医务人员压力状况及对策

压力也称应激,是机体的一种反应模式,当刺激事件打破了机体的平衡和负荷能力,或者超出了个体能力所及的时候,就会体现为压力〔1〕。过高的压力会对个体的心理、生理、行为产生不良影响。医护人员是一个特殊的职业群体,肩负着救死扶伤的职责,承担着繁重的医疗工作,面临着各种医疗风险,被普遍认为是一个充满压力的行业〔2〕。了解医护人员的压力状况及原因,可有针对性地采取相应措施,保障医护人员的身心健康。     

军队医务工作者压力管理及对策

目前，我国医疗市场中，医患矛盾突出，医务人员保障机制不尽完善，医务人员心理与职业的压力逐渐凸现。2007年12月《广东省医护人员精神状况调查报告》显示：医护人员的总体精神压力较大，84．6％的人压力达到中重度。军队医务工作者环境和任务的特殊性使得其压力更为特殊和复杂。缓解压力，进行有效的压力管理，已成为军队医院管理者必须面对和解决的重要课题。     

医护人员工作压力构成及减压策略研究

医护人员工作压力问题是当今社会的一个严峻问题。阐述医护人员的压力构成及减压策略，以便今后更好地处理医患关系，提高医护质量及保护医护人员身心健康。     

我院护士现阶段面临的压力调查及调适效果分析

目的 了解现阶段护士面临的压力来源，最大限度地缓解护士压力，保持身心健康。方法 自制护理人员压力相关因素调查表，针对压力来源采取适当的调适对策。结果 通过对我院200名护士面临的压力调适，前后差异有统计学意义（P〈0．01）。结论 现阶段护士面临的压力来源主要有社会压力、病人压力、工作压力、家庭压力、自身压力，通过采取积极的主客观措施进行调适，能使压力得到有效缓解。     

医护人员职业压力现状及管理策略

医务人员长期处于高压状态,如果调整不当会出现一系列身心问题,从而影响医疗质量。深入了解医护人员的职业压力状况、压力影响及减压策略,对处理好医患关系、提高医疗质量及保护医护人员身心健康有着重要意义。     

压力也上瘾

现代社会仿佛是用压力二字堆砌起来的．到哪儿都能听到人呻吟着压力大，心情得不到放松．然而．比较怪的是越是天天抱怨压力大的人，越似乎不会给自己减压．反而因为一时的压力得到了缓解而更加郁闷．于是便继续一边抱怨太苦、太累．一边又不停地谋划新的项目。建立新的目标．实施新的举措。[编者按]     

医护人员工作压力与生活质量和幸福感的相关分析

目的了解医院医护人员工作压力、生活质量及主观幸福感情况,探讨工作压力对医护人员生活质量和幸福感的影响及其影响过程中的关键因素。方法采用医护人员工作压力问卷、生活质量综合评定问卷-74(GQOLI-74)、总体幸福感量表(GWB)对381名医院医护人员进行测评。结果 (1)医疗事故压力、工作负荷压力是医护人员主要压力源,医生在医疗事故压力(P﹤0.05)、职称晋升及聘任压力高于护士(P﹤0.01)。(2)医生在躯体功能和心理功能纬度得分高于护士(P﹤0.01)。(3)全部压力源均与心理功能和总体幸福感呈负相关(P﹤0.01)。结论工作压力是影响医护人员生活质量与总体幸福感的重要因素。     

压力面面观——解密医生压力

专题策划中，我们调查发现，不管是男医生还是女医生、不管是刚踏入工作的实习生还是资深的专家，都面临着各种各样的压力，年轻人面临的是学习和提高技术的压力；年龄稍长面临的是家庭、晋升的压力；年介资深，就要考虑是不是要改行、退休以后怎么办……当然，还有来自身体健康状况的压力等等。下文中所有案例均引自真实的医生留言……     

