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.     

精神科开放式病房病人自杀危险因素调查

开放式精神科病房预防病人自杀自伤是护理管理中非常重要的内容之一。本文针对开放式住院病人的自杀危险因素调查,发现抑郁症占开放式病房住院总数的48.2%,开放式病人自杀危险评分为14.33±8.08,中度自杀危险性病人占29.5%,高度自杀危险性病人占15.8%。男女病人之间的自杀危险因素无显著差异(P>0.05);总自杀危险在51~60岁和21~30岁段评分最高,但P>0.05,无统计学差异;在各类自杀危险因素中,病人的自杀观念的评分最高2.33±2.06,有63.6%的病人存在自杀观念,其次是自杀企图(1.18±1.89,32.7%的病人存在)和无助、无望、自我评价低。在第二类危险因素中,病人的焦虑情绪评分较高0.87±0.67,而且70.9%的病人存在焦虑情绪。另外,自杀危险因素与年龄、诊断、职业、病程和婚姻有关,P<0.05或P<0.01。其中,第二类危险因素与年龄有关,P<0.01,第三类危险因素与诊断、住院次数和职业有关,P<0.05。上述结果提示,开放式精神科病房应高度重视病人的自杀危险,根据病人自杀危险的高危因素,开展针对性的预防,以保障病人的安全。     

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。     

精神科急性治疗病房全开放管理的探讨

在精神科急性治疗病房对部分病人试行全开放管理，共计有病例１５５７例，实施期间未发生意外事件。全开放管理给病人提供了接近正常人生活的自由度，最大限度地满足其心理需求。在帮助病人身心、社会适应等全面康复中具有积极意义，深受病人及家属的欢迎。作者详细介绍了全开放管理的方法，具体措施与有关制度及体会。     

精神科开放病房工休座谈新探索

工休座谈会作为医患交流的方式之一，在医院病区管理中占有十分重要的地位。精神科开放病房因病床周转快，有陪护，病人能参加社会活动等特点，开好工休座谈会有一定的难度。针对开放病房特点，对工休座谈会进行改革，收到显著效果。现介绍如下。     

关键环节心理评估与干预在预防综合性医院住院患者自杀事件中的作用

自杀是指个人在意识清醒的情况下,自愿、有目的、有计划地采取伤害,结束自己生命的行为。自杀既是一个健康问题,又是一个严重的社会问题[1]。它不仅存在于医院外的普通人群,综合性医院内的住院患者自杀的现象也时有发生。对住院患者自杀行为     

精神科患者自杀特征及危险因素的病例对照研究

目的探讨精神科自杀患者的特征及潜在的自杀危险因素。方法回顾性分析精神科门诊及住院的81例自杀或自杀未遂患者(研究组),并与同期505例无自杀倾向患者(对照组)对比,单因素分析和Logistic回归分析两者特征及危险因素,受试者工作曲线评估回归模型优劣。结果两组患者人口学特征无差异(P>0.05),多因素分析提示抑郁(OR=5.371)、精神分裂症(OR=2.812)、慢性疼痛(OR=3.278)、负性生活事件(OR=2.439)、高风险自杀量表得分(OR=2.133)和药物依赖(OR=2.518)为自杀危险因素,受试者工作曲线下面积为0.75。结论抑郁、精神分裂症、慢性疼痛、负性生活事件、高风险自杀量表得分和药物依赖为精神科患者自杀高危因素,得出的回归具有较好的诊断准确度。     

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。     

从探视后精神病人自杀谈如何加强病房管理

通过对６例精神病人自杀资料分析认为，部分病人的自杀死亡在一定程度上与其家属探视后病人思想上造成一定的压力，引起一系列心理变化有关，因此，提示医护人员补发家属探视前应向其交待探视须知，探视后应向病人和家属了解探视的谈话内容，病人的思想状况，情绪等，酌情进行心理护理，并进行交班重点护理。     

