Model essay on nursing of cardiac surgery 1: implementation method and experience of high-quality nursing service of cardiac surgery Keywords: cardiac surgery; Quality nursing service; Experience in implementing methods
introduce
At present, great changes have taken place in medical model and nursing concept. Since June 20 10 National Conference on Nursing Work, hospitals have carried out high-quality nursing demonstration projects. Taking this as an opportunity, in order to optimize the nursing management business system, improve the quality of nursing service, enhance the professional image of nurses, fully perform the duties of nursing staff and provide high-quality nursing services, the "Quality Nursing Service Procedure for Cardiac Surgery" is specially formulated. Quality nursing service? The initial implementation of the new concept in cardiac surgery has improved nursing quality, ensured nursing safety, further strengthened nurses' understanding of the connotation of the new concept of quality nursing service, and improved the satisfaction rate of inpatients.
1 Purpose of implementing quality nursing service
Cardiac surgery is a synthesis of acute, critical and severe patients. The patient's condition is complex and changeable, and there are many emergency treatments. Due to frequent treatment, nursing and observation, a very tense and fast-paced atmosphere has certain influence on patients. Patients' different cognition of diseases makes them have many ideas, which is not conducive to patients' cooperation and treatment. Through the implementation of high-quality nursing service, nurses establish a good relationship with patients through language and behavior, and responsible nurses actively guide and explain, dispel patients' doubts, make them actively cooperate with treatment, and make patients in the best treatment and rehabilitation state psychologically, physically and psychologically. From June, 2065438 to June, 2000, the new concept and new model of quality nursing service were applied to clinical nursing of cardiac surgery, and good results were achieved.
2 implementation method
2. 1 mobilization preparation
2. 1. 1 publicity and education, comprehensive deployment In order to make the medical staff in our department realize the importance and practical significance of this work as soon as possible, the department held several meetings of nursing staff to publicize this work, emphasizing development? Quality nursing demonstration project? Strengthening nursing work is an important measure to achieve the goal of medical reform, and it is an objective requirement to continuously improve medical quality and build a harmonious doctor-patient relationship. The head nurse took the initiative to understand the nurses' mental state and communicated with them effectively, so that the nurses' understanding was unified and this work was carried out in the hospital, which laid a good ideological foundation for the smooth development of the work and sent two nurses to participate? Provincial seminar on quality nursing demonstration project? Practical learning.
2. 1.2 Actively publicize and accept the active participation of all personnel in the regulatory department? Quality nursing demonstration project? Activities, in the start-up stage of the work, timely hold an implementation meeting to publicize to all employees? Quality nursing demonstration project? What is the purpose and significance of organizing all nursing staff to actively participate in the activities organized by the nursing department? Experience sharing meeting of quality nursing service. Learn and absorb the effective methods of other departments to carry out high-quality nursing services, and make them public on the hospital website? Quality nursing demonstration project? Columns learn from each other, learn from each other, publicize basic nursing items and contents at the same time, and accept the supervision of society and clients.
2.2 Revise various nursing responsibilities, systems and working procedures.
Organize general nurses to seriously study the Nurses Regulations and the Notice of the Ministry of Health on Strengthening Clinical Nursing in Hospitals. Due to the change of nursing work mode and work content, the nursing department revised the assessment standard of nursing quality, job responsibilities and work standards of clinical nurses, and related work processes such as discharge and admission around the 16 key tasks proposed by the Ministry of Health. Combined with the service standard of common clinical nursing technology and the working standard of basic nursing service, the operation procedures of common clinical nursing technology and basic nursing were formulated, and the Guide to Demonstration Project of High-quality Nursing Service was compiled, which was distributed to all departments to organize learning, carry out basic nursing operation training and standardize nurses' operation procedures.
2.3 Adjust the typesetting mode, carry out responsibility contracting, and earnestly implement basic nursing posts.
Reform the traditional scheduling mode and make reasonable scheduling according to the professional title and strength of nurses. There are 60 beds in the ward and 2 nurses1person. Except the head nurse, the main class nurse and the deputy class nurse, the rest 18 people are responsible. Pay in one lump sum? Patience. Ward beds are divided into two groups (consisting of 1 nursing team leader and 8 responsible nurses), with 30 beds in each group. The nursing team leader is a nurse and a senior nurse in turn. Each group of nurses served each group of patients for a long time. The names of nursing team leader, responsible nurse and team members are posted on the ward publicity wall to let patients know the names of nurses in charge of their nursing work. When the responsible nurse is not on duty, the nursing team leader or other responsible nurses are responsible. The responsible nurse will implement holistic nursing in her work, and integrate basic nursing, condition observation, treatment, rehabilitation and health guidance for patients. The nursing team leader should not only be responsible for the responsible nurse, but also be responsible for the nursing quality inspection of his group and the guidance of young nurses, and determine the division of responsibilities among the nursing team leader, the responsible nurse and the main nurse. According to the wishes of most nurses in the ward and the needs of patients, the nurse scheduling mode is adjusted, and the responsible nurses provide full, continuous and seamless satisfactory care.
