Clinical observation and psychological care of elderly patients with fracture Key words: psychological care of elderly patients with fracture
Objective: To explore the clinical characteristics and psychological nursing intervention measures of elderly patients with fracture. Methods: The clinical data of 6 elderly patients with fracture from June 2006 to February 2007 were analyzed retrospectively. Results: The patient had stable primary disease, no nursing complications, good mental state and improved anxiety and depression. Conclusion: Understanding the psychological needs and characteristics of elderly patients with fracture and formulating perfect psychological nursing and rehabilitation guidance are effective guarantees for the comprehensive rehabilitation of elderly patients with fracture in physical, psychological and social activities.
With the improvement of medical level and the extension of human life span, the proportion of elderly patients in orthopedic treatment has gradually increased. Due to the long treatment time and limited activities of elderly orthopedic patients, a series of complications are prone to occur during bed-rest treatment. Most patients are worried about physical disability and often show different emotional reactions and psychological needs. Therefore, in clinical nursing, we should strengthen psychological nursing according to the characteristics and psychological state of senile fractures, give patients as much care and comfort as possible, patiently explain the precautions of long-term bedridden patients, and enhance their confidence and courage to overcome the disease. The report is as follows.
Materials and methods
From June 2006 to February 2007, our department treated a total of 6 elderly patients with fracture1/kloc-0, including 49 males and 67 females. The age ranged from 66 to 98 years, with an average of 73 years. Fracture site: Femoral neck and intertrochanteric fracture accounted for 865,438+0%, forearm fracture accounted for 65,438+09%. All patients were accompanied by different degrees of hypertension, heart disease, cerebral thrombosis and other medical history.
Psychological nursing: As elderly fracture patients leave their families and work units after hospitalization and are unfamiliar with the surrounding environment, most of them will feel lonely, which is manifested as anxiety, depression, pain, fear of pain, inability to take care of themselves and accidents. Therefore, we nurses should create a good environment for elderly patients, pay attention to their words and deeds, treat patients enthusiastically, carefully and seriously, and do a good job of explanation patiently and meticulously. Nurses should introduce themselves to patients frankly through the opportunity of treatment and nursing, maintain elegant appearance and natural expression, and guide patients to have positive psychological reactions and related optimistic behaviors, so as to gain the trust of patients and their families and establish confidence in overcoming diseases.
Careful care: nurses should greet and care for the elderly patients in the new hospital with noble nursing ethics and good psychological state. For the elderly, smiling, talking, massage, rehabilitation guidance and assisting patients with necessary functional exercises can make them feel happy and satisfied.
Establish a good social support system: elderly inpatients need not only the care of medical staff, but also the support of family, friends, colleagues and society. They should be given more active guidance, persuasion, encouragement and comfort to help patients tide over the most difficult period and truly experience the care and warmth of society and relatives, so as to facilitate their early recovery. At the same time, we should introduce successful cases to elderly patients, and ask patients with good curative effect in the ward to talk about the treatment process and cooperation methods, so as to enhance confidence, relieve ideological concerns and actively cooperate with treatment and nursing.
Patient's explanation and careful observation: the elderly's experience of the disease can't be clearly and specifically said, and the nurse can't wait for the patient's active response. They must carefully examine a series of physiological and pathological changes of patients and collect detailed information about the condition of elderly patients, so as to correctly estimate the condition, make correct nursing judgments and take correct nursing measures.
Strengthen training and master nursing skills: Nurses should actively participate in various nursing special learning exchanges, receive nursing knowledge training, constantly improve their nursing ability, and fully trust elderly fracture patients in business technology. Every move, word and deed of nursing staff will have a great influence on elderly patients. If they are careless in the operation of a nursing technique, they will be considered as doing experiments on them, which will cause some psychological changes in elderly patients. Therefore, nurses should behave steadily, operate skillfully, operate gently, respond quickly, and care about and attach importance to their various treatments and examinations. If some patients need intravenous injection after operation, because the blood vessels of the elderly are hard and slippery, it will bring some difficulties to puncture. Coupled with the psychological role of the elderly, I am always worried that the new nurses will not? Hit the nail on the head? In this case, it is best to let the new nurse operate on other patients in the same ward first, so that the elderly patients can understand the excellent intravenous injection technology of the new nurse from the side, and let them have a sense of trust and security. result
The patient's primary disease is relatively stable, and there are no complications in nursing. The patient's mental state is good, and he can actively cooperate with clinical treatment and nursing. Most patients' anxiety, depression, loneliness and dependence have been improved accordingly, and they are very satisfied with the nursing work. discuss
Due to the poor physical fitness of elderly patients, and the fracture has the characteristics of long course of disease, poor curative effect, difficult healing, slow metabolic function, osteoporosis, decalcification, etc., the healing time of elderly fracture patients is generally 1 times or longer than that of young patients, which is prone to complications. The fractures of elderly patients, mostly femoral neck and intertrochanteric fractures, need traction treatment, and patients need to stay in bed for 2-3 months to get out of bed, which increases the probability of complications for most elderly patients. In this set of data, most elderly patients suffer from chronic diseases such as hypertension, heart disease and diabetes, which undoubtedly brings many difficulties to clinical orthopedic treatment and nursing, and often leads to the recurrence and aggravation of these chronic diseases due to pain, mental stress and long-term bed rest after fracture. Therefore, nurses should master the psychological needs and characteristics of elderly patients with fracture, and do a good job in psychological care and rehabilitation guidance, which is an effective guarantee for the comprehensive rehabilitation of elderly patients with fracture in physical, psychological and social activities, and is also very important for extensive and systematic holistic nursing. Only by doing psychological and rehabilitation nursing well can holistic nursing be implemented.
