护理行为涉及的法律责任探讨

目的：分析目前护理行为存在的缺陷及一些潜在的法律责任问题,以便更好地避免和减少医患纠纷。方法：对护理行为涉及的法律责任及其抑制方法进行全面的探索和总结。结果：了解护理过程中涉及的法律责任问题,有利于为护理行为提供正确的理论依据,完善相关的护理立法,改善护理人员的工作态度,提高技术水平,最终达到提高护理质量、避免护患纠纷的目的。结论：重视护理行为涉及的法律责任问题,促进护理工作不断改进。     

护理人员对医疗纠纷和相关法律、法规认知状况的调查与分析

目的调查分析当前发生医疗纠纷的现状、护患双方的态度、主要原因、护理人员对有关医疗法律、法规的知晓程度,提出相应对策。方法自行设计调查表,随机对江苏省5所综合性三级甲等医院发放调查表409份,由护理人员自愿填写,回收且资料完整进入统计的378份,占总发放数92%。结果调查表明患者与护士发生医疗纠纷的现状分别为:护士被骂占47.88%、被打占5.02%,发生纠纷占13.2%。护理人员对发生医疗纠纷的认识分别为:主要责任医患双方。主动沟通可以有效的减少矛盾。处理医疗纠纷最佳时间在萌芽状态。护患纠纷发生的主要原因前3位分别为:患者对医疗费用不满,缺乏与患者沟通交流,违反操作常规。护理人员对《医疗事故处理条例》相关知识知晓程度分别为:医生下达口头医嘱不执行占2.65%,医务人员是不是医疗事故的主体,回答是的占48%。护理人员对医疗相关法律、法规知晓程度:护士未取得执业证书回答不可以执业的仅占11.64%,学习过《中华人民共和国护士管理法》、《母婴保护法》者分别为:60.23%、44.71%。结论医疗纠纷其构成复杂,形式多样,加强护患沟通,制定突发事件预案,加强风险管理和有关法律、法规学习有利于减少纠纷发生。     

关于医院对在职护士开设《人际交流》课程的构思

目的 为了提高医院在职护士人际交流的能力,更好地为病人服务。 方法 对医院在职护士有计划地进行《人际交流》课程的设置,将《人际交流》课程改为十章节,总学时数为40学时。结果 通过系统、有目标地对护士进行人际交流知识的追加、补充教育,提高了护士在护理工作中运用人际交流的技巧。结论 护士通过学习掌握了人际交流知识与技巧,充分地运用于临床护理工作中,并与病人进行交流、沟通,获得较好的效果,也大大减少了临床工作医疗护理纠纷的发生。     

Operational efficiency of health care in police custody suites: comparison of nursing and medical provision

AIM: This paper is a report of a study to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England. BACKGROUND: Medical practitioners, trained specifically for the role of forensic medical examiner, have traditionally provided forensic and custodial medical services. However, there is a trend for police authorities in the United Kingdom to replace forensic medical examiners with custody nurses. Restructuring health care in police custody suites to a multidisciplinary team approach is a practical response to the challenges faced by an overburdened service. However, very few evaluations of the impact of a nursing addition to forensic medical services have been published. METHOD: One nursing service was evaluated by comparing performance indicators over a 6-months period with retrospective data from records of the traditional forensic medical examiner service. Data were extracted from 9,000 calls made by the police for medical assistance across five police stations, and analysed for response and consultation times. Five custody nurses, 20 custody officers and six forensic medical examiners were also interviewed, and the study was conducted in 2003. FINDINGS: In comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information. CONCLUSION: As nurses take on the roles previously performed by medical colleagues, so it will become increasingly important to define role boundaries and assess the impact on the quality of care of detainees.     

Patients' accounts of the differences in nurses' and general practitioners' roles in primary care

AIM: This paper reports a study of patients' accounts of the differences in nurses' and general medical practitioners' roles in primary care. BACKGROUND: Nurses are now diagnosing and treating illnesses including conducting first contact care consultations. However, the findings of international studies reporting patients' views of developments in nursing roles are not consistent. Whilst some studies report higher satisfaction following nurse consultations, others suggest that patients do not want nurses to replace general medical practitioners. Healthcare professionals' views of the boundaries of their roles have been studied, but patients' views have not been reported. METHOD: Semi-structured interviews were conducted with 28 adults attending general practices for urgent 'same day' appointments during 2004. Participants were interviewed prior to their consultation with either the nurse or general medical practitioner and 19 participants were interviewed after the consultation. Data collection and analysis were concurrent, and based on the constant comparative method. FINDINGS: Participants' views reflected traditional hierarchies in primary care. They preferred to consult with general medical practitioners if they perceived their symptoms to be serious and with nurses for minor symptoms and reassurance. They thought that nurses had more time for them and were more compassionate. Interpersonal/relational continuity of care was important and for most participants this was with a general medical practitioner who knew them. Participants trusted known practitioners; they also placed trust in professional groups and familiar structures such as the practice. CONCLUSION: New nursing services should incorporate patients' views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients' views should particularly be evaluated.     

