人性化心理干预在老年人临终关怀护理中的应用

目的:探究分析人性化心理干预在老年人临终关怀中的应用价值,旨在提高对老年患者进行临终关怀的护理质量。方法:选取2010年7月至2012年8月在我院接受临终关怀护理的老年患者42例,采取随机数字表法将其分为对照组与观察组,其中对照组患者仅采取常规临终关怀护理,观察组患者则结合个性化心理干预进行临终关怀护理,比较两组患者护理质量与护理满意度,完善有关资料的记录工作。结果:接受临终关怀护理后,观察组患者满意度95.2%显著优于对照组81.0%,P0.05;而且观察组患者生活质量评分显著优于对照组,P0.05,而且在护理期间内,对照组出现9例急救,死亡2例,而观察组仅有1例急救,无死亡发生。结论:采取人性化心理干预能够显著提高老年人临终关怀护理质量,提高患者生活质量,减少临终痛苦,临床价值显著,值得推广。     

60例艾滋病患者临终关怀护理

目的探讨艾滋病患者的临终心理问题及临终关怀护理措施。方法对2008年7月~2014年10月收治的60例艾滋病临终患者实施心理护理及临终关怀。结果 60例艾滋病患者均情绪稳定,平静安祥走完他们人生中的最后旅程。结论临终心理护理能增强艾滋病患者战胜疾病的信心,提高生活质量和抗病能力,缓解病情进展。     

中国临终关怀服务现状与伦理探讨

随着社会经济的发展、人口老龄化和疾病谱的改变,临终关怀已成为我国社会所关注的重要民生问题,也成为医学伦理的热点。该文结合中国生命关怀协会对我国城市临终关怀服务利用与需要状况的调研,反映当前我国城市临终关怀服务的基本特征,对临终关怀中涉及医学伦理的部分概念,以及临终关怀服务中的相关权益进行阐述,并建议应当在逐步完善全民医疗保健制度的基础上,健全服务体系,包括临终关怀伦理道德法规体系,才能更好地为临终患者服务,提高患者的生命质量。     

肝癌病人的临终关怀现况及临终护理

根据肝癌病人临终阶段的生理心理特点,为使晚期肝癌病人的生命质量得到提高,实现优终优逝。在分析了晚期肝癌病人的身心状况,结合临床实际,并参考大量文献的基础上,本文阐述了肝癌病人的临终关怀现状及临终护理方法,使患者能够安宁,舒适,有尊严的走完人生的最后阶段。     

726例晚清丹阳男女死亡日期调研

对《孙氏家乘》中记载的晚清726例男女死亡日期的调查,按上中下旬排序得出男女死亡人数的百分比顺序是上旬中旬下旬。其中下旬中的30号死亡人数最少,仅有2人,占总死亡人数的0.28%,中旬中的18号死亡人数最多,有36人,占总死亡人数的4.96%。通过此调查把握死亡时间的集中期,使其对当今的老年护理、临床护理、临终关怀有一定的指导意义。此次家谱调研结果,对于医务工作者、生物学工作者和人口调查者等相关工作人员均有一定的参考意义。     

浅谈临终患者心理护理体会

如今医疗界越来越发达,很多过去治不好的病都能得到治愈,但还有现如今医疗措施不能解决的病患,所以对于临终患者心理护理也是医护人员极其重要的任务。生命从开始的时候就意味着将来就会有一点会结束,人都要经历死亡,而如何让临终患者安详、平静、没有遗憾有尊严地死去,是医护界要学习的护理手段,应该通过满足患者心理和生理上的需求,照顾患者的心理和最后的衣食住行是护理人员应尽的义务,只有患者身心得到慰藉,生活质量得到提高才是对临终患者最大的帮助。所以医护人员治愈好患者是重要的,对于治不好的病人照顾他们的心理,做临终关怀也很重要,本文首先介绍了临终患者要经历的四个阶段,以及护理人员的应对措施,以及护理人员对患者心理干预,心理引导。     

第二届中国医学伦理学国际跨学科讨论会将在上海召开

由德国汉堡亚洲事务研究所、德国埃森ＨｅｌｍｕｔＳｔｏｒｚ博士基金会、上海第二医科大学和中国国家人类基因组南方研究中心联合赞助的“第二届中国医学伦理学国际跨学科讨论会”将于１９９９年１０月１９～２３日在上海第二医科大学举行,出席讨论会的特邀代表将来自我国大陆、香港、台湾以及美、德等国医学院校和有关研究机构。到会的中外专家将就生殖伦理（遗传咨询与人工流产,计划生育与优生优育）,医疗保健伦理（老年病和精神病的医学伦理）,死亡伦理（临终关怀,安乐死）以及遗传资源的收集、研究与保护等领域提出案例展开讨论。…     

