ICU患者家属焦虑与心理需求的相关性研究

目的:调查ICU患者家属的焦虑和心理需求现状,并分析两者的相关性,以便对家属采取针对性的关爱措施,提高ICU的护理服务质量.方法:在患者入住ICU24～36个小时后,119名患者家属接受焦虑自评量表(SAS)、危重患者家属需求量表(CCFNI)的调查.结果:在所调查的患者家属中,焦虑的发生率达到59.7%,焦虑与获取信息、接近病人呈显著正相关(r=0.341,p＜0.01;r=0.363,p＜0.01),与自身舒适呈显著负相关(r=-0.217,p＜0.01).结论:ICU患者家属焦虑发生率极高,医护人员在护理患者的同时,需兼顾患者家属,提供多方面心理护理,体现以人为本的护理理念.     

护理关怀理念对ICU危重患者护理质量及满意度的影响

目的:探讨对ICU危重症患者施以护理关怀干预治疗的临床疗效,并评价其护理质量和满意度。方法:将200例ICU患者随机分为对照组和观察组,每组100例,对照组施以常规护理,观察组则将护理关怀理念与常规护理融合而给予患者特殊护理干预,分析两组患者临床诊治、护理资料,以干预后SAS及SDS平均值为指标进行评价,分析护理关怀理念对患者满意度和护理质量的影响。结果:○1经t检验,护理后观察组ICU患者的SDS{(45.32±5.15)分}、SAS评分{(41.97±5.65)分}结果显著低于对照组(P0.05)。且,观察组护理质量明显优于护理前(P0.05)。经X2检验,观察组护理满意度(99%)和对照组(85%)差异显著(P0.05)。结论:对ICU危重患者实施护理与人文关怀的综合护理后,临床效果优良,有助于患者康复、提高满意度、改善护理质量,值得推广。     

神经外科危重病患者家属心理状况调查研究

目的:通过对神经外科急危重患者的家属进行心理问卷调査,来了解家属的心理状态,为提供个体化的心理护理提供依据。方法:本研究随机选择近三年入住我院神经外科的急危重患者家属共159人,其中男性89人,女性70人,进行心理状况调查问卷,量表采用精神卫生焦虑自评量表和精神卫生抑郁自评量表,所得数据采用SPSS18.0软件软件进行分析,P0.05为有统计学差异。结果:(1)结果显示,在被调查的89名男性家属与70名女性家属中,女性的焦虑程度较男性严重,而男性的抑郁程度又较女性严重,二者比较均有统计学差异(P0.05)。(2)医疗费用支付类别不同的患者家属间焦虑、抑郁症状有显著性差异,自费患者家属焦虑、抑郁程度均明显高出医保患者家属(P0.05)。(3)以脑力劳动为主的患者家属其焦虑量表评分明显低于以体力劳动为主的患者家属,而在抑郁量表评分中,脑力劳动为主的患者家属抑郁评分则高于以体力劳动为主的患者家属,二者相比均有统计学差异(P0.05)。结论:女性、体力劳动者焦虑症状明显,男性、脑力劳动者抑郁症状突出。自费医疗的患者家属焦虑和抑郁程度均高于医保患者。作为护士应针对患者家属提供不同的有针对性的心理护理,帮助家属应对心理危机状态,维持患者家庭功能,促进患者康复。     

公立医院医疗服务质量病人满意度测评量表研究

以Carey等研制的医疗服务质量监测量表为基础,通过专家咨询和病人问卷调查,构建了符合上海市公立医院医疗服务质量实际状况的病人满意度测评量表。分析显示,医疗服务质量病人满意度测评量表具有较好的结构效度、内部信度,并弥补了上海市现有医疗机构医疗服务质量病人满意度测评工具的不足,对上海市公立医院改善服务质量和卫生行政部门加强服务质量监管提供了有价值的信息。     

优质护理服务在门诊输液室实施的效果评价

目的探讨门诊输液室开展优质护理服务的实施效果。方法 2011年1～12月在门诊输液室实施优质护理服务,与2010年1～12月未实施优质护理服务进行比较,评价对比实施优质护理服务前后患者的满意度及护理投诉事件发生率。结果实施优护理服务后,患者对输液环境、护士技术水平、服务态度、仪容仪表及健康教育等5个方面的满意度较2010年均有所提高。患者对护理的投诉事件有所下降。结论在门诊输液患者中实施优质护理服务有助于改善服务质量,提高患者及家属的满意度,密切了护患关系,降低护理投诉事件的发生。优质护理服务是提高病人满意度和赢得医疗市场的重要保证。     

