心脏介入患者护理文件缺陷分析与对策

目的:分析我科心脏介入患者护理文件书写中常见的缺陷,探讨其原因,提出改进措施,规范护理文件书写方法,提高护理文件书写水平。方法:参照《病历书写规范》抽查我科200份心脏介入患者护理病历进行护理缺陷的检查。结果:护理文件书写中存在的各类缺陷137件次。结论:强化护理人员法律意识,重视业务素质的培养,加大管理力度,规范护理文件书写是提高护理文件书写质量的保证。     

护理医疗文件书写中存在的问题及其对策

护理医疗文件书写中存在的问题是造成近年来医疗护理纠纷处理难 ,使护理工作陷于被动状态的原因之一。为了提高护理人员的法律意识 ,避免或减少护理纠纷 ,分析书写中存在的问题 ,对护理文件书写与法律责任的关系进行了探讨 ,并对提高护士法制观念、严格按照要求写好文件及加强其质量监控提出对策。     

Dispatcher-assisted telephone CPR: a qualitative study exploring how dispatchers perceive their experiences

OBJECTIVES: To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). DESIGN: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. MAIN OUTCOME MEASURES: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. RESULTS: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. CONCLUSIONS: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.     

Medication errors during medical emergencies in a large, tertiary care, academic medical center

Purpose

Evaluate the rate, type and severity of medication errors occurring during Medical Emergency Team (MET) care at a large, tertiary-care, academic medical center.

Methods

A prospective, observational evaluation of 50 patients that required MET care was conducted. Data on medication use were collected using a direct-observation method whereby an observer documented drug information such as drug, dose, frequency, rate of administration and administration technique. Subsequently, a team of three clinicians assessed rate, type and severity of medication errors using definitions consistent with United States Pharmacopeia MEDMARX system. Severity was assessed on a scale of minor, moderate and severe.

Results

One hundred eighty six doses were observed for 36 different medications. A total of 296 errors were identified; of these 196 errors (66%) were inappropriate aseptic technique. Of the remaining 100 errors, 46% were prescribing errors, 28% administration technique errors, 14% mislabeling errors, 10% drug preparation errors and 2% improper dose prescribing. Examples included: (1) prescribing errors, (2) administering wrong doses, (3) mislabeling, and (4) wrong administration technique such as not flushing intravenous medication through intravenous access. The rate of medication administration errors was 1.6 errors/dose including aseptic technique and 0.5 errors/dose excluding aseptic technique. A notable portion (14%) of errors was considered at least moderate in severity.

Conclusions

One out of 2 doses was administered in error after errors of using inappropriate aseptic technique were excluded. There is a need for education and systematic changes to prevent medication errors during medical emergencies as an effort to avoid harm.     

Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study

Objective

To determine patients’ perspectives of components of patient-centred physiotherapy and its essential elements.

Design

Qualitative study using semi-structured interviews to explore patients’ judgements of patient-centred physiotherapy. Grounded theory was used to determine common themes among the interviews and develop theory iteratively from the data.

Setting

Musculoskeletal outpatient physiotherapy at a provincial city hospital.

Participants

Eight individuals who had recently received physiotherapy.

Results

Five categories of characteristics relating to patient-centred physiotherapy were generated from the data: the ability to communicate; confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome. These categories did not tend to occur in isolation, but formed a composite picture of patient-centred physiotherapy from the patient's perspective.

Conclusions and practice implications

This research elucidates and reinforces the importance of patient-centredness in physiotherapy, and suggests that patients may be the best judges of the affective, non-technical aspects of a given healthcare episode.     

The processes by which persons with HIV-related peripheral neuropathy manage their symptoms: a qualitative study

A variety of peripheral neuropathies occur throughout the course of HIV infection, with the most common peripheral nerve disorder of late HIV infection being distal symmetrical peripheral neuropathy (DSPN). Current management strategies often fail to achieve satisfactory pain relief. This study was designed to explore the everyday life experiences related to DSPN in persons with AIDS (PWAs) and the behaviors they initiate to alleviate the symptoms. A qualitative study using a grounded theory approach was used to better understand the impact DSPN has on PWAs. Many interventions were attempted and were ineffective; the effective ones were highly individualized. Emerging themes in the delimiting debilitation continuum included isolating the symptom cluster, inventing and testing interventions, and assimilating the annoyance. Results indicated a need for better DSPN assessment by nurses and teaching strategy development to manage the symptoms, and development of strategies to combat functional DSPN disabilities.     

