ICU医患沟通记录单的设计与应用

目的应用ICU医患沟通记录单,以降低医护患纠纷的发生率。方法将患者住院期间的治疗、护理方案、费用、皮肤情况等告知家属并在医患沟通记录单上签名。结果患者家属对医护工作满意度由95.08%上升至99.13%,投诉率由2.60%下降至0.57%。结论医患沟通记录单的应用有利于提高患者家属的满意度,减少护患纠纷。     

氧疗知情同意书的设计与应用

摘要：目的 提高早产儿氧疗安全性，降低医患纠纷的发生率。方法 参照《早产儿治疗用氧和视网膜病变防治指南》，自行设计新生儿病房氧疗知情同意书，对执行氧疗的早产儿父母及时告知病情并签署氧疗知情同意书。采用问卷调查形式收集患儿父母对医护工作满意度及投诉的情况。结果 患儿住院４～２６ｄ，均未发生氧疗并发症，患儿父母对医护人员的工作满意度为９９．２％；仅发生１起医患纠纷。结论 氧疗知情同意书应用于早产儿氧疗护理中，有利于提高早产儿氧疗的安全性，提高无陪患儿家属的满意度，减少医患纠纷的发生。关键词：早产儿；　氧疗；　知情同意书；　氧疗安全性中图分类号：Ｒ４７２．７２；Ｒ１９７．３２３　　文献标识码：Ｃ　　文章编号：１００１-４１５２（２００７）１７-００４４-０２     

知情同意对早产儿氧疗安全的作用

目的 提高早产儿氧疗安全性,降低医患纠纷的发生率.方法 对执行氧疗的早产儿及时告知病情,患儿父母签署早产儿氧疗知情同意书,采用问卷调查表和随机访谈形式,收集患儿父母对医护工作满意度及医患纠纷的情况.结果 满意度由2004年的95.1%上升到2006年的99.2%(P＜0.01);医疗纠纷由2004年4起减少到2006年1起.结论 氧疗知情同意书应用于早产儿氧疗护理中,有利于提高早产儿氧疗的安全性,提高无陪患儿家属的满意度,从而减少医患纠纷的发生.     

知情同意对早产儿氧疗安全的作用

目的 提高早产儿氧疗安全性,降低医患纠纷的发生率.方法 对执行氧疗的早产儿及时告知病情,患儿父母签署早产儿氧疗知情同意书,采用问卷调查表和随机访谈形式,收集患儿父母对医护工作满意度及医患纠纷的情况.结果 满意度由2004年的95.1%上升到2006年的99.2%(P＜0.01);医疗纠纷由2004年4起减少到2006年1起.结论 氧疗知情同意书应用于早产儿氧疗护理中,有利于提高早产儿氧疗的安全性,提高无陪患儿家属的满意度,从而减少医患纠纷的发生.     

针对性医患谈话制度在脑卒中患者中的应用

目的探讨适合脑卒中患者的针对性谈话制度。方法将2005年3-9月收住神经内科卒中单元的脑卒中患者155例,随机分成实验组和对照组,对照组采用传统的谈话制度,实验组采用针对性谈话制度,比较2组的医患纠纷发生率,病、陪人满意度,护理质量达标率,健康教育掌握率等。结果实验组的医患纠纷发生率明显低于对照组(P<0.01),而病、陪人满意度,护理质量达标率,健康教育掌握率均明显高于对照组(P<0.01)。结论针对性医患谈话制度能提高脑卒中患者的护理质量及满意度,减少医患纠纷的发生。     

针对性医患谈话制度在脑卒中患者中的应用

目的 探讨适合脑卒中患者的针对性谈话制度.方法 将2005年3-9月收住神经内科卒中单元的脑卒中患者155例,随机分成实验组和对照组,对照组采用传统的谈话制度,实验组采用针对性谈话制度,比较2组的医患纠纷发生率,病、陪人满意度,护理质量达标率,健康教育掌握率等.结果 实验组的医患纠纷发生率明显低于对照组(P＜0.01),而病、陪人满意度,护理质量达标率,健康教育掌握率均明显高于对照组(P＜0.01).结论 针对性医患谈话制度能提高脑卒中患者的护理质量及满意度,减少医患纠纷的发生.     

