护理质量管理的现状及发展趋势

建国以来,我国护理质量管理由经验管理到科学管理。由于医学科技的进步,护理观念也随着开始转变;以全面质量管理为基础,以整体护理为内容,以健全的质量保证体系为核心,以信息控制为手段的护理质量保证管理必将成为21世纪护理质量管理的发展方向。     

临床护理质量综合评价的方案初探

现阶段我国护理质量综合评价是以各项护理指标的达标为目标方向,质量管理方式多以检查或考核为主要形式,是一利以质量控制或质量保证模式为特点的、质量管理人员为主的质量评价体系。其指标中,较大局限性是不能体现以病人为中心,没有病人对护理质量的评价指标。现代国际护理质量综合评价方向则是以质量促进为特点,以临床护士为护理质量促进的主体,管理上更加注重预防质量问题的发生。人人参与持续性质量促进的新护理质量评价,是以如何不发生质量问题为质量促进的方向,虽也有质量指标,但不以达标为满足,而以不断提高质量为方向。另外,在评价指标中病人满意度为主要质量指标之一。     

医院消毒供应室的质量管理

目的：探讨医院消毒供应室质量管理的要素。方法：本根据近几年医院的建设实践，对供应室在基础设施，护理人员业务素质，规章制度等方面进行阐述。结果：供应室质量管理是一项全过程，全员性，全方位的管理工作；关键是领导重视，目标明确，齐抓专管，加强建设，知识更新，完善制度，强化管理。结论：以管理为手段，以提高护理质量保证患安全为目的，使消毒供应室工作迈上一个新台阶。     

我国护理质量评价现状与思考

随着医疗卫生的发展,护理质量评价的组织结构、内容、标准、指标及结果分析等均有所变化。在借鉴国际先进经验的同时,我国逐渐建立以医院整体评审标准为基础的质量保证系统和以解决问题为中心的质量改进系统相结合的护理质量评价模式。     

以人为本切实提高护理质量

为了适应社会的发展、医学模式的转变以及人类健康观念的更新，满足不同层次病人的需求，采取以人为本的科学管理策略，从调动护士、护理管理者及病人的积极性人手，提高护理管理者的自身素质、科学管理水平及质量意识。提高护理人员的整体素质及质量意识。以病人为中心，逐渐完善质量标准、评价体系。深化整体护理内涵，提高病人满意率及病人回归社会的能力。实行护理部-科护士长-护士长-主管护士四级质量保证网络，确保各项护理工作到位，护理质量提高。     

质量保证管理对护理质量零缺陷的促进作用

<正>护理质量的零缺陷是21世纪医院质量管理的目标,也是医院发展的生命线。其中质量保证是管理的基础,质量控制是管理的手段。现代管理学家克劳斯比提出:"质量管理的标准就是零缺陷,是要求每一个人第一次把事情做对,提高质量的良方是     

ISO-9002在护理质量管理中的建立与运行

ISO—9002族质量管理和质量保证(国际)标准在管理科学方面,创造性地赋予人类社会质量活动全新的科学概念。它第一次将纷繁复杂的各种质量活动以5个基本质量术语:即质量、质量管理、质量体系、质量控制和质量保证来精辟地加以概括;质量靠管理,管理靠体系,体系来控制,控制才有保证,成为一个环环相扣的质量链。质量管理、质量体系、质量控制和质量保证之间既有密切的联系,又相互区别,相互作用。     

持续提高护理质量的主要措施及方法

目的持续提高护理质量。方法培养高素质强适应的护理队伍,重视全面质量管理在现代化管理中的应用,实现从以往质量保证（QA）向持续质量改进（CQZ）转变。结果提高了护理质量,赢得了患者的信任与配合,使其在住院期间感到心情舒畅,有安全感,顺利接受治疗。结论提高护理质量就要有一整套与之相适应的工作方法和管理模式,只有具备高素质的护理人员,才能正确有效的将护理程序理论用于临床工作和护理管理中,才能使护理程序发挥更大的效能,适应整体护理的要求。     

护理风险因素与规避措施浅析

2005年卫生部“以患者为中心，提高医疗质量为主题”的医院管理年活动在全国范围的开展至今已两年多了。医疗护理质量管理是医疗质量管理的重要组成部分。医疗护理质量的提高，其前提条件是医疗护理的安全。随社会、经济的发展，人口老龄化的趋势，护理服务的范周及需求不断扩大，护士在提供护理服务的过程中时刻存在着各种风险，     

分病种质量管理方法在医院质控中的应用

现代医院管理的发展,对医疗质量管理提出了更高的要求,要对医疗质量进行全面质量管理,建立质量保证体系,完善标准化管理系统和质量反馈信息系统。使质量的各环节置于监控之下,发展和完善良性循环。以病种为质量管理单元的监控方法正是适应这种更趋科学化和现实意义,值得推广应用。     

优质护理服务中提高护士满意度的方法探讨

目的探讨一种以提高护士执业满意度的管理方法,对提升优质护理服务质量的影响。方法优质护理服务示范病区开展期间,在对科室14名护士采取常规管理的基础上,进行以提高护士执业满意度的护理管理方法,以1年为一个研究周期,在研究前、中、以自制调查问卷了解护士执业满意度,并结合同期当月病区护理部质量控制检查成绩及出院患者满意度评价护理质量。结果研究前、中、后三次发放满意度调查,护士对优质护理服务理念的接受程度、对参与基础护理的满意程度、对在护理工作中自身价值体现的满意度、对护理工作的执业前景满意度等平均秩次逐次下降,各时间段差异有显著统计学意义(P<0.05);对现有工作、酬劳的分配方案平均秩次虽呈现下降趋势,但各时间段差异无显著统计学意义(P>0.05);出院患者满意度调查各时间段中位数、最小值依次提高,差异有显著统计学意义(P<0.01);优质护理质控成绩逐次提高。结论在优质护理服务执行过程中,护士执业满意度的提高将有利于护理工作质量的提高。     

Are Dual Eligibles Admitted to Poorer Quality Skilled Nursing Facilities?

