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。     

加强护患沟通预防护理纠纷

目的加强护患沟通防止护理纠纷的发生。方法随着社会发展医疗改革，病人要求越来越高，护理管理者应该改善医院住院环境，加强医护人员责任心，提高护理人员法律意识，服务质量，沟通技巧，技术水平，改善护患关系，避免护理纠纷的发生。结果护理人员素质提高，注重和病人沟通，改善了护患关系，减少了护理纠纷。结论护理人员增加了竞争意识，法律意识，沟通意识，不断提高人文素质，提高病人满意度，使护患关系融洽。     

加强护士法律意识的探讨

随着社会的进步和人们生活、文化水平的提高，病人保护自己就医权利的意识增强，对医疗护理服务质量、医疗护理安全更加重视，近几年护理纠纷呈不断上升趋势。为了提供更高层次和要求的服务，适应新形势护理服务模式，护理人员必须提高法律意识，使护理缺陷消失在萌芽状态，杜绝护理纠纷的发生，尤其是年轻护士。根据当前形势，我们提出了如何提高年轻护士法律意识和加强其法制观念的问题。     

急诊护理纠纷的原因及防范措施

随着社会的进步,人们自我保护的法律意识不断增强,医疗护理纠纷呈不断上升趋势,护患关系也受到一定的影响。急诊科处于抢救急、危、重症患者的特殊环境,是护理纠纷的高发科室。因此,急诊护士在工作中应建立起较强的风险意识和法律意识,提高预见问题的能力,减少或避免急诊护理纠纷的发生。笔者通过对急诊护理纠纷产生的原因进行分析,提出了相应的防范措施,以供临床护理参考。     

加强法律意识 确保护理安全

随着社会的进步、经济的发展以及文明程度的提高，患者保护自己就医权利的意识增强，对医疗护理安全提出了更高的要求，更加重视护理服务质量。因此，护理人员必须不断学习法律知识，提高法律意识，使护理安全隐患和护理缺陷消灭在萌芽状态，杜绝医患纠纷。现就护理人员提高法律意识和增强法制观念体会报告如下。     

产科护理纠纷与防范

随着人民生活水平不断提高，法律意识的增强，患者对护理质量提出了更高的要求。分娩是正常的生理现象，在就医过程中一旦发生意外，产妇和家属无思想准备，无法接受现实，极易冲动，激化矛盾，发生纠纷。一旦发生纠纷，负面影响不可低估。针对产科护理纠纷发生的原因，采取循证护理模式进行防范，提高护理质量，现报告如下。     

防范护理纠纷要把握六字要诀

护理任务的日益繁琐和宽泛,社会对护理服务的期望和要求也越来越高,与此相对应的是患者的法律意识、自我保护意识不断增强,对护理服务的要求和期望值也越来越高。而部分护理人员的思维方式尚不能与时俱进,表现在法律意识淡薄、证据意识缺乏,由此导致护理纠纷不断增多。笔者在通过对诸多护理纠纷进行逐一剖析的基础上,总结了便于记忆、能起到警示作用和防范护理缺陷的准、早、快、细、实、常六字要诀,以期与同行切磋商讨。     

临床护士正确防范护患纠纷的探索

随着人们生活水平和法律意识的不断提高，患者对护理质量、护理安全提出了更高的要求。护理人员一旦侵犯了患者的权利，不管其行为是故意还是过失，都有可能引起护患纠纷。作为一个临床护士，笔者对如何正确防范护患纠纷有以下几点体会。     

刍议预防护理纠纷

随着人们生活水平的不断提高，患者对护理质量、护理安全提出了更高的要求，用法律衡量护理行为和后果意识不断增强。护理人员一旦侵犯了患者的权利，不管其行：勾是故意还是过失，都有可能引起护患纠纷。因此，如何正确防范纠纷是每位护理人员十分关心的问题。如何在诊疗护理过程中，避免和减少护理纠纷的发生，最根本是预防。护理人员只有加强法律意识，处理好各个环节的工作，才能预防护理纠纷的发生。     

