“五常法”在重症监护病房护理管理中的应用

目的探讨"五常法"在重症监护病房护理管理中的作用。方法采用"五常法"的5个步骤对物品、药品及抢救仪器加强规范管理,比较使用前后抢救成功率、物品完好率及患者家属满意率。结果医护人员的工作环境及患者住院环境得到改善,抢救成功率、物品完好率、患者家属满意率均得到明显提高,差异有统计学意义(P0.01)。结论 "五常法"是有效的科学管理方法,其成本低、实施易、见效快、能有效地提高重症监护病房的护理工作质量。     

引入“五常法”提升重症医学科护理管理质量的实践及效果

目的探讨"五常法"在重症医学科护理管理中的作用。方法采用"五常法"理论加强规范管理,并比较应用前、后1年某驻军医院重症医学科抢救成功率、物品完好率、患者家属满意率等之间的差异。结果医护人员的工作环境及患者住院环境得到改善,团队协作精神、抢救成功率、物品完好率、患者家属满意率得到提高,差异均有统计学意义(P<0.05)。结论 "五常法"是有效的科学管理方法,实施易、见效快,可有效提高重症医学科医护服务质量,值得推广。     

运用"五常法"加强手术室规范化管理

目的：提高手术室及管理的质量和效率。方法：应用＂五常法＂原理,对人、物、环境进行规范改进。结果：手术器械、物品准备完好率、精密贵重仪器使用保管完好率、急救物品完好率、物品消毒合格率符合标准要求。结论：＂五常法＂管理有效地提高了护理质量。     

五常法在口腔科门诊护理质量管理中的应用

目的:探讨五常法在口腔门诊护理质量管理中的应用效果。方法:根据口腔科门诊现状进行调查分析,然后严格按照五常法相关要求执行各项规定以及护理管理对策。比较五常法实施前后的护理质量管理水平。结果:实施五常法管理后,诊室环境合格率、无菌物品合格率、器械准备完好率、急救物品完好率、仪器性能完好率以及患者满意率均高于五常法实施前(P0.05)。结论:在口腔科门诊积极实施五常法,可有效提升护理管理质量水平,有助于保障医疗护理安全,对于促进患者预后具有积极意义,值得推广应用。     

应用五常法加强手术室护理管理

目的 探讨应用“五常法”( Seiri,Seilon,Seiso,Seikelsu and Shilsue,5S)在手术室护理管理中的效果.方法 应用“五常法”原理,对手术室骨科专科人、物、环境进行规范化管理,规范了手术室护士言行和技术,手术物品准备与放置统一标准,形成专科护理准则(标准),并设立五常组和对照组,观察五常法应用效果.结果 五常组器械准备完好率、物品准备完好率、贵重仪器使用管理完好率、手术科室及患者满意率均高于对照组.结论 五常法能改善手术室的工作方法和环境,提高工作效率和质量.     

“五常法”在急诊科护理管理工作中的应用

目的 介绍＂五常法＂在急诊科护理管理中的应用.方法 把＂五常法＂理论运用在护理管理中,制定实施计划,由病区管理者带头实行,定期进行检查,不断改进.结果 实施＂五常法＂4年来,急救物品完好率、患者满意率、差错事故发生率与实施前相比,有显著性差异（P＜0.05）.结论 ＂五常法＂是提升医务人员工作环境及病人住院环境、提高工作效率、降低管理成本的一种良好管理措施.应在急诊科大力推广＂五常法＂,并以点带面,逐步在全院各科室推广、实施,从而提高我院的护理质量.     

实施病区护理五常法管理的效果评价

目的:综合评价实施病区护理五常法管理的效果。方法:制定五常法管理制度、工作指引、检查标准,对比实施五常法管理前后的效果。结果:实施五常法管理后,住院患者对医院环境满意率、相关病区医疗仪器设备完好率、无菌物品合格率均优于实施前(P0.05);护理缺陷发生率低于实施前(P0.05)。结论 :在病区实施五常法管理,可不断改善医疗环境,持续提高护理服务质量,降低护理缺陷发生率,提高患者的满意率。     

"五常法"在门诊手术室护理质量管理中的应用

目的研究"五常法"在门诊手术室护理质量管理中的应用效果.方法把"五常法"应用于门诊手术室日常管理中,按照"五常法"原理,对手术室人、物、环境进行规范化改进,通过制定"五常法"审核表,对工作现场进行常组织、常整顿、常清洁、常规范、常自律,并定期进行检查评估,持续不断改进.结果门诊手术室护理质量明显提高:手术器械、物品准备完好率,精密、贵重仪器使用保管完好率,急救物品完好率,物品消毒灭菌合格率,手术科室及患者满意率等均明显提高(P值均＜0.05).结论在门诊手术室开展"五常法"活动,能有效提高护理质量和服务质量,确保医疗护理安全,达到护患双赢的目的.     

