浅谈县级医院开展优质护理服务的难点与对策

县级医院开展优质护理服务的难点是:①对优质护理服务的意义认识不足;②护理人员严重不足;③就医环境不理想;④后勤保障不到位;⑤健康教育流行于形式;⑥缺乏竞争机制。针对上述难点采取了如下对策:①转变观念,加强培训;②合理利用人力资源;③实行目标管理和质量控标准,规范优质护理服务需求的护理行为,推动优质护理的深化;④改善病房环境和后勤保障;⑤建立竞争激励机制;⑥提高护士的综合素质。     

住院精神病人意外事件的原因分析与护理干预

目的探讨精神科意外事件的防范与护理干预策略。方法对我院近二年发生的91例意外事件进行回顾性调查分析。结果意外事件的发生率4.39%,与护士交接班不细致,对异常病人警惕性不高,基础护理不到位,滥用约束或约束不当,医护沟通不到位等管理因素有关。结论加强护士学习和培训,注重医护沟通与合作,认真执行各项规章制度是防范意外事件发生的保证。     

优质护理服务在门诊的开展技巧与体会

目的通过开展优质护理服务,全面提高门诊护理服务质量和患者满意度。方法以深化优护理念、强化沟通技巧为重点,完善制度保障、规范护士行为、改进服务流程为基础,开展全面、全程优质服务。结果护理质量、安全管理零缺陷,护理服务零投诉,护士对职业的满意度提高5.8%,患者满意度提高4.1%。结论护士明确优质护理服务活动内涵,掌握沟通技巧,用"心"护患沟通,落实"以病人为中心"的服务理念是开展优护工程前提,也是提供满意服务的关键。     

护理投诉的原因分析及防范措施

目的:探讨护理投诉的原因分析及防范措施.方法:采用回顾性的方法对我院2008年1月～2010年12月11例病人对护理投诉的原因进行分析.结果:原因主要是护理服务不到位、护理技术操作欠缺、法律意识淡薄、沟通不到位.结论:增强法律意识,健全和完善护理管理机制,规范护士行为,提高护理质量,加强护患沟通是减少护理投诉的关键.     

探讨科护士长在开展“优质护理服务”活动中的督导作用

目的：指导开展优质护理服务活动,督促全面认真履行护士职责,提供优质护理服务,提高患者和社会满意度。方法：根据护理部制定的计划,首批开展优质护理服务活动试点,病房确定为三个,第二批开展优质护理服务活动的病房为十个,使本院的优质护理服务活动开展率达100％,指导护士认真学习,规范培训,开展讨论,转变观念,提高认识,合理调整排班模式,改变护理模式,每名护士分管一定数量的患者,包干到组,对护士实行分层管理和使用,简化护理文件书写,增加护患沟通时间,把时间还给护士,把护士还给患者。结果：开展优质护理服务活动后,护理质量及患者满意度有了明显提高。结论：护士转变观念,增强服务意识,夯实基础护理,各项护理措施落实到位,促进了护患沟通,提高了患者满意度。     

基层医院开展优质护理示范病房的方法及护理体会

目的探讨开展"优质护理示范病房"的方法及护理体会。方法该院以综合外科为试点开展"优质护理示范病房"的科室,采取的措施包括:组织科室护士反复学习相关文件、实施要求、方法,通过实施,不断总结经验,提出问题、整改措施;修订各班职责,实行责任护士包床,全程无缝隙护理;加强落实各项基础护理;加强护患沟通,做好心理护理辅导、宣教工作;改善病区环境;改善服务态度等等。结果开展"优质护理示范病房"效果很好,患者对医院提供的治疗和护理服务满意度大大提高,同时护理质量也得以提升。结论开展"优质护理示范病房"可以提高医院临床护理工作质量和患者对医院服务的满意度。     

手术室相关人员对优质护理内涵的认知调查

目的评价手术室相关人员对优质护理内涵的认知水平与特点。方法行问卷调查,对比医师与护士各维度认知水平差异。结果手术室护士对优质护理主体内涵88.00%、基础护理86.00%、责任整体护理94.00%内涵认知与总分合格率88.00%高于医生76.00%、69.00%、61.00%、79.00%,学历、职称、工龄影响手术室护士认知水平,差异具有统计学意义(P0.05)。结论护士对专业技术维度内涵认知仍有待提高;应针对性的开展优质护理培训活动;注重医护相互配合。     

加强沟通管理 促进优质护理服务

沟通管理是企业组织的生命线,管理的过程也就是沟通的过程。护理工作繁琐沉重,护士不止直面于病人,护士间、医护间及护士与医院行政部门、后勤部门间的沟通,直接影响到科室管理和工作质量。优质护理服务的持续推行需要改进管理模式,而沟通管理在护理管理中尤为重要。妇科在创建优质护理服务中坚持把质量管理与沟通管理放在护理管理的首要位置,并从中积累了一些经验,也获得良好成效,从而做到了患者满意、医生满意、社会满意。     

