人文关怀在老年病房中的实践与效果

目的探讨人文关怀在老年病房中的实践与效果。方法改善病房环境,开展优质服务,提高护士的技术操作水平及与病人沟通的能力,并将人文关怀体现在护理服务的每个细节。结果病人的满意度明显提高,增加了社会效益和经济效益。结论人文关怀在临床中的应用,有利于提高病人满意度,降低医疗纠纷的发生率,增强医院竞争力。     

妇科肿瘤病区实施人性化护理服务的体会

目的妇科肿瘤病区实施人性化护理,提高病人满意度。方法在人性化护理服务中开展"微笑和微小"护理服务,应用护理语言、护理行为、改进环境和工作流程、以品牌服务于病人。结果科室整体护理质量、护士素质、病人满意度提高。结论妇科肿瘤病区实施人性化护理服务有利于提高专科护理质量,提升护士综合素质和病人满意度。     

科室实施护士参与式管理的做法与体会

目的探讨参与式管理方式在护士长管理工作中的作用与效果。方法在全体护士中实施参与式管理,护士长与护士共同设立管理目标并共同实施,以提高管理效果。结果通过实施参与式管理,科室人员素质、护理知识、技术水平、护理质量、病人满意度均得到提高。结论实施参与式管理方式,有利于调动护士的工作积极性,使护理质量控制、服务水平和病人的满意度均得到不同程度的提高。     

Nurses' self-assessment of their nursing competencies, job demands and job performance in the Taiwan hospital system

This exploratory study investigated nurses' self-assessment of their own nursing competencies, job demands and job performance in Taiwan. Nurses' self-evaluation on their own job performance was conceptualized as an indicator of nursing care quality. A total of 21 competencies were clustered into three groups: basic-level patient care skills, intermediate-level patient care and fundamental management skills, and advanced-level patient care and supervision skills. Nurse subjects were randomly selected from the member roster of Kaohsiung Nurse Association; 850 nurses were invited to participate and questionnaire packets were sent to their homes. The overall response rate was 35.8%. Multiple regression analyses found that nurses' self-assessment of intermediate patient care skills, the difference between nurses' self-assessment and job demands for basic patient care skills, and nurses' overall satisfaction with their own nursing competencies were three significant predictors of overall satisfaction with nurses' own job performance. Nurses' self-assessment on basic patient care skills and advanced patient care skills contributed to nurses' levels of overall satisfaction with their own nursing competencies. These results suggest a relationship between competency and performance. These findings may serve as a guide to amend academic nursing courses and on-job training programs as appropriate to place a greater emphasis on the competencies desired for providing high quality of nursing services.     

An empirical test of the Nursing Role Effectiveness Model

AIMS OF THE STUDY: This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). RESEARCH METHODS: A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. RESULTS: Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. DISCUSSION: The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.     

A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study

AIM: To examine whether patient classification carried out in accordance with the Oulu Patient Classification (OPC) method can measure the patient's caring needs in a reliable manner as seen from the patient's perspective. BACKGROUND: On the basis of earlier research it can be established that there are differences between nurses' and patients' assessments of patients' caring needs. Research on patients' assessments of perceived caring needs and the care they receive in connection with patient classification does not seem to have interested researchers in caring science. METHODS: The reliability from the patient's perspective is gauged by comparing the patient's perceived caring needs with the nurse's patient classification during a 24-h bed-day. Data was collected during a semi-structured interview with a total of 73 patients. Documentary analysis was carried out on the basis of patient classifications by 30 ward nurses. FINDINGS: On the basis of the degree of correspondence between nursing care intensity experienced by the patients and the nurses' patient classification it was decided whether the patients' caring needs had been met. The results indicate, however, that patient classification as a gauging method has a built-in reductive function regarding the patient's need for care and nursing care intensity. CONCLUSIONS: Nevertheless the OPC offers possibilities from a patient perspective of providing an overall picture of the patient's nursing care intensity and can therefore serve as a reliable basis for decisions concerning staff planning.     

