出院指导中的问题与对策

随着整体护理工作的深入开展,进一步改善了护患关系,改变了以往病人住院-出院-护理工作结束的短期护理行为,出院指导得到了进一步加强。但在抽查护理记录和住院病人的实际护理质量中,发现在病人出院指导中还存在以下问题,由此提出相关对策。1存在问题1.1出院指导内容千篇一律、不具体抽查100份护理记录,同病种的不同病人,书写的出院指导内容相同,未体现出个体差异。其原因为人力资源短缺、责任心不够强、对出院指导的内涵理解不够及与病人的沟通交流不够,采集病例资料不全等所致。出院指导内容不够具体,如:嘱病人低盐饮食比较笼统,没有具体…     

中医护理计划软件的开发与应用

为了提高护理工作效率,缩短护理计划书写时间,开发了中医护理计划软件。软件包括人院病人评估表、住院病人评估表、护理记录单、健康教育单、出院病人评估及指导等5个模块。根据专科特点按病种分类,编制了标准中医护理计划。使用该软件书写护理计划简单方便,针对性强,提高了书写质量和工作效率,方便管理。中医标准护理计划软件有利于医院的全面护理质量管理。     

首次化疗肿瘤病人出院指导质量现状与期望的差异性研究

[目的]了解首次化疗肿瘤病人出院指导质量现状。[方法]选取103例首次因进行化疗入院的肿瘤病人为研究对象,采用中文版出院指导质量评估表,对化疗病人进行出院指导后,在计划出院前1～2 d进行问卷调查。结果采用配对t检验分析获得信息及需要信息2个维度差异。[结果]首次因肿瘤化疗的病人出院指导质量得分为(161.36±18.86)分。病人出院指导质量评估表中需要信息及获得信息2个维度的6个配对差异均有统计学意义(P0.05)。[结论]因化疗入院肿瘤病人的出院指导内容超出病人预期,相应健康教育质量需求较高。     

脑损伤患者家庭康复指导需求调查分析

目的:了解脑损伤患者出院前对家庭康复指导的需求,明确出院后家庭康复指导的具体内容。方法:使用专门设计的出院指导需求表对60名脑损伤患者进行调查,该表由"基本信息"、"自我功能评估"、"出院后安置"及"具体家庭训练指导需求"四部分共37个条目组成,对调查结果进行统计分析。结果:97%的患者对出院前针对性指导有强烈的需求。脑损伤患者在出院前仍面临的问题集中于手上肢功能障碍(71.67%)、个人自理问题(70%)及功能性行走(58.33%)。出院指导形式需求最受欢迎的是出院前一对一指导(63.33%),其次是宣传资料(单张和视频资料)(38.33%),再者是社区家庭跟进(25%)。指导的内容需求方面最多的是对具体的活动方法与技巧指导(79.07%)的需求,对辅助器具的选择和使用及活动的安全指导的需求也较突出(45.72%、62.86%)。对社区资源获得的需求集中在了解社区资源的分布(47.72%)和如何利用社区资源(52.26%)。结论:出院前家庭康复指导十分必要,指导内容和方式应结合患者及其家庭需要进行,同时应积极考虑帮助患者利用有效的社区资源。     

精神科护理病历出院指导存在的问题分析与思考

现对本病区 2 0 0 2年 3月～ 2 0 0 3年 2月 110份护理病历出院指导进行统计分析 ,并结合临床护理特点 ,提出自己的建议 ,与大家商讨。1　资料与方法随机抽取 2 0 0 2年 3月～ 2 0 0 3年 2月出院病人的护理病历 110份 ,对出院指导进行评分 ,具体评分标准见表 1。表 1　出院指导质量评分标准 (10 0分记 )项目满分扣分标准扣分字迹端正、卷面清洁 10一项不符要求 -5书写规范、医学术语 10一项不符要求 -5结合实际情况、切实可行 10一项不符要求 -5针对性强 2 0缺乏 -2 0全面详细 15不符合 -15突出专科特点 15未体现 -15卫生宣教 10缺少 -10预…     

精神科护理病历出院指导存在的问题分析与思考

现对本病区2002年3月～2003年2月110份护理病历出院指导进行统计分析,并结合临床护理特点,提出自己的建议,与大家商讨。1 资料与方法随机抽取2002年3月～2003年2月出院病人的护理病历110份,对出院指导进行评分,具体评分标准见表1。 2 结果2.1 出院指导得分结果,90分以上41份,占37.24%;80～89分45份,占41.00%;70～79分16份,占14.54%;60～69分6份,占5.42%;不及格2份,占1.8%。2.2 存在的问题与分析。(1)公式化。对于出院指导的重要性认识不足,认为病人、家属均看不到,成为千篇一律的通用指导。如按时服药、定期复查,而未讲明服药的具体要求、注意事项、时限及定期复查的具体内容。(2)简单笼统。认     

