某三级医院脑卒中住院患者医疗服务满意度调查

[目的]了解与评价脑卒中住院患者对医疗服务的满意度水平,找出医疗服务质量管理的薄弱环节,提出质量改进的对策。[方法]对青岛市某三级医院脑卒中住院患者进行现场问卷调查。[结果]脑卒中住院患者对维护患者安全、医疗技术、医患交流、健康教育等方面满意度高,与总体满意度相关系数高,是医院具有竞争优势的服务质量项目。医疗费用与总体满意度相关系数高,但满意度低,是竞争弱势待改进的服务项目。维护患者权利、服务态度、服务环境、服务流程等对患者总体满意相关性不是很高,满意度较高。[结论]医院应继续保持患者安全及竞争优势的服务项目,改进的焦点应该是竞争弱势的服务项目,在资源允许的条件下改进其他服务项目。     

Efficacy of a smoking-cessation intervention for elective-surgical patients

We tested an intervention to help smokers abstain (fast) from smoking before surgery, maintain abstinence postoperatively, and achieve long-term cessation. A randomized experiment included 237 patients admitted for presurgical assessment who smoked. The intervention included counseling and nicotine replacement therapy. Treatment group participants (73.0%) were more likely to fast than were controls (53.0%): chi(2)(1, N = 228) = 8.89, p =.003, and more likely to be abstinent 6 months after surgery (31.2% vs. 20.2%). There was no significant difference in the abstinence rates at 12 months after surgery, chi(2)(1, N = 169) <.001, p = 1.00. Encouraging patients to fast from smoking before surgery and postoperative support are efficacious ways to reduce preoperative and immediate post-operative tobacco use.     

精神科住院病人舒适需求状况调查

目的了解精神科住院病人的舒适需求状况。方法参考住院病人舒适需求问卷,针对精神科病人特点适当修改后,采用修改后的问卷对心身病科及4个重度精神病科病情稳定病人进行舒适需求调查。结果心身病科和重度精神病科病人在刚入院时最想知道什么、希望护士主动介绍的疾病知识、最大的舒适护理要求、希望护士对病人最主要的关心等方面,需求差异有统汁学意义(P＜0．05或＜0．01)。结论心身病科及重度精神病科病人对舒适的需求存在差异,提示舒适护理应根据病人的不同需求提供,以提高病人的生活质量,并使病人早日康复,同时也是提高服务满意度的有效途径。     

Limit-setting and decision-making in the management of aggression

BACKGROUND: Several published research studies have suggested that inpatient aggression against nursing staff may be directly precipitated by common nurse-patient interactions. This study sought to examine the structure of nurses' judgements in situations of conflict. METHOD: Seventy practising United Kingdom psychiatric nurses were presented with a number of conflict scenarios and were asked to rate a range of intervention options for each scenario according to how appropriate they perceived those interventions to be. Their responses were analysed using multidimensional scaling techniques. RESULTS: The results suggest that issues associated with limit setting and autonomy were perceived as most important by the nurses and that these issues are most likely to lead to disagreements in judgement between nurses of different status. Nurses of higher grades (levels) showed a significantly greater preference for respectful and autonomy-confirming interventions than their more junior nurses. These results have training and policy implications and further research should examine the effects of such nursing judgements on patient care.     

Seclusion of children and adolescents: psychopathological and family factors

This paper describes the use of seclusion in a child and adolescent inpatient unit, including precipitating events, management strategies, details of seclusion episodes and individual and family risk factors. Inpatient ward documentation of seclusion episodes, demographic data and measures of individual psychopathology and impairment, parent mental health, life events and family functioning were used to compare secluded, non-secluded and outpatient groups. Secluded individuals had elevated psychopathology compared with non-secluded inpatients and outpatients. Their families reported poorer parental mental health and family functioning and more recent stressful life events. The results indicate that seclusion is most common among high-risk inpatients.     

老年患者对新型冠状病毒肺炎防护知识的认知现状及其影响因素

目的了解老年患者对新型冠状病毒肺炎防护知识的认知情况并分析影响因素,以期为提高老年患者防护能力提供理论依据.方法2020年2月采用便利抽样法选取某三级甲等医院193例老年患者为研究对象,采用自编的新型冠状病毒肺炎防护知识测试卷对其进行调查,并分析影响因素.结果老年患者对新型冠状病毒肺炎防护知识得分为(39.34±11.88)分,不同年龄、居住地、文化程度、职业、家庭人均月收入的老年患者得分差异有统计学意义(均P<0.05),经多元逐步回归分析得出文化程度、年龄、居住地是其影响因素(P<0.001),可解释度为30.1%.结论老年患者对新型冠状病毒肺炎防护知识的认知现状不容乐观,且医务人员宣教不足,故应提高医务人员重视程度,并根据老年人不同特征采取有针对性的健康教育,以提高老年患者相关防护能力.     

Medicate,restrain or seclude? Strategies for dealing with violent and threatening behaviour in a Norwegian university psychiatric hospital

The aim of this study was to examine staff strategies for applying emergency procedures with patients who were violent or threatening. The study addressed those situations where verbal intervention, voluntary medication, and other interventions had been tried unsuccessfully and where staff found it necessary to apply emergency procedures in the shape of forced emergency medication (pharmacological restraint), physical restraint, and seclusion. The study was conducted in a 100-bed Norwegian university psychiatric hospital. By retrospectively examining hospital records we found there were 797 episodes of physical restraint, 384 episodes of pharmacological restraint, and 88 episodes of seclusion during a five and a half year period. The preferred emergency procedures varied significantly with patients' sex, age, and diagnoses. Physical restraint was preferred more often with male, younger, and nonpsychotic patients. Pharmacological restraint was preferred more often with female patients and older patients with a nonorganic psychotic disorder. Seclusion was preferred more often with older male patients with an organic psychotic disorder.     

Consumer feedback on nursing care and discharge planning

BACKGROUND: Gaining consumer feedback about nursing care and discharge planning is especially important given the changes that have occurred in acute inpatient mental health facilities. Consumers can best define the quality of the service they receive and surveys are considered to be good sources of information about nursing care and discharge planning. AIM: The aims of this study were to clarify consumer discharge needs, ascertain consumer perceptions of helpful practice, identify areas that require improvement, identify resources consumers deem important, ascertain satisfaction with specific aspects of services, and obtain baseline data to improve future discharge planning. METHOD: Satisfaction-with-services and discharge questionnaires were completed by clients (39 and 45, respectively) prior to discharge from three acute inpatient mental health units over a 2-month period. FINDINGS: Findings indicated that clients were most satisfied with the respect they received from staff, attention staff gave to concerns and worries, quality of service provided by nurses, way treatment met client needs and overall stay in hospital. The majority of respondents (95%) indicated that their discharge arrangements were explained to them and 90% were satisfied with these. Whilst over two-thirds indicated that the information provided in hospital to assist with discharge had been helpful, they highlighted some areas for service improvement. Resources to prepare them better for discharge included increased contact with consumer consultants and more information about mental health problems, medication and relapse prevention. CONCLUSION: This study constitutes another small step towards decreasing the gap between consumer expectations and actual treatment by asking consumers about their perceptions of discharge planning. The findings provide the basis for the development of more appropriate strategies to improve the continuity of services between hospital and community mental health settings.