对危重病人的护理查房

护理查房是八十年代借鉴国外的护理经验实施护理程序而兴起的一种护理制度。我院多年来坚持开展以危重病员为主的护理查房,以此形式在促进护理教学、规范技术操作等各个方面取得较大收益,有效地提高了危重病人的护理质量,使我院1994年顺利通过三甲评审,成为江苏省首批三级甲等医院并顺利通过以后的多次复查。现就对危重病人进行护理查房的目的、方法、形式、意义等与大家探讨。 一、护理查房的目的 对危重病人的护理查房,旨在通过负责护士(护理部主任、护士长、责任护士、教学护士)与有关护理人员巡视危重病人,以达到了解、分析和讨论病人的病情,明确护理论断、护理计划,检查护理质量,进行讲评,确保危重病人的临床护理质量,现场教学、示范操作,对护理人员达到因才施教,同时可以     

ICU护士对危重病人营养支持相关知识培训效果的评价

[目的]了解ICU护士营养支持相关知识的掌握程度,评价集中专题知识培训的效果. [方法]对82名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对危重病人营养支持相关知识的掌握程度. [结果]培训后ICU护士对危重病人营养支持相关知识的知晓率较培训前有明显提高;培训前后得分比较差异有统计学意义(P＜0.01).[结论] ICU护士对危重病人营养支持相关知识的掌握程度不够,对护士进行专题培训可提高护理人员对相关知识的掌握程度,指导护士参与对危重病人营养支持的护理实践.     

危重病人护理查房模式的探讨

目的围绕以病人为中心，将查房的重点放在护士为病人解决什么样的问题上，持续改进护理方法，不断提升护理服务品质。方法护理部制定危重病人护理查房考评标准及危重病人护理查房安排表，通过对危重病人护理查房，检查科室护理程序的实施情况。结果护理查房在护理程序的引导下逐步走向规范化和科学化。结论危重病人护理考评标准及查房安排表量化指标具体，可行性强，对科室有较强的指导意义，强有力地促进了科室运用护理程序，提高基础护理质量。以人为本，引导护士关心尊重病人，构建和谐的护患关系。     

危重病人护理查房模式的探讨

目的 围绕以病人为中心,将查房的重点放在护士为病人解决什么样的问题上,持续改进护理方法,不断提升护理服务品质.方法 护理部制定危重病人护理查房考评标准及危重病人护理查房安排表,通过对危重病人护理查房,检查科室护理程序的实施情况.结果 护理查房在护理程序的引导下逐步走向规范化和科学化.结论 危重病人护理考评标准及查房安排表量化指标具体,可行性强,对科室有较强的指导意义,强有力地促进了科室运用护理程序,提高基础护理质量.以人为本,引导护士关心尊重病人,构建和谐的护患关系.     

ICU护士对危重病人营养支持相关知识培训效果的评价

[目的]了解ICU护士营养支持相关知识的掌握程度,评价集中专题知识培训的效果。[方法]对82名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对危重病人营养支持相关知识的掌握程度。[结果]培训后ICU护士对危重病人营养支持相关知识的知晓率较培训前有明显提高：培珑前后得分比较差异有统计学意义（P〈0．01）。[结论]ICU护士对危重病人营养支持相关知识的掌握程度不够,对护士进行专题培训可提高护理人员对相关知识的掌握程度,指导护士参与对危重病人营养支持的护理实践。     

危重病人护理记录存在的缺陷及其相关因素分析

为了提高危重病人护理记录的书写质量 ,对 3所三级甲等医院 2 2个病区的危重病人护理记录进行随机抽样调查 ,对危重病人护理记录中出现问题所涉及的护士进行分析。调查结果表明 :出现的危重病人护理记录问题主要分为治疗记录不准确、病情观察不连续、医学术语不规范、记录与实际不符以及未签名 5类。这些问题的出现与护士的年龄、学历、所在科室等因素有关 ,且不同科室的危重病人护理记录问题有显著性差异。因此 ,为了提高危重病人护理记录质量 ,针对不同护士进行有针对性的护理文件书写培训十分必要 ,同时制定全国统一的护理记录标准是目前提高护理医疗文件质量的当务之急。     

实行护理部跟班查房的做法与体会

护理部对全院护理质量的管理和控制除了建立健全各项制度及各项工作质量考核标准外 ,更重要的是要了解各项制度和要求在临床各科室的落实情况。通过实行跟班查房制度 ,即由护理部主任、科护士长和护士长组成查房小组 ,定期到临床科室进行跟班查房 ,更全面的了解各临床科室护士长及护士完成工作的状况以及病人对护理服务的满意度 ,从而对科室的护理质量做出客观确切的评价 ,对查房中发现的问题及时加以改进 ,一些护士长好的管理经验得到推广 ,进一步提高了护士长的管理水平 ,提高了护理人员的服务意识和服务质量 ,从根本上提高了护理质量及病人对护理工作的满意度     

整体护理病房三级护理查房的体会

我院自1999年7月开始在整体护理模式病房中实施三级护理查房。1年多来,对800例危重病人进行了护理查房,查房的形式为责任护士每天查,主管护师或护士长每周查,副主任护师以上或科护士长每月抽查,护理部主任每季抽查。通过查房,明显提高了危重病人的护理质量,病人得到了更为优质的服务,护理服务满意率提高;对护理人员来说,提高了业务水平,锻炼了口头表达能力;对护理管理来说,及时了解护士对护理程序的应用情况,掌握危重病人的护理质量,对护理中存在的不足及时提出指导意见。     