优质护理服务在老年病区临床护理工作中的应用效果

目的推行优质护理服务,改革护理工作模式,提高患者满意度与护理服务质量。方法 2013年9月至今在我院老年病区全面推行"以病人为中心"的责任制整体护理工作模式,从确立护理理念、创立工作模式、创建护士管理方式等方面开展基础护理、专项护理等优质护理服务活动。结果开展优质护理服务后患者满意度、护理质量均高于优质护理服务前(P﹤0.05),陪护率明显下降(P﹤0.05)。结论优质护理服务能够显著提高护士的主动服务意识,提高患者对护理服务质量的满意度,可以推动护理质量持续改进。     

优质护理服务示范工程的实施现状与分析

目的:调查了解江苏、上海两地优质护理示范工程实施的情况。方法:采取随机抽样法调查15家城市医院的268名患者,自行设计问卷展开调查。结果:床护比≥1∶0.4的医院占42.7%;71.6%的患者知道医院有优质护理服务;48.9%的护士能够介绍优质护理服务内容、项目及收费标准;53.0%的患者认为有必要开展基础护理;99.6%的患者对护士的技术满意;41.8%的患者能接受无陪护护理。结论:优质护理服务尚有提升的空间,应该在人力资源和硬件配备等方面继续努力,护理人员应加强与患者交流和沟通,提高护理质量。     

Providing asthma care in elementary schools: understanding barriers to determine best practices

School nurses play a critical role in the management of children's asthma, yet they face barriers in their efforts to deliver quality care. In this qualitative study involving focus groups with school nurses, we identified key barriers in order to inform best practices. School nurses identified 4 main barriers to effective asthma care in elementary schools: lack of education, lack of communication, lack of resources, and lack of respect. An analysis of the barriers suggests that best practices for asthma care in elementary school settings require collaborative strategies that involve schools, families, the community, and the healthcare profession.     

肿瘤病人健康教育管理方法的探讨

目的探讨肿瘤病人的健康教育管理方法。方法①建立医院健康教育管理架构;②完善健康教育质控体系,由主管护士-科护长-护理部主任和专职质量督导员负责;③保证健康教育的实施细则;④加强健康教育专员技能的培训,以点带面实行多元化的健康教育方法。结果2007年住院的肿瘤病人健康知识知晓率为98%,行为形成率为80%,与2006年90%相比,知识知晓率提高了8%。病人对护理质量的投诉明显减少。护士重视自身素质及基础理论知识的提高,参加继续教育护士人数明显增加。结论加强肿瘤病人健康教育管理对护士学习积极性有促进作用,有利于提高护理质量。     

Assessing the Barriers to Engaging Challenging Populations in Disease Management Programs

Disease management has gained popularity as a way to improve health status and control of chronic illness through the use of risk stratification, targeted nurse outreach, telephonic nurse advice, and evidence-based guidelines in managing illness. Disease management programs have been successfully implemented by commercial insurers and managed care plans, as well as in Medicare and state Medicaid programs. Although evidence regarding cost savings is inconsistent, it appears that disease management programs do impact health status and quality of care, and improve self-management among the chronically ill.Disease management programs can be customized to meet the needs of vulnerable subpopulations. This article explores the barriers to dealing with chronic illness and other factors faced by disease management programs for Medicaid populations. Barriers to participation and success in disease management for Medicaid beneficiaries are apparent due to lack of access to translation and interpretation services; difficulty with community outreach; achieving buy in from providers and beneficiaries; problems with housing; difficulties accessing primary and specialty care; problems with the availability of pharmacy, durable medical equipment, and other support services; as well as difficulties with Medicaid eligibility and ‘churn’.In order to create a successful disease management program that positively impacts health status, utilization, and cost, it is necessary to consider all of these barriers when designing an intervention for Medicaid beneficiaries. Some of the innovative ways to handle the difficulties of dealing with Medicaid or other low-income populations with special healthcare needs include expanded interpretation and translation activities, extensive community outreach to patients and safety net providers such as clinics and public hospitals, providing support services related to non-medical problems experienced by enrollees, providing understandable written and verbal instructions and training related to health education and medication adherence, as well as efforts to track and maintain contact with eligible and enrolled individuals. Disease management programs can be successful in saving money and improving health in Medicaid populations. However, they must be carefully designed with the specific state Medicaid program and should target the needs of the state’s beneficiaries.     

