护患沟通双方对沉默方式感受的质性研究

目的了解护患沟通双方对沉默这一非语言沟通方式的使用感受,为医护人员有效应对沉默提供参考。方法采用录像法、深度访谈及焦点小组访谈相结合的质性研究方法,对150名医院实习护生客观结构化临床考试(OSCE)中的护理人文部分护患沟通进行录像分析并初步建模,结合对7名护士的深度访谈及5名患者及家属的焦点小组访谈,运用话语分析和内容分析方法分析访谈内容形成主题编码。结果提炼出7个主题,分别为安全的沉默、解决问题的沉默、缺乏兴趣的沉默、共情的沉默、中立的沉默、制造压力的沉默、尴尬的沉默。结论沉默行为在护患沟通过程中的出现主要与护患双方为表达某种特定情感或需求如安全、解决问题、缺乏兴趣、共情、中立、制造压力、尴尬等有关。制定护患沟通中的沉默应对模型,形成护理人员对沉默的应对措施,将利于良好护患关系建立,减少护患纠纷。     

同理心地图联合情景教学在护患沟通技巧教学的应用

目的 探讨同理心地图联合情景教学在护患沟通技巧教学中的应用效果。方法 采用便利抽样法选取某高校本科护生114人,将本科一班（56人）设为对照组,在护患沟通技巧实训教学中实施常规教学法;本科二班（58人）设为研究组,实施同理心地图联合情景教学。采用共情量表和临床沟通能力测评量表对两组护生进行效果评价。结果 教学后研究组护生共情能力和临床沟通能力得分显著高于对照组（均P<0.05)。结论 将同理心地图联合情景教学融入本科护生护患沟通技巧课程中,能有效提高护生的临床沟通能力,有助于护生共情能力提升。     

巴林特小组培训提升护士情绪智力及沟通能力的作用

目的探讨巴林特小组培训对护士共情能力、情绪智力能力和沟通能力的干预效果。方法选取30名护士为研究对象,以案例汇报及讨论、情境模拟及角色扮演等巴林特小组模式培训,共12次,并于结束前后用共情能力量表、情绪智力量表、护理临床沟通能力量表进行测评。结果护士培训后情绪智力总分及情绪知觉、他人情绪管理、情绪利用维度得分,临床护理沟通能力总分及情感感知维度得分显著高于培训前(P0.05,P0.01)。结论巴林特小组模式培训提升了护士的自身素质即情绪智力与护士沟通能力,而共情能力提高不明显。     

内分泌科的护患沟通技巧

目的:探讨内分泌科护患沟通的必要性和内容。方法:采用以培训、不同的沟通形式、提高护理人员自身素质和以老带新等方法扩大效果。结果:通过开展护患沟通技巧培训1年,患者满意度、"三基"合格率和技术操作优秀率均显著提高(P<0.01)。结论:深入浅出、持之以恒、因人施教是内分泌科护患沟通的主要沟通方式,护士要拓宽自身专业知识面和服务面才能做好护患沟通、建立融洽的护患关系。     

护患沟通中沉默行为应对模型的构建

目的针对护患沟通中出现的沉默行为,构建具有可操作性的应对模型。方法根据有效沟通的6个步骤,以沟通前、沟通中、沟通后为阶段,初步制定护患沟通中沉默行为的应对流程。采用德尔菲专家咨询法对14名专家进行2轮函询。结果专家权威程度0.8,2轮函询后结果趋于一致。最终形成护患沟通中7个主题、3种类型沉默的应对流程。结论沉默应对模型的建立,有利于护理人员正确识别护患沟通中的沉默行为,依据应对模型采取有效的沟通方法,减少护患沟通不良导致的护患纠纷。     

人工肝支持系统治疗患者预防深静脉血栓形成知信行量表的编制及信效度检验

目的 了解护理人员在护患沟通中的负面经历状况,为加强对护士的沟通技能培训提供参考.方法 使用自行设计的调查问卷,以广东省25所医院377名护士为调查对象,对其在工作中遇到的护患沟通不良或沟通失败等负面经历进行调查.结果 87.27%的护理人员曾有过护患沟通负面经历,发生频率最高的是"虽然护理人员耐心解释,家属仍反复询问、不理解";发生频率最低的是"家属酒后侮辱医务人员";发生护患沟通负面经历后超过70%的护理人员认为通过向别人倾诉可以缓解压力.结论 护士在护患沟通过程中出现消极体验的频率较高,对构建和谐护患关系有一定的影响,医院管理人员应加强对护患沟通的关注和培训.     