稳定期脑卒中患者实施自我管理模式的临床效果分析

为了探讨稳定期脑卒中患者自我管理模式的构建与应用,以及对患者生活质量的影响,本研究选取2016年1月至2017年9月期间我院收治的稳定期脑卒中患者200例,根据不同的护理方式将患者分为常规护理组(对照组)和自我管理模式护理组(观察组),比较两组患者神经功能缺损程度、日常活动能力、生活质量和满意度的差异。研究结果表明,护理6个月后,两组患者的NIHSS评分均显著下降(p0.05),观察组的NIHSS评分显著低于对照组(p0.05)。护理后两组患者的FMA评分均显著上升(p0.05),观察组的FMA评分显著高于对照组(p0.05)。观察组患者的情绪功能(1.91±0.67)、躯体功能(1.87±0.53)、社会功能(1.33±0.63)和角色功能(1.89±0.57)评分均显著高于对照组(依次为(1.32±0.43),(1.45±0.61),(0.82±0.44),(1.32±0.50))。康复护理结束时,观察组的满意度为96.00%,显著高于对照组(83.00%)。本研究结论初步表明,采用自我管理模式对稳定期脑卒中患者进行护理,可以显著降低患者的神经功能缺损程度,提高日常活动能力和生活质量,且具有较高的护理满意度。     

人性化护理在心内科优质护理服务中的应用研究

目的:研究人性化护理在心内科优质护理服务中的应用。方法:选取我院2013年10月-2014年10月间收治的心血管病患100例,随机划分为对照组和观察组,每组各50例,对照组采用基本常规的护理方法,观察组采用人性化护理方法,对比两组患者的住院时间及对护理的满意度。结果:实施人性化护理后,对照组患者的住院时间为(17.5±2.3)d,观察组患者的住院时间为(9.9±2.1)d,显著短于对照组的住院时间(P0.05)。观察组对护理的满意度为98.0%,显著高于对照组的78.0%(P0.05)。结论:对心内科患者推行人性化护理,有助于缩短患者的住院时间,提高患者的护理满意度,改善生活质量。     

强化护理干预对预防ICU患者谵妄的效果研究

目的探讨强化护理干预对预防患者ICU谵妄的效果,为减少危重病人ICU谵妄发生提供依据。方法采用前瞻性与回顾性调查相结合的方法 ,选择我院EICU 2011年1月1日~2013年5月31日收治的内、外科危重症患者320例,按入住EICU的时间顺序分为两组,即强化护理干预组(B组,n=160例)和常规护理组(A组,n=160例)。两组均采用重症监护患者谵妄筛查量表(ICDSC)于患者入院当日12h内,24、48、72、96h进行ICU谵妄状态测评,并比较两组ICU谵妄发生率,以评价强化护理干预措施对预防患者ICU谵妄的效果。结果 A组患者发生ICU谵妄51例,B组患者发生ICU谵妄25例,两组比较具有差异性。结论强化护理干预措施可降低患者ICU谵妄的发生。     

放松训练对老年冠心病介入治疗患者围手术期心理应激干预效果研究

目的:探讨放松训练对老年冠心病介入治疗患者围手术期心理应激的干预效果。方法:选择2013年7月至2014年1月在某院接受介入治疗的老年冠心病患者120例为研究对象,随机分为干预组和对照组,各60例。对照组接受手术治疗和常规护理,干预组在对照组治疗方案的基础上采用放松训练进行围手术期心理干预。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)量表和生活满意度量表(SWLS)施测,并进行比较分析。结果:手术后放松训练干预组焦虑、抑郁和睡眠质量评分比手术前明显下降[(39.28±2.32),(41.68±2.76),(8.97±2.11)vs.(48.78±5.11),(54.37±6.68),(10.88±2.21),均P<0.01],显著低于对照组[(44.78±4.09),(49.08±3.58),(10.40±1.87)vs.(48.83±5.28),(54.40±3.72),(10.87±2.86),均P<0.01]。放松训练干预组手术后与手术前睡眠质量各分量表比较,除"催眠药物"和"日间功能障碍"2个因子外,其余各因子均有显著差异(均P<0.05)。放松训练干预组术后生活满意度量表评分明显高于术前[(23.27±4.61)vs.(20.17±4.99),P<0.01],显著高于对照组[(21.15±4.16)vs.(19.90±4.38),P<0.01]。结论:放松训练心理干预技术对接受介入治疗的老年冠心病患者的焦虑、抑郁情绪和睡眠质量具有良好的缓解和改善作用,可以降低患者的心理应激程度,提高患者术后的生活质量。     

通过患者满意度调查评价护理质量

目的:通过患者满意度调查,进一步了解我院护理工作中的成效及存在问题,评价护理工作的质量,探索医院管理中护理科学管理方法。方法:①住院病人:采用问卷调查法;②出院病人:采用电话或上门随访方法;两种方法共对568例进行满意度调查,针对病人反馈的问题进行原因分析,提出改进措施并落实。结果:在疾病宣教及护理质量方面存在问题。结论:以医院管理年及创建优质护理服务为契机,以病人为中心,以质量为核心,逐步完善各项护理规章制度,加强护理安全管理,强化"三基三严"的训练,努力改善护理管理,提高护理服务质量。     

Oral health care issues in aged care facilities in Western Australia: resident and family caregiver views