2.4 Strengthen nursing quality management and human resource management.
Nursing safety is the basis of nursing quality, the key to high-quality nursing, and an important link to prevent and reduce medical accidents and disputes. The head nurse and nursing team leader check the implementation of each shift every day, discover and eliminate all kinds of hidden dangers, the implementation of various inspection systems, the implementation of basic care for critically ill patients, the standardized writing of nursing documents, whether comatose patients use bed bars, and whether they fulfill their obligations of informing and recording in time. , strengthen the management of human resources of nurses at all levels, reasonably arrange their duties and strictly fulfill their obligations as nurses.
2.5 Reform the salary mechanism, use different levels of nurses, and expand the content of nursing services.
Change the original? A pot of porridge? Equal distribution, the implementation of a clear reward and punishment salary mechanism. All staff actively offer suggestions and suggestions for the effective implementation of high-quality nursing services, and actively and effectively reward them. One-on-one delivery, help and guidance are provided to new and old nurses, and each shift is implemented in double shifts, which refines the workflow, expands the content of nursing services, strictly implements the basic nursing work of patients every day, and personally implements life care such as washing hair, wiping back and washing feet for each patient.
2.6 Pay attention to humanistic care and create a warm ward.
Paying attention to humanistic care, providing humanized nursing service for patients and good service attitude and behavior are the keys to improve nursing quality and provide the best service for patients [1]. Our nursing work requires five points: beautiful appearance, many greetings, diligent inspection, careful observation and fine business. In particular, nurses' sincere smiles and concerned eyes have narrowed the distance with patients, increased understanding and tolerance, and built a solid bridge of communication.
3 experience
3. 1 changed the concept and improved the service attitude. Good service attitude and behavior is the key to improve nursing quality and provide the best service for patients. In nursing work, we should persist in taking the patient as the center and achieve four lightness: speaking lightly, walking lightly, closing the door lightly and operating lightly; Four hearts: warmly receive patients, patiently answer questions, accept opinions with an open mind, and conscientiously implement doctor's advice; Six tones: when the patient comes, there is a greeting, when he asks, there is an echo, when he leaves, there is a farewell, when he cooperates, there is a thank you, when he makes a mistake at work, there is a greeting when he answers the phone. Frequently asking patients about their diet, medication and whether they need help in life not only improves patients' satisfaction, but also improves nurses' cultural quality and accomplishment.
3.2 The sense of responsibility was strengthened, and the quality of nursing was obviously improved. After the development of high-quality nursing service, a group of nurses provide patients with full-time responsibility nursing service from admission to discharge, so that nurses can master the patient's condition more carefully and comprehensively, including psychological changes, implement basic nursing and do a good job in specialized nursing, so that all treatment and nursing work can be completed accurately. Departments focus on organizing nurses to study every month, strengthen nursing safety education and enhance the awareness of law and self-protection; Arrange standardized training every week. After the implementation of high-quality nursing service, the quality of nursing has been obviously improved.
3.3 Life care in place, patient satisfaction improved significantly. Implement basic nursing and life nursing, effectively care for patients' condition by mastering professional knowledge, and bear in mind that therapeutic nursing and life nursing are equally important, and take meticulous care of patients. In the process of implementation, the basic nursing operation process is constantly standardized, the basic nursing service facilities are improved, and the basic nursing service scope is expanded, so that patients can truly feel the high-quality nursing service.
3.4 A harmonious doctor-patient relationship has been created, and the doctor-patient relationship has been significantly improved. Nurses improve communication with patients by providing them with all-round holistic nursing services. Patients can feel the care of nurses at any time, and patients and their families have more trust and dependence on nurses.
After the development of high-quality nursing service ward in our department, the ward has become clean and hygienic, and the proportion of patients accompanying and self-employed nurses has been greatly reduced. Many wards are crowded with nurses who praise us and thank their patients. Nurses' active work consciousness and working methods have also changed, and their work enthusiasm has been greatly improved. However, there are still many shortcomings, and efforts are still needed to further deepen the patient-centered service concept. Demonstration project of quality nursing service? The activities are consistent, so that patients can really get benefits, thus achieving a common goal: patient satisfaction, government satisfaction and social satisfaction.