Fan Wen -2: Hidden dangers and countermeasures of rescue nursing in community hospitals. Rescue room is a high-risk place for medical disputes, because nurses are not skilled enough, services are not in place, rescue equipment is out of order, and communication art is lacking. Patients' legal awareness is enhanced, while some patients have poor quality and high requirements; Dissatisfaction with some hospital services will be vented on nurses, leading to conflicts between doctors and patients and medical disputes. In order to adapt the rescue nursing work in grass-roots hospitals to the needs of the development of modern society and make the rescue nursing work move towards the track of standardization, institutionalization and standardized management, a series of preventive measures have been taken in view of the above-mentioned reality, which has made our hospital receive satisfactory results in the rescue nursing work and obviously reduced the incidence of errors and disputes. Hidden dangers and countermeasures are discussed as follows.
1 Difficulties and hidden dangers in nursing
1. 1 The division of labor among departments is not clear and the responsibilities are not in place. Because the grass-roots community hospitals are small in scale, even the departments are not perfect, and there is no distinction between outpatient and emergency, so many emergency patients go to the outpatient clinic, and the real emergency rescue patients can not be treated promptly and quickly.
1.2 A considerable number of patients have low comprehensive quality and poor communication between nurses and patients. Most of the rescues in primary hospitals are car accidents, fights, pesticide poisoning, alcoholism, drowning and so on. Young age, language communication barriers, etc. It is difficult to cooperate with nurses in the rescue process. They often blame the nurses for their resentment against the accident, the patients' pain, family conflicts and mental losses, which leads to the tension between nurses and patients, great pressure on nurses and difficulties in nursing work.
1.3 Nurses have low emergency ability and insufficient awareness of safety precautions. There are few high-quality comprehensive talents among nurses. The basic professional knowledge is not solid, the operation of nursing technology is not standardized, the evaluation ability of critically ill patients is poor, the obligation to publicize and inform patients and their families is lacking, the compliance signatures are few, and the awareness of safety prevention is insufficient.
1.4 the number of nursing staff is small, and the hidden dangers are mostly with the full implementation of the new rural cooperative medical system, the number of patients increases, but the number of nursing staff is insufficient; There are many supernumerary nurses with high mobility; Young nurses are not active enough and have poor adaptability to work; These are all factors that cause hidden dangers. Because of the excellent care when saving patients? Urgent? In other words, skilled rescuers and sufficient personnel are needed to ensure the quality of rescue. However, due to the limited manpower, grass-roots hospitals spend most of their time as nurses on duty, not only participating in the rescue of critically ill patients, but also taking into account routine treatment such as outpatient injection. Sometimes the rescue of critically ill patients is delayed because the injection is not guaranteed in time, resulting in unnecessary quarrels between patients' families and nurses, and even family members hitting people; At the same time, the outpatient injection room is unattended (for example, the skin test time is up and the intravenous injection is over), and the nurses are busy around; In addition, due to busy work and few nurses, it is often easy to ignore the observation of other patients' illness, and the illness record is not timely and comprehensive, leaving hidden dangers for medical care.
1.5 Incomplete infrastructure, affecting the efficiency of rescue. One is to have a skilled medical team, and the other is to have a series of advanced medical rescue equipment, so as to ensure the quality and success rate of rescue. Poor working environment, insufficient instruments and equipment needed for work and aging staff are the sources of stress for emergency nurses in grass-roots hospitals. Some rescue equipment is not commonly used at ordinary times, and in case of critical patients, the rescue equipment also fails, such as the weakness of sputum suction device, the failure of gastric lavage machine in and out of water, and the difficulty in starting ECG monitor. It will not only delay the rescue time, but also bring unnecessary medical disputes.
1.6 Due to disrespect, the principle of losing is that the distance between the emergency room and the infusion hall is not far, and individual nurses do not follow the rules and regulations due to disrespect. When patients are not rescued at ordinary times, some acquaintances and friends inside and outside the hospital infuse fluids on the empty beds in the rescue room, accompanying a large number of family members, which makes the rescue bed unable to be in an emergency state at any time, affecting the indoor environment and equipment application. Once the infusion patient is abnormal or suddenly comes to rescue the patient, it may cause contradictions between doctors and patients.