乳腺癌术后康复期患者对医护联合康复门诊需求的研究

目的深入了解乳腺癌术后康复期患者对医护联合康复门诊的需求状况,完善医护联合康复门诊的服务内容。 方法采用质性研究的现象学方法,选取13例乳腺癌术后患者进行半结构式深入访谈,并运用Colaizzi现象学7步分析法对资料进行分析。 结果提炼出3个主题和5个亚主题：延续性的患肢康复需求（患肢功能障碍的康复需求、淋巴水肿管理的需求）;多样化的信息需求（对健康生活方式的关注、对性健康及生育相关知识的需求、对辅助治疗相关知识的需求）;专业和持续的情感支持需求。 结论乳腺癌术后康复期患者对医护联合康复门诊存在较多方面的需求,应根据患者需求设置并细化门诊服务内容,为患者提供延续护理服务,改善乳腺癌术后患者的长期生活质量。     

How physiotherapists perceive,interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.     

Service user experiences of information delivery after a diagnosis of cancer: a qualitative study

GOALS OF WORK: This paper presents findings from a qualitative study investigating service users' experiences of a patient information pathway after a diagnosis of cancer. MATERIALS AND METHODS: Patients (27) and relatives (20) were recruited from two identified Cancer Network sites representing a pathway that had been information mapped (Lung) and one which had not (Head and Neck). Respondents participated in up to three qualitative interviews in the year after diagnosis. MAIN RESULTS: The need for information in response to serious health problems has become widely accepted. Providing cancer patients and their carers with high-quality information throughout their care pathway is a policy priority. However, the study findings contribute to a growing body of evidence that far from embracing the active role of "expert patient", many patients continue to prefer verbal to written information, to trust in health professionals as their primary and preferred source of information, and to be quite cautious and selective about what they want to know about their illness. CONCLUSIONS: Good information is regarded as a prerequisite for informed decision making and a primary means of coping with the stress of illness. However, patient attitudes to information are complex and encompass resistance, ambivalence and indifference, active engagement and interest. The study findings reinforce the need for health professionals to develop competence as skilled communicators, and for efficient local systems of information transfer between service agencies and health professionals as prerequisites for delivery of the timely, tailored and personalized information which patients require.     

Perceptions of nurses in Japan toward their patients' expectations of care: A qualitative study

ObjectivesThis study aimed to investigate ideal nurse involvement based on the expectations of patients. Data on conflicts between nurses and patients were obtained. The patient situation involved standard nursing treatment, rather than acute phase or palliative care.MethodsQuestionnaires were distributed among senior nurses attending a series of trainings in 2012 and 2013. The nurses were requested to return their completed questionnaires within two weeks. We ensured the effectiveness of the interview process to obtain accurate answers.The sample comprised 240 head nurses and assistant head nurses who were asked to respond anonymously to 57 questions about non-acute (stable) psychiatric or physical nurse–patient scenarios. Qualitative data analysis was conducted using these responses.ResultsWe received 41 completed responses (response rate = 17.1%). The expectations of patients and their families were reflected in five categories, namely, inference, empathic understanding, listening attitude, individual treatment, and reliable skills and explanations. Inference was independently categorized as a particularly strong characteristic of Japanese patients' expectations.ConclusionsNursing care in situations where conflicts or misunderstandings may arise can be improved by encouraging nurses to be attentive to the moods, feelings, and expectations of patients and their families. The findings from this study can improve the quality of Japanese nursing care with regard to sensing (inferring) and reacting to the expectations of patients.     

Pediatric medical line safety: the prevalence and severity of medical line entanglements

The purpose of this cross-sectional study was to describe the prevalence and severity of medical line entanglements among pediatric patients (N = 486). Most patients, with ages from birth to 6 years, had at least 1 medical line (n = 444, 91%), and 294 children (60%) had 2 to 11 medical lines. Observed entanglements included lines around body parts (n = 31), lines under the body (n = 71), and lines tangled with other lines (n = 50). One third of the children were at risk for adverse events due to entanglements, and 1 patient actually experienced real harm.     

