皮肤科门诊设立病人接待中心工作模式的探讨

目的皮肤科门诊设立病人接待中心,提高医院服务质量和病人满意度。方法从细节做起,开展咨询、导医、个性化服务、健康教育等工作,拓宽服务范围。结果把以病人为中心落到实处,真正满足病人的就医需求,为病人提供更优质的服务。结论为病人提供多角度、全方位的就医服务,能提高医院服务质量和病人的满意度,不断满足病人的医疗服务需求。     

提高门诊优质护理管理途径的探讨#$NL李鹏涛

由于医学模式的转变和社会发展中人们对生育、健康和医疗保健需求的日益增长,护理服务的模式也发生了很大的变化。2010年卫生部发出关于优质护理服务的文件,各大医院纷纷开始贯彻和落实优质护理服务的精神。优质护理服务强调在完成基础护理工作,满足患者各项基本生活需要的同时还要进行专科护理,促进患者康复,最终达到提高患者满意度的目的。本文着重探讨我院作为皮肤科的三级专科医院,应如何提高门诊优质护理服务,主要从门诊健康教育及门诊预约等方面来研究。     

优质护理服务在内科门诊实施的分析

目的:探讨优质护理服务在内科门诊的实施效果。方法:通过主动美声微笑服务、开展礼仪服务培训、制订预检分诊应急预案、强化护理安全、心理护理、提高内科门诊护士多专科护理知识水平、建立交班日志、做好流行病学调查、开展便民惠民服务、亲情服务及健康教育、全面开展预约诊疗服务等措施实践优质护理服务。结果:护理投诉有所减少,应急抢救成功率、患者及其家属的满意度均有所提高。结论:优质护理服务在内科门诊实施顺应了国务院办公厅2011年公立医院改革《工作安排》中要求,树立了良好的医院临床一线窗口护理服务形象。     

基于家庭医护平台延续性护理模式的构建及应用

目的 基于家庭医护信息化管理平台（以下简称平台）,构建居家延续性护理模式,并评价其应用效果,以期提高出院患者居家护理质量。 方法 平台由监控平台和操作平台构成。操作平台包括：①患者端APP,包括服务项目页面和个人信息页面,支持用户注册、项目选择、项目预约和评价;②护士端APP,包括提供服务项目、服务申请显示、安全中心及个人信息页面,支持护士注册、接单和安全监控。监控平台负责用户管理、服务项目维护、数据管理及安全监控。利用平台实施出院后患者居家护理服务。调取2018年10月—2019年3月患者满意度和健康知识掌握率等数据,评价平台效果。结果 共231名护士、109例患者完成注册,进行居家护理164次,陪诊8次;接受延续性护理服务后,患者满意度为93.9%,明显高于出院时患者86.2%的满意度（χ ²=4.623,P=0.032）;接受延续性护理服务后,患者对健康知识掌握率为97.7%,明显高于住院患者87.6%的健康知识掌握率（χ ²=14.545,P<0.001）,无投诉和不良事件发生。 结论 家庭医护信息化管理平台可充分发挥临床护士的专业价值,为出院患者提供系统、规范、安全、优质的居家护理服务,明显提高了居家患者满意度和健康知识掌握率,为患者提供了高效、便捷的就医途径。     

Outcomes and effectiveness research: capacity building for nurse researchers at the Agency for Healthcare Research and Quality

Several of AHRQ's priority areas including disease prevention, health promotion, primary care, quality of care, service delivery, and patient safety are particularly relevant to nurse researchers. With much national attention focused on nursing-related issues such as staff shortages, training, mandatory overtime, working conditions, and autonomy, it is mandatory that nursing research be conducted to inform healthcare delivery and policy. Nurses also need to contribute to the health services literature so that an even balance of discipline perspective is represented. AHRQ's mandate is represented by the slogan "quality research for quality health care." Although our understanding has expanded of contributors to and determinants of evidence-based practice and the relationship between clinical care and improved outcomes, we have much to learn. Appreciating how and which components of nursing care influence patient outcomes represents an essential area of research in need of development. While clarifying nursing contributions to improved outcomes is not the sole purview of nurse researchers, it is plausible to assume that a clinical background in nursing combined with strong methodological skills can help policy makers and health system leaders understand how nurses can most effectively contribute to outcomes and quality improvement. AHRQ is clearly interested in capacity building of researchers from all relevant disciplines. Nurses, the largest provider of healthcare, need to build capacity and develop a much stronger presence in the health services research community of scholars.     