护患沟通在妇科护理工作中的应用

现代护理是指"以病人为中心"、以护理程序为方法,对患者进行全方位的护理.护理程序的第一步是评估.在收集资料时,就要与患者沟通.有效的沟通能使双方建立良好的护患关系.     

护士共情能力的研究现状及展望

护士共情能力是良好护患关系的切入点,是护患沟通的基础,是实现优质护理的重要保证.对护士共情的概念和意义、国内常用的测量工具进行综述,归纳和总结了护士共情的影响因素,阐述了护士共情的培训现状,探讨了护士共情能力的研究现状及展望.     

同理心在护患沟通中的应用

针对目前临床护患沟通中存在的问题，提出一个新的服务理念即同理心，并通过同理心理念的具体表达和应用进行阐述，认为同理心即共感、共情，是一种将心比心，感同身受，体察他人内心世界的心理品质，亦是改善人际关系的润滑剂。提出将同理心运用于临床护理工作中，能促进护患沟通交流，增强患者对护理人员的信任，提高护理质量。     

应用巴林特小组培训模式提高新护士护患沟通能力

目的 探讨巴林特小组培训模式对新护士护患沟通能力的影响.方法 将34名新护士按学历分层抽样均分为对照组和观察组,分别参加护患沟通能力的传统培训和巴林特小组培训.培训结束3个月后采用护生护患沟通能力量表和情绪智力问卷评价效果.结果 两组护士护患沟通能力总体评定和情绪智力总分,护患沟通各维度,情绪智力问卷中除自我激励和经营人际关系外的其他维度评分比较,差异有统计学意义（P＜0.05,P＜0.01）.结论 巴林特小组培训模式能有效提高新护士的护患沟通能力和情绪智力.     

Missed Empathic Opportunities During Hand Surgery Office Visits

Background: Empathy (conveyance of an understanding of a patient’s situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = −0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.     

安宁疗护护士对哀伤辅导影响因素感知的质性研究

目的 了解安宁疗护护士对哀伤辅导影响因素的感知,为探索哀伤辅导护理路径、推动安宁疗护的规范化开展提供参考。方法采用描述性现象学研究,选取江苏省9个安宁疗护试点单位的21名安宁疗护护士进行半结构式访谈,运用Colaizzi 7步分析法进行资料分析。结果共归纳出感知到的个人因素（感知重要性但能力不足、哀伤辅导经验积累、共情投入、益处发现、职业倦怠）、工作因素（工作负荷、上级重视与支持）和患方因素（家庭内部关系、灵性需求、年龄与病程）3个主题和10个亚主题。结论安宁疗护护士哀伤辅导的影响因素较为复杂,应加强安宁疗护护士哀伤辅导能力培养,加大哀伤辅导工作的组织支持力度,在哀伤辅导过程中重视患者及家属的个性化需求,为家属提供高质量、高水平的哀伤辅导服务。     

平行病历书写在新护士规范化培训中的应用

目的 提高新护士共情能力与职业认同感.方法 在对65名新护士进行规范化培训过程中安排书写平行病历,记录患者就医经历与体验、新护士对护理工作的心理感受,进行课堂分享;每人书写1份平行病历体验报告.6个月后评价效果.结果 培训后,新护士共情能力3个维度得分及总分显著高于培训前(均P＜0.01);从65份书写平行病历体验报告...     

Importance of positive interaction in the initial meeting between plastic surgeons and patients: A survey

The aesthetic plastic surgery patient represents a particularly sensitive and highly demanding client within the whole patient population. There is no doubt that a kind and understanding response to his problems and needs, which are often rather complex, contributes decisively to the establishment of a basis of confidence and it predominantly determines the further course of any interpersonal relationship with the surgeon. A kind response, i.e., positive interaction, signifies the complete acceptance of the patient, both verbally and nonverbally. The surgeon must be all ears to the requests and concerns and must attentively concern himself with all the patient's physical impairments that have grown into a problem. Positive interaction also means assessment and understanding of the patient's personality, including his self-image, his view of reality, and his present condition in order to choose correctly the suitable level of communication. Finally, positive interaction means the precise analysis of the patient's rational and irrational fears and his conceptions and expectations. There must be discussion of his wishes and the therapeutic and surgical possibilities in order to map out an acceptable path of treatment.Presented at the annual meeting of the Austrian Society of Plastic Surgery, 4–6 October 1990, Feldkirch, Austria Address reprint requests to G.M. Beer, M.D., Plastic, Aesthetic and Reconstructive Surgery Unit, Landeskrankenhaus Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria     

