精神科开放病房患者104例自杀危险因素评估分析

目的 分析精神科开放病房患者自杀危险因素,为护理提供可靠依据.方法 采用自杀危险因素评估量表对精神科开放病房104例患者进行评估分析.结果 存在自杀风险的患者38例,其中极危险4例(30～41分),很危险11例(20～29分),危险23例(10～19分),较安全(10分以下)的66例.结论 精神科开放病房住院患者存在自杀风险.量化评估可为住院患者安全提供护理依据.     

精神科开放病房精神分裂症患者危险因素调查与分析

目的探讨精神科开放病房精神分裂症患者的危险因素,为护理干预提供可靠依据。方法采用自杀危险因素评估量表、攻击危险评估量表对我院2008年5月至2009年5月在开放病房住院的123例精神分裂症患者进行危险因素评估。结果存在自杀危险的41例,占33.33%,其中极危险5例(30~41分),很危险9例(20~29分),危险27例(12~19分)。存在攻击危险的患者58例,占47.15%,其中攻击危险Ⅳ级3例,Ⅲ级23例,Ⅱ级32例。结论精神科开放病房精神分裂症住院患者存在自杀、攻击行为的危险,量化评估可为住院患者护理提供干预依据。     

老年精神科住院患者意外事故危险因素分析及护理对策

目的：探讨老年精神科住院患者意外事故危险因素及护理防范措施。方法：采用自制精神科意外事故高危人群评估表进行评估。结果：本组总体评分为（30．80±9．43）分，大大高于15分的临界值，占住院总人数的37．5％。本组发生意外事故9例，其中跌倒5例，烫伤1例，输液管脱落3例。结论：早期对老年精神科住院患者进行意外事故危险因素评估，及时采取综合性防范措施，可减少其意外事故的发生。     

精神科开放病房的患者出走原因分析及防范措施

目的分析精神科开放病房患者出走的原因,为制定防范措施提供依据。方法采用自设调查表,内容包括患者一般情况、疾病诊断、出走原因及出走后果等。通过实例调查、收集病案及护理文件中的相关资料等方式获得信息。结果1126例住院患者中有出走行为者86例,占7．64％。总出走次数为116次,出走原因分别为疾病因素42例次（占36．21％）、心理因素27例次（占23．28％）、陪护因素23例次（占19．83％）、医护因素19例次（占16．38％）、其他因素5例次（占4．31％）。结论精神科开放病房患者出走更便利,原因多种多样,医护人员应针对不同原因制定相应防范措施。     

精神科新入院老年患者意外风险评估与护理对策

目的 比较男性和女性精神科新入院老年患者存在意外风险的差异,以便护士更好地掌握不同性别患者的意外风险和重点观察内容,防止或减少意外风险发生.方法 运用跌倒、噎食、攻击和自杀4个风险因素评估量表及护士用住院患者观察量表（NOSIE）,对2011年8月至2012年8月北京市某三级甲等精神病专科医院新入院的83例60岁以上的患者进行评估.结果 老年精神科新入院患者存在风险排序前3位为攻击（43.4％）、跌倒（37.3％）、自杀（31.3％）.男性患者33例,有攻击风险的20例,女性患者50例,有攻击风险的16例,男性与女性攻击风险比较差异有统计学意义（x2 =5.510,P＜0.05）.男性有跌倒、自杀、噎食、外走风险的分别有12,11,8,9例,女性分别有19,15,15,11例,男女比较差异均无统计学意义（x2值分别为0.023,0.103,0.329,0.302;P ＞0.05）.不同性别的老年患者NOSIE各因子分比较差异均无统计学意义（P＞0.05）.结论 为保证精神科老年新入院患者住院期间的安全,男性患者更应关注攻击风险因素的评估,女性患者更应关注跌倒风险因素的评估.     

开放式与封闭式病房新入院老年精神分裂症患者意外风险对比分析

目的：探讨新入院老年精神分裂症患者入住开放式与封闭式病房的意外风险状况,为开展有针对性的护理干预提供依据。方法将90例新入院老年精神分裂症患者随机分为两组,研究组入住开放式病房,对照组入住封闭式病房;采用跌倒、噎食、攻击、自杀、出走5个风险因素评估量表及护士用住院病人观察量表评估两组患者的风险状况。结果两组患者中有攻击风险者占40．0％,有自杀风险者占24．4％;研究组跌倒、噎食发生率显著低于对照组（P＜0．05）,出走发生率显著高于对照组（P＜0．01）。两组护士用住院病人观察量表各因子评分比较差异均无显著性（P＞0．05）。结论对新入院老年精神分裂症患者加强风险评估管理,是预防患者住院期间发生意外事件的重要措施。     

