护理专案管理对夜间护理安全质量改善的效果分析

目的 探讨护理专案管理对夜间护理安全质量改善的效果。方法 选择武汉大学人民医院心内科收治的住院患者共332例,按照实施护理专案改善方法干预的前后顺序,分为对照组160例和试验组172例,通过对对照组运用护理专案改善方法分析夜间护理安全不良事件高发的原因,制定提高夜间护理安全质量的标准化方案对试验组进行干预。比较2组患者发生夜间护理安全不良事件、护理缺漏及杜绝护理缺陷的达标率情况。结果 对照组患者发生夜间护理安全不良事件、护理缺漏及杜绝护理缺陷分别为8.75%（14/160）、10.00%（16/160）、3.12%（5/160）,试验组分别为1.74%（3/172）、2.33%（4/172）、11.04%（19/172）,差异有统计学意义（χ²=6.904、9.981、10.626,P<0.01）。对照组患者依从性、心理情绪、安全意识、合理用药发生率分别为56.25%（90/160）、52.50%（84/160）、62.50%（100/160）、67.88%（107/160）,试验组分别为86.63%（149/172）、74.41%（128/172）、91.28%（157/172）、88.37%（152/172）,2组比较差异有统计学意义（χ²=4.656~10.756,P<0.01或0.05）。干预后患者的自我管理能力明显提高。结论 护理专案管理能有效提高夜间护理安全质量和患者的自我管理能力,减少护理缺陷的发生,对改善夜间护理安全具有可行性。     

闭环护理管理模式在神经内科中的应用

目的:研究闭环护理管理模式在神经内科护理管理工作中的应用效果。方法:选择2016年4月—2017年3月在医院住院的780例病人为对照组,2017年4月—2018年3月在医院住院的820例病人为观察组。对照组病人给予常规护理管理;观察组应用闭环护理管理模式进行管理,是以护士护理病人的时间为主线,把护理工作内容贯穿于护士从开始护理、执行护理过程、护理结束到交接的整个护理工作流程中,形成一个闭环流程链,将护理工作精细化、流程化,强调全过程质量控制。通过护士对病情知晓率、病人或陪护安全知识掌握率、病人或陪护满意度、护理质量和护理风险事件发生率5项指标进行对比,评定两种护理管理模式效果的差异。结果:两组护理不良事件发生率、护士病情知晓率、病人或陪护安全知识掌握率及满意度、优质护理和护理安全评分比较差异有统计学意义(P<0.05),观察组均优于对照组(P<0.05)。结论:闭环护理管理模式优于常规护理管理模式,具有良好实用性及可行性。     

Twenty-four hour presence of physicians in the ICU

Intensive-care units (ICUs) must be utilised in the most efficient way. Greater input of intensivists leads to better outcomes and more efficient use of resources. 'Closed' ICUs operate as functional units with a competent on-site team and their own management under the supervision of a full-time intensivist directly responsible for the treatment. Twenty-four-hour coverage by on-site physicians is mandatory to maintain the service. At night, the on-site physicians need not necessarily be specialists as long as an experienced intensivist is on call. Because of the shortage of intensivists, such standards will be difficult to maintain everywhere, but they should, at least, be mandatory for larger hospitals serving as regional centres.     

基于全程风险管理的数字化防控体系在输液室安全用药质量控制中的应用研究

目的:探讨应用全程风险管理的数字化防控体系在输液室安全用药质量控制中的效果。方法:依托信息化平台,设计基于全程风险管理的数字化防控体系应用于输液室安全用药质量控制过程中,采用运行前后对比研究方法,选取2020年8月—2020年9月收集的数据作为体系建立前的基础数据,2021年3月—2021年4月收集的数据作为体系建立后的数据。比较用药风险防控体系建立前后用药流程中RPN值、护士用药环境感知水平及病人对安全用药管理的满意度。结果:在输液室安全用药质量控制过程中建立全程风险管理的数字化防控体系后,RPN值均明显低于体系建立前,护士用药环境感知水平明显高于体系建立前,病人对安全用药管理的满意度高于体系建立前,经比较差异均有统计学意义(P<0.05)。结论:基于全程风险管理的数字化防控体系运用于输液室安全用药质量控制过程中,实现了全程用药安全管控的科学、量化、规范化,提升了护士对安全用药的满意度和接受程度,同时提高了病人对安全用药管理的满意度。     

Who is the key worker in palliative home care?

