Addressing Nursing Safety Hazards and Mitigation Strategies for Elderly Endocrinology Patients in Hospital Care

Objective:To investigate the safety hazards in nursing and explore mitigation strategies for elderly patients in the endocrinology department.Methods:A total of 240 bedridden elderly patients from February 2021 to January 2023 were recruited and divided into two groups using the random number table method.The control group(n=120)received conventional nursing care,and the observation group(n=120)received personalized nursing care.Patients’quality of life,the incidence rate of pressure sores,and patient satisfaction with nursing care were observed and analyzed.Results:The incidence of pressure ulcers in the observation group was significantly lower at 17.50%compared to 30.00%in the control group(P<0.05).Quality of life in the observation group was significantly higher than that in the control group(P<0.05).The satisfaction rate in the observation group was significantly higher at 93.33%compared to 84.17%in the control group(P<0.05).Conclusion:These findings emphasize that only through the implementation of scientific and rational nursing measures can effectively reduce nursing risks,enhance therapeutic outcomes,and improve the quality of life for elderly patients.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Nursing Diagnoses of the Domain Safety/Protection and Socioeconomic and Clinical Aspects of Critical Patients

Objective: The objective is to correlate the nursing diagnoses of the domain Safety/Protection of NANDA-I in critically ill patients with sociodemographic and clinical data. Method: A cross-sectional study with 86 individuals was conducted, from October 2013 to May 2014 in the Intensive Care Unit of a university hospital in northeastern Brazil, through a formal interview and physical examination. Results: It was possible to identify a total of 20 significant statistical associations, and 15 were clinically justified by the literature, namely: risk for aspiration and reason for admission;impaired dentition and age;risk for peripheral neurovascular dysfunction and sex and comorbidity;skin integrity and comorbidity;risk for impaired skin integrity and gender and reason for admission;impaired tissue integrity and gender and reason for admission;risk for perioperative positioning injury and reason for admission;risk for thermal injury and age and comorbidity;delayed surgical recovery and reason for admission;risk for poisoning and years of schooling;and risk for imbalanced body temperature and age. Conclusions: By understanding the relationship between customers’ answers and the sociodemographic and clinical profile, positive health outcomes can be achieved in particular in the prevention of risks facing vulnerability characteristics, providing greater safety and protection for the critical customer.

The effects of Professional Commitment and Patient Safety knowledge-attitude-practice on Undergraduate nursing students’ Humanistic Care Ability in clinical practice

Objective:To describe the status quo of humanistic care ability,the knowledge-attitude-practice of Patient Safety and professional commitment among Undergraduate Nursing Students in clinical practice,and to determine the effects of professional commitment and patient safety knowledge-attitude-practice on humanistic care ability.Methods:Two hundred and thirty-two undergraduate nursing students in clinical practice were investigated with the general questionnaire,Caring Ability Inventory(CAI),Patients Safety knowledge-attitude-practice(KAP)Questionnaire and the Nursing Professional Commitment Scale.Results:The score of humanistic care ability of nursing undergraduates was 185.19±20.95,patients safety KAP score was 106.94±11.62,professional commitment score was 74.93±10.44.Undergraduate nursing students’humanistic care ability were positively correlated with professional commitment and patients safety KAP(P<0.05).Multiple Linear regression analysis showed that professional commitment,patient safety KAP entered the humane care equation(F=24.051,P<0.001),and explained 39.1%of the total variation in humane care.Intermediate effect analysis shows that patient safety played a partial mediating role in professional commitment and humane care.Conclusion:The professional commitment and patient safety KAP of undergraduate nursing students were positively related to their humanistic care ability.Improving the professional commitment and knowledge and patients safety KAP of nursing students can strengthen their humanistic care ability to provide high-quality nursing for patients.