医疗护理纠纷原因分析及防范措施

随着经济的发展和社会的进步,医疗科学技术水平不断发展,人民群众生活水平、保健意识、法律意识的提高,对医疗护理服务的期望值也不断增高。近年来,护理纠纷案例呈逐年上升趋势。因此,分析护理纠纷的原因,研究解决避免纠纷的对策是维护正常的医疗秩序、减少和杜绝护理纠纷发生的重要措施。     

Improvement of quality of nursing care: a goal to challenge in the eighties

Some general thoughts on the use of the quality concept as a means to structure critical reflection on patient-client care and health services is discussed. The continuous request for more health care facilities and quality of services occupies not only the minds of the health workers, but also of the consumer who is becoming more aware of his rights and privileges. Health care should not be identified with curative care only. It involves prevention and promotion of people's status of health as well. Nurses have an important contribution to make in the promotion of health. The paper deals also with the evaluation of quality of care. If nurses become involved in the evaluation of nursing care they should have a clear concept of what nursing is. The nursing profession has a responsibility to develop standards and criteria for the evaluation of nurses' contribution in patient care. An example of a well-tested monitoring quality instrument is given. In the last part of the paper some practical suggestions for managers who are responsible for the quality care improvement in their own health care institutions are given.     

Multidisciplinary nursing: re-thinking role boundaries

The ambiguous role of nurses within the health care team has been a subject of much debate, evident in current practice and the study of the early development of nursing in Australia. Early nursing work was broad and uncontested. Debates about nursing and 'non-nursing' tasks are thought to have emerged after the establishment of 'Nightingale reforms' in the 1870s. Nursing role conflicts may be due in part to the rise in technology and medical intervention, the demise of 'generalist' doctors, nurses and patient-centred care, the creation of nursing specialists who moved to other community care positions and nursing's drive for professionalization. Nurses' role in mealtimes provides one example of the ambiguous and contentious issue of nursing and non-nursing work. Health services need a generic worker who is client-focused, possesses multidisciplinary skills, manages the care environment, humanizes the system at the point of contact and acts therapeutically. This broad and flexible role ascribed to nurses is threatened by cost containment and the scramble for new occupations within the broad field of health services, which is plagued with increasingly rigid role boundaries. The examination of nursing workforce planning arrangements is needed to ensure greater coherence and clearer lines of nurses' roles and responsibilities.     

医养结合背景下居家养老护理服务需求调查

目的了解社区居家养老老人对护理服务的需求情况,为开展针对性护理提供依据。方法采用自行编制的调查问卷于2018年8月对上海市徐汇区康健街道的750名居家老人进行现场问卷调查。调查内容包括:老人一般资料以及对医养结合相关政策知晓程度、对健康及护理服务的需求和满意度情况。结果被调查的750名社区老人的平均年龄为(72.62±8.17)岁,87.5%具有初中及以上文化程度,59.1%的老人缺乏照护人员,74.1%的老人患有一种及以上慢性病,79.4%的老人不知晓医养结合,92.1%的老人对提供居家护理服务项目所知甚少。护理需求中排序前3位的是输液(52.5%)、抽血检验(42.2%)和疼痛护理(9.9%),83.0%的接受过相关服务的老人对目前居家养老护理服务感到满意。结论目前居家养老的老人年龄偏大、合并的慢性疾病多,且缺乏照护人员,对居家养老护理服务需求高。今后需针对居家老年人的需求,建立健全的居家养老护理服务模式,以满足其医疗健康服务需求。     

Nursing approaches to the mental health of the elderly: a position paper

Although geropsychiatric nursing or mental health nursing with the elderly (MHNE) can be conceived of as a new subspecialty in psychiatric mental health nursing, in essence it is as old as nursing itself, for caring for people of all ages has always been within the purview of nursing. Today, however, in the more developed countries, older adults have increased both in numbers and in sophistication. These two changes have altered mental health care for the elderly. For example, mental health professionals now recognize that the elderly have an image problem which leads to underutilization of existing services. Psychiatric mental health nursing as a whole is questioning the nature of its practice and its place both within academic settings, and within the health care service delivery system. This paper explores the future possibilities and choices for the new subspecialty, mental health nursing with the elderly.     

