知情同意告知书的设计与应用

为减少医疗护理纠纷,维护病人就医的知情同意权,增强医患之间的理解和信任,我科自2000年1月起,自行设计知情同意告知书,在临床实际应用中收到满意效果.     

知情同意签字在眼科护理告知中的应用

随着社会主义法制建设的不断完善和人们物质生活与文明程度的提高,病人自我保护意识和对医疗保健质量的要求不断增强,医疗护理的纠纷逐渐随之上升。知情同意签字在眼科护理告知中的应用,有助于提高护理人员的法律意识,维护病人和自身的合法权益,防范护理纠纷的发生。     

知情同意在护理工作中的应用

患者在就医诊疗过程中应享有知情同意权。不管是从医德伦理,还是法律上,护士无疑与医生同样负有责任。实践中人们认识不一,做法也各不相同。本文在参阅大量相关资料的基础上,重点从什么是知情同意、知情同意在国内外进展状况、知情同意与护理工作的关系、知情同意在临床护理中存在的问题以及知情同意在实践中应注意的问题和技巧等方面进行了综述,认为不断提高法律意识和自身修养,明确职责范围和法律责任,对提高医护质量,减少医护纠纷有着重要的意义。     

从知情同意谈医务人员告知义务

对知情同意包含的内容、如何履行告知义务进行了论述。提出对住院病人应进行入院告知,住院期间根据病情、治疗进程及时告知,出院前进行详细的出院指导;医务人员必须提高法律意识,适当把握“告知度”,掌握沟通交流的技巧,才能充分履行告知义务。     

知情同意在临床护理操作告知中的应用进展

护理操作是临床护士实施的与病人治疗和护理密切相关的技术性操作,是临床医疗工作的重要组成部分,通常医生对病人的医嘱和部分治疗性操作须由护士来实施.然而,对病人实施的治疗措施的意义、风险与后果一般人难以知悉,因未履行告知义务或履行不当侵犯病人知情同意权引起的纠纷呈逐年上升趋势[1],为此,护理界对知情同意的关注和研究已形成国际化趋势[2].当前,在护理操作中规范知情同意,履行全面告知,可以减少护患纠纷已成为护理界的共识.现综述如下.……     

析知情同意权利与告知义务在护理活动中的效应及影响

《医疗事故处理条例》、《医疗机构管理条例》的相继出台和实施，从法律的角度把患在医疗活动中的知情同意权利和医疗机构的告知义务给予了立法上的规定。从实践来看，医患双方的法律意识明显增强。在医疗护理活动中，双方权利和义务的履行，使医疗护理活动在双方的积极配合、理解、支持下顺利进行，医患关系逐渐缓和，医疗护理服务逐渐规范，医患纠纷明显下降。但也有因患对医疗护理行为知悉不足，权利的使用不当，干扰着医疗护理活动的正常运行。     

病人安全进展与挑战——知情同意与告知

“告知”是医务人员在实施临床诊疗、提供医疗服务过程中积极主动的行为，是知情同意原则履行中的关键。随着人们维权意识的逐渐增强，因轻视或忽视告知义务，侵犯病人知情同意，引发的事件逐渐上升。本文就告知的概念、意义及其内容、程序进行了探讨，并讨论了知情同意与告知的关系。     

临床护理中的知情同意

知情同意 (ｉｎｆｏｒｍｅｄｃｏｎｓｅｎｔ)是指临床上具备独立判断能力的病人 ,在非强制状态下充分接受和理解各种与其所患疾病相关的医疗信息 ,在此基础上对医务人员制定的诊疗计划自行决定取舍[1] 。知情同意原则的提出于 2 0世纪 60年代起源于美国 ,是一项有利于达到医疗目标的措施 ,体现了对病人人格尊严和个性化权利的尊重。目前 ,它已被国际医学界广泛接受并被广大病人所认同 ,成为一项基本的临床伦理原则[2 :12 0 ] 。1　知情同意与护理的关系　　从表面上看 ,知情同意是病人与医生在临床上权利与义务的体现 ,似乎与护理工作无直接…     

知情同意在护理调查研究中的应用

调查研究又称观察性研究，是指采用问卷或访问等手段，有目的地从某特征群体或其样本搜集相关资料，并通过对资料的统计分析来认识某现象及其规律的研究方式。科研中的知情同意（informed consent）是指在以人为研究／试验对象的科研领域，     