团队工作模式在抑郁症患者自杀干预中的应用Δ

目的：探讨团队工作模式对开放精神科病房住院的抑郁症患者自杀干预效果。方法将400例在开放病房住院的抑郁症患者随机分为两组,均予以抗抑郁药物治疗及常规护理干预,干预组在此基础上运用团队工作模式进行自杀干预,观察8周。于干预前后采用汉密顿抑郁量表及自杀态度问卷评定干预效果。结果干预8周末两组汉密顿抑郁量表总分均较干预前显著下降（P＜0.01）,干预组较对照组下降更显著（P＜0.01）;自杀态度问卷各维度分均较干预前显著升高（P＜0.01）,干预组较对照组升高更显著（P＜0.01）。干预组自杀行为发生率显著低于对照组（ P＜0.01）。结论在精神科开放式管理病房运用团队工作模式对抑郁症患者实施自杀干预,能有效缓解患者的抑郁症状,改善患者的自杀态度,减少患者自杀行为的发生。     

精神科患者医院感染的危险因素分析

目的探究精神科患者医院感染的危险因素,为在治疗和护理中进行感染预防提供理论基础。方法对张家口市沙岭子医院2008年1月至2011年12月精神科发生院内感染的住院患者进行回顾分析,对其住院时间、发病季节、感染部位及原发疾病等临床资料进行对比,分析影响精神科患者医院感染的危险因素。结果1362例患者中共出现141例感染,占10．4％,146次感染,占10．7％,其中精神分裂症及器质性精神障碍感染率最高,分别为13．0％及14．9％;经多因素 COX 模型分析,原发疾病、住院时间及封闭式管理是影响精神科患者医院感染的独立危险因素（P＜0．05）。结论应加强精神科病房管理,采取积极有效的干预措施,控制医院感染的发生。     

鱼骨图法分析精神科住院患者暴力攻击原因

目的：探讨运用鱼骨图分析精神科住院患者暴力攻击的原因。方法通过查阅不良事件讨论登记表、病历等分析327例发生暴力攻击行为的精神科住院患者的相关资料,查找暴力攻击的原因,绘制鱼骨图。结果精神科住院患者暴力攻击的原因可概括为患者因素、家属因素、工作人员因素、环境因素和管理因素,其中患者因素中最高的是既往暴力攻击史,占64．5％;家属因素中最高的是家属对患者的态度生硬、冷漠,占19．6％;工作人员因素中最高的是服务态度不好、说话太生硬,占30．0％;护理管理因素中最高的是封闭式管理,占61．8％;环境因素中最高的是病房拥挤嘈杂,占30．9％。结论鱼骨图用于精神科住院患者暴力攻击原因的分析简单实用,为防范精神科住院患者暴力攻击提供了对策依据,为进一步实现护理安全的持续质量改进提供了有力保证。     

自杀风险评估在精神科病房管理中的应用

精神疾病是自杀的高危因素,其中抑郁症的危险性最高.抑郁症患者的自杀风险比其他精神疾病高近20倍,自杀观念和行为是抑郁症患者最严重而危险的症状.25%的重性抑郁症患者有过自杀未遂[1],其中15%的患者最终死于自杀[2].近年来抑郁症的自杀干预已逐渐受到广泛重视.本文对抑郁症的自杀风险进行了连续、动态的护理评估,为提高对抑郁症患者自杀行为的预测性和精神科病房更好地实施风险管理提供依据.     

Suicidal behavior in psychiatric emergency room patients

BACKGROUND: Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS: Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal behavior was considered present if current suicidal ideation or attempts within 24 hours of or during the emergency evaluation were noted in the chart. RESULTS: Suicidal behavior was present in 38% of the psychiatric ER patients. Younger age, white race, affective disorders in female patients, and substance abuse disorders in male patients were features of the suicidal group. Sex of the patient was not associated with suicidal behavior. CONCLUSIONS: Suicidal behavior is prevalent in the psychiatric ER. Effective suicide prevention in this setting will hinge on finding more specific risk factors.     

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.     

Does the Nursing Care Plan help in the management of psychiatric risk?