The beginning of the journey to study patient safety and care quality in hospital settings using inpatient falls as an example

病人安全是WHO2006年启动的一项全球性工作。我国卫生部与国家中医药管理局在2005-2007年开展的医院管理年活动中,都将提高医疗质量和保证医疗安全作为重中之重。本刊特邀曾惠明（Huey-Ming Tzeng）博士,美国密歇根大学护理学院副主任、教授、美国中西部护理研究协会会员,撰写了《病人安全与护理照护的研究旅程：以住院病人跌倒为例》。

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

Establishing Patient Safety in Intensive Care—A Grounded Theory

Background: The modern intensive care unit (ICU) is a complex and high-risk environment, and even small adverse events and changes may deteriorate the patient’s conditions and eventually cause harm. Many factors can potentially be associated within an increased amount of errors, leading to adverse events. Nurses, nurse managers, and other leaders all play important roles in establishing patient safety. Aim: This study aimed to obtain a deeper understanding of leaders’ and nurses’ main concerns in establishing patient safety in Swedish intensive care units. Method: A grounded theory methodology was used. Data from 15 interviews with leaders and nurses involved in critical care in Sweden were collected, analysed and constant compared. Findings: The main concern in establishing patient safety was promoting quality of care, work engagement, and staffs well-being in strained ICUs. The core category building trust explained how the leaders’ and nurses’ strove for quality of care and wished a healthy, safe work environment. This is further explained in the categories “Being an accessible and able leader”, “Creating knowledge and understanding”, and “Establishing collaborative practice”. Conclusion: Establishing patient safety in the ICU requires that staffs enjoy going to work, have good work relations, are committed and want to stay at the unit. A healthy, salutogenetic unit with a work environment marked by trust provides a better opportunity to establish patient safety, and various leaders have potential to achieve this.

ISBAR沟通模式在护理实践中的应用研究进展

从ISBAR沟通模式概述、在护理实践中的应用、在护理实践中的挑战及对策等4个方面对ISBAR沟通模式在临床护理中的应用进行综述,以期为在临床工作中应用ISBAR沟通模式提供参考。

Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries

Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.

Nurses’ Perceptions of Patient Safety in Community Mental Health Settings: A Qualitative Study

Mental health care has moved from hospital settings to community mental health settings, and there is a need to explore the perceptions of patient safety among registered nurses working in this field. Patient safety is to include everyone and to be the goal in all aspects of health care. The aim of the study was to explore registered nurses’ perceptions of patient safety in community mental health settings for people with serious mental illness. The study was qualitative and descriptive in nature and interviews were carried out during spring 2012, with seven registered nurses working in community mental health settings for people with serious mental illness in five municipalities in the middle of Sweden. The sampling was purposive and data were analysed using qualitative content analysis. The findings showed that the registered nurses understood patient safety as providing support to people with serious mental illness in regaining and maintaining health through good treatment and respecting self-determination and avoiding coercion. The terms of daily living in small community mental health settings within the a large community health care organization, communication, sufficient knowledge of psychiatric disabilities among people in the residents’ network, and national laws and regulations, all had implications for patient safety. The registered nurses perceived patient safety as involving a wide range of issues that in other areas of care are more often discussed in terms of quality of care. Determining the boundaries of patient safety in community mental health settings for people with serious mental illness can be a first step in establishing workable routines that ensure safe patient care.

重症监护病房护理缺失现状及原因分析

目的:调查重症监护病房(ICU)内护理缺失现状并分析其原因,为减少ICU护理缺失,提升重症患者护理质量提供参考。方法:采用便利抽样法,于2023年12月1日至30日在湖南省5家医院选取305名ICU护士作为研究对象,使用一般资料调查表以及ICU护理缺失量表进行调查。结果:ICU护理缺失得分为(64.48±20.60)分,有91.8%的护士报告了他们在工作期间至少发现了一项护理缺失活动。其中缺失最多的项目为重症患者心理社会评估、早期康复、心理护理以及肌力和营养状况评估。ICU护理缺失受护士学历、职称、所在ICU类型的影响(P<0.05)。ICU护理缺失原因得分为(61.29±16.28)分,最主要的原因是护士人力资源不足。结论:护理缺失在ICU内发生率高,其发生受多种因素影响,提示护理管理者应重视ICU内护理缺失的发生现状及原因,并采取相应措施,进一步提高ICU护理质量。