浅议职工的职业压力管理

职业压力管理是对员工工作压力进行疏导,通过压力评估、组织宣传、培训教育、压力咨 询等方式减轻员工工作压力,提高工作效率,保持组织发展生命力。现代医院需要采取压力管理方法, 缓解医护人员的压力,提高医疗服务质量与卫生管理水平。     

精神科医务人员压力来源分析及疏导

目的对湖南省衡阳市第一精神病医院部分医务人员进行压力来源分析,并对其进行心理疏导,以帮助医护人员减轻工作压力,提高工作质量。方法对湖南省衡阳市第一精神病医院41名医护人员进行SCL-90和Grey—Toil和Anerson护理工作压力问卷调查和心理疏导,以探讨压力源和合理疏导方法。结果年龄30岁以下所受压力大于30岁以上,男性高于女性,工作年限5年以下者高于5年以上者,文化程度本科以上者高于其他,差异均有统计学意义（均P〈0．05）;职称对压力无影响,差异无统计学意义（P〉0．05）;医生压力主要来源前3位分别是专业及工作（2．91±1．31）、工作量和时间分配（2．84±1．08）和工作环境（2．69±1．41）,护士压力主要来源前3位分别是专业及工作（2．87±1．64）、患者方面（2．82±1．58）和工作量及时间分配（2．51±1．25）;心理疏导后,医务人员在SCL-90的强迫、焦虑、抑郁、人际关系、敌对5方面与疏导前表现出区别,差异有统计学意义（P〈0．05）,在躯体化、恐怖、偏执和精神病性4方面与疏导前无区别,差异无统计学意义（P〉0．05）。结论精神科医务人员压力大,心理状况不佳,需要针对性疏导和干预。     

Stress, coping and health: enhancing well-being during medical school

Summary. Medical education can be a health hazard for many students, and far-reaching reforms are needed to improve it. This article reviews the literature on stress, coping and health during undergraduate medical education. The conclusions drawn from this review are used as a basis for advancing recommendations to improve medical education. It is essential to incorporate the principles of health promotion and disease prevention throughout medical education in order to minimize and prevent later burn-out and impairment. Healthy medical students are likely to become healthy doctors who can then model and promote healthy lifestyles with their patients. This preventive approach to health care can lead to an improvement in our health care delivery system.     

Straight talk--new approaches in healthcare. Want better relationships with payors? Focus on medical management

When it comes to managing medical care for their enrollees, payors are moving towards a broader focus for medical management that includes both costs and quality. In the twelfth installment of Straight Talk, we look at how health plans, such as CIGNA, are developing incentives to reward high-quality, low-cost providers of medical care and transitioning their utilization management operations to a new model. To ensure quality, they are beginning to compare providers' performance to national standards for medical outcomes. Through these initiatives, known as "medical management," payors hope to improve not only medical care but also their relationships with providers.     

Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism

CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.     

Implementing health information technology to improve the process of health care delivery: a case study.

Integration of health information is critical to the provision of effective, quality care in today's fragmented health care system. The increasing prevalence of chronic conditions and the demand for a comprehensive understanding of patient health on the part of providers are driving the need for the integration of health information through electronic health information systems. Two distinct health information systems currently utilized in the health care field include electronic medical records (EMR) and chronic disease management systems (CDMS). The integration of these systems is likely to enable the efficient management of health information and improve the quality of health care as it would provide real-time patient information in a coordinated manner. The lack of real-time information may result in delayed treatment, uninformed decisions, inefficient resource use, and medical errors. Despite their importance and widespread support, these systems have slow provider adoption rates. Our understanding of how health information technology may be used to improve health care is limited by the relative paucity of research on the adoption, integration, and implementation of these 2 types of systems. This paper documents the use of an EMR at Marshfield Clinic, a multidisciplinary group practice in the United States. We review the concomitant use of an EMR for clinical data capture and the implementation of a proprietary CDMS, InformaCare, for care management of chronic diseases. These 2 systems allow providers to deliver health care using evidence-based guidelines that meet the Institute of Medicine's aim of providing safe, efficient, patient-centered, and timely care.     