Health promotion for frail older home care clients

AIM: This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone. BACKGROUND: An ageing population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care. For frail older people with long-term needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on demand rather than proactively. METHODS: A two-armed, single-blind, randomized controlled trial was carried out with older people > or =75 years and eligible for personal support services through a home care programme in Ontario, Canada. Participants were randomly allocated either to usual home care (control) or to a nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education about management of illness, coordination of community services, and use of empowerment strategies to enhance independence. The data were collected in 2001-2002. RESULTS: Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared with providing nursing services on-demand, resulted in better mental health functioning (P = 0.009), a reduction in depression (P = 0.009), and enhanced perceptions of social support (P = 0.009) at no additional cost from a societal perspective. CONCLUSIONS: Home based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of health care. The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care.     

Public Health Nurses' Vision of their Future Reflects Changing Paradigms

Health care over the past decade has undergone important changes that have implications for public health nursing. The focus of public health has expanded, as a result of the World Health Organization establishing the goal of "Health for All by the Year 2000," with its strategy of primary health care. To be active participants in this expansion, public health nurses must be more explicit about their current contributions to health care systems; develop nursing frameworks consistent with the systems' changing goals; and articulate their visions of the future. It is clear that the medical paradigm of health care services needs to change to one of primary health care. Based on results of a recent public health nursing research study, a conceptual framework for the future practice of public health nursing was developed .     

The functions of the nurse in an integrated national health service.

The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.     

Characteristics of Clients Who Receive Home Health Aide Service

Abstract Nurses who plan and supervise home health aide service must have a good understanding of the amount and intensity of nursing care and the amount of home health aide service that individual clients will need. However, there is little in the nursing literature that describes how clients who receive both RN and home health aide services differ from clients who receive only RN care. Indeed, there have been few reports on how need for home health aide service relates to the amount of nursing care received. Secondary analysis of data from a study on resource consumption in home care revealed that clients who receive home health aide service: 1) are older; 2) are more likely to be women; 3) have a higher rating using the Community Health Intensity Rating Scale; and 4) are discharged from the caseload due to death or institutionalization at a higher rate than those who receive only RN care. Clients who received both home health aide services and RN care needed assistance with activities of daily living, but they also required more RN care than did clients who received only RN care. These data hold implications for nurses in addressing agency staffing, focusing home health aide training, and advocating for resources to address service needs of this segment of their care population.     

The Relationship Between Demographic Characteristics and Nursing Problems in Home Health Care

Abstract The delivery of home health services that are accessible and cost effective is contingent on understanding the characteristics and needs of the aggregates who use the services. This study examined the relationship between socio-demographic characteristics and nursing problems among a sample of home health patients. Data were gathered by retrospective record review of all 209 patients with medical-surgical problems who were discharged from home health services during a six-week period. Nursing diagnoses were identified by nurses at the time of the admission assessment. Impaired mobility, the most frequent nursing diagnosis, occurred in 73% of the sample, cardiovascular problems in 52%, and respiratory problems in 48%. Analysis of the data revealed a relationship between source of payment and age with nursing diagnosis. No significant relationship was found between nursing diagnosis and gender, although a weak relationship was identified with living arrangement. Results have important implications for the planning, delivery, and reimbursement of home care services that equitably address populations with the greatest nursing needs. If patients with specific predisposing characteristics have different needs, it may be possible to evaluate patients more accurately early in care delivery so that these needs can be more effectively met.     

优质护理服务对PICC患者心理健康状况及护理满意度的影响

目的:探讨优质护理服务对临床PICC患者心理健康状况及护理满意度的影响.方法:本组行PICC治疗者213例.其中将我院开展"优质护理服务示范"活动期间收治的110例患者设为干预组,将开展此项活动前收治的103例患者设为对照组.对照组采用常规护理,干预组实施优质护理服务.采用问卷调查法对患者进行调查,并分析两组患者的心理状况及护理满意度.结果:两组患者对护理工作的满意度和护理后SCL-90评分比较差异有统计学意义(P＜0.01).结论:优质护理服务能有效提高护理工作质量和效率,改善PICC患者的心理状况,提高患者对护理工作的满意程度.