BackgroundDual eligibles, persons who qualify for both Medicare and Medicaid coverage, often receive poorer quality care relative to other Medicare beneficiaries.ObjectivesTo determine whether dual eligibles are discharged to lower quality post-acute skilled nursing facilities (SNFs) compared with Medicare-only beneficiaries.SubjectsA total of 692,875 Medicare fee-for-service patients (22% duals) who were discharged for Medicare paid SNF care between July 2004 and June 2005.MeasuresMedicare enrollment and the Medicaid Analytic Extract files were used to determine dual eligibility. The proportion of Medicaid patients and nursing staff characteristics provided measures of SNF quality.ResultsDuals are more likely to be discharged to SNFs with a higher share of Medicaid patients and fewer nurses. These results are robust to estimation with an alternative subsample of patients based on primary diagnoses, propensity of being dual eligible, and likelihood of remaining in the nursing home.ConclusionsDisparities exist in access to quality SNF care for duals. Strategies to improve discharge planning processes are required to redirect patients to higher quality providers, regardless of Medicaid eligibility.     

Advancing nursing practice for improved health outcomes using the principles of perceptual control theory

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses’ actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them.     

开展优质护理服务提升专科监护病房患者满意度

目的研究重症监护病房推行优质护理服务模式对患者满意度的影响。方法心胸外科重症监护病房实行优质护理服务模式,包括增进护患沟通、争创特色专科护理、延伸护理服务、增加直接护理时间和提高护士工作积极性等,比较分析优质护理服务模式推行前、后的患者满意度。结果患者满意度由模式推行前的84．54％上升至推行后的90．02％,两者差异显著（P〈0．05）。结论优质护理服务模式的推行能有效提高重症患者满意度,应在重症监护病房深入推广。     

玻璃体切割手术的护理

目的总结玻璃体切割手术前后护理的要点。方法回顾分析我科2003年1月至2006年1月共完成59例玻璃体切割手术的护理配合过程情况。结果59例患者手术治疗过程顺利,效果良好,无一例护理并发症出现。结论玻璃体切割手术的成功与否固然与医生的操作熟练程度密切相关,但护士充分的术前准备、术中密切配合、良好的术后观察及护理是保证手术成功的重要环节。     

Defining roles, relationships, boundaries and participation between elderly people and nurses within the home: an ethnographic study

Recently there has been a marked shift in the location of nursing care in the UK from the hospital setting to the community and more particularly the home, with elderly people identified as key recipients of care in this setting. A number of commentators have highlighted the particular situation of elderly people with regard to care provision, illuminating the often disempowering nature of care interactions between nurses and elderly people. However, although there is clear evidence from a number of settings that care for elderly people has been less than optimal, to date there is little comparable evidence available regarding elderly people's experiences of nursing care within the home environment. Utilising an ethnographic approach, incorporating participant observation and semistructured interviews with nurses and elderly people (aged 65 years and over), the aim of this study was to explore the nature of the care relationship within the home setting. Thirteen elderly people who were receiving nursing care within the home and 16 community nurses within one Primary Care Trust in the UK took part in the study and data were collected over a period of 1 year. Three themes emerged from the data: the location of care; the nature of nurse–patient relationships; and the meaning of health and illness. These offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and elderly people in the home, illuminating the centrality of relationships between nurses and elderly people in defining the experiences and perceptions of both groups of the quality of care overall. As the location of care continues to move closer to home, it is crucial that the implicit qualities that are valued within nurse–patient relationships in this context are recognised and made more explicit at both the organisational and policy level.     

The impact of nursing grade on the quality and outcome of nursing care

The large industry which has grown up around the estimation of nursing requirements for a ward or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers tend to concentrate on the appropriate organisation of the nursing process to deliver best quality care. This paper, drawing on a Department of Health funded study, analyses the relation between skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15 wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades, which allowed for analysis at several levels from a specific nurse-patient interaction to the shift sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of aggregation. The conclusion is simple; you pay for quality care.     

舒适护理模式在剖宫产术中的应用

目的 探讨舒适护理模式在剖宫产术中的应用方式与应用效果.方法 选择2011年3月行剖宫产术的79例产妇为对照组,2011年4月行剖宫产术的64例产妇为观察组.对照组给予常规护理,观察组在此基础上实施舒适护理.结果 通过实施舒适护理,观察组产妇术中紧张恐惧、感到躯体不适、术中心慌恶心及术中低血压的发生率显著低于对照组(P＜0.05),对留置导尿感到不适的发生率显著低于对照组(P＜0.01),2组产妇术中寒战的发生率比较差异无统计学意义(P＞0.05).结论 将舒适护理模式应用于剖宫产术,可有效提高产妇的术中舒适程度,提高病人满意度;同时可提高手术室护士的主动服务意识与沟通协调能力,提高护理质量.     

“What a nurse suffers”: Care left undone in seventeenth‐century Madrid

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth‐century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice.