全麻恢复期躁动原因分析及护理

目的分析全麻患者恢复期躁动的原因,提出相应的对策。方法通过对1989例术后入麻醉恢复室全麻患者的观察,分析导致躁动的各种不良刺激,不同手术类型麻醉恢复期躁动的发生率。结果282例患者发生不同程度的恢复期躁动,发生率14．1％,各种不良刺激所致恢复期躁动的发生以疼痛和尿管刺激为多见。结论医护人员应熟悉麻醉恢复期患者躁动产生的原因及危害,并采取针对性的对策。     

Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover

Street M, Eustace P, Livingston PM, Craike MJ, Kent B, Patterson D. International Journal of Nursing Practice 2011; 17 : 133–140 Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross‐sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part‐time compared with full‐time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation‐Background‐Assessment‐Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care.     

Exploring the structure and organization of information within nursing clinical handovers

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.     

Developing a Model of Care for a 4- to 6-Bedded Postanesthetic Recovery Unit: A Delphi Study

PurposeRecovery units are typically open-plan rooms where all patients can be seen at all times; however, a new hospital has been built with 4- to 6-bed perioperative bays. The purpose of the study was to establish expert consensus regarding problems, benefits, and suggested solutions for the new design across four domains: patient safety, staff satisfaction, organizational efficiency, and maintenance of professional standards.DesignWe conducted a Delphi study to inform the development of a model of care for this new design.MethodsA two-round Delphi study involved 71 recovery unit nurses from 13 countries. Problems, solutions, and any potential benefits of the new design were collected in round 1 and ranked in round 2.FindingsThe highest ranked problems were mixing conscious and unconscious patients and need for safe skilled staffing levels. The highest ranked solutions were division of patients, increased safe skilled staffing, and staff education.ConclusionsParticipants identified clear risks and mitigation strategies. Implementing these strategies should allow for a safer environment for both patients and staff. A model of care to ensure safety and quality in 4- to 6-bedded bay postanesthetic recovery units should address mixing of patients, staffing levels and staff education.     

Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre‐ and post‐implementation study

The aim of this study was to evaluate whether implementation of a new nursing handover model led to improved completion of nursing care activities and documentation. A pre‐ and post‐implementation study, using a survey and document audit, was conducted in a hospital ED in Melbourne. A convenience sample of nurses completed the survey at baseline (n = 67) and post‐intervention (n = 59), and the audit was completed at both time points. Results showed significant improvements in several processes: handover in front of the patient (P < 0.001), patients contributed and/or listened to handover discussions (P < 0.001), and provision of adequate information about all patients in the department (P < 0.001). Nurses also reported a reduction in omission of vital signs (P = 0.022) during handover. Three hundred sixty‐eight medical records were audited in the two study periods: 173 (pre‐intervention) and 195 (post‐intervention). Statistically significant improvements in the completion of two nursing care tasks and three documentation items were identified. The findings suggest that implementation of a new handover model improved completion of nursing care activities and documentation, and transfer of important information to nurses on oncoming shifts.     

The art of oral handovers: A participant observational study by undergraduate students in a hospital setting

Aims and objectives

To explore the conditions for oral handovers between shifts in a hospital setting, and how these impact patient safety and quality of care.

Background

Oral handovers transfer patient information and nursing responsibilities between shifts. Short written summaries of patients can complement an oral handover. How to find the balance between a standardised protocol for handovers and tailoring variations to specific patients and situations is debated in the literature. Oral handovers provide time for discussion, debriefing and problem solving, which can lead to increased team cohesiveness.

Design

This study used a participant observation design.

Method

Fifty‐two undergraduate nursing students conducted 1100 hr of participant observation in seven different units in a hospital in Western Norway from 2014–2015. Field notes were analysed using qualitative content analysis.

Results

Six themes emerged from the data: (i) content and structure of the handover, (ii) awareness of nurses’ attitudes during oral handover, (iii) verbal and nonverbal communication, (iv) distractions, (v) relaying key information accurately , (vi) ensuring quality through oral handovers.

Conclusion

Developing a familiar structure for oral handovers and minimising the use of abbreviations and unfamiliar medical terms promote clarity and understanding. Limiting disturbances during handovers helps nurses focus on the content of the report. Awareness of one's attitudes and the use of verbal and nonverbal communication can enhance the quality of a handover. Time allocated for an oral handover should allow for professional discussions and student supervision. Involving nurse leaders in promoting the quality of oral handovers can impact the quality of care.

Clinical implications

Oral handovers serve many purposes, such as the safe transfer of patient information between shifts and staff education and debriefing, which enhance team cohesiveness.     

Challenges Associated With Patient Transfer From Postanesthesia Care Unit to Surgical Unit in Iran: A Mixed-Method Study

PurposeThis study aimed to explore the entire spectrum of challenges associated with the process of patient transfer from the postanesthesia care unit (PACU) to the surgical unit.DesignThe study employed a mixed-method design with concurrent triangulation approach.MethodsThe study was conducted during July-December 2018 at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. A total of 23 health-care providers involved with the patient transfer process from the PACU and surgical unit were recruited. Data were collected using quantitative and qualitative approaches. The quantitative study included 25 structured observations. The qualitative study included 12 unstructured observations, individual semistructured in-depth interviews (n = 13), and focused group sessions (n = 3). Data were managed using MAXQDA.10 software and analyzed using SPSS software (version 22.0).FindingsBased on qualitative data, 4 main categories and 14 subcategories were extracted. The main categories were “Multifarious Activities of Nurses”, “Insufficient Organizational Resources”, “Task-oriented Approach”, and “Deficient Professional Performance”. Results showed that 51% of patient-specific information, 64% of anesthesia information, and 74% of surgical information was not transferred during patient handoffs.ConclusionsInsufficient organizational resources and deficient professional performance were identified as the main challenges associated with the transfer process of postoperative patients. Our findings provide a better understanding of these challenges and encourage health policymakers and planners to resolve these issues to promote patient safety during handoffs.