Scope of practice of an Advanced Practice Nurse at the Swiss Epilepsy Centre

Epilepsy is, after stroke, the second most prevalent neurological disease. The disease has a manifold etiology and symptoms and hence treatment options. From the patients who seek treatment in epilepsy centres, some suffer from psychogenic, non-epileptic seizures. Patient with epileptic seizures have to integrate a medication regimen into their lives, accept symptoms and change their life style to seizure preventing habits. Patients with non-epileptic seizures need psychotherapeutic treatment. Care has to be offered over long periods of time and needs to be tailored to very diverse patients' and family situations. Nurses in this field need broad knowledge about the diseases and treatments as well as enhanced skills in counselling and caring for these patients. Therefore the Swiss Epilepsy Centre in Zurich hired an Advanced Practice Nurse (APN) to increase patients' satisfaction with care and enhance nurses' skills and knowledge. This article analyses the work content of the advanced practice nurse and describes first experiences one year after the implementation of an APN-role. The APN worked half of her time in direct patient and family care. The rest of her work load concerned practice development in coaching and educating the nursing staff, being involved in projects and collaborating with the head nurse on specific topics. In conclusion, implementation of an advanced practice nurse has been shown to be beneficial since patients' feedback were very positive and the increase in nurses' skills and competencies has been assessed as noticeable.     

住院病人对护理服务质量满意度调查与分析

目的了解住院病人对护理服务质量的满意度情况,探讨提高护理服务质量的应对措施,以适应日益激烈的市场竞争形势。方法采用问卷调查法调查540例住院病人对护理人员护理服务质量满意度情况,内容包括入院教育、对病人态度、提供护理及时、病人感受、病房环境、操作水平、住院教育、出院前教育、护患沟通共9个方面。结果入院教育、护患沟通满意率均<90%,住院教育8项内容中5项满意率<95%、3项满意率>95%,其余各方面满意率均>95%。结论开展人性化护理服务,加强管理,提高护士健康教育能力,确保健康教育质量,并以娴熟的护理操作,良好的护患沟通,舒适的病房环境全面提高病人满意度。     

塑造"好妈妈俱乐部"护理品牌的实践与成效

目的塑造“好妈妈俱乐部”护理品牌,实现特色的人性化服务。方法在产科病房设俱乐部主场,内容包括:产妇学校、产后健身班、新生儿游泳、新生儿抚触等。在产科门诊、产房等设分场,内容包括孕妇学校、音乐胎教、导乐陪伴分娩等。以娱乐的方式向孕产妇传授优生、优育、优教及自我保健知识和技能。结果护士综合素质和产妇满意度均提高。结论塑造“好妈妈俱乐部”护理品牌,拓展护理服务,满足产妇需求,收到良好的社会效益和经济效益。     

Staffing in acute hospital wards: part 1. The relationship between number of nurses and ward organizational environment

This paper is one of two that explores relationships between nursing staff resources, ward organizational practice and nurses' perceptions of ward environments. Here we examine relationships between staff numbers, care organization and nursing practice. A subsequent paper examines the effects of grade mix and staff stability. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Our analyses provide important insights for managers seeking to achieve the strategic aims set out in Working Together, and subsequent National Health Service (NHS) policy placing emphasis on making the best use of nurses, focussing on mobilising their knowledge, skills and talents within the context of extended work roles. Findings show that number of nurses is associated not only with ward organizational systems but also with a range of care processes and staff outcomes which hitherto have been linked only to ward organizational systems. The latter have been identified as providing different opportunities for developing multidisciplinary working and nurses' autonomy but the central importance of having an adequate number of staff to achieve these aims has been largely overlooked in research. Having fewer nurses was associated with both hierarchical ward organizational structures and hierarchical attitudes to care provision, denoting lower standards of nursing practice. A larger nursing complement was significantly associated with devolved organizational structures but no link was established between more staff and higher standards of nursing practice. When there were more staff there was a positive association with nurses' perceptions of multidisciplinary collaboration, their ability to cope with workload and job satisfaction. Employing an adequate number of nurses to provide care is clearly beneficial for nurses themselves. Patients are also likely to benefit from a lower incidence of 'hierarchical practice' associated with having a low nurse/bed ratio within a ward.     

