Pediatric nursing; Nursing management research; Nurse-patient relationship
Nursing management is an activity process with the main goal of improving nursing quality. Whether advanced nursing theory and technology can be well applied to practice depends on whether there is scientific nursing management. Comprehensive pediatrics includes all diseases in pediatrics, and there are many kinds of diseases. At the same time, the pediatrics department of our hospital also includes neonatal intensive care unit, with many patients and heavy work. In addition, due to the characteristics of pediatric children, such as young age, poor cognitive ability, more accompanying, more temporary disposal and trivial nursing operation, nursing management has certain particularity and difficulty, which is summarized as follows:
1 Management should embody the people-oriented principle.
The first content of management science is human management, and nursing management is no exception. Nursing management refers to nurses, patients, family members, doctors and head nurses themselves.
1. 1 Care and respect for nurses. Nowadays, most pediatric patients are only children, and their parents regard them as the apple of their eye. A child has two or even four or five family members around him, and they have high requirements for scalp venipuncture. At the same time, these parents are young and have a big temper. If nurses can't "hit the nail on the head", they will often be accused, complained and even abused by their parents. If they can't hit the nail on the head, they will deny you everything. Moreover, pediatric children's condition changes rapidly, and their self-expression ability and cognitive ability are poor, which is more difficult to observe and care than adults. Therefore, pediatric nurses have to bear great psychological pressure in their work, and many nurses are not at ease with pediatric work. Therefore, the head nurse should not only strictly demand nurses at work, but also urge nurses to complete various nursing work as required; We should also care about, respect and understand nurses, be brave in taking responsibility and risks for nurses on key issues, criticize them separately after mistakes, and safeguard nurses' self-esteem; If nurses have any difficulties in life, the head nurse should try to create conditions to help them, care for them, let them feel the warmth of the group and work in pediatrics with peace of mind.
1.2 The nursing process of establishing a good nurse-patient relationship is, in a certain sense, a nurse-patient management process, and a problem that cannot be ignored in the management process is the nurse-patient relationship. Now they are all only children. Parents with sick children are particularly anxious and have high requirements for nursing. For this reason, our department arranges two nurses with strong sense of responsibility, excellent venipuncture skills and communication skills to take charge of the day shift, responsible for the reception, treatment and nursing of newly admitted children, and requires them to receive warmly, have comprehensive health education, treat and nurse in time, so as to leave a good first impression on their families. He is also responsible for the nursing work of all critically ill children in the department and the health education of patients in the group under his jurisdiction, so that family members can understand the condition and treatment. At the same time, each ward has a special nurse in charge. In addition to health education, we should also make use of every opportunity to get in touch with and play with children to eliminate their strangeness and fear. In addition, nurses with many patients implement flexible shifts, such as increasing middle shift and night shift staff, to ensure timely treatment and nursing work and reduce the contradiction between nurses and patients.
1.3 Strengthen the cooperation between doctors and nurses to create a good working atmosphere. In pediatrics, the cooperation between doctors and nurses is particularly important because the children are young and their condition changes rapidly. However, there will inevitably be some differences and frictions in the process of cooperation. For example, doctors require nurses to correctly carry out the doctor's orders, carefully observe the condition and reflect the condition in time, while nurses should comprehensively care for children, carry out health education, answer related questions, solve nursing problems and make nursing records. And they are very busy with their work. Some doctors don't understand. They think that nurses are busy doing nothing and don't respect nurses' work, while some doctors are busy writing illness records in the morning, which leads to untimely rounds, untimely orders, too many temporary orders and hectic nursing work. Nurses have opinions about doctors, etc. For these contradictions, the head nurse should first find the reasons from nursing. If the main responsibility lies in nurses criticizing and helping nurses and explaining their apologies to doctors, should the responsibility lie with doctors? Create a good working atmosphere based on the principles of equality, respect and unity.