护理缺失研究进展

护理缺失是指护理行为的缺失,其存在必然导致护理质量降低,影响患者安全。本文就护理缺失的概念、理论模型、主要缺失内容、测评工具、不良影响及相关干预措施进行阐述,并对未来研究提出建议和展望,以期引起国内护理工作者和管理者的重视,为相关研究的开展提供借鉴和参考。

成人重症监护室护理缺失的研究进展

护理缺失对患者和护士皆会造成不良影响,深入了解重症监护室的护理缺失情况对提升科室护理质量、增强护士个人职业能力及确保患者安全具有重要意义。文章综述了成人重症监护室的护理缺失发生现状、原因及评估工具,并提出加强人力资源管理、优化工作环境、积极开发本土化的ICU护理缺失评估工具的干预策略,旨在为促进患者安全和提升护理质量提供参考。

ICU护理缺失量表的编制及信效度检验

目的 编制ICU护理缺失量表并检验其信效度。方法 以护理缺失理论模型为框架,通过文献分析、质性访谈和专家咨询编制量表初稿。于2021年9月-10月选取湖南省某三级甲等医院的219名ICU护士进行调查,分析量表的信度及效度;于2021年11月-2022年1月选取湖南省3所医院的203名ICU护士进行调查,用于验证性因子分析。结果 ICU护理缺失量表共分为2部分,ICU护理缺失量表(A部分)和ICU护理缺失原因量表(B部分)。A部分共37个条目,不进行维度划分,B部分包含护理人员绝对不足、护理人员相对不足、物质资源因素、沟通交流因素、组织管理因素5个维度,共25个条目。通过探索性因子分析共提取5个公因子,累计方差贡献率为66.938%,验证性因子分析提示模型拟合较好(χ^(2)/df=2.029,近似误差均方根=0.071,增值拟合指数=0.923,比较拟合指数=0.922)。量表两部分内容效度分别为0.89和0.84。量表A、B部分的Cronbach’s α系数分别为0.963和0.946,B部分各维度的Cronbach’s α系数为0.708~0.904。结论 重症监护病房护理缺失量表具有较好的信效度,适用于我国ICU内护理缺失现状的调查。

重症患者急性皮肤衰竭风险评估及危险因素的研究进展

维持皮肤完整性并预防皮肤相关并发症是重症患者的护理重点之一,但某些皮肤完整性受损是因低灌注不足导致的皮肤和皮下组织死亡,即急性皮肤衰竭,作为一个新兴概念,我国在该领域的研究处于起步阶段,医护人员对其认知不足。文章对急性皮肤衰竭的概念、现状、风险评估、危险因素进行综述,并提出规范危重患者皮肤管理、研制本土化急性皮肤衰竭风险评估工具、强化护士对急性皮肤衰竭的识别及教育培训的合理化建议与展望,旨在加强医护人员对急性皮肤衰竭的关注,为科学化、系统化、精细化的临床工作提供指导与参考,从而提高皮肤护理质量。

模拟训练在提高肿瘤护理质量和患者安全中的应用:范围综述

目的模拟训练(simulation-based training,SBT)是一种有效的教育方法,广泛应用于包括肿瘤学在内的多种临床环境中。该文对肿瘤学中与SBT相关的研究进行了范围综述,全面了解SBT在提高医护人员技能方面的作用,从而提高护理质量和患者安全。方法根据Arksey和O’Malley提出的范围综述方法框架,在Medline、Scopus和Web of Science数据库中检索于2012年至2022年发表的,与SBT在提高肿瘤科医护人员技能方面的相关研究文献,仅纳入经过同行评审的英文或法语文献。由2名研究员独立进行文献的筛选、提取和分析。结果检索出1013篇文章,共纳入29篇文献。其中25篇文献侧重于非技术技能,如决策技能、沟通和团队合作技能以及认知能力;13篇文献侧重于技术技能。纳入文献研究结果表明,通过SBT项目,肿瘤科医护人员的技能得到了显著提高。其中14篇文献对SBT的应用进行了主观评估,9篇文献对其进行了客观评估,6篇文献采用了主观和客观相结合的评估方法。结论SBT是提高肿瘤科医护人员技能的有效方法,支持和推广SBT对提供高质量的医疗服务和确保患者安全至关重要。

