Model essay on psychological nursing in internal medicine 1: risk factors and management countermeasures of department nursing 1. Materials and methods
1. 1 general information
68 cases of internal medicine patients admitted to a hospital from March 20 1 1 to February 201were selected as the research objects, including 3 cases of female patients and 37 cases of male patients. Age 14 ~ 66 years old with an average of 36 years old. Among these 68 patients, gastroenterology 12 cases, cardiovascular medicine 18 cases, respiratory medicine 20 cases and nephrology 18 cases.
1.2 research methods
Through retrospective analysis, the clinical data of 68 patients were sorted out and analyzed, and a special investigation team was set up to investigate the possible nursing risk factors in internal medicine. Statistically, the problems caused by possible nursing risk factors were recorded in detail, classified and summarized, and then counted with tables.
Second, the result
68 patients received scientific and effective nursing in the internal medicine department of this hospital. 1 patient had transfusion leakage, and the symptoms were relieved after timely treatment and treatment; Two patients had an economic dispute with the hospital, which was finally solved reasonably through patient explanation and hospital verification. The overall complaint rate of internal medicine was 2.94%.
Three. discuss
3. 1 Analysis of risk factors of internal medicine nursing
3. 1. 1 The allocation of internal medicine nursing staff is insufficient and the workload is unreasonable.
Under the background of the gradual popularization of the new rural cooperative medical system and urban medical insurance, the number of inpatients in hospital internal medicine has also increased year by year. At the same time, the quality of nursing in hospital internal medicine is also improved with the improvement of patients' and their families' requirements. The related technology and operation of clinical nursing and the workload of basic nursing have also increased exponentially. Coupled with the shortage of clinical nursing staff, the bed-to-nurse ratio is unreasonable, which can not meet the relevant regulations of the health department. In this working environment and requirements, nurses are often in a state of high tension and are very tired after work every day. In this way, when a nurse faces multiple critical patients, the nursing risk will increase, which will increase the occurrence of her negligence.
3. 1.2 The knowledge of some nurses is relatively narrow.
There are many kinds of medical diseases, the age gap between patients is also large, there are many rescues, the situation of combined medication is more complicated, and there are many nursing operations. This requires the nursing staff of internal medicine to have knowledge of multi-disciplinary related aspects at the same time, and also have the ability to observe the patient's condition. In addition, they should be proficient in using various rescue instruments and master some necessary first aid techniques. But some nurses can't do it at all because of their narrow knowledge and low professional level. Usually reflected in the following three aspects: first, when observing the patient's condition, it is impossible to make a correct understanding of some symptoms of the patient, which will delay the diagnosis and treatment of the patient's condition; Secondly, nurses can't skillfully use the commonly used or latest related diagnosis and treatment equipment, and they can't cope with some unexpected situations when operating, which is likely to make mistakes in chaos and even cause some unnecessary nurse-patient disputes; In addition, in the process of treating patients, nurses may also cause unnecessary pain to patients because of their unskilled operation techniques, thus causing dissatisfaction among patients and their families, and then causing some disputes.
3. 1.3 bed movement events are frequent.
In internal medicine, it is likely that some bed-moving events often occur because of age, patient's condition change, disease change and other reasons. However, after moving to the hospital bed, there may be some mistakes or untimely changes in bedside cards, medication lists, nursing lists and treatment lists, which may lead to some nurse-patient disputes.
3. 1.4 Nurses lack certain legal awareness.
According to the investigation on the legal consciousness of internal medicine nurses, the awareness rate of ordinary nurses about medical litigation is only 38. 12%, so they can't fully understand some legal problems that may exist in their working environment. In the process of work, I just started from serving patients and didn't consider some of my rights and interests.
3. 1.5 Some risks in inpatient management
Under normal circumstances, inpatients need to comply with the requirements of relevant hospital systems, actively cooperate with the work of medical staff in departments and obey management. However, some inpatients ignored the requirements of the hospital system and went out privately. In this process, some accidents are likely to occur, which will lead to legal disputes and increase nursing safety hazards. In view of some possible nursing risks in hospital internal medicine, corresponding risk management measures must be taken to reduce the probability of risk events as much as possible, help patients recover, and be conducive to harmonious doctor-patient relationship.
3.2 the corresponding countermeasures to improve the risk of internal medicine nursing
3.2. 1 Rational allocation of internal medicine human resources to improve the knowledge and technical level of nursing staff.
