荆州市医护人员在抢救病人过程中的沟通与医嘱执行现状调查

[目的]探讨建立抢救病人过程中规范标准的沟通交流模式和高效便捷的医嘱执行流程的必要性与重要性。[方法]采用自行设计的问卷对2013年9月荆州市各级医院147名医护人员在抢救病人过程中的医护沟通与医嘱执行现状进行调查。[结果]医生下达的医嘱不规范，对医嘱反馈重视度不够；医护配合不理想；医护人员普遍认为抢救时有效沟通很重要，有必要制定规范、标准的医护沟通模式。[结论]提高医护人员对抢救病人过程中医护沟通与医嘱执行的重要性认识，建立病人抢救中规范有效的医护沟通模式，以确保抢救质量。     

外科危重手术病人亲属的需求调查研究

目的 探讨外科手术病人亲属的需求.方法 对我院100例需要手术的危重病人亲属进行调查研究.结果 手术病人亲属首要需求是保障病人生命安全,其次是手术效果及预后情况的信息需求,对于人口学特征方面的某些需求存在差异.结论 医护人员要准确评估手术病人亲属的需求的重要性,注意人口学特征方面不同需求,以便给予帮助.     

荆州市医护人员在抢救病人过程中的沟通与医嘱执行现状调查

[目的]探讨建立抢救病人过程中规范标准的沟通交流模式和高效便捷的医嘱执行流程的必要性与重要性。[方法]采用自行设计的问卷对2013年9月荆州市各级医院147名医护人员在抢救病人过程中的医护沟通与医嘱执行现状进行调查。[结果]医生下达的医嘱不规范,对医嘱反馈重视度不够;医护配合不理想;医护人员普遍认为抢救时有效沟通很重要,有必要制定规范、标准的医护沟通模式。[结论]提高医护人员对抢救病人过程中医护沟通与医嘱执行的重要性认识,建立病人抢救中规范有效的医护沟通模式,以确保抢救质量。     

创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响

[目的]探讨创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响.[方法]采用90项症状清单(SCL-90)和重危病人亲属需求量表(CCFNI)调查不同病情组的病人亲属的心理健康状况及需求.[结果]不同病情组病人亲属的SCL-90总分和各维度得分存在显著的差异(P均<0.05);需求种类也存在差异(P<0.05).[结论]病人的病情越重,亲属的心理压力越重,医护人员应关注病人亲属的心理健康,尤其是重症病人的亲属;重度病情组的亲属其获取信息、接纳及病情保证的需求明显高于轻度病情组,且获取信息和病情保证明显高于中度病情组的亲属.     

医护闭合式循环沟通配合培训在急性心肌梗死抢救中的应用

[目的]探讨医护闭合式循环沟通培训在急性心肌梗死病人抢救配合中的作用。[方法]运用医护闭合式循环沟通培训评价调查问卷对我院急诊科38名医护人员进行急性心肌梗死医护配合急救流程闭合式循环沟通培训调查,通过现场模拟演练进行培训前后对比。[结果]38名医护人员对医护闭合式循环沟通评价满意度提高,培训前后总分及各维度得分差异有统计学意义(P0.05)。[结论]医护闭合式循环沟通配合培训法可以提高急性心肌梗死抢救效率,保证抢救工作质量。     

创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响

[目的]探讨创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响。[方法]采用90项症状清单（SCL-90）和重危病人亲属需求量表（CCFNI）调查不同病情组的病人亲属的心理健康状况及需求。[结果]不同病情组病人亲属的SCL-90总分和各维度得分存在显著的差异（P均〈0．05）;需求种类也存在差异（P〈0．05）。[结论]病人的病情越重,亲属的心理压力越重,医护人员应关注病人亲属的心理健康,尤其是重症病人的亲属;重度病情组的亲属其获取信息、接纳及病情保证的需求明显高于轻度病情组,且获取信息和病情保证明显高于中度病情组的亲属。     

危重病人亲属的需求及其影响因素分析

目的 探讨危重病人亲属的需求及其影响因素.方法 采用危重病人亲属需求量表,对120例危重病人亲属进行调查.结果 危重病人亲属认为最重要的是保证病人安全的需求,其次是接近病人、获得信息、支持的需求和舒适的需求.病人亲属的人口学特征影响其某些需求,而病人的急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分与亲属的需求无相关性.手术病人与非手术病人亲属有5项需求存在显著性差异.结论 护理人员应准确评估病人亲属需求的重要性,注意影响需求的因素,以便为亲属提供有效的帮助,维持家庭结构的健康和功能.     