Abstract

Objective. Palliative home care involves coordination of care between the professionals involved. The NICE guideline on supportive and palliative care (UK) recommends that teams, regardless of their base, should promote continuity for patients. This may involve nomination of a coordinating “key worker”. This study aimed to explore who acts as key worker and who ought to take on this role in the views of patients, relatives, and primary care professionals. Furthermore, it aimed to explore the level of agreement on this issue between study participants. Design. Interview and questionnaire study. Setting. Former County of Aarhus, Denmark (2008–2009). Subjects. Ninety-six terminally ill cancer patients, their relatives, general practitioners (GPs), and community nurses (CNs). Main outcome measures. Actual key worker as valued by patients, relatives, and primary care professionals; ideal key worker as valued by patients and relatives. Results. Patients, relatives, GPs, and CNs most often saw themselves as having been the key worker. When asked about the ideal key worker, most patients (29%; 95%CI: 18;42) and relatives (32%; 95%CI: 22;45) pointed to the GP. Using patients’ views as reference, we found very limited agreement with relatives (47.7%; k = 0.05), with GPs (30.4%; k = 0.01) and with CNs (25.0%; k = 0.04). Agreement between patients and relatives on the identity of the ideal key worker was of a similar dimension (29.6%; k = 0.11).

Conclusion. Poor agreement between patients, relatives, and professionals on actual and ideal key worker emphasizes the need for matching expectations and clear communication about task distribution in palliative home care.     

护理缺失与干预现状的研究进展

就护理缺失的概念、测量工具、影响因素及干预对策进行综述,旨在借鉴国内外发展经验,探索有效的干预措施以逐步解决这一安全隐患,从而长效、稳妥、规程化推进医院护理质量的提高和保障病人安全。     

Understanding medication safety in healthcare settings: a critical review of conceptual models

Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.     

Does nursing leadership affect the quality of care in the community setting?

haycock-stuart e. & kean s. (2012) Journal of Nursing Management 20, 372–381 Does nursing leadership affect the quality of care in the community setting? Aim To examine perceptions about how nursing leadership affects quality of care in the community setting. Background Quality care is considered an essential component of nursing work and recent policy has emphasized the role of leadership in meeting the quality agenda. As shifting the balance of nursing care from the hospital to the community occurs in the UK, there is an imperative to confirm more effectively the quality of care that patients and families receive from nurses working in the community. Methods A qualitative study involving community nurse leaders (n = 12) and community nurses (n = 27) in semi-structured individual interviews (n = 31) and three focus groups (n = 13). Results Tensions exist between ‘leading’ for quality care and ‘delivering’ for quality care. Organisational decision making is challenged by limited measures of quality of care in the diverse roles of community nursing. Conclusions Frontline community nurses and nurse leaders need to articulate how they intend quality of nursing care to be appreciated and actively indicate ways to show this. Implications for nursing management Mechanisms to monitor patient safety, a key aspect of the policy agenda for quality care and other technical aspects of care are important for nurse leaders to develop with frontline community nurses.     

建立与国际接轨的护理评审评价方法

护理管理改革是公立医院改革的重要环节。本文从目前我国护理管理工作现状入手,从护理管理角度阐述了“以病人为中心”“质量、安全、服务、管理、绩效”为主题的新的医院评审标准和多维度的综合评审评价方法在护理工作评价中的体现和应用,从而逐步建立与国际接轨、适合中国国情、科学的护理评审评价方法体系,这对当前我国深化医药卫生体制改革、落实公立医院改革任务、进一步提高医院护理管理和服务水平具有重要意义。     

风险管理在基层医院护理管理中的应用

目的探讨风险管理在基层医院护理管理中的应用效果。方法在护理管理中实施风险管理,主要包括：分析护理过程中存在的安全隐患、提高护理人员风险管理意识以及完善医院风险管理制度。比较实施风险管理前后护理不良事件发生情况以及护理人员理论及技能成绩的差异。结果实施风险管理后护理人员理论与技能成绩较管理前提高;护理不良事件发生例数较管理前少,管理前后比较,均P〈0．05,差异具有统计学意义。结论在护理管理中实施风险管理,提高了护理人员的理论及技能成绩,降低护理不良事件的发生率．从而提高护理质量。     