Quality of nursing diagnosis and patient satisfaction. A review of the literature

This article presents the current state of the art regarding the relationship between nursing diagnostics and patient satisfaction. Of the 98 studies examined, nineteen met the inclusion criteria and were investigated by content analysis. Answering the question of a possible relationship is based on a preceding conceptual analysis of nursing diagnostics and patient satisfaction. The results yield concept clarifications and rationales for these concepts. Nurses aiming to meet patients' needs and giving patient centred care use nursing diagnostics. Nursing diagnostics allow specific assessments of nursing problems and provide the basis for nursing interventions. Nursing diagnoses influence all elements of professional practice and are basic for patient classification systems. Patient satisfaction was mainly investigated in relation to the nursing process and often showed high overall scores. The interactive, social and supporting skills of nurses are most important for patient satisfaction. Nursing diagnostics and patient satisfaction have been evaluated frequently. However, only little research was done to find results about their relationship. The state of the current literature is discussed and recommendations for further research are presented. The literature review yields implications for practice and education.     

Nurses' empathy and patients' satisfaction with nursing care.

Nurses' self-reported levels of empathy were studied in relation to patients' perceptions of satisfaction with nursing care received. Data were obtained from a volunteer sample of registered nurses and patients using two standardized, paper and pencil questionnaires: Empathy Construct Rating Scale and LaMonica/Oberst Patient Satisfaction Scale. No significant relationship was manifested between the variables under study. It was concluded that empathy training programs for nurses may not be necessary. In addition, although patients are generally satisfied with nursing care received in acute care settings, the data do not support a relationship between nurses' empathy levels and patients' satisfaction. Suggestions for further study are offered.     

系统健康教育对血液透析患者护理服务质量的影响

目的通过系统健康教育提高血液透析患者的存活率和生活质量,并进一步提高护理服务质量。方法对2007年5-10月接受血液透析的患者60例进行系统健康教育（包括护理人员血液透析知识的培训、患者基本情况和病情的评估以及健康教育措施的落实）,并评估实验前后患者的满意度及血压、高血钾发生率、瘘管堵塞率、肌酐等病情观察指标。结果实验前后患者对血透室护理工作满意率分别为81．96％和99．70％,就介绍血透注意事项、内瘘的按压和护理、药物及饮食指导等条目实验前后有统计学意义（P〈0．01）;实验前,血液透析患者发生高血钾2例、内瘘闭塞4例,实验后仅发生1例内瘘闭塞（P〈0．05）;实施系统健康教育后,血液透析患者的透析后血压、透析前后肌酐均显著降低（P〈0．05）。结论系统的健康教育可提高血液透析患者对疾病的认识和自我管理能力,提高其存活率和生活质量;同时,也有助于不断提高护理服务质量,提升护理人员的整体素质。     

Working effectively with clients who self-injure using a solution focused approach

In Australia, the most common service used by self-injurers is the emergency department. Even though nurses are the key clinician available to such patients, nurses have usually received no special training to identify and address the needs of these clients. Building on the knowledge that emergency nurses feel ill-prepared, lack clear frameworks for practice and are thus vulnerable to subtle discourse tensions such as managing versus caring, and diagnosing versus understanding, an intervention was conducted and evaluated to enhance understanding and build proactive nursing skills. It was centred on a nursing philosophy known as solution focused nursing (SFN) - a model of care developed by author to orient care away from a deficit model. Deficit models tend to be reactive and centred on presenting problems. SFN is designed to move nurses' perspective towards a proactive, strengths orientation, the aim of which is to assist them to instill hope in the client and motivate him/her to take the next steps needed for change and recovery. Nurses in two Australian emergency departments completed questionnaires before and after participating in SFN training focused on working with complex clients who self-harm. A comparison group of nurses also completed questionnaires. Results indicated some benefits of the intervention; there were improvements in participants' perception that nursing is strengths oriented and in nurses' satisfaction with their skills. Yet, there were no significant improvement in nurses' reports of their professional self-concept. There is merit in: broadening access to the intervention, so that more nurses in other contexts can learn a strengths model of care and apply it to their practice; and extending the research to measure sustained learning outcomes and improvements to practice.     