自杀风险护理评估记录单在防范患者自杀中的应用

目的 探讨自杀风险护理评估记录单在防范患者自杀中的应用。方法 选取2018年4月至2021年8月景德镇市第三人民医院收治的住院患者100例病例资料进行回顾性分析，依据自杀风险护理评估记录单应用与否分为应用组(2018年9月至2021年8月住院，n=50)和未应用组(2018年4月—8月住院，n=50)。比较2组患者的自杀风险和自杀行为发生情况。结果 干预后，2组自杀低风险比率均高于干预前，中风险、高风险比率均低于干预前(均P<0.05);应用组的自杀低风险比率高于未应用组，中风险比率低于未应用组(均P<0.05),但2组高风险比率比较，差异无统计学意义(P>0.05)。应用组自杀行为发生率为2.0%(1/50),未应用组为8.0%(4/50),应用组显著低于未应用组(P<0.05)。结论 自杀风险护理评估记录单在防范患者自杀中的应用效果较好。     

精神科病房强制性护理干预潜在的法律问题及管理对策

目的 探讨精神科病房强制性护理干预潜在的法律问题,并提出护理管理对策.方法 对我院273例患者实施保护性约束的原因进行分析,探讨精神科护士实施强制性护理干预行为的原因以及潜在的法律问题.结果 精神科强制性护理干预在患者的生命健康权、知情同意权、人身自由权、人格受尊重的权利方面存在法律问题,并可能存在过失、渎职行为及违反法律法规的行为.结论 在精神科病房实施强制性护理干预时应尊重患者,做好相关告知,保障患者及家属的各种相关权利,并认真执行各项相关制度,使强制性护理干预措施更加人性化、科学化、规范化、程序化,避免医疗纠纷的发生.     

Evaluating STORM skills training for managing people at risk of suicide

AIM: This paper reports a study evaluating the Skills Training On Risk Management (STORM) training initiative in three mental health services in the North-West of England, UK. BACKGROUND: Training for health workers has been widely advocated as a key route to suicide prevention. However, reports of evaluations are scarce in the literature. In previous research, we have demonstrated that the STORM intervention results in acquisition of new skills and can be disseminated in a community setting. METHOD: The training was delivered during a 6-month period in 2002 by three mental health nurses who were seconded part-time to the project. The quantitative evaluation, which assessed change in attitudes, confidence, acquisition of skills and satisfaction, used a pretest/post-test design, with participants acting as their own controls. Qualitative interviews were conducted with a purposive sample of 16 participants to explore the impact on clinical practice, and with the three trainers at the end of the study. FINDINGS: Data from 458 staff members were collected during a 6-month period. Positive changes in attitudes and confidence were shown, but previous evidence of skill acquisition was not replicated. Qualitative interviews revealed important insights into changes in clinical practice, particularly for less experienced or unqualified nursing staff, but also concerns about the lack of an educational culture to foster and support such interventions in practice within the organizations. CONCLUSION: STORM training for the assessment and management of suicide risk is both feasible and acceptable in mental health trusts. However, we remain uncertain of its longer-term impact, given the lack of engagement of senior staff in the enterprise and the absence of linked supervision and support from the organizational management to reinforce skill acquisition and development. We consider that regular supervision that links STORM training to actual clinical experience would be the ideal.     

Integration of a suicide risk assessment and intervention approach: the perspective of youth

The process of suicide risk assessment is often a challenge for mental health nurses, especially when working with an adolescent population. Adolescents who are struggling with particular problems, stressors and life events may exhibit challenging and self-harm behaviour as a means of communication or a way of coping. Current literature provides limited exploration of the effects of loss, separation and divorce, blended families, conflict and abuse on child and adolescent development and the increased vulnerability of at-risk youth. There is also limited research that provides clear and practical models for the assessment and management of youth suicidal ideation and behaviour. This paper will discuss the integration of a number of theories to establish a comprehensive assessment of risk. The research study described the perspective of youth and their families who had experienced this particular model; however, this paper will discuss only the youth perspective. In order for this model to be successful, it is important for mental health nurses to make a connection with the youth and begin to understand the self-harm behaviour in context of the adolescents' family, and their social and school experiences. It also requires recognition that adolescents with challenging and self-harm behaviour are hurting and troubled adolescents with hurtful and troublesome behaviour.     