安全宣教记录单在脑卒中患者安全管理中的应用

目的探讨使用安全宣教记录单对脑卒中患者安全的影响,以保证患者安全。方法选取2015年7~12月入住本院神经内科的脑卒中患者396例为观察组,在给予患者常规安全宣教的同时,针对存在高危安全风险的患者应用安全宣教记录单;将2015年1~6月收治的脑卒中患者329例列为对照组,对两组患者的意外受伤事件发生率、医患纠纷发生率、患者满意度进行对比。结果观察组意外受伤事件发生率和医患纠纷发生率较对照组患者明显降低,患者满意度较对照组明显提高,差异均具有统计学意义(P0.05)。结论在脑卒中患者安全管理中,应用安全宣教记录单,可提高责任护士的安全意识,强化安全教育,降低患者意外受伤事件发生率,从而保证患者安全。     

静脉输液护理记录单在儿科的临床应用

目的观察静脉输液护理记录单在儿科应用的效果。方法设计“静脉输液护理记录单”,利用表格的形式对患儿静脉输液进行评价。结果因静脉输液引起的护患纠纷明显减少。结论使用“静脉输液护理记录单”后,增强了护士的责任心,增进了护患关系,提高了患儿及其家长对医院的满意度。     

术前行政谈话在预防医患纠纷中的作用探讨

目的 研究术前行政谈话在预防医患纠纷中的作用。方法 选取2016年1月至12月同济大学附属第十人民医院的572例术前进行行政谈话的患者作为行政谈话组,另随机选取同期的572例配对的未进行术前行政谈话的患者作为非行政谈话组,比较两组患者的平均住院日、平均住院费用、并发症发生率、病死率和发生医患纠纷比率。结果 术前行政谈话组和非行政谈话组在患者年龄、平均住院日、并发症例数和死亡人数上差异无统计学意义（P>0.05）,行政谈话组发生医患纠纷6例,非行政谈话组纠纷例数为25例,两组比较差异有统计学意义（P<0.05）。结论 术前行政谈话可以减少医患纠纷的发生。     

唇腭裂患者父母对序列治疗问卷调查初期研究

目的明确唇腭裂患儿父母对唇腭裂序列治疗的了解状况，为临床护理提供依据。方法通过对31例手术前腭裂和唇腭裂患者父母的问卷调查分析患儿家属对治疗的要求及对治疗过程的目的的了解程度，并对所有被调查者予以针对性宣教。结果31例腭裂及唇腭裂患者父母对序列治疗均不甚了解；51．6％的被调查者关注术后语言功能，32．3％关注面部外形。结论唇腭裂患者父母对唇腭裂序列治疗的了解程度关系着患者的治疗效果，因此对患儿父母应加强护理知识的宣教以利于建立良好的医患关系和获得满意的治疗效果。     

《护理学基础》教材中增加尊重患者同意权内容建议

知情同意权是由“知情权”和“同意权”两部分构成的一个整体。尊重患者的知情同意权是医务人员必须遵守的临床伦理法则,体现了对患者生命价值和人格尊严的尊重,也是防范医疗纠纷的重要内容。为了让护生在专业课程的学习过程逐渐培养尊重患者知情同意权的意识,在《护理学基础》教材的相关内容中,不仅要体现对患者“知情权”的尊重,也应强调尊重患者的“同意权”。     

人性化护理在美容外科的应用效果研究

目的:探讨人性化护理在美容外科的应用,以减少医疗纠纷和术后并发症的发生,提高患者依从性和满意度。方法:将2010年6月～2011年6月就诊患者1027例为对照组,实施一般常规护理;将2011年7月～2012年7月开展人性化护理后到我科就诊的患者1384例为试验组,实施人性化护理。比较两组患者医疗纠纷、术后并发症发生率及患者依从性和满意度情况。结果:实施人性化护理后,医患纠纷发生率和并发症发生率分别由1.46%和4.48%下降到0.43%和2.31%(P<0.05),患者依从性和满意度分别由86.95%和89.00%提高到90.46%和92.34%(P<0.05),差异有统计学意义。结论:人性化护理的实施对减少美容外科医患纠纷及提高护理质量和患者满意度有重要意义。     