建立病人择医机制促进医院科学管理

国家提出病人择医改革意见,其目的是引起竞争机制,提高医疗机构的医疗质量和效果,方便群众就医。但在执行过程中,择医面过宽过乱,要尽快建立病人择医机制,提高管理水平。     

Outing lesbian health in medical education

Lesbian health is emerging as a distinct discipline in practice and research. Evidence is increasingly available that lesbians are a unique and underserved population in the health care system. They display reduced health seeking behaviors and have specific risk factors which potentially affect their health and well being. They also have specific health issues in fields as diverse as fertility, sexual health and mental health, which require specific knowledge from health care practitioners. Above all, lesbian health care consumers repeatedly decry the lack of sensitivity and knowledge that they experience in their interactions with providers, and call for improved training. However, medical education generally ignores lesbian health at all levels. In this paper, the inclusion of lesbian health in medical education programs is reviewed, and recent political initiatives involving gay and lesbian health in Australia are discussed. The paper concludes with suggestions to integrate lesbian health in medical training.     

Assessing quality. As pressure mounts for clinics to deliver quality, medical practice blueprints and genograms serve as useful tools

Increasingly, medical practices feel pressure to provide and communicate high quality patient care. Offering their insight on how a medical practice can improve quality, the authors describe the process of delivering medical care during patient encounters. Specifically, they present two methods that can be used to understand, evaluate, and improve interactions between patients and providers: medical practice blue prints and medical practice genograms.     

急诊科护士压力来源及相关因素的调查分析

目的本调查旨在了解急诊科护士的工作压力水平,探讨其压力来源的相关因素及如何采取有效措施缓解其压力,为护理管理者有效地帮助护士减轻工作压力提供依据,以增进其群体的身心健康。方法采用工作压力源量表对我院急诊科病房及门诊60名护士进行调查。结果在病人护理方面、护理专业及工作方面和时间分配及工作量等问题上护士感到压力较高,均值分别为3.29、3.07、2.51,为急诊科护士主要的工作压力源。结论护理人员应当提高自身抵抗压力的能力,以更好地适应压力和进行高效的工作。同时医院管理者应针对护士工作压力源,采取有效措施,使护士在为患者提供满意的服务中获得成功的喜悦,从而优化护患关系,提高护理质量。     

Life, death, and liability: duties of health care providers regarding withdrawal of treatment

Many of the issues surrounding refusal and withdrawal of medical treatment are so new and complex that the U.S. society has not resolved the ethical or legal questions involved. Questions such as where life ends and death begins, how to determine the circumstances when withdrawal of treatment is appropriate, and who should make such decisions will have to be resolved before the law in this area can become settled. Naturally, society is a long way from resolving these issues, since they involve such fundamental social, moral, medical, and legal considerations. Nevertheless, a body of law has developed that increasingly recognizes the right of an individual to direct his or her own medical care. To that end, an individual's clearly expressed intention to discontinue medical treatment will generally be honored, even if death results from the withdrawal of that treatment. Legislatures and courts have also encouraged health care providers to abide by the wishes of their patients by giving immunity to health care providers who comply in good faith with the provisions of a living will. Courts have also been reluctant to impose liability on health care providers for withdrawal of treatment absent a living will if it were done in good faith (with the consent of family or guardian) and was in accordance with accepted medical practice. It would appear that as the law gives individuals increased control over the private matter of their own medical treatment, health care providers may face more civil suits for maintaining life support systems against the patient's (or family's) wishes. In any event, while society is in the process of catching up with medical technology, individuals can best protect their right to medical self-determination by expressing their wishes clearly in the form of a living will and durable power of attorney. Health care providers can best protect themselves by keeping abreast of medical and legal developments in connection with these issues and by communicating effectively with their patients as to their wishes regarding life-prolonging medical treatment.