护理实践中落实患者知情同意权的问题与困惑

本文概述了落实患者知情同意权的意义,分析了护士在落实患者知情同意权过程中存在的问题与困惑,提出了有待进一步探讨的问题。     

精神科医生对知情同意告知义务的态度状况调查

目的探讨精神科医生对抗精神病药物与迟发性运动障碍知情同意状况。方法采用Schachter等编制的精神科医生对抗精神病药物与迟发性运动障碍知情同意的态度问卷对56名上海市精神卫生中心分部的精神科医生及43名同期在该中心进修的精神科医生予以调查。结果90%以上的精神科医生对精神病人或家属的知情同意表示赞同;80%以上的医生认为对迟发性运动障碍的告知应成为知情同意的一部分;但有三分之二的医生担心这种告知会增加病人的焦虑情绪,担心病人难以理解迟发性运动障碍的风险;与进修班同道相比,本中心医生更倾向于应用新型抗精神病药物替代传统药物治疗,以避免迟发性运动障碍的发生。结论精神科医生对抗精神病药物与迟发性运动障碍的知情同意持谨慎积极的态度。     

甲基强的松龙冲击治疗护理记录单的设计与应用

目的 自行设计并应用甲基强的松龙冲击治疗护理记录单,探讨提高专科护理记录的效率和质量的方法.方法 以护理表格体现专科特色、避免重复记录、简单及易行等原则,记录单内容与内科护理常规和免疫专科评估、观察和护理项目相结合,书写方法基本以打勾和填空为主.结果 新的护理记录单在很大程度节省了护理记录的时间,提高了护理文件书写质量和临床护理质量,体现了专科特色.结论 采用突出专科特色的护理记录单,既能提高护理人员的工作效率,又能提高护理质量,有利于保证患者的安全.     

Communication and informed consent in phase 1 trials: a review of the literature

Phase 1 (P1) trials are vital to the development of cancer treatments; however, the patients involved in these trials are unlikely to receive any therapeutic benefit, and there are significant possibilities that they will experience serious side effects. Ethical requirements stipulate that patients must be adequately informed before they consent to participate in P1 trials. This review focuses on studies that have measured patient comprehension of information given during the informed consent process of P1 cancer trials. Patients consenting to participate in P1 trials currently have a limited understanding of trial purpose, an unrealistic expectation of the benefits and risks associated with trial participation and a questionable appreciation of their right to abstain or withdraw. Health care professionals recruiting to P1 trials need clear and practical guidelines and training packages designed to ensure that all details of P1 trials are communicated effectively to eligible patients.     

Heart transplantation without informed consent: discussion of a case

Objective: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose. Setting: ICU of a university teaching hospital. Patient: a 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. Intervention: heart transplantation. Results: despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient. Conclusions: Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority. Received: 18 February 1997 Accepted: 18 December 1997     

The patient who is unable to consent to nursing care

The aim of this paper is to examine the way in which nurses manage patients who are unable to consent to nursing care procedures. This paper reports on a qualitative study using focus groups and critical incidents collected through in-depth interviews to explore the way in which nurses obtain consent prior to nursing care procedures. The finding indicate that nurses are uneasy about administering care to a patient who cannot consent. When complicating factors are present this unease is exacerbated and sometimes the appropriate delivery of care is withheld.     

Psychological impact of informed consent in hospitalized cancer patients

 Patients with cancer receive an explanation of their disease and the recommended treatment when they are asked to give informed consent (IC). In the course of this process patients suffer severe distress, including anxiety and depression, but physicians tend to underestimate it. The goal of this study was to reveal the magnitude of such stress and any changes to this during the IC process by means of the Hospital Anxiety and Depression (HAD) scale, a self-assessment scale. Of 171 in-patients newly diagnosed with lung cancer, 119 were assessable for serial HAD scale scores on admission, immediately after the IC process, and at 1 and again at 2 weeks after the IC. Both anxiety and depression scores increased significantly immediately after IC. Female patients had significantly higher anxiety and depression scores than males at 1 week after the IC. The patients with poor performance status demonstrated high anxiety scores on admission and immediately after the IC, and substantial depression persisted longer in these patients. The prevalence of high scores of more than 11 (judged as adjustment disorder or more severe state) immediately after the IC was 50% for anxiety and 31% for depression. The prevalence decreased significantly within 1 or 2 weeks, but 41% and 14% of the patients still showed high anxiety and depression scores, respectively. Physicians should be aware of these facts and pay special attention to their patients' psychological distress in routine clinical practice.     

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。