精神病患者住院前后自杀行为分析及护理干预

目的:分析精神病患者自杀的潜在危险因素,探讨如何从护理角度进一步预防住院精神病患者的自杀行为。方法:对2004年1月至2008年12月住院且在住院前后有自杀史的258例患者的临床资料进行回顾性分析。结果:258例患者住院前的自杀方式以服毒、自缢、割腕、跳楼居多,住院后的自杀方式以自缢居多;出院后自杀成功7例,住院期间自杀成功1例。结论:住院精神病患者自杀具有一定的规律性,通过增强护理防范意识,及早对患者实施有针对性的护理干预,可预防、降低患者的自杀成功率。     

Nursing people who are suicidal on psychiatric wards in Taiwan: action/interaction strategies

Suicide is a major mental health problem in Taiwan. Estimations revealed that approximately 41% of people who committed suicide had a previous history of psychiatric inpatient care. To date, a suicide nursing care theory has not been developed. Consequently, the aim of this study was to formulate a suicide nursing care theory with the aim of enhancing and advancing the nursing care provided to people who attempt suicide or have suicidal thoughts. A qualitative approach using grounded theory was adopted. A total of 15 peoples who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding and the NUD*IST software program. A substantive theory of suicide nursing care was developed from the emergent findings. Four categories surfaced in the nursing care theory relating to the nurses' 'action/interaction strategies'. They were: the holistic assessment of people who are suicidal; providing protection; providing basic care; and providing advanced care. The findings from this study could be used to influence and advance nurse education and training, clinical practice, management and further research.     

精神科医院感染的危险因素分析

目的了解精神科住院患者医院感染发生情况,分析其危险因素,探讨预防对策。方法采用回顾性调查方法,对2012年1月至12月1 986例住院的精神疾病患者发生医院感染情况进行调查,并分析其危险因素。结果共发生医院感染88例,感染发生率为4.43%。医院感染部位以呼吸道为主,占47.73%,其次是胃肠道、泌尿系统、口腔等;医院感染危险因素包括高龄、住院时间较长、有合并症、有侵入性操作。结论精神科住院患者医院感染发生率高,应加强病区环境管理,严格执行无菌操作规程及消毒规范,降低精神科住院患者医院感染发生率。     

精神科护士的职业危险因素及防护对策

高风险性的护理工作存在多种危险因素,通过普及法制教育、加强责任心、增强护士的自我防护意识,同时完善管理制度、规范操作规程、减轻工作压力等积极的防护对策,收到了良好的效果。     

骨质疏松症危险因素分析及护理

笔报道骨质疏松症的危险因素及护理。总结骨质疏松症危险因素有不良生活方式、性激素下降、饮食结构的不合理及户外活动减少：采取干预措施有加强健康教育．培养良好的生活方式，规律性的身体锻炼，支持人群为患提供支持，终生足够的补钙。     

Potential risk factors for psychiatric disorders in patients with headache

Background.— Psychiatric comorbidities are common among patients with headache. These can compromise the quality of life of patients and may affect the result of treatment. No available systematic study concerning this problem has been conducted in Thailand. Objective.— The study aimed to determine the prevalence and risk factors of psychiatric disorders in patients with headache in tertiary care facility. Methods.— The study was conducted at the Headache Clinic, King Chulalongkorn Memorial Hospital in Bangkok, Thailand. One hundred and thirteen patients were enrolled. Diagnosis of headache was made based on International Classification of Headache Disorders II system. Mental disorders were assessed using Primary Care Evaluation of Mental Disorders. Other possible risk factors were extracted using significant physical symptoms count and accumulated risk for mental disorder. Results.— Of the 113 samples analyzed, the prevalence of depression, anxiety, and somatoform disorder was found to be 29.2%, 9.7%, and 27.4%, respectively. No definite relationship between headache types and mental disorders was observed. High number of significant physical complaints and health concerns significantly increased the risk for depression (OR = 4.6, 95% CI = 1.6 to 13.5) while the level of possible risk for mental disorder was associated with an increased risk for somatoform disorder (OR = 1.6, 95% CI = 1.2 to 2.2). Conclusion.— The study confirmed high prevalence of psychiatric comorbidities in patients with headache. The results of this study will raise the awareness of physicians to possible underlying mental disorders in patients with headache and facilitate appropriate treatment or psychiatric referral.