Discussing life expectancy with terminally ill cancer patients and their carers: a qualitative study

Goals of work There is uncertainty regarding the preferred content and phrasing of information when discussing life expectancy with terminally ill cancer patients and their carers. The objective of this study was to explore the various stakeholders perceptions about these issues.Subjects and methods We conducted focus groups and individual interviews with 19 patients with advanced cancer and 24 carers from three different palliative care (PC) services in Sydney and 22 PC health professionals (HPs) from ten different sites in Australia. The focus groups and individual interviews were audiotaped and fully transcribed. Further focus groups and/or individual interviews were conducted until no additional topics were raised. Participants narratives were analysed using qualitative methodology.Main results Participants suggestions regarding the content of prognostic discussions included: explaining uncertainty and limitations, explaining the process involved with making survival predictions, and avoiding being too exact. Those patients and carers who wanted to be given a time frame mostly wanted to know how long the average person with their condition would live and/or be given a rough range. HPs had various views regarding ways to phrase life expectancy: days versus weeks versus months, likelihood of the patients being alive for certain events, a rough quantitative range and probabilities (e.g. 10% and 50% survival). However, most HPs said they would rarely if ever give statistical information to patients.Conclusions This paper provides some potential strategies, words and phrases which may inform discussions about life expectancy. Further research is needed to determine the generalizability of these findings.     

Discussing end-of-life issues with terminally ill cancer patients and their carers: a qualitative study

Goals of work Discussing end-of-life issues is of key importance to terminally ill cancer patients and their families, and a challenging topic for both health professionals and patients/carers. There is a lack of research evidence in the literature to guide clinical practice. The objective of this study was to explore the optimal content and phrasing of information when discussing the dying process and end-of-life issues with terminally ill cancer patients and their carers.Subjects and methods We conducted focus groups and individual interviews with 19 palliative care patients and 24 carers from three palliative care services in Sydney, and 22 palliative care health professionals from around Australia. The focus groups and individual interviews were audiotaped and fully transcribed. Further focus groups and/or individual interviews were conducted until no additional topics were raised. Participants narratives were analysed using qualitative methodology.Main results Distinct content areas emerged for discussing end-of-life issues: treatment decisions at the end-of-life; potential future symptoms; preferences for place of death; the process of dying; what needs to be done immediately after death; and existential issues. When discussing the process of dying participants recommended: exploring the persons fears about dying and dispelling myths; describing the final days and the likely unconscious period; and the reduced need for food and fluids. Many participants identified the dilemma regarding whether to discuss potential complications around the time of death.Conclusions This paper provides strategies, words and phrases which may inform discussions about the process of dying and end-of-life issues. Further research is needed to determine the generalizability of these findings.     

The views and preferences of resuscitated and non-resuscitated patients towards family-witnessed resuscitation: A qualitative study

Background

A number of international studies have explored the views of family members and healthcare professionals on the concept of family witnessed resuscitation. However, the perspective and preferences of patients have been under-researched.

Objectives

To explore the views and preferences of resuscitation survivors and those admitted as emergency cases, as to whether family members should be present at their resuscitation.

Design

This paper reports the qualitative findings of a wider study, whose aim was to explore patient preferences towards family witnessed resuscitation.

Settings

Study sites included four acute university hospitals in two large cities of the South-West of England.

Participants

A purposive sample of 21 patients who underwent successful resuscitation and 41 patients, who presented to hospital as emergency cases, but without the experience of resuscitation, were recruited to the study.

Methods

To generate in-depth understanding about the phenomenon under inquiry, qualitative data were collected from face-to-face interviews. All responses were hand written and analysed using recognised qualitative techniques.

Findings

Three main themes emerged and these included: ‘being there’, ‘welfare of others’ and ‘professionals’ management of the event’. While the majority of participants supported the premise of having loved ones present during resuscitation, their motives varied and often related to the needs of families. Participants recognised that healthcare professionals had to exercise discretionary judgements to manage the resuscitation, which could embrace shielding relatives from distressing scenes and dealing with issues of confidentiality.

Conclusions

The study provides a unique understanding of patient preferences of family witnessed resuscitation with some of their views contesting arguments in the literature. Patients’ perspectives suggest both relatives and they themselves benefit in different ways. Although participants recognised that family members had emotional, informational and proximity needs, these had to be balanced with allowing the resuscitation team to manage the clinical emergency and make decisions. It is also evident that not all patients wish their families to be present. Healthcare professionals should strive to identify the wishes of patients and relatives in respect to family witnessed resuscitation and facilitate the presence of loved ones as appropriate. Further research into the area is still required.