Objective: To investigate resident and family perceptions and attitudes towards oral health care and access to dental services for aged care facility residents. Method: Focus groups and individual interviews with residents and family caregivers were conducted at aged care facilities in the Perth Metropolitan Area, Western Australia. Results: There were 30 participants from twelve aged care facilities (21 residents and nine family caregivers). Five focus groups comprising both residents and family caregivers were conducted in addition to three face‐to‐face interviews with residents. Both groups considered oral health very important to overall health and quality of life. Family caregivers noted a lack of dental check‐ups and specialised professional oral care, particularly in high‐care facilities. Low care residents were more likely to have regular dental check‐ups or dental treatment and off‐site dental visits were straightforward due to their mobility and family member assistance. Family caregivers noted time limitations and lack of expertise in oral health care amongst staff in high‐care facilities, and the challenges of maintaining oral care for residents with poor mobility or cognitive impairment. It was considered important that staff and management liaise with family caregivers and family members in provision of oral care. Conclusion: Regular oral care, assessment and treatment were considered limited, particularly for residents in high care. There is a need for comprehensive, ongoing oral health programmes involving appropriately trained and empathetic dental health professionals and staff to improve oral health care in Perth’s aged care facilities.     

Patient satisfaction and quality in home health care of elderly islanders

Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Losinj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease (14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.     

Patient Satisfaction with HIV/AIDS Care and Treatment in the Decentralization of Services Delivery in Vietnam

Objective

We evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam.

Methods

We interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS) was developed, and 3 dimensions were constructed using factor analysis, namely “Quality and Convenience”; “Availability and Responsiveness”; and “Competence of health care workers”.

Results

In a band score of (0; 10), the mean scores of all domains were large; it was the highest in “Competence of health workers” (9.34±0.84), and the lowest in “Quality and Convenience” (9.03±1.04). The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users.

Conclusion

This study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.     

Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models

Background

Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors.

Methods

We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: “Services quality and convenience”, “Health workers’ capacity and responsiveness” and “Inter-professional care”.

Results

The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient’s satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction.

Conclusion

Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program.     

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.     

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou,China

Objectives

China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.

Methods

The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.

Results

After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001).

Conclusions

This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care.     

Weiqu,structural injustice and caring for sick older people in rural Chinese families: An empirical ethical study

This paper examines caregiving for sick older family members in the context of socio-economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members’ weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest or make care-related choices. Underpinning people’s weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings.     

Effect of electronic health records in ambulatory care: retrospective,serial, cross sectional study

Objective To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality of ambulatory careDesign Retrospective, serial, cross sectional study.Setting Colorado and Northwest regions of Kaiser Permanente, a US integrated healthcare delivery system.Population 367 795 members in the Colorado region and 449 728 members in the Northwest region.Intervention Implementation of electronic health record systems.Main outcome measures Total number of office visits and use of primary care, specialty care, clinical laboratory, radiology services, and telephone contact. Health Plan Employer Data and Information Set to assess quality.Results Two years after electronic health records were fully implemented, age adjusted rates of office visits fell by 9% in both regions. Age adjusted primary care visits decreased by 11% in both regions and specialty care visits decreased by 5% in Colorado and 6% in the Northwest. All these decreases were significant (P < 0.0001). The percentage of members making ≥ 3 visits a year decreased by 10% in Colorado and 11% in the Northwest, and the percentage of members with ≤ 2 visits a year increased. In the Northwest, scheduled telephone contact increased from a baseline of 1.26 per member per year to 2.09 after two years. Use of clinical laboratory and radiology services did not change conclusively. Intermediate measures of quality of health care remained unchanged or improved slightly.Conclusions Readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive.     

Association between obesity and patient satisfaction

Objective: To examine the relationship between BMI and patient satisfaction with health care providers using a nationally representative survey. Research Methods and Procedures: This analysis examined the 9914 adult patients who completed the 2000 Medical Expenditure Panel Survey and had visited a health care provider within 12 months of the survey. Linear regression models were employed with patient satisfaction as the dependent variable. The patient satisfaction scale was based on ratings from five questions assessing the quality of provider interactions. The independent variable was BMI, with adjustments for the domains of demographics, social‐economic status, health attitudes and behavior, health status, and health care use. BMI (weight in kilograms/square of height in meters) was classified as normal weight (18.5 to 24.9), overweight (25.0 to 29.9), or obese (≥30.0). Hierarchical models were used to evaluate how each domain modified the BMI‐satisfaction association. Results: Obese patients reported significantly greater satisfaction with their health care providers than their normal‐weight counterparts did (p < 0.05). There were no significant differences in satisfaction between normal‐weight and overweight patients or between overweight and obese patients. The health status domain produced the largest modification in the BMI‐satisfaction relationship. Examination of interaction effects revealed that the association between BMI and satisfaction was confined to older persons. Discussion: In this nationally representative sample of individuals, obese persons were more satisfied than their normal‐weight counterparts. This finding counters those of previous studies. Incomplete adjustments for health care use and insurance status may have led to those conclusions.     

Frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan

Objective

To study frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan.

Methodology

A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent.

Results

A total of 400 elderly completed the interview. Majority were females, 65–69 years age, More than half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195(72%) had care provided by an immediate family member. A large proportion of them stated that their Care Givers managed to provide less than four hours in a day for care giving. Around 37% showed substantial improvement in their relationship with the care givers. About 70% of the respondents stated that the care provided by the Care Giver improved their quality of life.

Conclusion

Elderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.