浅谈静脉输液的心得体会

输液是一种治疗措施，目前相当多的病人在家庭接受输液治疗。常常是医护人员到家庭给病人输液，输上液体后即离开病人，换液体、拔针之类的事情则由病人家属代劳，不少病人及家属因缺乏医学知识，没有医疗安全意识。在输液过程中，一旦发生了严重的并发症，医护人员不能及时赶到现场实施抢救，即使医护人员在场，因为家庭不具备抢救的条件，而耽误抢救时机造成严重后果。     

创伤性颅脑损伤患者一级亲属的社会支持状况

目的 了解创伤性颅脑损伤患者一级亲属的社会支持状况,为提供有效的社会资源提供参考.方法 采用社会支持量表调查300名颅脑损伤患者一级亲属的社会支持状况.结果 本组一级亲属的社会支持总分显著高于常模(P<0.01);影响一级亲属社会支持状况的因素有:获取信息、居住地点、精神病性因子、医疗费用来源、职业状态、患者住院天数、自身舒适需求、支持需求和一级亲属的年龄.结论 创伤性颅脑损伤患者一级亲属的社会支持整体水平较高,医护人员应该指导一级亲属充分利用社会资源,以提高对创伤事件的应对能力.     

住院精神病人亲属的心理需求分析与对策

在精神病科陪护或探视的病人亲属,由于对精神疾病的基本知识、药物治疗知识及医院的规章制度了解甚少,往往顾虑重重。他们一方面希望病人的病情尽快得到控制,另一方面又对医院的药物治疗、病程预后、医疗水平和病人的安全十分担心。调查旨在了解住院精神病人亲属的心理需求,以寻求有效措施帮助其减轻心理负担,使病人得到更有效的社会支持,促进病人的康复。1对象与方法1.1对象随机调查2004年1月～6月来院陪诊的精神病人亲属106人,其中男56人,女50人,年龄30～64岁。文化程度:高中及以上42人,初中及以下64人。职业:干部14人,工人41人,农民43人,其他8人。与病人的关系:父母53人,兄弟姐妹30人,配偶23人。1.2方法采用自行设计问卷调查法。内容包括:精神病人亲属的心理需求内容及其需求程度;满足亲属心理需求的方式。根据亲属的心理需求程度分为强烈需求(希望深入了解)、一般需求(希望简单了解)和无需求(无所谓或已经了解)。调查者以问卷为基础,与调查对象交谈,充分讲解问卷中的各项问题,病人亲属回答,调查者代为填写。本组发放问卷106份,收回有效问卷106份。2结果精神病人亲属的心理需求内容及其需求程度见表1,满足亲属心理...     

Feedback to emergency medical services providers: the good, the bad, and the ignored

HYPOTHESIS: To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel. METHODS: Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale. RESULTS: In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (< 1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill. CONCLUSIONS: The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.     

Surrogate Consent by Family Members for Out-of-hospital Cardiac Arrest Research

OBJECTIVES: To evaluate the availability of family members of potential subjects to provide consent for participation in out-of-hospital cardiac arrest (OOHCA) research and to estimate the time required to contact a family member. METHODS: This study was a prospective observational study of adult patients (>18 years old) with nontraumatic OOHCA treated by an urban emergency medical service. Emergency medicine resident physicians responded to each scene and noted the presence of family members. A subsequent convenience sample of family members answered standardized questions about their ability to provide consent for research participation on behalf of the patient. RESULTS: Physicians were present at 100 of the 112 adult medical cardiac arrests during the study period. A family member was present at 57% of the scenes (95% CI = 47% to 67%). Patients with family present were older and were less likely to have bystander cardiopulmonary resuscitation (CPR) or live in a nursing home. The mean time (+/-SE) from emergency dispatch to family contact was 24.40 (+/-2.60) minutes and from physician arrival to family contact was 2.45 (+/-0.87) minutes (n = 20). Eight of 13 family members were willing to enroll the patient into a resuscitation study, but five family members were unable to understand the explanation of informed consent. CONCLUSIONS: Family members were present for an unrepresentative subset of OOHCA cases, and were contacted after the therapeutic window for many interventions. The emotional nature of the emergency situation also limited the reliability of surrogate consent for OOHCA research.     

急诊留观室病人家属需求的调查与分析

目的通过对急诊留观室家属的调查,了解急诊留观室家属的需求,从而改进急诊就医的环境与质量。方法采用方便抽样的方法,应用自行设计的问卷对100例急诊留观室病人家属进行调查。结果急诊留观室病人家属的各项需求中,从高到低依次为：对医生护士的需求,对急诊设施及管理的需求,对健康教育的需求。结论护士对病人家属需求的准确把握,是提高病人及家属满意度的前提。     

有创操作家属陪伴的研究现状

综述了家属与医务人员对有创操作家属陪伴的态度,病人、家属及医务人员对有创操作家属陪伴利弊的看法,提出医疗机构应制定相应的措施和规章制度.     