黄蜂蜇伤的急救与护理

目的探讨黄蜂蜇伤患者的急救与护理措施。方法对2014年6月~2015年11月我科收治的179例黄蜂蜇伤患者的急救和护理措施进行总结分析。结果 179例黄蜂蜇伤患者主要护理措施有伤口处理,疼痛护理,遵医嘱正确使用药物,并发症的观察与预防,血液净化护理,饮食指导、心理护理及出院指导。结论黄蜂蜇伤患者在给予及时有效救治的同时,做好并发症的观察与预防、血液净化护理及有效的心理护理是护理的关键。     

内科护理中心血管护理风险防范研究

护理心血管内科患者的工作,对病人恢复与治疗具有特别的意义,细致、专业的护理可以增强病人治疗效果。内科护理中心血管护理时要面对很多风险,若想提高护理质量,就要寻找、分析所有不安全因素,具有针对性的提出完善与整改的策略,为病人提供全面、周到的服务。本文分析内科护理中心血管护理,探讨护理过程中存在的安全风险,并着重分析防范与控制风险的策略,以期增强护理质量,完善护理机制。     

急诊科护理绩效考核与奖金分配的建立和实施效果观察

目的探讨急诊科护理绩效考核与奖金分配的建立和实施效果。方法 2013年我科对护士进行绩效考核管理,并根据绩效考核成绩分配奖金,观察实施绩效考核后的效果。结果实施护理绩效考核与奖金分配方案措施后,提高了护士工作的主动性及积极性,提高了护理质量,同时也提高了护患的满意度。结论护理绩效考核与奖金分配是临床护理管理的有效方法,可提高护理人员对奖金分配满意程度,持续改进护理质量,提高工作效率。     

Care of dying patients in hospital.

OBJECTIVE--To study the process of care of dying patients in general hospitals. DESIGN--Non-participant observer (MM) carried out regular periods of continuous comprehensive observation in wards where there were dying patients, recording the quantity and quality of care given. Observations were made in 1983. SETTING--13 wards (six surgical, six medical, and one specialist unit) in four large teaching hospitals (bed capacity 504-796) in west of Scotland. SUBJECTS--50 dying patients (29 female, 21 male) with mean age of 66 (range 40-89); 29 were dying from cancer and 21 from non-malignant disease. RESULTS--Final period of hospitalisation ranged from 6 hours to 24 weeks. More than half of all patients retained consciousness until shortly before death. Basic interventions to maintain patients'' comfort were often not provided: oral hygiene was often poor, thirst remained unquenched, and little assistance was given to encourage eating. Contact between nurses and the dying patients was minimal; distancing and isolation of patients by most medical and nursing staff were evident; this isolation increased as death approached. CONCLUSIONS--Care of many of the dying patients observed in these hospitals was poor. We need to identify and implement practical steps to facilitate high quality care of the dying. Much can be learned from the hospice movement, but such knowledge and skills must be replicated in all settings.     

Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?

doi: 10.1111/j.1741‐2358.2011.00554.x
Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Objective: To explore nursing home patients’ oral hygiene and their nurses’ assessments of barriers to improvement. Background: In nursing homes, nurses are responsible for patients’ oral hygiene. Materials and methods: This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. Results: More than 40% of patients had unacceptable oral hygiene. ‘More than 10 teeth’ gave OR = 2, 1 (p = 0.013) and ‘resist being helped’ OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients’ teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty‐one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. Conclusion: Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses’ education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.     

Staff attitudes to oral health care. A comparative study of registered nurses,nursing assistants and home care aides

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.     

The nurse's role in immediate postoperative care.

From the time that a patient leaves the care of the anaesthetist after an operation until he wakes in the ward his physiological state should be continuously and expertly supervised. Postoperative nurses are provided only when the operating theatre has a recovery room. A survey among consultants and nurses in one region showed that many surgical units did not have recovery rooms and that inexperienced ward nurses were often sent to collect patients. The survey showed that most nurses were competent to care for unconscious patients so long as an emergency did not arise. In many hospitals the facilities for the safe nursing of postoperative patients were totally inadequate. The very least that is needed is good communications with the anaesthetist, adequate lighting, and a source of oxygen and suction. Because of the shortage of nurses likely to have to care for postanaesthetic patients early on and to train them accordingly. Nevertheless, recovery nurses, whose sole responsibility is to care for a patient until be has recovered from anaesthesia, should be appointed for all busy surgical units.     