References:
[1] Hu Deying, Preliminary study on developing responsible nursing in surgical high-quality nursing service pilot wards [J]. Journal of Nursing Science, 20 10/0,25 (18); 22- 23
Model article 2: Blood transfusion risk of patients undergoing heart surgery and nursing countermeasures. Blood transfusion therapy can make the recipients get the most effective treatment and the greatest safety. Although the surgical skills and perfusion techniques of cardiac surgeons have improved, the goal of the new blood transfusion therapy is to reduce or not transfuse blood after heart surgery. However, due to the particularity of heart disease patients' condition and the requirements of surgery, blood loss during operation, unstable circulation after operation and insufficient volume will all require blood transfusion treatment. Through blood transfusion treatment, patients with blood loss can quickly replenish blood volume and improve circulatory function. Turn the dying life around. Therefore, blood transfusion nursing is one of the routine work of cardiac surgery nurses. The cardiac surgery department of Xijing Hospital performs more than 3,800 cases of cardiac surgery every year, and tens of thousands of milliliters of blood are injected into each patient through the hands of different nurses every year. However, blood transfusion may cause adverse reactions and complications. Any negligence in this link from the application for blood transfusion to the completion of blood transfusion may affect the life of patients. And limited by the current level of science and technology, blood transfusion can not reach zero risk [1]. Medical disputes caused by blood transfusion are also reported in the media from time to time, so safe blood transfusion is a concern of the whole society.
1 Risk factors affecting blood transfusion safety in patients undergoing cardiac surgery
1. 1 Nurses are indifferent to the laws and regulations related to blood transfusion: "People's Republic of China (PRC) Blood Donation Law" and "Technical Specification for Clinical Blood Transfusion" are important legal documents to ensure the safety of clinical blood use and guide clinical blood transfusion. Some nurses only pay attention to routine work in clinical work, ignoring the study of laws and regulations, which leads to the lack of relevant knowledge and blind operation, which affects the curative effect of blood transfusion, increases the pain of patients and even leads to their death.
1.2 nurses are overworked, and the rules and regulations are not effectively implemented: nurses are the concrete executors of blood transfusion treatment. In clinical work, especially in big hospitals, nurses have a heavy workload. In a busy state, individual nurses often ignore the implementation of rules and regulations and simplify their work. Failure to strictly enforce the rules and regulations at work will lead to mistakes. For example, when several patients need to collect blood samples at the same time, the nurse will bring several patients' test tubes at the same time, so that the blood samples will be misplaced in the busy work. Especially in the past two years, the reform of the national medical system and the implementation of the new rural cooperative medical system have brought vital benefits to the broad masses of the people, but at the same time, they have also brought about a sharp increase in patients in large hospitals, and sometimes even a blowout state. With more patients, the workload of nurses and doctors is bound to increase. Every day, the ward nurses need to complete the preoperative preparation for patients with 6- 10 heart disease. Chen Yuning [2] and others reported that the defects caused by clinical blood transfusion in a hospital in Chengdu accounted for 4.09%, the main defect was incomplete blood transfusion records, and the serious problem was the wrong matched blood samples.
1.3 there are many links in the treatment of patients during hospitalization; Most patients admitted to cardiac surgery are critically ill, and their hospitalization needs the cooperation of many departments. After hospitalization, patients need to go through ward (preoperative preparation), operating room (operation, anesthesia, cardiopulmonary bypass perfusion), intensive care unit (critical period) and ward recovery. Whether it is emergency or elective surgery, patients' blood samples must be collected for cross-matching test before heart surgery. Under normal circumstances, the cross blood samples of patients undergoing elective surgery are collected by ward nurses and sent to the blood bank by medical staff. Some emergency operations will collect blood samples in the operating room, and most patients' blood transfusion is carried out in ICU during or after the operation. During the period, we passed the staff of ward nurses, medical staff, blood bank staff, operating room nurses, ICU and other departments, and any negligence in the process may lead to blood transfusion errors, from the labeling on the test tube where blood samples are stored during blood collection, the verification during blood collection, the handover during sample delivery, and the verification with blood bank staff during blood collection to blood transfusion for patients. Literature [3] reported that 10% of blood transfusion errors occurred in nurse sampling, and 5 1% occurred in blood sample collection and management. The analysis of blood transfusion error data by Naqin [4] and others shows that most of them are not technical reasons, but are caused by ignoring the inspection.