有创操作家属陪伴的研究现状

摘要：综述了家属与医务人员对有创操作家属陪伴的态度,病人、家属及医务人员对有创操作家属陪伴利弊的看法,提出医疗机构应制定相应的措施和规章制度。     

急诊危重患者家属需求的满足情况调查

目的了解急诊危重患者家属需求的满足情况。方法在中文版危重患者家属需求量表（critical care family needs inventory,CCFNI）的基础上应用自行设计的需求满足量表,采取分层整群抽样的方法,对下“病危”或“病重”医嘱后24h内的急诊患者家属进行调查。结果急诊危重患者家属需求的满足程度较低,满足较好的是病情保证的需求和与探视有关的需求,满足较差的是希望在医院能进行特殊宗教信仰活动和有人协助解决经济问题;不同健康状况组家属之间的需求满足得分差异有统计学意义（P〈0．05）。结论急诊医护人员应重视评估和满足急诊危重患者家属的需求,提高这一特殊群体的身心健康和家庭满意度。     

The mosh pit experience: emergency medical care for concert injuries

Effective planning is essential for medical personnel preparing to provide emergency care at mass gatherings. At large concerts where audience members participate in "moshing," crowd surfing, and stage diving, there may be a potential for a dramatic increase in injuries requiring medical attention. Injuries seen at emergency medical stations at 3 concerts, all with large mosh pits, over 4 event days were recorded and evaluated. Each event day had over 60,000 attendees. A total of 1,542 medical incidents (82.9 per 10,000) were reported over the 4 event days. There were 37% (466 patients, 25.1 per 10,000) of incidents related to moshing activity. Hospital transport was required for 2.5% (39 patients, 2.1 per 10,000) of medical visits with 74% (29 patients, 1.5 per 10,000) of those transported being for mosh pit-related injuries. When planning emergency medical care for such concerts with mosh pits, the potential for an increase in the number of medical incidents and injuries requiring medical attention and hospital transport should be taken into account for efficient medical coverage.     

How do ambulance personnel experience work at a disaster site?

Working at a major accident site is a complex matter where knowledge from various fields must be put into practice. In addition, the different situations at emergency and disaster sites place a variety of demands on personnel, equipment and organization. The aim of the present study is to investigate how the ambulance personnel perceived their own action and the functioning of the whole emergency organization at a major accident site (large discotheque fire) in 1998. Working from a list obtained from the fire department, a questionnaire with 57 questions was sent to the personnel (n = 36) who had participated at the accident site either as ambulance crew members or as members of a medical team sent out from the hospital. The response rate was 80 per cent. Despite the extreme situation, most of the ambulance personnel involved were satisfied with their own preparedness as well as the medical and nursing care performed at the site. Those who where not satisfied reported that the main reason for dissatisfaction was lack of time to calm and comfort people who were not injured or had only minor injuries. The need of more medical support for the medical team members at the site was also emphasized with regard to the care of the severely injured. The ambulance service crews from the suburbs, in comparison with the local city rescue service, were, in general, less satisfied with the co-operation from other rescue units.     

The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest

OBJECTIVE: We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. METHODS: One hundred people from each of three population lists were randomly selected at a large, urban school of medicine and affiliated medical center: (1) year III and IV medical students; (2) residents in family medicine, emergency medicine, internal medicine, anesthesia, and surgery; (3) attending physicians in the same departments. A questionnaire was distributed that elicited estimates of in-hospital and out-of-hospital cardiac arrest (IHCA and OHCA, respectively) survival rates, and CPR training referral history. Estimates were compared against published data for accuracy (IHCA: 5-20%; OHCA 1-10%) RESULTS: The overall response rate was 63%. Accurate in-hospital cardiac arrest estimates [% (95% CI)] of survival were provided by 51.1% (36.8-63.4%), 47.3% (35.9-58.7%), and 36.7% (23.2-50.2%) of students, residents, and attending physicians, respectively. Accurate out-of-hospital estimates of survival were provided by 51.1% (36.8-63.4%), 52.1% (40.6-63.5%), and 70.8% (57.9-83.7%), respectively. Most thought that family members of cardiac patients ought to be CPR trained (92.6%). However, few had referred any for training in the past year (16.5%). There was strong support across respondent groups for including death notification information in the ACLS training program, with 80.4% of all respondents in favor. CONCLUSIONS: This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.