1.4 The head nurse should establish her own prestige.
1.4. 1 A head nurse should have good moral character. Many examples in history show that people who are morally decadent will not be trusted, and a noble, selfless, decent and fair head nurse can gain the trust of nurses. It can be seen that Xiu De was the first person to learn from others. The thought, morality and behavior of head nurses have great influence on the effectiveness of nursing management and people's hearts. Noble thoughts, morality and prestige are silent commands and invisible forces, and they are examples for nurses to follow [2].
1.4.2 lead by example. As the ancients said, "if it is not right, it cannot be right." Head nurses should set an example in their work, set strict standards for themselves, ask nurses to do well first, and ask nurses not to do anything resolutely. However, at the same time, you can't "do it overnight", and the "hard" leadership has been eliminated by modern management. An excellent head nurse should reasonably use the incentive mechanism to arouse everyone's enthusiasm and let every nurse do her job well. Common motivation methods include motivation, emotional motivation, goal motivation and behavior motivation.
1.4.3 the head nurse should have rich professional knowledge, excellent technology and innovative consciousness. There are many kinds of pediatric diseases, and their professionalism is not strong. Some diseases can't find nursing basis in professional nursing books and need clinical exploration, which requires head nurses to walk ahead of nurses in studying business seriously, making continuous progress and mastering knowledge about pediatric diseases. In technical operation, the head nurse should also have excellent skills. Nurses should be proficient, and nurses who are not proficient should be familiar with it. When the scalp venipuncture of the nurse is unsuccessful, the head nurse can "hit the nail on the head" ... so as to get the respect of the nurse.
1.4.4 employing people correctly and being approachable, any head nurse comes out of ordinary nurses. Although their job responsibilities are different, they are equal in personality. Head nurses should be fair and reasonable, appoint people on their merits, give full play to each nurse's specialty, and strive to create a space for them to realize their self-worth.
2. Flexible use of management strategies to strengthen ward management.
2. 1 The formulation and implementation of the "first inquiry responsibility system" in wards around the patient-centered principle includes two aspects. On the one hand, nurses should take the initiative to ask: who are you looking for? what can I do for you? Do you need any help? The second aspect is what questions parents have. If they ask which nurse, that nurse will take care of it immediately and will not pass it on to other nurses. Even medical problems that nurses can't solve must be conveyed to doctors by nurses, so as to avoid the situation that family members can't convey clearly or parents think that nurses deliberately push the Committee.
2.2 Create a humanized environment according to the characteristics of pediatrics In order to alleviate children's fear of unfamiliar environment in the hospital, create a family-style warm environment in the ward. We stick plastic cartoon Donald Duck, Mickey Mouse and other children's favorite patterns on the ward perspective window through electrostatic adsorption. Posting colorful parenting knowledge on the wall of the ward corridor, with exquisite cartoon pictures; Hang wind chimes on the ceiling of the nurse station lobby; Each ward has colorful and illustrated parenting brochures, and there are various warm reminder cards in the ward. Parents are encouraged to buy toys for their children, and both nurses and patients should work together to create a good rehabilitation environment.
2.3 Strict control of cross-infection Pediatrics is the key department to control cross-infection. In view of this situation, our department has changed from passively coping with the examination in the past to actively welcoming the examination now, and adopted methods such as daily reminder, weekly emphasis and monthly examination to make each nurse master the aseptic operation principle and disinfection and isolation system skillfully. Actively promote disposable goods. Various models of children's stomach tubes, children's anal tubes, children's oxygen tubes, children's sputum tubes and disposable sheets specially made by manufacturers for our department have been widely used. Disposable articles are not only convenient for nurses to operate, but also popular with parents. Strictly disinfect articles that cannot be used at one time, such as oxygen meter, negative pressure meter, atomizer, ventilator pipeline and aspirator device, to prevent cross infection. Wards are regularly disinfected by ultraviolet rays, and wards where patients with enteritis are treated are dragged with xiaojiajing disinfectant once a day.