层级管理在产科护理管理中的应用

目的探讨层级管理在产科护理管理中的应用。方法在我院妇产科实施层级护理管理,比较实施层级护理管理前后住院患者对护理工作满意度及护理部对护理质量考核得分的变化。结果实施层级护理管理后取得了以下效果：（1）患者对护士的服务、工作能力、沟通及病区管理及总体评价都有显著提高。（2）患者对初级护士和高级护士的评价显著提高,对中专学历及本科学历护士的满意度显著提高。（3）产科护士在理论知识、基础护理、专科护理、护理文书、危重患者护理、病房管理等方面显著提高。结论层级护理管理能够提高产科护理质量,值得在临床工作中广泛推广。     

The struggle to improve patient care in the face of professional boundaries

Professional boundaries make inter-professional communication, collaboration and teamwork more challenging and can jeopardise the provision of safe, high quality patient care. This in-depth interview study conducted in three UK acute hospital organisations in 2003-2004 explored how professional boundaries affected efforts to improve routine practice by acute pain services (small specialist teams set up to drive improvements in postoperative pain management through education, training, standard-setting and audit). The study found that many anaesthetists and to a lesser extent nursing staff saw postoperative pain management as a new and unjustified addition to their professional role. Professional identities and strong fears about the risks of treatments meant that health professionals resisted attempts by the acute pain services to standardise practice and to change medical and nursing roles in relation to postoperative pain management. Efforts by the acute pain services to improve practice were further hindered by inter-professional boundaries (between the medical and nursing professions) and by intra-professional boundaries (within the medical and nursing professions). The inter-professional boundaries led to the acute pain services devoting a substantial part of their time to performing a 'go-between' function between nurses and doctors. The intra-professional boundaries hindered collaborative working among doctors and limited the influence that the acute pain service nurses could have on improving the practice of other nurses. Further work is needed to address the underlying fears that can lead to resistance around role changes and to develop effective strategies to minimise the impact of professional boundaries on patient care.     

The family and nurse in partnership: providing day-to-day care for rural cancer patients

OBJECTIVE: To explore demands made on family members in managing symptoms and providing for the day-to-day care of relatives with cancer in rural New South Wales and how specialist palliative care nurses support these family members. DESIGN: Cross sectional qualitative study. SETTING: Seven health centres across rural New South Wales that cover a broad geographical area and reflect the diversity in economic conditions, population density and distance from three major urban centres in New South Wales. SUBJECTS: The study involved two groups of participants. The first group consisted of one or more members of families of oncology patients who were accessed through health workers at the seven centres. Nineteen family members from 17 families were interviewed. The second group comprised 10 nursing staff working as specialist palliative care nurses across the same geographical area as the families. MAIN OUTCOME MEASURES: Physical care and symptom management were the two main areas of interest. RESULTS: The rural experience of caring for palliative care patients was challenging, with support nurses needing to take into consideration all aspects of the patients' and families' living environments. CONCLUSION: There is a need for equipment and basic resources to be readily available to practitioners, funding for ongoing education and 24-h care.     

Using school staff to establish a preventive network of care to improve elementary school students' control of asthma

School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools, families, and primary care providers (PCPs). To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (-35% vs -9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned.     

Case Management

New roles for nurses are emerging as managed-care organisations continue to evolve. Many of these roles are new for nurses; others expand or redefine traditional roles in the diabetes disease management environment in integrated healthcare systems. It is important now to redefine these roles for nurses in a way which supports the organisations’s quality outcomes.Patient education, one of the cornerstones in diabetes disease management programmes, has been an important nursing role for decades. In the diabetes disease management environment, the challenge for nurses is to provide appropriate education to the diabetes population in a way which acknowledges the continuum of care, the course of the disease and the progression of patient learning needs. Much of the outcomes research studying the effectiveness of patient education programmes is related to traditional, hospital-based programmes. Simply adapting traditional diabetes education programmes may not be sufficient to address patient education needs for the entire diabetes population within the integrated healthcare system.Phased diabetes competency for nurses is built on the premise that both patients and nurses acquire diabetes expertise in a phased, progressive manner. This model matches the competency of nurses at each level with parallel competencies for patients with diabetes.     

优质护理服务在手术室的实施

目的探讨优质护理服务在手术室的实施效果。方法通过转变工作模式;加强手术室环境管理;加强手术管理,包括术前访视、术中支持、术后随访的落实及围手术期患者安全管理;加强护士业务技术的培训;加强服务态度的教育,在手术室实施创优质护理活动。结果通过优质护理服务在手术室的开展,提高了手术室的工作效率和服务能力,加强了手术管理,提高了患者满意度,避了缺陷和差错的发生。结论优质护理服务的实施,使围手术期患者享受到了人性化、系统化、规范化的优质护理服务,达到了创优质护理活动的目的。