In order to maximize the rational allocation of human resources, we can implement flexible scheduling system, reform the old scheduling mode, appropriately strengthen the nurses from 12: 00 to 13: 00 and 18: 00 to 19: 00, alleviate the chaos and avoid mistakes in busy work as much as possible. At the same time, it is necessary to strengthen the knowledge and technical training for nursing staff so that they can skillfully use various instruments and equipment in the department. Only in this way can we ensure that the nursing work is carried out in an orderly manner in the intense progress, and then prevent some unnecessary mistakes and accidents.
3.2.2 Standardize the work of internal medicine nurses.
Medical nursing managers must formulate and improve the relevant nursing system according to the relevant situation of their own hospitals, standardize the work of nursing staff and enhance their sense of responsibility. For example, when moving a bed, the patient's bedside card, medication list, nursing list and treatment list should be replaced in time.
3.2.3 Strengthen the study of legal knowledge of internal medicine nurses and improve their awareness of self-protection.
Department nursing managers should regularly organize nurses to learn medical-related legal knowledge, such as the Regulations on Handling Medical Accidents and other legal provisions, be familiar with and master the relevant rights and obligations of nursing staff and the corresponding legal responsibilities, and improve their legal awareness. In the learning process, it is necessary to increase the relevant analysis of actual cases, so that nursing staff can understand and abide by the law and minimize some safety hazards in nursing work.
3.3 Strengthen the management and education of internal medicine inpatients.
While improving the management system of internal medicine, we should also strengthen the publicity and education of inpatients in internal medicine, so that patients can have an accurate understanding of their own condition, and explain some rules and regulations that need to be observed during hospitalization, so that patients can sign the admission notice and file it with medical records. During hospitalization, it is necessary to strengthen the inspection of the ward, keep abreast of the latest developments of patients, and find and discourage patients from going out unnecessarily in time. For patients who leave the hospital without permission, they should promptly notify the doctor on duty and contact their families, and keep a record of the time when the patients leave the hospital.
Fan Wen-2, Psychological Nursing of Internal Medicine: Hidden Dangers and Measures of Respiratory Medicine Nursing 1. Analysis of Hidden Dangers of Respiratory Medicine Nursing
Accident 1. 1
1. 1. 1 fell.
Most of the patients in respiratory medicine are elderly people, and there are some factors such as weak constitution, poor eyesight and poor response ability. Some patients use diuretics, vasodilators, antiallergic drugs, hypoglycemic drugs and other drugs that are easy to fall, which are prone to accidents.
1. 1.2 falling into bed
Patients with pulmonary encephalopathy often show excitement and irritability, while patients with nervous system diseases, such as Alzheimer's disease, are prone to fall.
1. 1.3 Asphyxia and aspiration
Patients with hemoptysis and increased sputum that are not easy to cough up are prone to suffocation; Patients with nervous system diseases (such as cerebral infarction). ) It is prone to dysphagia, and food choking causes suffocation and aspiration.
1. 1.4 Pipeline falls off.
Patients with pneumothorax and pleural effusion often use closed thoracic drainage, such as improper fixation, improper activity, excessive traction and other reasons will lead to catheter fall off; Whether it is possible to pull out the stomach tube, catheter, tracheal intubation and tracheotomy.
1.2 specialist operating procedures are not implemented in place.
1.2. 1 hidden danger of oxygen therapy
Oxygen poisoning can occur when the oxygen concentration is too high and the oxygen inhalation time is too long during oxygen therapy. In patients with chronic obstructive pulmonary disease, continuous high-concentration oxygen inhalation will cause carbon dioxide retention and cause or aggravate type ⅱ respiratory failure; Some patients have poor compliance with oxygen therapy, and stopping oxygen inhalation by themselves can not achieve the expected curative effect.
1.2.2 nursing hidden trouble of sputum aspiration
Inadequate assessment of the condition, too long time of single sputum aspiration and too short interval between two sputum aspiration can all lead to hypoxemia, aggravate the condition and cause accidents.
1.3 factors of nursing staff
1.3. 1 lack of comprehensive ability.
Although the knowledge level of nurses has improved at this stage, their ability to find and solve problems in practical work is uneven. Factors such as inadequate specialist training, insufficient first aid skills and poor emergency ability directly affect the rescue effect; The same patient is often complicated with many diseases, and there will be some nursing contradictions because of the nursing problems involving many specialties, which puts higher demands on nurses.