Overcoming the barriers to patient-centred care: time, tools and training

Aims and objectives. To investigate whether nurses experience barriers to delivering high quality care in areas that are of particular concern to patients and to describe which aspects of care are most affected when nurses lack the required resources, such as time, tools and training to do their job. Background. Patient surveys conducted in the National Health Service of the United Kingdom tend to show there is variation in the extent to which they are satisfied with care in a number of important areas, such as physical comfort, emotional support and the coordination of care. Design. A sample of nurses working in 20 acute London hospitals was asked to complete a postal questionnaire based on a prototype employee survey developed in the United States and adapted by the authors for use in the United Kingdom. Method. Staff in the human resources departments of participating hospitals mailed the questionnaires to nurses’ home addresses. After two reminders, 2880 (out of 6160) useable responses were returned, giving a response rate of 47%. Results. Nurses are aware that there are deficits in standards of care in areas that are particularly important to patients. The majority feel overworked (64%) and report that they do not have enough time to perform essential nursing tasks, such as addressing patients’ anxieties, fears and concerns and giving patients and relatives information. Their work is often made more difficult by the lack of staff, space, equipment and cleanliness. They are often unable to control noise and temperature in clinical areas. Nurses in acute London hospitals are subject to high levels of aggressive behaviour, mainly from patients and their relatives, but also from other members of staff. More positively, high proportions of the nurses in our survey expressed the desire for further training, particularly in social and interpersonal aspects of care. Relevance to clinical practice. This paper goes beyond reporting problems with the quality and safety of care to try to understand why patients do not always receive optimum care in areas that are important to them. In many cases nurses lack the time, tools and training to deliver high quality care in acute London hospitals. We suggest a number of low‐cost interventions that might remove some of the barriers to patient‐centred care. The questionnaire we have developed could be a useful tool for improving quality locally.     

Reduction of ventilator-associated pneumonia: active versus passive guideline implementation

Purpose  Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP. Method  A ‘VAP prevention bundle’ was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change. Results  Compliance with the VAP prevention bundle increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 (2.3–21.0) per 1,000 ventilator days; rate ratio (99% CI) = 0.39 (0.16, 0.96). Conclusions  An active implementation programme increased staff compliance with evidence-based interventions and was associated with a significant reduction in VAP acquisition. This article is discussed in the editorial available at: doi:.     

Differences between Registered Nurses and nurse assistants around missed nursing care—An observational,comparative study

Background

From a nursing perspective, tasks that are not carried out, and the consequences of this, have been studied for over a decade. The difference between Registered Nurses (RNs) and nurse assistants (NAs) regarding qualifications and work tasks, and the profound knowledge around RN-to-patient ratios, warrants investigating missed nursing care (MNC) for each group rather than as one (nursing staff).

Aim

To describe and compare RNs and NAs ratings of and reasons for MNC at in-hospital wards.

Methods

A cross-sectional study with a comparative approach. RNs and NAs at in-hospital medical and surgical wards for adults were invited to answer the MISSCARE Survey-Swedish version, including questions on patient safety and quality of care.

Results

A total of 205 RNs and 219 NAs answered the questionnaire. Quality of care and patient safety was rated as good by both RNs and NAs. Compared to NAs, RNs reported more MNC, for example, in the item ‘Turning patient every 2 h’ (p < 0.001), ‘Ambulation three times per day or as ordered’ (p = 0.018), and ‘Mouth care’ (p < 0.001). NAs reported more MNC in the items ‘Medications administered within 30 min before or after scheduled time’ (p = 0.005), and ‘Patient medication requests acted on within 15 min’ (p < 0.001). No significant differences were found between the samples concerning reasons for MNC.

Conclusion

This study demonstrated that RNs' and NAs' ratings of MNC to a large extent differed between the groups. RNs and NAs should be viewed as separate groups based on their different knowledge levels and roles when caring for patients. Thus, viewing all nursing staff as a homogenous group in MNC research may mask important differences between the groups. These differences are important to address when taking actions to reduce MNC in the clinical setting.