2.4 Strengthening ward economic management Because of the characteristics of many patients, quick turnover, many temporary disposals, hectic and trivial work, there has always been a phenomenon of neglecting work without charge. In view of this situation, it is specially stipulated that whoever disposes of the patient is responsible for the charge, and the doctor's advice is checked by the singer in the morning. At the same time, the head nurse will check the medical records on the bookshelf twice a week, and the responsible class will be responsible for the charge for long-term medical treatment in the afternoon. Those who pass the doctor's advice will be responsible for checking whether the doctor's advice is written in accordance with the requirements of the charging standard and whether there are any omissions. If there is any omission, it will be fed back to the parties in time and linked to the secondary distribution. Pediatric consumables are profitable, so we must do a good job of increasing income and reducing expenditure and strictly grasp economic management.
3 correctly handle nursing disputes
3. 1 causes of pediatric nursing disputes ① blood collection and infusion failed to "hit the nail on the head"; ② Poor fixation after successful scalp venipuncture, resulting in fluid extravasation or needle prolapse; (3) the work is not in place, lack of liquid; ④ Bleeding due to needle eye compression after needle extraction; ⑤ The baby's skin is delicate and the liquid oozes, causing local redness and blisters; ⑥ Nurses are busy rescuing critically ill patients or dealing with new patients, and have no time to deal with children immediately; ⑦ There are many patients, so the treatment and nursing can't be timely; (8) The family members were not informed of the purpose and precautions of various disposal and operations. Pet-name ruby explanation impatient, blunt attitude; The attending doctor comforted the child and sent him to the clinic, failing to arrange the examination in time.
3.2 dispute prevention measures ① strengthen the "three basics" training to improve their own technical level; (2) Nurses are arranged flexibly, and nurses are matched according to age, technical level, strong sense of responsibility and complementary advantages, which solves the problem of few nurses and weak technical strength beyond 8 hours; (3) Strengthen legal awareness, carry out responsibility education, conscientiously do every nursing operation, truthfully record nursing documents, and protect yourself while protecting children; (4) Strict physical examination system. Every child's daily infusion (including temporary liquid) should be carefully checked. The name, dosage, maker, infusion time and operating nurse of each bottle of liquid shall be recorded, and the responsibility shall be borne by myself; ⑤ Strictly implement the notification system to inform the purpose and precautions of each operation and disposal; ⑥ Contact the corresponding departments in advance when sending for inspection, and send the children to check in time after calming down; ⑦ Implement dispute early warning system. For children who have a tendency to argue, the nurse on duty should not only report to the director and head nurse, but also do a good job of handing over the shift and quickly transmit the information to each class, so that each class can be cautious and prevent the situation from expanding.
3.3 coping strategies of head nurses First of all, head nurses should find, intervene and deal with nursing disputes as early as possible, stop emotional dissatisfaction or excessive behavior as early as possible, and block its malignant development in time. There are three things to be done in dealing with disputes, namely, avoiding them at first sight, persuading them not to provoke them, and dispersing them without gathering them [3]. Secondly, we should face the children's parents with a good psychological state, receive them calmly and enthusiastically, listen patiently to complaints and reflections, and let the children speak their minds. If we really can't work, we should apologize to our families. Fighting, gathering people to make trouble, unreasonable entanglement and other illegal means. They are all solved through legal channels in the hospital.
refer to
Xu Meifang. On the non-right influence of head nurses [J]. Journal of Practical Nursing, 2002, 18 (4): 68.
Jia Chongling. Analysis of nursing disputes in pediatric wards [J]. Inner Mongolia Medical Journal, 2003,35 (2):184.
[3] Li Hua, Fu Minghui, Zhou Shujun. Cultivation of head nurses' emergency ability to deal with nursing disputes [J]. Contemporary Nurses: Comprehensive Edition, 2003 (8): 20.