护理部垂直管理下护理人员绩效工资改革方法与成效

目的：探索建立护理部垂直管理下合理、科学、可行的护理人员绩效薪酬分配体制。方法2009年我院展开了护理垂直管理改革,通过护理工作量标准化计算,细化护理质量考核,护士能级评定及患者满意度考核护理人员绩效薪酬。比较改革前后护理人员绩效成果。结果护理绩效改革使绩效分配切实反映护理工作量,改革后绩效工资分配方案和改革前按科室效益分配绩效比较,31个科室中16个科室提高、6个科室持平、9个科室减少。并且提升患者及护士满意度,改革前为90．12％,改革后为95．37％,保证护理质量,稳定护理队伍。结论护理部垂直管理下的绩效改革实现了护理部对全院护士人、财、物的统一管理及调配,加强了医院管理。     

调查骨折病人对责任护士健康教育的满意度与管理对策

目的了解骨折住院病人对责任护士健康教育的满意程度,以提高整体护理质量。方法采用自制调查表,对192例骨折病人进行问卷调查。每月由护理部不定期到病房进行随机抽样调查,并将调查结果反馈给科室。结果病人健康教育的总体满意度较好,满意率为82.3%～96.9%,不满意率为2.1%～15.6%。结论骨折病人对责任护士的健康教育满意度与护士的服务理念、掌握医学专科知识的程度及健康教育技巧、护士的年龄、学历等密切相关。     

Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective

Background : Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre‐transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. Objectives : To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre‐transfusion checking behaviours. Measures : A cross‐sectional design was employed assessing willingness to participate in pre‐transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1–7. Participants : One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Results : Mean scores for patients' willingness to participate in safety‐relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4·96–6·27 to 4·53–6·66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Conclusion : Overall, both patients and healthcare professionals view patient involvement in transfusion‐related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.     

QUEST: Questionnaire relating to patients’ Understanding and Expectations of their Symptoms and Treatment

Objectives : To survey patients’ perceptions of illness and their expectations of the emergency department visit in a major tertiary‐referral teaching hospital and to compare these responses with the doctors’ assessment in a major tertiary‐referral teaching hospital. Method : A two‐part survey was conducted. Patient questions focused on patient perception of illness severity, and expectation of process and outcome. Doctor questions focused on the severity of illness and the advice given. Results : Pre‐consultation: Of 141 patients, 94 (67%) were concerned that they were suffering from something serious or dangerous. Eighty‐three of 145 patients (57%) expected an explanation and/or reassurance. Eighty‐four of 145 patients (58%) expected investigation. Twenty‐seven of 135 patients (20%) expected admission to hospital. Post‐consultation: 119/126 patients (94%) who were given an explanation stated that they understood their illness. One hundred and thirteen of 122 patients (93%) felt reassured on departure. Conclusions : In this group of patients, fear of a dangerous or life‐threatening condition not borne out in the doctors’ assessment is common. Present clinical practice, including explanation and reassurance based on clinical and investigation findings, appears sufficient to meet patient expectations.     

Exploring the care experience of patients undergoing spinal surgery: a qualitative study

Purpose This exploratory study sought to explore the patient experience of the surgical journey from decision to operate, to hospitalization, discharge and subsequent recovery. Design Patients attended one of two focus group discussions. Patient sample Seven patients that had undergone surgery for spinal stenosis or disc prolapsed participated, aged between 48–75 years (mean age 59); five were male. Methods Patients’ attitudes towards the information and care they received from the point of the decision to operate through to post‐operative recovery were explored. Particular attention was paid to patients’ information needs, support provided, general understanding of the processes and ways in which care could have been improved. Results Patients identified nine main ‘needs’ they felt played an integral part in enhancing the patient experience including the need for reduced waiting times, for better information and preparation, to be proactive, to speak up and ask questions, to feel safe and to be treated with dignity and respect; and the need for ongoing support, human contact, and; continuity of care. Conclusion These findings suggest that there are several measures that could be taken to improve the patient's surgical experience. In particular, providing appropriate information to patients in a timely manner and ensuring that support and advice is easily accessible for those patients that need it are key areas for improvement.     

The development and piloting of a patient held record with adult mental health users

This article reports on the development and piloting of a patient held record for adult mental health users. Development of the format and content of the record was determined in consultation with a user group. Piloting and subsequent evaluation of the record with users revealed a number of issues which need to be addressed in the promotion of a patient held record.     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.

     

Patient turnover and the relationship between nurse staffing and patient outcomes

High patient turnover (patient throughput generated by admissions, discharges, and transfers) contributes to increased demands and resources for care. We examined how the relationship between registered nurse (RN) staffing and failure-to-rescue (FTR) varied with patient turnover levels by analyzing quarterly data from the University HealthSystem Consortium. The data included 42 hospitals, representing 759 nursing units and about 1 million inpatients. Higher RN staffing was associated with lower FTR. When patient turnover increased from 48.6% to 60.7% on nonintensive units (non-ICUs), the beneficial effect of non-ICU RN staffing on FTR was reduced by 11.5%. RN staffing should be adjusted according to patient turnover because turnover increases patient care demand beyond that presented by patient count, and outcomes may be adversely affected.     

Using Patient Advisory Boards to Solicit Input Into Clinical Trial Design and Execution

Academic institutions, pharmaceutical and biotechnology companies, foundations, and associations are routinely implementing patient advisory boards (PABs) to solicit patients' voices and perspectives on a variety of clinical research–related areas, including protocol design, clinical trial execution, informed-consent form design, clinical trial medicine kit design, wearable devices and mobile technologies, and patient-communication materials. Based on experience conducting >50 PABs during the past several years, the authors provide insights into how to best plan and execute PABs and their value in informing improvement in patient engagement.