The Nursing Care Plan (NCP) is routinely used to direct the nursing care of psychiatric in-patients, but the impact of NCPs on patient care and clinical outcome is not firmly established NCPs from 246 patients, chosen at random from admissions to acute psychiatric wards, were analysed The NCPs were scored for quality and also specifically for the presence of recorded risk assessment and appropriate level of nursing supervision NCPs were evaluated in relation to psychiatric risk factors present prior to admission, and in relation to risk behaviour during hospitalization Quality of NCP records was generally poor, with scores in all areas assessed being approximately half of the possible maximum Patients with a perceived high risk of suicide prior to admission had significantly better NCP quality than other patients, but about a third of these high risk patients had no recorded risk assessment or supervision level in the nursing notes Patients who had actually self-harmed within 4 weeks prior to admission were more likely to have a recorded risk assessment but did not score more highly than the rest of the patient population on any other measures of NCP quality Patients who had made suicidal threats prior to admission but who were not deemed to be of high suicide risk before admission had significantly lower quality NCPs and were less likely to have a record of supervision level than the rest of the patients The highest rate of supervision records occurred in patients who had shown dangerous behaviour prior to admission Outcome in terms of two risk behaviours during admission (self-harm and violence) was not related to whether or not risk assessment and supervision levels had been recorded Patients admitted compulsory to hospital were more likely to have a supervision level recorded but were also more likely to abscond It is concluded that issues of psychiatric risk were not raise serious questions about the usefulness of the NCP in helping to predict and prevent risky behaviour amongst psychiatric in-patients     

在精神科建立护理安全等级的思考

通过对精神科住院患者自杀、蓄意自伤、攻击性暴力行为等不安全因素进行评估,根据评估结果将患者的危险度等级划分为低、中、高3个档次,以识别精神科高危患者并采取相关护理干预措施,杜绝安全隐患有积极意义。     

Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.

OBJECTIVES: To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. METHODS: The Manchester and Salford Self-Harm project is a multi-centre deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments. RESULTS: A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk. CONCLUSION: In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.     

A theory for the nursing care of patients at risk of suicide

AIM: This paper presents a nursing care theory developed to guide the care given to people with suicidal ideas and those with a previous suicide attempt. BACKGROUND: Suicide is a major public health problem. According to the World Health Organization, international suicide rates range from highs of more than 20 per 100,000 people in Hungary (1997 figures), to fewer than 10 per 100,000 in the United Kingdom (2002 figures). In 2002, the number of completed suicides in Taiwan increased by nearly 10% over the previous year, and the Taiwanese Government has set targets to reduce this rate. Psychiatric nurses play a vital role in helping reduce the suicide rate through prevention, education and by providing care that promotes the healing of patients who attempt suicide. METHODS: A grounded theory approach was used. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses working on acute wards were interviewed and observed using an observer-as-participant strategy. Data were collected through field notes and by tape-recorded interviews during 2003, and analysed using open, axial and selective coding and the qualitative software program QRS NUD*IST. FINDINGS: The core category that emerged from the data collected was the provision of 'safe and compassionate care via the channel of the therapeutic relationship'. Other key categories linked to and embraced within this core category were: providing holistic assessments; providing protection; providing basic care; and promoting healing through advanced care. CONCLUSION: The theory generated from the findings could be used by nurses as a guide as they initiate and maintain therapeutic relationships with patients who are at risk of suicide. The theory could advance the quality of care provided by nurses. In addition, it holds potential for instilling hope in patients who have lost their ability to cope with life events and perhaps life itself.     

精神科护士心理健康状况调查

目的探讨精神科护士心理健康状况和相关影响因素,为改善精神科护士心理健康状况和应付方式提供参考依据。方法对105名精神科护士采用症状自评量表进行测评,并与全国常模进行比较;对开放式病房和封闭式病房护士的症状自评量表评分结果进行对比分析。结果精神科护士症状自评量表躯体化、人际敏感、焦虑、敌对因子分及阳性项目数均高于全国常模（P〈0．01）;封闭式病房护士的心理健康问题较开放式病房护士严重。结论精神科护士存在一定的心理健康问题,而封闭式病房护士的心理健康问题更加严重。     

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients,such as age,sex,education level,history of suicide attempts,psychotic symptoms,social factors,and substance abuse.However,there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts,such as medication and treatment.AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more.The outcomes and possible suicide risk factors in these patients were collated.The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none(0 points),mild(1-8 points),moderate(9-16 points),or severe(17 or more points).This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTS Of 228 hospitalized schizophrenia patients,214(93.9%)were included in this study.The majority(79.0%)of patients were males.Females appeared to have a slightly higher suicidality risk than males,with borderline significance.With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview,172(80.4%)schizophrenic patients scored zero,20(9.4%)had a mild risk,8(3.7%)had a moderate risk,and 14(6.5%)had a severe risk.The total prevalence of current suicide risk in these schizophrenic patients was 19.6%.Based on multivariable ordinal logistic regression analysis with backward elimination,it was found that younger age,a current major depressive episode,receiving fluoxetine or lithium carbonate in the previous month,or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high.Considering risk factors in routine clinical assessments,environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.