Evaluation of a gerontological nursing continuing education programme: effect on nurses'' knowledge and attitudes and on patients'' perceptions and satisfaction

The purpose of this study was to evaluate the effects of a four-session (8-hour) gerontological nursing continuing education (CE) programme on nurses' knowlege of and attitudes towards the elderly. The study also sought to ascertain the effects of the CE programme on patient satisfaction with and perceptions of nursing care. Seventy-six nurses completed the Miller-Dodder Revision of the Palmore Facts on Ageing Quiz and the Kogan Attitudes Towards Old People Scale before and after participating in the CE programme. Post-test scores on both measures were slightly but significantly higher than pretest scores. Thirty hospitalized elderly patients were interviewed before and 33 were interviewed after the CE programme was offered to the nurses on their hospital units, using the LaMonica-Oberst Patient Satisfaction Scale and the Harrison-Novak Patient Perception Scale. Post-test measures of patient satisfaction and perception were not significantly different from pretest scores. Patients were generally satisfied with their nursing care, but perceived that nurses did not focus on health promotion activities. In addition, 59% of the patients indicated that they were unable to distinguish nurses from other health care providers. The article identifies implications of the study for nursing education, practice and research.     

Evaluating the effectiveness of pediatric pain management guidelines

In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation.     

护士角色患者化与模拟人技能培训法对护理服务质量的影响

目的探讨护士角色患者化与模拟人两种技能培训法对护理服务质量的影响。方法随机选择我院独立执业3年以上的临床一线护士34名为培训学员,另选择34名护士长为指导老师,采用抽签方式进行分组,每4人为一组,共分为17个组,其中2名护士长为指导老师。首先采用模型人培训法,即在模型上对17项基础护理服务技能按操作程序进行操作,然后再采用护士角色患者化培训法,即互为患者对17项基础护理服务技能按操作程序进行操作。采用自制的护理服务质量调查表,从指导老师、护士评价两方面对两种培训方法的护理服务质量进行比较。结果模拟人操作培训法的指导老师评价、护士评价对护理服务满意度都较低,分别为24．0％、38．5％,护士评价的满意度高于指导老师评价,差异有统计学意义（Х^2=17．63,P〈0．05）。护士角色患者化培训法的指导老师评价、护士评价的护理服务满意度都较高分别为98．3％、99％,且明显高于模拟人培训法,指导老师评价、护士评价比较,差异无统计学意义（Х^2=1．468,P〉0．05）。结论护士角色患者化培训法可让护士从患者角度去感受护理服务中的缺陷,更能体验患者的病痛和需求,从而主动遵守操作规程,实施人性化的护理服务,提高服务质量。     

Developing ethical skills: from sensitivity to action

Acute and critical care nurses routinely encounter ethical "quandaries" such as providing perceived futile care. Other everyday ethically important occurrences may go unrecognized, however, thus diminishing their importance to moral nursing practice. This column presents a framework that may assist in developing specific skills to recognize and engage in both critical and everyday ethical situations with confidence. James Rest's Four Component Model addresses the role of the moral practitioner from initial recognition that an ethical situation exists to implementation of a justifiable action. Patient/provider scenarios are used to illustrate components of Rest's model followed by an approach to distinguish ethical from nonethical situations. Practical strategies to enhance ethical skills such as development of nursing ethics groups and providing continuing ethics education also are presented.