“五常法”在门诊手术室护理质量管理中的应用

目的 研究“五常法”在门诊手术室护理质量管理中的应用效果。方法 把“五常法”应用于门诊手术室日常管理中，按照“五常法”原理，对手术室人、物、环境进行规范化改进，通过制定“五常法”审核表，对工作现场进行常组织、常整顿、常清洁、常规范、常自律，并定期进行检查评估，持续不断改进。结果 门诊手术室护理质量明显提高：手术器械、物品准备完好率，精密、贵重仪器使用保管完好率，急救物品完好率，物品消毒灭菌合格率，手术科室及患者满意率等均明显提高（P值均〈0．05）。结论 在门诊手术室开展“五常法”活动，能有效提高护理质量和服务质量，确保医疗护理安全，达到护患双赢的目的。     

运用“五常法”加强手术室物品的管理

目的探讨“五常法”（Seiri，Seilon，Seiso，Seikelsu and Shilsuke，5S）在手术室物品管理中的应用效果。方法在手术室物品的管理中采用“五常法”管理，并比较实施“五常法”前后手术室物品管理的质量。结果实施“五常法”前后，手术器械和物品准备完好率、仪器使用管理完好率、医务人员及患者满意率等比较，均P〈0．05，差异有统计学意义。结论“五常法”具有简单、实用、高效的管理特点。它在手术室物品管理中的应用，有助于提高手术室物品管理的质量。     

分级监控管理对预防重症脑外伤患儿术后压疮的影响

目的：探讨分级监控管理对预防重症脑外伤患儿术后压疮的影响。方法选取2013年1月至2014年12月收治的84例重症脑外伤患儿为研究对象,根据患儿入院时间分为观察组(2014年1~12月)和对照组(2013年1~12月)各42例,对照组给予常规性护理,观察组给予分级监控管理,对比分析两组患儿护理质量、压疮风险评估率、压疮发生率、护理纠纷投诉率及家属满意率情况。结果观察组基础护理、专科护理、危重患儿护理、护理记录、病房管理、急救药品和器械以及总护理质量评分显著高于对照组( P<0.05)。观察组压疮发生率、护理纠纷投诉率低于对照组(P<0.05),压疮风险评估率、家属满意率高于对照组(P<0.05)。结论分级监控管理能有效提高重症脑外伤患儿护理质量,提高压疮风险评估率,从而降低患儿压疮发生率,降低护患纠纷事件发生率,提高患儿家属满意率。     

创伤性脑损伤的康复目标、时限与管理

目的创伤性脑损伤(traumatic braininjury,TBI)多由交通事故、体育活动、工伤或暴力袭击等引起.患者主要为青年男性,多数出现明显残障.研究欧美国家有关TBI的康复管理模式有助于提高TBI患者的康复治疗水平.资料来源应用计算机检索Medline1990-01/2004-06与TBI相关的文章,检索词"traumatic brain injury;rehabilitation",并限定文章语言种类为English.共检索到15篇.同时手工检索<中国临床康复>杂志2003-01/2004-06期间的相关文章,限定文章语言种类为中文,检索词"创伤性脑损伤;康复",检索到3篇.资料选择选择有关TBI康复管理的文献,包括著作、论著等.数据提炼共收集到18篇近5～10年有关TBI的预后评价与影响因素、康复目标、康复时限、昏迷阶段的治疗、康复阶段管理和有关并发症的处理等方面的文献.资料综合TBI康复阶段管理贯穿TBI康复全过程,了解每个阶段康复管理要点,尤其对患者残障情况做出正确评价并制定康复方案,是保证康复预后的关键.康复工作者对患者认知障碍以及伤前状况、损伤程度和康复方式对康复目标的影响,必须有足够的认识.结论从已检索的文献报告表明,康复管理水平是影响TBI康复效果的关键.     

Life satisfaction and psychosocial outcome in severe traumatic brain injuries in Aquitaine]

OBJECTIVE: To assess late outcome and satisfaction of life of patients with severe traumatic brain injury (TBI) patients who received inpatient rehabilitation in Aquitaine. DESIGN AND PATIENTS: Seventy-nine consecutive patients out of the 158 who were hospitalized for rehabilitation in 1993 were asked for in 2000 by a phone interview including standardised scales and free talk as well. RESULTS: The results showed that nine years on average after their injury, 65 to 85% of patients were independent for daily living, whereas 35 to 55% only were independent in social life. Most of them were satisfied with their autonomy (67%), family life (66%) and financial status (41%), but they were dissatisfied with leisure (36%), vocational adjustment (28%) and sexual life (32%). CONCLUSION: Return to work, leisure and sexuality are major parameters of satisfaction of life after a severe TBI, and should be emphasized in goal-directed rehabilitation programs.     

