现代护理中护士压力分析及对策

目的：深入了解护士的压力来源并寻找减压对策。方法：运用随机抽样方法对110名护士进行了自填式问卷调查。结果：90％的护士存在较大的压力，压力源有五种：职位竞争压力；知识技能压力；劳动强度压力；护患关系压力及投入与报偿压力。结论：护士压力普遍较大，建议针对不同的压力源采取相应的措施，以减轻护士压力。     

骨科医疗纠纷相关因素的分析与对策

随着人们生活水平的提高和法制观念的增强，患者对健康恢复的要求也越来越高，医生一旦侵犯了患者权益，不管行为是故意或是过失，都可能引发医疗纠纷。尤其骨科医疗纠纷发生率比较高，位居医院各专业科室之首，占医疗事故鉴定总例数的30％左右。所以了解骨科医疗纠纷发生的规律，掌握其特点，找出重点防范环节，才能进一步提高医疗质量，预防或减少医疗纠纷的发生。     

What happens when the doctor denies a patient’s request? A qualitative interview study among general practitioners in Norway

Objective: To explore general practitioners (GPs’) experiences from consultations when a patient’s request is denied, and outcomes of such incidents.

Design and participants: We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient’s request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis.

Main outcome measures: Accounts of experiences from consultations when GPs refused their patients’ requests.

Results: Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient–doctor relationships were injured or came to an end.

Conclusions: The price for denying a patient’s request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels.     

Shifting Images of Chronic Illness

Purpose: To describe results of a meta-study of client roles in two decades of qualitative research on elements of chronic illness experiences. While a vast body of qualitative health research has uncovered insider perspectives on a range of chronic diseases and their related illness experiences, Systematic analysis has not been attempted, and research has not yet contributed to coherent theoretical developments.
Organizing Construct: Health care relationships as articulated in the context of insider research into chronic illness experience.
Sources: Elements of meta-theory, meta-method, and meta-data-analysis in the available qualitative research reports addressing chronic illness experience published 1980 through June 1996. Of over 400 published reports, 158 met the inclusion criteria and were subjected to systematic analysis on a number of themes, one of which is reported in this article.
Methods: Data selection, reduction, thematic analysis, and synthesis using constant comparative analysis.
Findings: Early conceptualizations of individuals with chronic illness shift from a focus on loss and burden toward images of health within illness, transformation, and normality. Parallel conceptualizations of health care relationships appropriate to chronic illness shift from client-as-patient to client-as-partner for the 15-year period.
Conclusions: Meta-study permits critical analysis of the location of current inquiry into the larger context of systematic patterns in knowledge development. Researchers are cautioned against uncritical acceptance of current trends in interpretation.     

医学生医患沟通能力培养研究及探讨

近年来,我国医疗纠纷逐年上升,医患矛盾日益突出,已经成为影响社会和谐的重要因素。而其根源是缺乏良好的医患沟通能力,良好的医患沟通能力是医学生成为一名合格医生不可缺少的条件。因此,如何培养医学生良好的医患沟通能力逐渐成为医学界的重要课题。该文就医学生医患沟通能力的培养进行了研究及探讨。     

Training programme in techniques of self-control and communication skills to improve nurses' relationships with relatives of seriously ill patients: a randomized controlled study

The interpersonal relationships with relatives of seriously ill patients may cause anxiety on the part of nurses and the need for adequate communication and self-control skills. To assess the efficacy of training nurses in self-control techniques and communication skills when they interact with relatives of seriously ill patients we planned a randomized, controlled trial in two parallel groups: an experimental group, with immediate training, and a control group, with training delayed for 6 months. We recruited 61 nurses from the nursing staff of a university hospital of 500 beds. The intervention consisted of training in relaxation, cognitive restructuring and some communication skills. The outcome variables were communication skills measured under simulated conditions using an observation instrument of our own, administered by observers masked with respect to the study groups, and the levels of state-anxiety measured with the self-assessment questionnaire the State-Trait Anxiety Inventory, under imaginary conditions. The two groups initially had similar scores in the scales of communication skills, and state and trait-anxiety. After intervention, compared with the control group, the experimental group showed significant improvements in the skills of listening, emphasizing, interrupting and coping with emotions (P < 0.05). State-anxiety levels did not show any changes. In conclusion, the joint training in self-control and communication improves some communication skills in nurses when they interact with relatives of seriously ill patients under simulated conditions.     

危机管理理论在门诊护理管理中的应用

运用危机管理理论 ,分析门诊医护工作危机产生的因素 ,制定防范措施和处理对策 ,强化全体医务人员的危机意识 ,学习危机管理知识 ,从而保障门诊工作顺利进行     

护患沟通障碍导致护患纠纷的原因分析及防范对策

医疗纠纷已成为广大民众关注的问题。尤其护患纠纷作为医疗纠纷的一种,其发生率在上升。而实际工作中,许多护患纠纷的发生都直接或间接地由护患沟通障碍引起,现将其对策作一综述。     

移情在护患沟通中的应用

为促进护患沟通,提高护理工作质量,介绍了沟通技巧中移情的定义和内涵,移情式沟通技巧及步骤,并指出了阻碍移情的因素。     

论叙事医学对高职护生共情能力的培养

文章主要对叙事医学与共情的概念及内涵进行梳理,研究叙事医学对护生共情能力培养的作用和影响,分析其必要性与可行性,从医学史与中文叙事的视角出发,具体阐释叙事医学对高职院校护生共情能力培养的两条路径:一是精细阅读医学史,为培养护生共情能力奠定良好契机;二是反思性中文叙事,为构建护患共同体搭起共情桥梁。