1.4 The patient's condition is complex and changeable, so it is difficult to make a detailed and accurate assessment. Because of the particularity of heart disease, the condition of heart patients changes dramatically and rapidly, and more drugs are used in clinic. The clinical emergency is several times that of other surgical patients. Combined with the influence of drugs that may be used before operation, the coagulation mechanism of patients is disordered; The collateral circulation of patients with special cyanosis is rich; Due to the influence of cardiopulmonary bypass during operation, coagulation factors and platelets are destroyed more; In addition, the operation is complicated, and the early postoperative circulatory stability of patients is poor. Therefore, it is difficult to evaluate the patient's condition in detail and accurately, which requires nurses to have rich nursing experience, wide knowledge and strong understanding. 2 nursing countermeasures
Blood transfusion is one of the important clinical treatment measures [5], especially in cardiac surgery, where there are more critically ill patients and more blood transfusion in clinical work. In the process of blood transfusion, every nurse should be careful, always pay attention to the safety of patients, play a high sense of responsibility, and prevent mistakes.
2. 1 informed consent before blood transfusion: the family members of patients have the right to informed consent for blood transfusion. Because there is a window period for viral infections such as AIDS and hepatitis, the blood infection index of blood donors in the window period is negative. Although the detection methods are more and more advanced, there is also the possibility of being infected with AIDS, hepatitis and other viruses during blood transfusion. Talk to the patient's family before blood transfusion, tell the patient the purpose and risk of blood transfusion in detail, get the understanding of the patient and his family, and make them ask for information actively during blood transfusion.
2.2 Strictly abide by professional ethics and conscientiously implement rules and regulations: Nurses should not only have excellent skills, but also have noble professional ethics, conscientiously implement various rules and regulations in the process of clinical blood use, set an example, and be responsible for patients and themselves. Seriously implement the technical specifications of blood transfusion, strictly follow the blood transfusion process and detailed operating procedures, so that every heart patient can get safe blood collection and safe blood transfusion during clinical treatment.
2.3 Strengthen the observation of the condition and prevent the adverse reaction of blood transfusion: Because the condition of heart patients is complicated and changeable, the requirements for blood transfusion should be stricter. Nurses should do a good job at all levels before blood transfusion treatment, and do a good job according to the condition after blood transfusion? Dos? That is to say, it is necessary to monitor, patrol, ask and observe more to prevent the occurrence of transfusion reaction. Once there is an adverse reaction to blood transfusion, it is required to stop blood transfusion immediately, actively report to the doctor, and actively treat and prevent other complications on the premise of maintaining stable circulation. At the same time, it is necessary to organize relevant staff to discuss and analyze the reasons for the investigation in order to eliminate hidden dangers. After each blood transfusion, it is required to keep the blood transfusion bag for 24 hours so that it can be rechecked in case of an accident.
2.4 Strengthen link control, pay attention to knowledge training, and prevent mistakes: All departments should pay attention to regularly training all kinds of medical personnel on blood transfusion and related knowledge, so that they can fully master blood transfusion knowledge and skills, and be familiar with the purpose, function, method and safe time of blood storage, requirements during blood transfusion, and key points of handover, etc. Make medical staff constantly update the new knowledge and methods of blood transfusion and blood use in their work, and choose component blood transfusion more appropriately according to the characteristics of different treatment stages of each heart patient, so as to reduce the risk of blood transfusion, thus reducing disputes and making clinical blood transfusion safer.
3 abstract
Reducing the risk of clinical blood transfusion is a systematic project, and it is also a stage work that medical staff at all levels need to work hard for a long time. It requires the unremitting efforts of all medical personnel involved in blood transfusion and the participation and support of the whole society. Only by fully understanding the risk of blood transfusion, understanding the measures to reduce the risk, strengthening publicity and education, and using blood scientifically and rationally can this risk be minimized.
refer to
Li Aiqin. Problems that nurses should pay attention to in preventing blood transfusion disputes. Chinese Journal of Nursing, 2004,39 (3): 206-207.
[2] Chen Yuning. Contrastive analysis of defects in main links of clinical blood transfusion. Noise of medical practice in China, April 2005 (11):1162-1163.
[3] Lv Zhenxiu, Chen,. Nursing safety management of blood transfusion in operating room. Nursing Practice and Postgraduates, June 2009 (17):120-121.
[4] that piano. Clinical transfusion nursing. Journal of Military Medical University, 2005,26 (3): 239-240
Cloud spiritual practice. Discussion on nursing care of safe blood transfusion. International Journal of Nursing, 2007,4 (26): 337-338
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