Evalution of Home Nurse Attachment in Bristol

By the end of June 1969 home nurses in Bristol were attached to 18 general practices caring for about 137,000 patients, or about one-third of the city''s population. Attachment was associated with an increase by about one-third in the number of patients referred by general practitioners for home nursing. Additional benefits derived from attachment during the nine months from January to September 1969 were 2,047 items of service performed by nurses in general practitioners'' surgeries, 65 home visits to patients who were not receiving domiciliary nursing care, improved communications between general practitioners and nurses, and opportunities for both doctors and nurses to widen their fields of work. The travelling expenses paid to Bristol''s nurses increased by 9·5%.It is suggested that the benefits to patients, doctors, and nurses of attachment far outweigh the costs and that there is scope for extending the role of the attached nurse in the surgery and in home visiting.     

广西新生儿专科护士的现况调查

目的了解并分析广西新生儿专科护士的现况,为广西新生儿专科护士的培训提供客观依据。方法通过查阅文献,结合广西新生儿专科护士培训方案及培训计划,采用自制调查表及自评式问卷对3期共163名广西新生儿专科护士进行培训技能需求调查,并对培训前、培训后的专科技能掌握现况进行自评。结果基本技能需求构成比为80.98%,重症护理需求构成比为93.25,外科护理需求构成比为51.53%,科研指导需求构成比为41.72%。培训前后新生儿专科基本技能和科研能力掌握评分比较,差异有统计学意义(P<0.05);新生儿重症护理技术和新生儿外科护理技术培训前后的评分比较,差异无统计学意义(P>0.05)。结论广西新生儿专科护士在重症护理技术和外科护理技术能力较低,系统、全面、规范的人才培养及培训有助于提高专科护士的专业技术水平。     

“情绪管理”在临床护理管理工作中的应用体会

目的：探讨情绪管理在临床护理管理工作中的应用和效果,为临床护理管理的实践提供指导和帮助。方法：选取我院244名护士为研究对象,随机分为常规管理组和情绪管理组,每组各122名护士。常规管理组采取常规的护理管理模式,情绪管理组则对护士进行情绪调节、以适当方式释放压力等情绪管理方法。比较两组研究对象在解决问题、求助、合理化、退避、自责、幻想等方面的评分情况。结果：实施不同的管理措施后,情绪管理组护士在解决问题、求助、合理化、退避、自责、幻想等方面的得分结果明显优于常规管理组护士的得分结果,差异显著有统计学意义（P〈0．05）。结论：情绪管理对临床护理管理工作的实践具有重要意义,可有效调节护理人员的工作情绪,从而提高临床护理的质量。     

An Approach to Patient Care Classification

Employing the principles of progressive patient care and using data obtained from charts, nurses and resident physicians, 265 patients on the wards of a teaching hospital were classified into one of six optimal levels of care by the resident physicians and also by an outside observer. It was assumed that facilities for the three alternatives to general hospital care, i.e. long-term hospital care, nursing care and sheltered care, were available in the community. It was also assumed that socio-economic factors presented no barrier to hospital discharge.The outside observer allocated 96 patients, approximately one-third, to the alternative facilities outside the general hospital. Those factors found to have statistically significant effects on assigned levels of care were the diagnoses, length of stay, region of residence, bed status, extent of nursing care, hospital service and discharge status. The residents allocated 60 patients, approximately one-fifth, to alternative facilities.The extent of agreement between the residents and the outside observer reached 81% for those to alternate versus general hospital care.This method could be used by nurses and residents to screen out those most suitable for care in alternate facilities.     

Anti-infective therapy at the end of life: ethical decision-making in hospice-eligible patients

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases.     

Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia

doi:10.1111/j.1741‐2358.2009.00344.x
Oral health‐related quality of life in patients receiving home‐care nursing: associations with aspects of dental status and xerostomia Objective: To explore the differences in oral status, dental attendance and dry mouth problems between patients with long‐term disease with high and low scores on Oral Health Impact Profile 14 (OHIP 14) and how patients cope with oral problems such as xerostomia and a reduced ability to brush their teeth. Background: There has been a lack of studies of oral health and oral health‐related quality of life in the frail elderly within the community services. Materials and methods: A cross‐sectional questionnaire study was conducted with 137 patients receiving home‐care nursing. Structured interviews were conducted by student nurses using OHIP‐14, items from the Xerostomia Inventory and questions concerning dental visit habits, brushing of teeth and data from medical records. Results: Eighty‐three per cent of patients had natural teeth and 60% had only natural teeth. ‘Natural teeth only’ indicated a low score on OHIP‐14. Problems with brushing and items concerning xerostomia indicated a high score on OHIP‐14. Contrasts in the assessments concerning brushing of teeth and xerostomia indicated low priority from the patients themselves and the nursing staff. Conclusion: Community health services should focus upon oral health. Both patients and nurses should assess the need for regular brushing of teeth carried out by home‐care nurses. Assessment and treatment of dry mouth problems should have higher priority.