Congestive heart failure education study.

Nursing staff providing care to patients on a medical/surgical unit must be generalists rather than specialists in disease management. The diversity of illnesses seen among this population requires the nurse to be expert in many disease processes. The complexity of patients who are admitted to a medical/surgical unit continues to increase and is therefore challenging to nurses. Complex patient populations can be attributed to individuals living longer and the advancement of technology and information in treating serious medical conditions. Nursing expertise for different disease processes can vary according to experience, educational level, and knowledge regarding evidence-based practice. Lack of knowledge regarding current practice guidelines and care may result in poor patient outcomes and high cost. Confidence in performing safe and quality nursing care can also be affected by lack of knowledge. Continuing education for nursing must be made a priority for nurses to provide safe and high quality care. Education provided must be current and based on positive outcomes through research-based nursing practice.     

Partners in caring: an innovative nursing model of care delivery

Nursing leadership at Morristown Medical Center, a Magnet-designated, 600-plus bed tertiary care center, in response to forces, such as health care reform, and recommendations, such as those outlined in the Institute of Medicine report The Future of Nursing, developed an innovative model of care delivery called the Partners in Caring. This model of care delivery is an approach built on a functional unit of registered nurse-nurse assistant partnership supported by a patient care facilitator. The nursing partners are accountable for the coordination of patient care with an emphasis on patient and organizational goal achievement of (1) improving the health of our patients, (2) developing and maintaining an improved and responsive health care system, and (3) lowering costs while delivering quality care. The model of care was developed and is being implemented and evaluated using a knowledge translation methodology to ensure its evidence base and outcome achievement. Transforming workforce roles and communication patterns, incorporating technology to benefit time management and maintaining a keen focus on achieving patient outcomes are hallmarks of this new model.     

Oncology patients' perceptions of quality nursing care

The purpose of this study was to analyze theoretically oncology patients' perceptions of the attributes and outcomes of quality nursing care. The grounded theory method as described by Strauss and Corbin (1998) was used. The purposive sample comprised 22 oncology patients being treated at an urban medical center; they were interviewed using a semistructured schedule. Eight attributes of quality nursing care emerged from the data. From the patient's perspective, excellent care was characterized by professional knowledge, continuity, attentiveness, coordination, partnership, individualization, rapport, and caring. In addition, two outcomes of quality care included increased fortitude and a sense of well-being with its constituents of trust, optimism, and authenticity. These findings can inform investigations of how oncology patients may experience "being well cared-for by nurses. Copyright John Wiley & Sons, Inc.     

A research-based practice model in a hospital setting.

Nursing exists for the purpose of rendering patient care. If nurses are to provide cost-effective, quality care, they must become involved in nursing research that is related to patient care outcomes. Having a nursing research department in the hospital setting will offer the resources to enable nursing staff to meet the challenge. The nurse executive plays a vital role in initiating nursing research programs. The author highlights the critical factors that made it possible to initiate and support the development of a nursing research department in a community medical center.     

Creating and Analyzing a Statewide Nursing Quality Measurement Database

PURPOSE: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals. DESIGN: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual. METHODS: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care. FINDINGS: As of May 2003, the CalNOC database contained staffing data from 842 units in 134 acute care hospitals over 20 quarters from April 1998 to March 2003. The repository also included clinical outcome information on 34,262 reported patient falls, pressure ulcer prevalence data on 41,982 patient observations, and service outcome data on patient satisfaction from 26,461 patients. Participating hospitals receive quarterly reports allowing them to benchmark their own performance against other participating hospitals. CalNOC methods have been adapted and replicated by both the Military Nursing Outcomes Database and VA Nursing Outcomes Database projects, and CalNOC nursing-sensitive measures have been endorsed by the National Quality Forum. CONCLUSIONS: This working model for collecting reliable and valid data was derived from multiple hospitals across California. The data are the basis for studies to contribute to the development of evidence-based public policy, and for ongoing study of the effects of nurse staffing on clinical and service outcomes.     