烧伤病人的出院指导

总结了近年来对烧伤病人开展系统出院指导的体会,着重介绍了“出院指导单”、“各部位功能锻练表”、效果观察和加强指导者的管理和训练等内容,重点强调了如何做好出院病人的心理调整、创面的自我护理、坚持加压疗法和各部位功能锻练的方法、要求及其重要性。     

冠状动脉支架植入术病人出院准备度与出院指导质量现状及相关性研究

[目的]探讨冠状动脉支架植入术病人出院准备度与出院指导质量现状及其相关性。[方法]随机选取在我院进行冠状动脉支架植入术的病人115例为研究对象。采用一般资料和疾病相关资料问卷、出院准备度量表和出院指导质量量表对115例冠状动脉支架植入术后病人于出院当天上午进行调查。[结果]病人出院准备度条目得分为(7.40±1.34)分,出院准备度各维度各条目得分从低到高依次为疾病知识、出院后应对能力、自身状况以及可获得的社会支持;病人出院指导质量条目平均得分为(8.16±1.54)分,各维度平均得分从高到低依次为讲授技巧和出院指导内容;病人出院准备度各维度和出院指导质量各维度得分呈正相关(r=0.451,P0.01)。[结论]冠状动脉支架植入术病人出院准备度为中等水平,出院指导质量较高,其出院准备度和出院指导质量呈正相关。需加强对护理人员进行高质量的出院指导培训,制定多样的讲授方法和全面的宣教内容,从而提高病人的出院准备度。     

简化护理文书书写中存在问题及对策

目的:探讨简化护理文书书写方法、质量控制和管理措施,持续提高护理文书书写质量.方法:通过对250份在架和出院病历的护理文书抽查,针对问题进行分析,采取相应对策,及时反馈、指导、改进.结果:通过改革护理记录的内容和形式,对存在的问题进行分析整改后,书写合格率由原来的90%上升至97%,患者满意度由95%上升到98%,平均每天用于护理书写时间减少了120 min.结论:针对简化护理文书书写中存在的问题,采取相应措施,有效地减少了因书写中出现的失误,提高护理文书书写质量及患者的满意度.     

糖尿病病人出院指导卡的设计与应用

为了更好地指导糖尿病病人管理好糖尿病,追踪评价健康教育的效果,提高病人的生活质量。2008年8月我科自行设计了糖尿病病人出院指导卡,经实践取得了良好的效果。现介绍如下。1糖尿病病人出院指导卡(见表1)2指导卡优点病人出院时,由糖尿病专科护士填写病人的病情及各种检查,并进行登记,输入电脑,建立糖尿病病人的数据库,为以后科学研究提供了数据。指导病人出院后半个月,携带此卡来内分泌科专科护士处就诊,追踪并评价病人出院以后的遵医行为,自我管理糖尿病的能力,检查血糖、血压、血脂、体重等情况,并针对性地对病人进行个体指导,并与出院时的情况做比较,进一步对病人实施后期的糖尿病健康宣教。指导卡设计简单、具体、实用,从而在护士进行健康教育时,避免了盲目性,方便了医生了解病人病情,具备了内分泌科专科的特点,适合推广使用。糖尿病病人出院指导卡的设计与应用@孙海峰$江苏省无锡市人民医院 @陆群$江苏省无锡市人民医院 @周向丽$江苏省无锡市人民医院糖尿病;;出院指导卡;;健康教育     

运动方式指导对体外震波碎石术后排石效果的影响

目的探讨运动方式指导对体外震波碎石(ESWL)后排石效果的影响.方法选择160例上尿路结石病人随机分为实验组(运动方式指导组)和对照组(随意运动组)各80例.实验组根据不同部位结石的受力特点采取不同运动方式,对照组对运动方式不做具体要求.观察两组排石效果.结果实验组碎石后第3天和第7天的疗效均优于对照组,两组比较,差异均具有显著性意义(UC =2.62, P1<0.01;UC =1.76,P2<0.05).结论运动方式指导可以提高ESWL后的排石效果.     

定期出院回访对精神病病人遵医行为的影响

[目的]探讨出院回访对精神病病人遵医行为的影响,制订合理有效的家庭护理措施,提高病人依从性,促进病人康复.[方法]将380例病人随机分为实验组(190例)和对照组(190例),对照组实施常规出院指导,实验组进行前瞻性的定期回访,分别在出院后1周、1个月和半年等不同阶段采用电话、信件等方式进行回访,1年后进行遵医行为和满意度调查.[结果]实验组病人遵医行为、满意度明显高于对照组,差异具有统计学意义(P＜0.01).[结论]定期出院回访可提高病人遵医行为和满意度,制订合理有效的家庭护理措施,对促进医患关系和谐、提高病人生活质量具有积极意义.     