重型闭合性颅脑损伤综合康复的效果评定

目的：研究康复科住院的重型闭合性颅脑损伤患者经综合康复治疗后残疾水平恢复情况及影响残疾水平恢复的因素。方法：对49例住院的重症闭合性颅脑损伤患者进行回顾性调查研究。在入院后及出院前采用残疾分级量表（DRS）对患者的残疾水平进行评定；患者的年龄、性别、病程、康复治疗时间对康复治疗效果的影响进行多元回归分析，并分析昏迷时间与DRS评分的关系。结果：治疗前与治疗后DRS评定结果差异有显著性，残疾水平明显下降。非手术组改善较手术组明显，考虑与手术组病情较重有关。DRS评定结果与昏迷时间及治疗时间有关，良复治疗时间长则功能恢复好，残疾水平低。结论：综合康复治疗后残疾水平明显降低，昏迷时间短及康复治疗时间则残疾水平低；脑损伤的严重程度是决定残疾水平恢复的最重要因素。     

精神科护理风险标准化管理实践

[目的]评估精神科护理风险标准化管理实施效果.[方法]选择10个精神科病区（6个普通病区、4个老年病区）,随机分为观察组和对照组,分别实施精神科护理风险标准化管理和常规护理管理,比较两组护理不良事件发生率、病人和家属的满意度、护士对护理工作的满意度、护理质量指标.[结果]两组自杀、暴力行为、外走、跌倒、噎食护理不良事件发生率、病人满意度、家属满意度、护士对护理工作满意度比较差异有统计学意义（P＜0.05）;观察组各项护理质量指标合格率均高于对照组,但差异无统计学意义（P＞0.05）.[结论]实施精神科护理风险标准化管理能有效减少护理不良事件的发生,提高服务满意度及护理质量.     

Gender and deprivation and rates of referral and thereby admission to a national neurorehabilitation service

OBJECTIVE: To investigate the association between gender and deprivation and rates of admission to a national neurorehabilitation facility following subarachnoid haemorrhage or traumatic brain injury. DESIGN: Retrospective analysis of hospital activity data. SETTING: Lothian Health Board hospital activity; national neurorehabilitation centre. SUBJECTS: Patients with subarachnoid haemorrhage or traumatic brain injury. METHODS: We obtained data for hospital discharge for subarachnoid haemorrhage and traumatic brain injury for patients living in the Lothian Health Board area for the five years 1995 to 1999 by age (15 and over), sex and deprivation category of home residence from nationally held data sets. Similar data were extracted for discharges from the national neurorehabilitation unit. MAIN MEASURES: Rates of neurorehabilitation admission per 1000 hospital admissions. Chi-squared testing was used to assess statistical significance. RESULTS: Data for 13338 hospital admissions and 329 neurorehabilitation admissions were available. We observed higher than expected rates of rehabilitation admission for men with subarachnoid haemorrhage and for patients from more affluent postcode sectors with traumatic brain injury. CONCLUSION: Higher rehabilitation rates are seen among men following subarachnoid haemorrhage and may indicate a focus on return-to-work in the referral or assessment of those suitable for or requiring neurorehabilitation. Higher rehabilitation rates in head injury in those from Carstairs Deprivation Category (DepCat) 2 postcode sectors may represent a bias favouring those from affluent areas in the interaction between the individual and the health service in this group.     

Post-acute care referral and inpatient rehabilitation admission criteria for persons with brain injury across two Canadian provinces

Purpose: Investigate health care providers’ perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces.

Methods: Health care providers (n?=?345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e.g., tracheostomy). The participants reported the perceived usefulness of referral/admission policies and assessment tools used.

Results: Ninety-one percent acute care and 98% rehabilitation participants reported the person with traumatic brain injury would likely or very likely be referred/admitted to rehabilitation compared to respectively 43% and 53% for the patient with hypoxia. Two additional factors significantly decreased the likelihood of referral/admission: older age and the combined presence of minimal learning ability, memory impairment and physical aggression. Some significant inter-provincial variations in the perceived referral/admission procedure were observed. Most participants reported policies were helpful. Similar assessment tools were used in acute care and rehabilitation.

Conclusions: Health care providers appear to consider various factors when making decisions regarding referral and admission to rehabilitation. Variations in the perceived likelihood of referral/admission suggest a need for standardized referral/admission practices.

• Implications for Rehabilitation

• Various patient characteristics influence clinicians’ decisions when selecting appropriate candidates for inpatient rehabilitation.

• In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury.

• Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.

     

早期康复护理对重型颅脑损伤患者的影响

目的观察康复护理对重型颅脑损伤患者早期康复的影响。方法将142例重型颅脑损伤患者随机分为康复组72例和对照组70例,对照组行常规护理;康复组除行常规护理外,同时实施系统、规范的早期康复护理。比较两组Barthel指数评分及生活质量。结果康复组患者入院后30dBarthel指数评分和生活质量明显高于对照组(均P<0.01)。结论康复护理可降低颅脑损伤残疾率,提高患者生活质量。     

Recovery of function during inpatient rehabilitation for moderate traumatic brain injury

This study evaluated the functional improvement of 189 patients with traumatic brain injury (TBI) who participated in a comprehensive rehabilitation program at a National Institute on Disability and Rehabilitation Research--designated Center for traumatic brain injury rehabilitation. Data were comprised of functional ratings reported by therapists in nine disciplines. Improvement in mobility, self-care, communicative, family, nursing, psychological, and recreation functions were observed. The relationship between functional level and length of stay, onset-admission interval, age, sex, education, and work history were examined. The benefits of rehabilitation are supported by this multidimensional study.