1.3.2 Lack of high sense of responsibility in work
Careless work, lack of cautious and independent spirit; The observation of the disease is not careful enough, the hidden danger is not found in time, and the intervention is not timely; The implementation of responsibilities, systems and processes is not standardized.
1.4 nursing management factors
The quality management system of 1.4. 1 is not perfect.
Nursing management monitoring pays too much attention to assessment, lacks refined management concept, the emergency plan is not implemented in place, the measures are not effective, and the nursing core system is not strictly implemented, which leads to nursing defects, which is a risk with high incidence and great loss.
1.4.2 The allocation and work intensity of nursing staff are asymmetric.
The allocation of nursing staff can not meet the needs of patients, and the lack of nursing human resources, especially the growing nursing needs of patients, makes nurses overload and work hard, resulting in insufficient energy, inattention, uncontrollable link quality and inadequate service, which brings insecurity to patients; Imperfect management system and inadequate quality control are all important factors that cause nursing insecurity.
Two, respiratory medicine nursing safety hidden trouble prevention countermeasures
2. 1 accident prevention
2. 1. 1 Fully evaluate patients and take corresponding protective measures.
For patients with high risk factors of accidents, establish warning signs at the bedside; Communicate effectively with family members, gain their trust and cooperation, and give them care; At the same time, seriously implement the system of succession and graded nursing. Patients who are prone to fall should avoid walking alone and stay in bed if necessary; Patients who are prone to bed accidents such as excitement and irritability should take necessary protective measures, such as applying bed railings and limb straps; For patients with risk factors of suffocation and aspiration, effective measures should be taken in time, and an aspirator should be equipped at the bedside, and the patient should be placed in the rescue room if necessary; For patients with dysphagia and cough, turn the food into paste and raise the bedside by 30? ~45? , if necessary, indwelling gastric tube; All kinds of drainage tubes are properly fixed to avoid folding, twisting, falling off and being pressed, to maintain effective drainage and avoid unplanned extubation; For patients with closed thoracic drainage, there are related items at the bedside, such as blood forceps and sterilized vaseline gauze.
2. 1.2 Make emergency plans for common accidents in respiratory department and organize nurses to study.
The morning meeting and shift change are used to simulate the situation and how to deal with emergencies, so as to continuously improve the problem-solving ability of nurses.
2.2 Standardize specialist nursing operation and strengthen supervision and management.
2.2. 1 oxygen therapy nursing
Correctly evaluate the condition and conscientiously implement the doctor's advice; Strictly master the requirements of oxygen therapy indications, oxygen concentration, oxygen inhalation mode and time; Closely observe the effect and reaction of oxygen therapy; Strengthen patients' safety and health education and improve patients' compliance with oxygen therapy.
2.2.2 Master the essentials of sputum aspiration operation.
Correct control of negative pressure (40.0 ~ 53.3 kpa, children
2.3. 1 Improve the overall quality of the nursing team, encourage nurses to participate in various forms of continuing education and training, and obtain new knowledge, new trends and new concepts at home and abroad through multiple channels; Strengthen the training of young nurses, cross-train as needed, and implement? Three schemes for dynamic continuous observation and evaluation of young nurses' growth.
2.3.2 Strengthen the sense of responsibility.
Educate nurses to implement various treatment and nursing measures in strict accordance with their duties, systems and procedures, overcome their careless working attitude, and cultivate their due cautious and independent spirit.
2.4 Strengthen nursing safety management and rationally use human resources.
2.4. 1 Strengthening nursing safety management
Formulate the nursing quality standard and emergency plan of respiratory medicine specialty, and revise the nursing routine and operating routine of respiratory medicine specialty; The ward implements the quality control mode of full participation, establishes a quality control team, establishes a follow-up checklist for continuous improvement of nursing quality, strengthens quality control, and corrects problems in time when found.
2.4.2 Rational use of human resources to improve the working conditions of overload.
Head nurses make full use of existing human resources according to the specific conditions of their own specialties; Improve the nursing work mode and implement the responsibility system; Improve workflow and implement flexible scheduling. (This article is from the journal of Nursing Practice and Research. For a brief introduction of nursing practice and research, please refer to. )
Three. abstract
Clinical nursing managers should attach importance to nursing risk education and formulate corresponding emergency plans for the hidden dangers of specialized nursing; Improve the nursing workflow and routine, standardize the operation process; Strengthen the training of professional ability and emergency ability of nursing staff; Strictly control the quality of nursing, find the existing problems in time, and take effective preventive measures to intervene to ensure the safety and rights of patients.
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