Education for worksite monitors of impaired nurses

Boards of nursing sponsor programs, including those for alternatives to discipline, for recovering nurses. These programs rely on worksite monitors who are oftentimes other nurses or supervisors of nurses, to work with recovering nurses when they return to practice. The skills of these monitors vary with respect to understanding the monitor role and recognizing traits in chemical dependency and relapse. To determine the degree of content value and the best teaching method for monitors to learn program content, 17 currently active worksite monitors participated in a study to evaluate content value to 2 groups, new and experienced monitors, and to select the best method to teach 4 content topics. Results showed that current content was valued without necessary additions and that group instruction in urban areas was preferred over one-to-one instruction. Implementation of study outcomes yielded that issues of confidentiality made group instruction unsatisfactory.     

医疗植入性器械全程安全管理的探讨

本文从严把进货渠道关、严把临床使用关、出院指导、不忘使用后随访、植入性器械取出后的处理五大方面探讨了医疗植入性器械的全程安全管理     

Laypersons may learn basic life support in 24min using a personal resuscitation manikin

BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation and the challenge is to find the most efficient one. AIMS: To compare the efficiency of a 24 min instruction using a DVD-based self-training BLS course combined with a simple, take-home resuscitation manikin to a conventional 6h course for teaching BLS to laypersons. METHODS: In total, 238 laypersons (age 21-55 years) without previous BLS-training were allocated into two groups: one group received 24 min of instruction using a DVD-based instruction tool on a big screen combined with a BLS self-training device, Laerdal MiniAnne manikin (MAM), before taking home the instruction material for subsequent self-training. The second group attended a conventional 6 h BLS course (6 HR). After 3 months BLS skills were assessed on a Laerdal ResusciAnne manikin using the Laerdal PC Skill reporting System, and a total score was calculated. RESULTS: There was no significant difference between groups in BLS performance using the total score. Assessment of breathing was performed significantly more often in the 6 HR-group (91% versus 72%, P=0.03). In the MAM-group, average inflation volume and chest compression depth were significantly higher (844 mL versus 524 mL, P=0.006, and 45 mm versus 39 mm, P=0.005). CONCLUSIONS: When assessed after 3 months, a 24 min DVD-based instruction plus subsequent self-training in BLS appears equally effective compared to a 6h BLS course and hence is more efficient.     

中文版患者学习需求量表的研制及评价

目的 译制患者学习需求量表(patient learning needs scale,PLNS)并检验其可行性及信效度.方法 译制并形成中文版PLNS量表,由专家组对其内容效度进行评定;采用中文版PLNS量表对385例内外科住院患者进行调查,对量表的可行性、内部一致性、分半信度、结构效度进行评定.结果 问卷回收率98.5%,完成率97.7%,完成问卷时间为(13.75±4.36)min;总量表Cronbach'α系数为0.95,5个分量表的Cronbac'α系数为0.7～0.86;总量表分半信度为0.935,5个分量表的分半信度为0.802～0.876;内容效度指数(CVI)为0.86;经主成分及因子分析,得到负荷较大的9个因子,累计贡献率达64.55%.各因子所在维度基本原量表设想相符.结论 中文版患者学习需求量表有较好的可行性,较高的信度和效度,可用于内外科出院患者健康教育学习需求的评估.     

消毒剂医消灵的研究

<正> 当前,用于外科器械的消毒液,有的不能杀灭细菌芽胞或灭活乙型肝炎病毒,有的刺激性、腐蚀性较大,有的气味难闻,有的需要较长的作用时间,为得到杀菌效果较好,刺激性、腐蚀性较小,气味较好的消毒     

Survey of burn education in entry-level physical therapy programs

We investigated the extent of burn education in entry-level physical therapy curricula and also collected information about oncology instruction. A questionnaire was sent to the directors of 96 entry-level physical therapy curricula, and 76 directors responded. Most of the respondents (98.7%) indicated that burn and cancer management warranted lectures. The programs that quantified instruction averaged 4.8 hours of burn-related medical and surgical lectures and 4.2 hours of burn-related physical therapy procedure lectures. The instructional time devoted to oncology was slightly less. Physicians presented the medical and surgical lectures in 36% of the curricula and provided instruction with physical therapists and nurses in 39% of the curricula. Physical therapists alone presented the lectures on physical therapy procedures in 83% of the curricula. Sixty-three percent of the respondents believed that new graduates could effectively treat both patients with burns and those with cancer, but other respondents attached various qualifiers to their responses. Some respondents thought that new graduates could not adequately treat patients with burns (12%) or cancer (8%). Suggestions for future physical therapy burn education are given.     

Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators

AIM OF THE STUDY: There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest. MATERIALS AND METHODS: In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure. RESULTS: Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p相似文献   

广播法在眼科住院患者健康教育中的应用

目的针对眼科住院患者视力障碍问题,从实践的角度探讨符合眼科住院患者的护理健康教育新模式,提高患者手术前、手术中、出院后的健康教育知晓率。方法采用广播法录音制成CD,每天早、中、晚播放,调查289例接受广播法健康教育患者的满意度。结果眼科住院患者对广播法健康教育很欢迎,满意率高。289例患者中满意275例,占95.2%。结论广播法健康教育不仅能解决眼科患者视力障碍的阅读问题,还能解决护士人力紧张问题,提高眼科患者健康教育知识的知晓率。