护理文件书写中常见问题原因分析与对策

目的提高护士书写护理文件的质量，减少因护理文件书写不当造成的医疗纠纷。方法对2007年终末护理病历抽查中发现的问题进行分析。结果护理文件书写缺陷原因主要与护理人员少、责任心及法律意识不强有关。结论提高护理人员法律意识，不断学习和加强培训，严格护理质量控制是护理文件书写质量的保证。     

两起因告知不详引发医疗纠纷的思考与对策

通过案例分析,对两起因告知不详引发的医疗纠纷进行思考,要明确护理告知的含义和内容,提高护理人员自身素质和法制观念,从患者人院到出院采取正确的行之有效的护理告知义务,提高沟通技巧,适时制订各项管理制度,是避免护患纠纷的重要保障。     

护理缺陷产生的相关因素及对策

目的调查和分析护理缺陷产生的相关因素，探讨有效控制和降低护理缺陷发生率的措施。方法对2002年9月至2004年9月期间40起护理缺陷进行回顾性调查和分析。结果40起护理缺陷普遍存在年资较低的护士不规范操作、高危时段、涉及高龄患者等，与护理管理机制、人员结构层次、法律意识等因素有关。结论加强降低护理缺陷的有效措施：(1)完善有效的管理机制；(2)增强护理人员的风险意识；(3)规范护理操作和行为；(4)加强护理人员的岗位培训；(5)注重环节及即时质量。     

儿科护患纠纷原因探讨及预防

[目的]探讨引起儿科护患纠纷的常见原因并提出防范对策,以预防和减少护患纠纷。[方法]回顾我科发生的31例护患纠纷,结合自己的工作经验,并参考相关文献,对儿科护患纠纷的原因进行分析。[结果]引起护患纠纷的主要原因有业务水平、人员短缺、医疗收费、服务态度、沟通障碍以及患方原因,针对这些原因提出一些防范对策和处理方法。[结论]通过对儿科护患纠纷原因的分析,提出有建设性的防范对策,极大地减少护患纠纷的发生,提高护理质量。     

设置妇产科专职健康护士的效果

目的了解设置妇产科专职健康教育护士的效果。方法将2010年9—11月入院的797名患者设为实验组,在常规责任护士负责健康教育的基础上,由专职健康教育护士进行系统健康教育,将6-8月入院的805名患者设为对照组,按常规由责任护士负责健康教育;比较两组患者满意度、医生对护理工作的满意度、不良事件投诉及纠纷数量进行统计比较。结果两组患者满意度及不良事件投诉、纠纷数量上,差异有统计学意义（U=2．02,289．4;P〈0．05）;两组医生的满意度差异无统计学意义（U=1．54,P〉0．05）。结论设置妇产科专职健康教育护士利于患者心理疾病的早期干预,有效缓解医患冲突,提高患者满意度,一定程度上融洽了医护关系,拓展了护理专业建设与学科发展、护士职业规划。     

社区护士护理文件书写相关知识管理现状调查

目的:了解社区护理人员在家庭护理过程中护理文件书写现状。方法:采用自设问卷,对16家社区卫生服务机构94名社区护理人员进行问卷调查。结果:94例社区护士中44例(46.8%)不熟悉病历书写规范;70例(74.5%)认为病人有权复印护理记录单、医疗病历、病程记录等资料;74例(78.1%)不了解因抢救急危病人未能及时书写护理记录,应在6小时内核实后据实补记;89例(94.7%)认为试用期人员经医疗机构审核可以独立书写护理记录;15例(16.0%)不能够在完成家庭护理后即刻完成护理记录;49例(52.1%)护士在家庭护理的病人无签字能力时,经病人口头授权会让保姆代签。结论:社区护理人员医疗文书书写相关知识掌握不足,应针对家庭护理过程中如何完善护理记录的知识进行培训。     