签订患者知情同意书在难免性压疮护理中的作用

目的:探讨签订患者知情同意书在难免性压疮护理中的作用,避免压疮护理中的护患纠纷。方法:我科从2005年1月起,对申报的难免性压疮由患者法定代理人签订知情同意书,作为观察组;2004年12月31日以前的患者,采用常规告知,患者法定代理人未签订知情同意书,作为对照组。比较两组患者家属寻求压疮护理知识和参与压疮护理的主动性、护理记录举证有效性、压疮发生率及护患纠纷发生率。结果:两组患者家属寻求压疮护理知识和参与压疮护理的主动性、护理记录举证有效性比较,有统计学意义(P0.01),观察组优于对照组。两组患者压疮发生率比较,无统计学意义(P0.05)。两组患者护患纠纷发生率比较,有统计学意义(P0.05)。结论:签订患者知情同意书有利于提高患者家属对难免性压疮的正确认识,从而自愿作出理性的配合,有利于提高护士的举证意识,减少护患纠纷。     

破伤风抗毒素脱敏注射知情同意书的应用及效果

目的探讨破伤风抗毒素脱敏注射知情同意书的应用及效果。方法对门诊注射室破伤风抗毒素皮试阳性患者,签署破伤风抗毒素脱敏注射知情同意书并进行健康教育。结果应用破伤风抗毒素知情同意书后无纠纷、投诉发生。结论在行破伤风抗毒素脱敏注射中应用破伤风抗毒素脱敏注射知情同意书,维护了患者和护士自身的合法权益,有效降低了脱敏注射的风险,防范了护患纠纷的发生。     

The quality of parental consent for research with children: a prospective repeated measure self-report survey

BACKGROUND: Researchers have ethical and legal responsibilities to ensure that individuals give informed consent to participate in research. The few studies of parental consent for paediatric research suggest there may be inadequate competence, information, understanding, or voluntariness for valid consent to occur. OBJECTIVES: To determine parents' level of understanding of the research study requirements and satisfaction with the informed consent process. PARTICIPANTS: English literate parents of children actively involved in research studies. METHODS: A repeated measures self-report survey was conducted to measure parent understanding (actual and perceived) of the study consented for and satisfaction with the informed consent process. Relationships between parents understanding of the research and their satisfaction with the consent process were explored and changes in parent understanding or satisfaction over time were described. RESULTS: Questionnaires from 109 parents were returned, representing 25 different studies. Parents demonstrated a high level of knowledge of information essential for informed consent, such as the purpose, benefits, and participant rights. Nervousness or inability to concentrate, and reading ease of the information sheet were found to relate to parents' knowledge and their perceptions of the adequacy of the consent. Parents overall reported high satisfaction with the consent process. CONCLUSIONS: These findings support and extend previous research on parental consent for research with children. They suggest areas where further research is indicated, including: the value and use of information and consent documents given to parents, the views and concerns of parents for whom English is not their first language, and further exploration of the concerns of the few dissatisfied parents. Current practices of obtaining informed consent for research lack supporting research evidence and may not be ethically justifiable.     

Informing parents about newborn screening

OBJECTIVE: To evaluate current rules and regulations for educating parents about newborn screening. DESIGN: Cross-sectional survey. SAMPLE: Newborn screening program coordinators in all 50 states and the District of Columbia. MEASUREMENTS: Answers to a standardized semi-structured telephone survey in January 2004. RESULTS: Fifty programs provide standardized information about screening, and 32 of these have information available in multiple languages. Most programs (n=36) believe that parents should be informed about newborn screening as a part of prenatal care; however, none has rules or regulations requiring this. Five require documented informed consent; only one provides the consent form in a language other than English. Hospitals and birthing centers are required by many programs to educate families, including providing information (n=12), obtaining informed consent (n=5), informing parents of the right to refuse screening (n=13), and documenting refusal on institutionally developed forms (n=9). We found considerable variation in policy language across the newborn screening programs. CONCLUSIONS: The complexity of current newborn screening programs and the likelihood of expansion in the number of conditions on newborn screening panels present a unique opportunity and challenge for public health nurses to ensure that these programs are effective and that care is integrated.     