基于认知学徒制的高职护患沟通课程教学改革研究

目的探讨基于认知学徒制的高职护患沟通课程教学改革的效果。方法将2014级三年制高职护理专业2个班级设为对照组(94人),《护患沟通》课程采用传统授课方式;2015级2个班级设为观察组(103人),以认知学徒制理论为指导实施《护患沟通》课程教学。结果观察组护生护患沟通技能考核成绩、自评沟通能力得分显著高于对照组(P0.05,P0.01);对教学改革评价得分(4.26±0.93)~(4.53±0.67)分。结论实施基于认知学徒制的高职护患沟通课程教学改革,有助于培养护生护患沟通能力和沟通技能,提高护理教育教学质量。     

护患治疗性沟通质量评价标准的构建

目的 构建护患治疗性沟通质量评价标准,为促进护患有效沟通提供参考。方法 在医患沟通质量评价指标的基础上,通过文献回顾制订护患治疗性沟通质量评价标准初稿,采用德尔菲法对27名专家进行2轮问卷函询,确定护患治疗性沟通质量评价标准。结果 2轮函询专家的积极系数分别为96.43%和100%,权威系数为0.860,肯德尔和谐系数分别为0.146和0.160（均P＜0.05)。构建的护患治疗性沟通质量评价标准包括2个一级指标（沟通过程质量评价、沟通结果质量评价）、3个二级指标（沟通内容、沟通技巧、沟通效果）、67个三级指标。结论 构建的护患沟通质量评价标准兼具可靠性、创新性和实用性,可用于护患治疗性沟通质量的评估。     

实习医学生沟通技能评估及相关因素分析

目的 了解实习医学生沟通技能现状并探索其相关因素.方法 采用自行设计的一般资料问卷及沟通行为自我评价量表对260名医学生进行问卷调查.结果 医学生在与患者的沟通、对特定疾病或具体健康问题指导、与医务人员的沟通三方面的得分分别为3.26±0.55、3.00±0.69、3.43±0.64.医学生对受虐待/暴力及艾滋病患者的...     

Local flap therapy for the treatment of pressure sore wounds

The aim of this study was to analyse the effectiveness of an interdisciplinary cooperation between conservative and surgical disciplines for the treatment of pressure sores (PS). From January 2004 to December 2005, a single‐centre study was performed with paraplegic and tetraplegic patients presenting with PS grades III–V. Outcome measures were defect size, grade, method of reconstruction, complication and recurrence rate as well as average length of hospitalisation. A total of 119 patients aged 22–84 years with totally 170 PS were included. The most common PS were located in the ischial region (47%), followed by the sacral (18%), trochanteric (11%), foot (9%) and the malleolar (8%) regions. Defect sizes ranged between 4 and 255 cm². Grade IV was the most common PS (68%), followed by grade III (30%) and grade V (2%) PS. For wound closure, fasciocutaneous flaps were used most frequently (71%), followed by skin grafts (10%) and myocutaneous flaps (7%). Postoperative follow‐up ranged between 6 and 38 months. The overall complication and recurrence rate was 26% and 11%, respectively. If no complication occurred, the average duration of hospitalisation stay after the first debridement was 98 ± 62 days. In conclusion, our treatment concept is reliable, effective and results in a low recurrence rate. The complication rate, even though favourable when compared with the literature, still needs to be improved.     

基于SEGUE框架的儿科护患沟通教学模式的构建与效果评价

目的 基于SEGUE框架构建儿科护患沟通教学模式并进行效果评价。方法 设计包含准备（Set the stage）、信息收集（Elicit information）、信息给予（Give information）、理解患者（Understand the patient′s perspective）、结束（End the encounter）5个环节的结构化儿科护患沟通教学模式,应用理论学习、案例分析、情境模拟及临床实践等教学方式,对2018、2019级共98名护理本科生（试验组）进行教学实践,并与采用常规方法教学的55名2016级护理本科生（对照组）进行教学效果比较,采用哈佛医学院沟通量表及美国内科协会病人满意度量表进行评价。结果 试验组沟通评估总分及标准化病人满意度总分显著高于对照组（均P＜0.05）。结论 基于SEGUE框架的儿科护患沟通教学模式有利于提高学生的临床沟通能力,改善沟通效果。