临床精神科护理不良事件的认知现状及应对措施

目的探讨临床精神科护理不良事件的认知现状及应对措施。方法抽取我院在2011年1月~2013年12月上报的80例不良事件,通过回顾性分析法对不良事件的相关性进行分析,并制定针对性的应对措施。结果 不良事件以跌伤、给药错误、药品交接错误为主,分别占50%、40%、35%。护理人员的护龄、职称以及学历等严重影响不良事件的发生率,差异具备统计学意义(P0.05)。结论 提高认知,制定应对措施,降低不良事件的发生率。     

Improving quality of psychiatric care in Latvia by measuring patient experiences

In Latvia, as in many former Soviet Union countries, there used to be little priority given to systematic assessments of the quality of psychiatric care. Furthermore, using the experiences of patients as a measure of quality was unthinkable because psychiatric patients were seen as incapable of assessing quality of psychiatric services. Over the past few years, and facilitated by Latvia's progress along the route of Western democracy and participation in international organizations (EU, OECD), as well as funding support from the EU, several policy documents have been developed with the aim of improving healthcare quality. Simultaneously, several small-scale initiatives have emerged aiming at the promotion of quality of care, such as the quality award, and the quality comparison of psychiatric hospitals. Furthermore, the Psychiatric Inpatient Patient Experience Questionnaire for on-site measurement (PIPEQ-OS) has recently been adapted for use in Latvia. The first application of PIPEQ-OS in a psychiatric hospital in Riga reveals high patient responsiveness, interest and surprise about being asked to participate in the decision-making process regarding treatment and pharmaceutical choices. More widespread use of the PIPEQ-OS has considerable potential for (1) improving information about treatment shortcomings from the patients' perspective and (2) improving the treatment process by opening doors of cooperation with patients and changing deep-rooted paradigms.     

Patient assessment within the context of healthcare delivery packages: A comparative analysis

BackgroundDue to an increased focus on productivity and cost-effectiveness, many countries across the world have implemented a variety of tools for standardizing diagnostics and treatment. In Denmark, healthcare delivery packages are increasingly used for assessment of patients. A package is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery packages.MethodsThe study used a constructivist Grounded Theory approach. Ethnographic fieldwork was carried out in three specialized units: a mental health unit and two multiple sclerosis clinics in Southern Denmark, which all used assessment packages. Several types of data were sampled through theoretical sampling. Participant observation was conducted for a total of 126 h. Formal and informal interviews were conducted with 12 healthcare professionals and 13 patients. Furthermore, audio recordings were made of 9 final consultations between physicians and patients; 193 min of recorded consultations all in all. Lastly, the medical records of 13 patients and written information about packages were collected. The comparative, abductive analysis focused on the process of assessment and the work made by all the actors involved. In this paper, we emphasized the work of healthcare professionals.ResultsWe constructed five interrelated categories: 1. “Standardized assessing”, 2. “Flexibility”, which has two sub-categories, 2.1. “Diagnostic options” and 2.2. “Time and organization”, and, finally, 3. “Resisting the frames”. The process of assessment required all participants to perform the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre-defined scope of relevant diseases targeted by the package. The inflexible frames of the assessment package could cause resistance among clinicians. Moreover, expert knowledge was an important factor for the efficiency of the process. Some types of organizational work processes resulted in many patients being assessed, but without being diagnosed with at package-relevant disease.ConclusionLimiting the grounds for using specialist knowledge in structured health care delivery may affect specialists’ sense of professional autonomy and can result in professionals employing strategies to resist the frames of the packages. Finally, when organizing healthcare delivery packages, it seems important to consider how to make the optimal use of specialist knowledge.     

精神科护理管理中的以人为本理念探讨

目的探讨"以人为本"的护理理念在精神科护理中的应用价值。方法选取自2016年6月-2018年5月期间该院收治的100例精神病患者作为实验研究对象,随机将100例患者分为实验组与对照组,对照组患者采用常规方法进行护理,护理人员在"以人为本"的理念的指导下对实验组患者进行护理。6个月后比较两组患者的疗效及IPROS评分。结果经过一段时间的护理,采用住院精神病患者康复疗效评定量表(IPROS)对两组患者治疗前后的评分进行比较分析。护理前,两组患者的评分对比差异无统计学意义(P>0.05)。护理后,两组患者的评分明显低于对照组患者的评分。实验组中,33例对护理满意,15例基本满意,不满意2例,护理满意度为96.00%;对照组中,20例对护理满意,17例基本满意,不满意13例,护理满意度为74.00%。护理满意度方面实验组明显高于对照组,两组差异有统计学意义(P<0.05)。结论在精神病患者的临床护理中,遵循"以人为本"的护理理念,能够在很大程度上改善精神病患者的临床护理效果,大大提升护理满意度,从而达到满意的治疗效果,因此,"以人为本"的护理理念值得在临床实践中进行推广。     

Réflexion sur la péréquation financière de psychiatrie en France

For 25 years work has been underway in France for the implementation of an alternative to public financing of health care. In the absence of progress, some regional health agencies are engaged in work related to the reallocation of public finances between psychiatric institutions. We propose a reflection with suggestion on the method proposed by the Provence Alpes Côte d’Azur Regional Health Agency. Without questioning the need for a reallocation of resources between psychiatric institutions, the method proposed here needs to evolve further to be applied in a legitimate and appropriate manner. There is a kind of urgency for a reallocation of resources between psychiatric institutions in France, but it implies a collective thinking and especially the definition of evaluation procedures for the selected models. These conditions are necessary to guarantee the quality of French psychiatry and equity in access to psychiatric care.     

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.