1.7 subject to the bonus distribution system, the relationship between doctors and patients is not harmonious. In recent years, due to the principle of doctor bonus distribution, the humanitarian awareness of saving lives is weak. The emergency patient goes to the emergency room first, and then the nurse goes to the doctor. Some doctors only prescribe and examine outpatients, rarely actively cooperate with nurses to participate in emergency treatment immediately, and rarely give patients psychological counseling and conflict resolution. Therefore, nurses in primary hospitals are often abused by patients' families and even unfairly accused. The work and psychological pressure of nurses are gradually increasing.
2 rescue nursing countermeasures
The work characteristics of emergency room are: there are many urgent, dangerous and serious patients, the work pace is fast, and patients and their families are impatient. Therefore, emergency room nurses must have good qualities such as strong emergency response ability, skilled rescue technology, quick response, high work efficiency and good communication skills. In many cases, it is necessary to do preliminary treatment before the doctor arrives, such as establishing venous access, oxygen inhalation, sputum aspiration, hemostasis and so on. At the same time, we must make a good record of the rescue and check it. In order to ensure the safety of patients' lives, avoid medical disputes, discover nursing hidden dangers in time, and effectively strengthen safe medical care, the following preventive measures are formulated to rescue emergency nursing hidden dangers by summing up many years of undergraduate work experience.
2. 1 Improve hardware facilities, ensure the attention of safety medical departments, win the support of hospital leaders, and equip and improve various rescue facilities. The replacement of rescue facilities must be standardized and standardized, and the handover and management of rescue equipment should be done well. Instruments should be kept by special personnel and checked in shifts. When problems are found, repair them in time to ensure that the first-aid instruments are in good condition at 100%. Nurses can operate skillfully in first aid, thus improving the quality of rescue, reducing medical hidden dangers and disputes and winning the popularity of the hospital.
2.2 Changing service mode and standardizing service behavior With the change of modern medical model, the care of patients has not only relied on superb professional skills, but should pay more attention to the care of psychological, social and emotional factors, advocate humanistic care and carry out humanized services. Treat patients' hearts and diseases? . Improve the understanding and trust of patients and their families in nursing work. Release? People-oriented? Our service concept and practice run through the whole clinical nursing work, caring for every patient with love and responsibility, implementing humanized and humanized nursing service, and constantly promoting and improving the overall nursing quality.
2.3 Strengthen the standardized training of emergency nurses, comprehensively improve the overall quality of nurses, and conduct professional and standardized training for emergency nurses, so that they can master the use methods of various instruments, the observation points and methods of common diseases, and the rescue techniques for critically ill patients. Senior nurses should do a good job of mentoring, and the nursing department will organize nurses to learn new knowledge and technology from time to time, and regularly assess their theoretical knowledge and emergency response ability. Such as cardiopulmonary resuscitation, oxygen inhalation and gastric lavage. In order to improve the emergency response ability of emergency nurses, to be alert, witty, unhurried and calm, so as to complete nursing tasks with high quality.
2.4 Strengthening the education of legal concept and improving nurses' legal awareness requires nurses to learn, understand, apply and strictly abide by legal norms. When carrying out various nursing activities, we should strictly within the legal scope, improve the sense of responsibility, and reduce the occurrence of nursing errors and accidents. Such as alcoholism, suicide by taking poison and other first-aid work with legal disputes, need nurses to observe and record the illness in time and accurately. The vomit or stomach contents of patients who take poison should be kept for examination. All kinds of dangerous nursing operations must be clearly explained to patients and their families under strict operating procedures, explaining the necessity and danger of the operation, and striving for their understanding and signature support. This not only relieves the worries of saving patients, but also protects themselves and protects their legitimate rights and interests.
2.5 Strengthen nurses' sense of responsibility, strictly perform their duties as nurses, stick to their posts and be ready at any time. When rescuing patients, adhere to the principle of first being urgent and then being light, first being treated and then paying fees, and do not delay the rescue treatment because of not paying fees, and write all rescue nursing records accurately, timely and completely. Don't give up principles because of acquaintances and friends, leading to medical disputes.
2.6 Pay attention to language art and do a good job in nurse-patient communication. People-oriented? Our service concept, warm reception for every patient, sincere attitude and civilized language. Avoid being cold and hard. When patients or their families show impatience, they should explain and appease patiently, which truly reflects the clinical nursing work. Patient-centered? 、? Taking nursing quality as the core? Nursing management, strict implementation of various nursing operation procedures and nursing rules and regulations, and gradually solve the problem of insufficient nursing human resources, so that every nursing staff can start from the vital interests of patients, change their perspective, improve communication, change passive service into active service, win the praise and trust of patients, and nurse-patient disputes will be reduced.
2.7 Handle the relationship between doctors and nurses, and enhance the collective cohesion. In hospital work, although medical treatment and nursing are independent systems, the clients are the same. Doctors and nurses should establish a communication, cooperation and complementary relationship in different jobs. Patients' information should be exchanged with each other, especially when there are contradictions or even disputes between doctors and patients and between nurses and patients. They should communicate with each other, find out the reasons, study and take measures in time to solve the contradictions as much as possible. We must not blame each other, pass the buck and provoke each other.
Establish a good team spirit and nip hidden dangers in the bud.