门诊输液室小组长负责制的实施与体会

目的探讨儿童门诊输液室护理管理方法，以适应医疗市场的需求，提高患儿家长的满意度。方法在20名输液护士中选拔5名小组长，以其为核心，分为5个输液小组，小组长的主要职责是解决疑难穿刺问题，负责对年轻护士静脉穿刺技术的培训，协助护士长进行护理质量管理。结果患儿家长满意度由原来的83．13％提高到95．63％，患儿家长投诉率由原来的0．45％降低到0．29％，护士静脉穿刺一次成功率由88．51％提高到95．95％。结论输液小组长负责制的实施能够有效解决因静脉穿刺而引发的护理问题，培养了静脉穿刺人才，促进了护士整体素质的提高。     

护士"通知"与"发现"义务的法律和现实意义

目的探讨护士通知义务和医嘱违规发现与报告义务的证据保存方法。方法以护理记录和说明书等书面材料作为标准,进行方法分析。结果护理记录、药品说明书的禁忌证和本科室常规操作的禁忌证可以帮助护士举证。结论严格、详细记载,并向医生报告患者病情危急情况的护理记录,帮助发现违规医嘱的记载及禁忌证的药品说明书,规定本科室常规操作禁忌证的操作流程,对护士履行通知与发现义务,避免医疗纠纷和护患纠纷的发生具有重要意义。     

社区团队式服务模式中社区护士角色功能的质性研究

目的 探讨社区护士在团队式服务模式中的角色功能和影响因素.方法 对14名医护人员采用半结构式面对面深度访谈进行资料收集与整理分析.结果 社区团队式服务模式中护理工作模式包括基本医疗服务为主、承担较多非社区团队护士工作和较少承担公共卫生服务角色;影响因素包括政府的投入与政策支持、公共卫生服务的效率与可行性、社区护士自身的...     

对耳鼻咽喉科门诊患者医疗法律知识认知情况的调查与分析

目的对耳鼻咽喉头颈外科门诊患者进行与医疗相关的法律知识调查,了解患者对医疗法律知识的知晓程度。方法对耳鼻咽喉头颈外科门诊612例就诊患者进行问卷调查。结果57.5%的患者懂得如何用法律保护自己就医过程中的合法权益,知晓举证责任倒置、《医疗事故处理条例》和患者知情同意权的患者分别占41.3%、44.8%、91.0%。结论护理人员加强法律知识学习是安全护理的必要保证,依法施护是保障护患权益、预防医疗事故的重要措施。     

Trialing collaborative nursing Models of Care: the impact of change.

OBJECTIVE: The aim of the project was to develop and trial a nursing Model of Care (MoC) and devise a framework to investigate the impact of nursing staff mix on patient outcomes and job satisfaction (nurses). SETTING AND SUBJECTS: In 2001-2002 a pilot project was undertaken to explore issues related to the delivery of patient care by nurses on two medical inpatient wards, one acute and one subacute, at a referral teaching hospital in New South Wales (NSW), Australia. The framework employed was an adaptation of, and based on, the Clinical Practice Improvement (CPI) model developed by NSW Health. PRIMARY ARGUMENT: Countries across the world are seeking solutions to a shortage of registered nurses and their ability to sustain quality care services. It becomes imperative that organisations develop strategies to attract and retain nurses in the health care system. CONCLUSIONS: Results of the project highlighted areas related to the quality of care delivery: clinical supervision; continuity of staffing; trust; employer of choice; more effective nurse to patient ratios; educational preparation; and recognition of prior experience.     

Individual Professionalism: Part of the Solution to the Nursing Shortage Crisis

Changes in the health care delivery system in the United States have affected the practice of nursing. Disruption in the status quo has led to confusion as to the functions and role of nurses among health professionals, the public, and the nurses themselves. As demand for nursing services has increased, more and more nurses are leaving practice and fewer individuals are choosing nursing as a career. Others have proposed causes and solutions to this most recent shortage, which are primarily directed at changing the structure of the delivery system or the reward system for practice. The authors suggest that individual nurses have a role in the solution.     

护理行为风险管理的实践

目的探讨风险管理在防范医疗纠纷、投诉和满意度中的作用。方法我们对工作中高风险的护理行为制定风险管理制度,并组织全体护士认真学习考核,在护理操作中实施告知制度和意外风险预报制度。管理者随时督导检查评价制度落实情况,不断完善和修订制度。结果实施风险管理1年多来,密切了护患关系,变“家长制”为“理解配合型”的护理模式,降低了纠纷和投诉的发生率,提高了护理工作的满意度。结论在护理行为中实施风险管理体现了以人为本的科学管理理念,在护士和病人间架起了一座沟通的桥梁,经护患双方共同努力将高风险因素降至最低限度,受益的不仅是病人还有护理人员,达到了降低护理纠纷、投诉发生和提高满意度的目的。