住院患者对优质护理服务认知的调查研究

目的:探讨住院患者对优质护理服务的评价和期望。方法:采用调查问卷的形式对796例住院患者进行优质护理服务问卷调查,将调查项目进行编码,用统计学软件SPSS13.0版本进行频数、构成比、均数和标准差的计算。结果:住院患者认为优质护理服务指征依次为:知识与技能、服务态度、关爱与沟通、患者感受、健康指导、及时提供患者所需的护理。结论:患者对优质护理服务要求全面,在开展优质护理服务示范工程时,可参照本研究结果,制定更加符合患者实际期望的质量评价标准、患者满意度调查问卷,从而指导临床实践。     

Initiating a long-term care nursing service for aging inmates

In establishing a new long-term care nursing service in a correctional health care setting, the director of nursing (DON) sets the organizational milieu with a holistic humanistic perspective. She is expected to demonstrate the leadership attributes of vision, creativity, and accountability as manifested through outcomes. Based on her 6-year experience, the author delineates the DON's role in collaboratively initiating a program at a new facility, devising a method to identify geriatric inmates in need, and establishing a hospice program in a federal medical center where security takes precedence.     

骨科护理专业培养与发展之路

随着医学知识与技术日益进步,医护分工逐渐精细,相互协调以使服务更臻完善,以达整体护理和满足患者需求。骨科护理是体现整体护理的专科,从骨折发生至康复,护理从医院至回到社区。除了医疗专科,骨科专科护理支持对患者的照顾绝不能缺少。提高骨科护理的专业水平,最重要是护理人员需保持与时俱进的高素质骨科护理培训。骨科专科护士要接受从基础至专科有系统而循序渐进式的培训,知识和技术更扎实,专业使命和自信使他们感受到服务需要创新。香港骨科专科护士在跨界顾问服务和护理门诊工作的开展,显示着骨科专科护理更趋成熟,为协调好医生、护理好患者而不断努力,让护理服务求进求新。     

Effects of New Zealand's health reengineering on nursing and patient outcomes

BACKGROUND: In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States. OBJECTIVE: The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce. RESEARCH DESIGN: The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. SUBJECTS: All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined. MEASURES: Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. RESULTS: After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. CONCLUSIONS: In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.     

“三制一体”护理模式对推进精神科优质护理服务的影响

目的 探讨“三制一体”护理模式对推进精神科优质护理服务的影响。方法 选取我院2012年4月—2013年3月优质护理服务示范病区100例患者为研究组,普通病区100例同期住院患者为对照组。研究组采用新制定的服务标准,并采用“三制一体”护理模式,对照组采用传统服务标准及护理模式对患者实施护理。对两组患者住院满意度、住院患者家属满意度、住院患者健康教育知识知晓率及护理质量进行比较。结果 研究组的患者住院满意度、住院患者家属满意度、健康教育知识知晓率及护理质量与对照组比较,差异有统计学意义(P<0.05)。结论 精神科“三制一体”护理模式有利于进一步提高护理服务质量,提高患者及家属满意度,提高患者健康教育知识知晓率,是一项推进精神科优质护理服务行之有效的护理工作模式。     

Ethical decision making.

Members of the health care profession have a responsibility to identify and regulate their practice to protect consumers and assure the delivery of quality service. In this case study in which a patient wakes up during surgery, the nurse's code of ethics, standards of care, and ethical decision-making models provide guidance toward the resolution of this clinical dilemma. Such resolution requires sound nursing knowledge, knowledge of the facts of the situation, knowledge of the law, and application of critical thinking skills to facilitate positive outcomes for all parties involved.     

Describing a model of nursing as a focus for psychiatric nursing care

This thesis would not be complete in it's review of Psychiatric nursing and Psychiatric nurse education, without reference to one of the fundamental changes that is occurring in nursing. One of the major changes that had occurred in recent years has been in the focus of nursing management nurses are placing much more emphasis on nursing diagnosis and nursing theories and are detaching from the more traditional medical model when planning nursing care. This movement towards a greater autonomy in planning their nursing care is assisting nurses in becoming a professional and independent group. Nurses are establishing a body of knowledge and skills which may be called "nursing science". Through the use of nursing models for planning patient and health care, nurses are offering a better service to the individual and the community. These changes in the focus of care commenced in the 1950's within the United States with the introduction of nursing models and theories. The Philosophies and concepts of these theories have outlined various methods and ways that the nurse could better plan and organize their professional work, including patient assessment and care. As early as 1953 the term "nursing diagnosis" was introduced by Fray to describe a step in the organization of a nursing care plan. (1) The various nursing models and theories seemed to have coincided with the movement through the 1950's and 1960's within America towards more generic based integrated curricula.