paper focuses instead on current pressing issues and opportunities for addressing them in the short-term future. The intended audience includes provider organizations responsible for the safe delivery of health care; policy makers responsible for funding and regulatory decisions that influence health care safety, and the health informatics developers community (including vendors) who build the computer systems that support patient care.     

EICU患者外出检查的风险分析及安全护理

目的减少EICU患者外出检查的风险,确保护理安全。方法应用风险管理理念对患者外出检查过程中存在的风险因素及环节全面分析,检查前全面评估患者病情,准备充分,加强转运途中的安全监护及返回后的护理,加强对患者及家属的健康宣教及心理护理。结果586例外出检查的患者中,除1例在途中突发心跳呼吸骤停抢救无效死亡外,其余均安全完成检查。结论在EICU患者外出检查的过程中实施护理风险管理,显著降低了患者外出检查的护理风险,有效降低了护理缺陷及纠纷的发生,为优质、安全的护理服务提供了保障。     

加强护理管理，提高护理质量

目的:探讨影响护理安全的因素及其预防方法.方法:通过开展安全教育、规范管理制度等措施加强护理安全管理.结果:护理工作面广、琐碎复杂、存在不安全因素较多,直接影响患者疾病的康复,从细节上落实护理安全管理,保证患者的安全.结论:护理人员在实际工作中应加强工作责任心,预防不安全隐患,提高护理质量.     

E-health in Australia: time to plunge into the 21st century

E-health is the health care buzzword of the moment, with a person-controlled electronic health record funded in the 2010 federal Budget and legislation to introduce health identifiers recently passed by Parliament. E-health can ease the patient journey, improve quality of care and reduce costs. Australia's health care system lags behind all other sectors of our economy in the use of computerised systems. While general practice and community pharmacy are highly computerised, the hospital sector is not. Adopting e-health is likely to result in higher quality practice, but general practice and hospitals need a mechanism for securely sharing patient data. Uncoordinated implementation of differing, incompatible systems within and between hospitals compounds a dire lack of national coordination of effort. Multiple funding streams and jurisdictions and the lack of an implementation strategy have slowed e-health development. Government programs underestimate the costs of change management and the need for training and technology. Confusion reigns about responsibilities, but governments must ensure connectivity between health care providers and recognise that the benefits will accrue into the future. The National E-Health Transition Authority has developed national open-access standards, and its foundation projects and the National Broadband Network are now coming into place. To ensure the clinical relevance, utility, safety and acceptability of e-health systems, health professionals urgently need technical capacity and expert guidance.