智能排泄护理系统对重症患者照护影响的质性研究

目的了解智能排泄护理系统对重症患者临床护理实践的影响,为推动康复护理智能化发展提供参考。方法2024年3-5月,采用描述性研究方法,对使用过智能排泄护理系统的12名护士进行半结构式访谈,采用内容分析法进行资料分析。结果共提炼出3个主题:智能排泄护理系统能减轻护理工作负担(减轻护理工作压力、缓解护士身心压力),护士使用智能护理排泄系统存在的问题(系统性风险、对传统照护模式的挑战),护士对于功能完善的需求(清晰直观的可视化特性、持续优化舒适质感、实现便捷与精准的融合)。结论智能排泄护理系统在减轻护理人员体力负担方面发挥着积极作用,使用中需以患者为中心,提高安全可靠性,准确量化临床监测指标,继续优化排泄护理系统,满足患者需求。

1例先天性心脏病术后患儿因怀抱致低温烫伤事件的根因分析

目的探讨RCA 2在儿科重症监护病房怀抱患儿致低温烫伤事件中的应用效果。方法成立RCA 2团队,对1例先天性心脏病术后患儿因怀抱护理造成低温烫伤事件进行根本原因分析,制订改进方案并落实。结果规范了怀抱患儿操作标准化流程与评分标准,降低了术后患儿怀抱风险。结论RCA 2可有效避免护理不良事件发生,保证医疗护理质量安全。

基于自护理论的安全健康教育对老年肌少症患者护理安全及自我管理能力的影响

目的:探析老年肌少症患者护理中运用基于自护理论的安全健康教育干预对患者护理安全及自我管理能力的影响。方法:选取2022年1—12月联勤保障部队第九〇〇医院诊治的91例老年肌少症患者为研究对象,随机将患者分为对照组(44例,常规健康教育)、试验组(47例,基于自护理论的安全健康教育)。评估并比较两组患者干预前、干预后(出院后3个月入院复查时)的四肢骨骼肌质量指数(SMI)、握力、步速、5次起坐时间、运动功能、跌倒效能、自我管理效能及机体功能、生活质量。结果:干预后,两组SMI、握力、步速均高于干预前,而5次起坐时间短于干预前,且观察组比对照组改善幅度更大,差异有统计学意义(P<0.05)。干预后,两组运动功能评分明显较干预前降低,且试验组低于对照组,两组跌倒效能评分、自我管理效能评分、机体功能评分、生活质量评分均高于干预前,且试验组均高于对照组,差异有统计学意义(P<0.05)。结论:对老年肌少症患者采取基于自护理论的安全健康教育干预的效果显著,可有效改善患者SMI与运动功能,提高患者跌倒效能与自我管理能力,优化机体功能与生活质量。

三级甲等综合性医院护理缺失现状及其原因调查

目的了解三级甲等综合性医院护理缺失的现状,探索其原因,提高护理质量,保障患者安全。方法采用修正后的护理缺失问卷对594名三级甲等医院的临床护理人员进行问卷调查。结果在护理缺失的项目中,14.81%~66.16%基础护理缺失,3.20%~23.91%护理干预缺失,14.14%~14.98%护理计划缺失,4.71%~11.95%护理评估缺失。而护理缺失的原因中,63.30%~98.48%为人力资源不足,73.74%~85.35%为物质资源不足,62.96%~83.16%为沟通交流不足。结论护理缺失普遍存在,而导致这些护理缺失的原因也很多,护理管理者要高度重视护理缺失的问题,采取相应措施,避免或减少护理工作的缺失,以保证护理质量和患者安全。