抑郁症发作期患者就诊与住院知情同意状况的调查与分析

目的探讨抑郁症发作期患者就诊与住院知情同意状况,寻找既方便患者就诊和住院,又可避免因患者知情同意问题引起医疗纠纷的方法。方法对符合CCMD-3的抑郁发作期患者进行知情同意状况调查。结果患者对就诊知情者87例(52.41%),不知情者79例(47.59%);同意就诊者70例(42.17%),不同意就诊者96例(57.83%)。患者对住院知情者65例(39.16%),不知情者101例(60.84%);同意住院者53例(31.93%),不同意住院者113例(68.07%)。结论保证监护人对患者就诊和住院治疗的知情同意权是减少医疗纠纷的关键。     

Circumcision and informed consent. Is more information always better?

This study observes that physicians routinely inform parents about a small minority of the medical complications and risks associated with elective circumcisions. When selecting which medical complications to mention to parents, physicians appeared to use a policy based on their subjective assessment of the frequency and seriousness of the complications' occurrence. Subsequent analyses revealed that the physicians' probability estimates were biased and their seriousness assessments were consistently less than those expressed by mothers of newborn sons. Replacing the physicians' policy of partial disclosure with a comprehensive disclosure of "unbiased" information of possible risks and complications had no effect on the mothers' decisions to have their sons circumcised but did generate numerous influences on the mothers' attitudes. Among the effects observed in mothers were a reduction in their confidence in the appropriateness of their decision and a dissatisfaction with their physician's behavior. The implications of these findings to informed consent are discussed, and a greater flexibility in providing informed consent is advocated.     

从"知情同意"谈患者的权利

在近几年繁多的医疗纠纷中,围绕知情同意权的纠纷不在少数,本文主要围绕患者的知情同意权 进行分析,并介绍了患者在诊疗护理过程中享有的主要权利。保护患者的权利,不仅要加强医护人员的法律意识, 而且要加强医护人员与患者之间的沟通和交流,如在患者的知情同意权的实现中,医护人员加强语言社会化,使之 能与患者更好的沟通,使得患者对相关事宜有更好的了解,也是减少医患纠纷的措施之一。     

Lack of correlation between satisfaction and knowledge in clinical trials participants: a pilot study

OBJECTIVES: To address participants' knowledge of informed consent and to explore whether knowledge level is related to clinical trial satisfaction. METHODS: One hundred and fourteen patients enrolled in three ongoing randomized controlled trials of osteoarthritis and rheumatoid arthritis were asked to complete a mailed form. The survey was related to aspects of the informed consent process: quality of information given during the informed consent process, participants' self perception of knowledge, objective evaluation of participants' knowledge and participants' overall trial satisfaction. These four aspects were categorized as high, intermediate or low. Correlation between participants' knowledge and satisfaction was measured using the Spearman's Rho test and variables associated with knowledge by standard univariable analyses. A p value< or =0.05 was considered significant. RESULTS: One hundred and five participants answered the questionnaire. The quality of information given during the informed consent process was rated as being high by 81% participants, intermediate by 15.2% and low by 3.8%. Fifty-one percent of the participants believed they had a good level of knowledge, but, objective evaluation qualified as high in only 14.3% of them. Overall trial satisfaction was high in 95% of the participants. No significant correlation was found between knowledge and satisfaction (r=0.16; p=0.086). Age was negatively associated with a higher level of knowledge (48 vs. 58 years old, p=0.008). CONCLUSIONS: We found a lack of correlation between satisfaction and knowledge in clinical trials participants. During a randomized controlled trial the investigator should consider encouraging activities to improve not only participants' satisfaction, but also their level of knowledge.