quality care

优质护理
  • 文章类型: Journal Article
    背景:随着医疗技术的不断进步,神经外科护理不断发展和完善,提供更优质的护理服务。
    目的:探讨神经外科护理中不同类型优质护理对临床护理质量及患者满意度的影响。
    方法:选择2020年6月至12月在西南医科大学附属医院接受神经外科治疗的80例患者作为研究对象,分为研究组和对照组。研究组由40名患者组成,他们接受了4种不同类型的优质护理,而对照组包括40例接受常规护理的患者。经过一段特定的时期,比较两组患者的护理满意度、不良事件及并发症发生率。
    结果:对高质量护理的满意度高于常规护理,高质量的卫生服务和区域服务表现出最高的满意度,格拉斯哥量表的平均得分为12分。研究组和对照组的满意度分别为75%和57%,分别,差异具有统计学意义(t=7.314,P<0.05)。在护理期间,III级病理分级和神经外科手术患者的不良事件和并发症发生率最高(40.02%和85.93%,分别),差异有统计学意义。
    结论:在神经外科护理中,采用适当的优质护理方法可以有效降低患者的不良事件和并发症发生率,从而提高护理质量,增加临床护理价值。
    BACKGROUND: With continuous advancements in medical technology, neurosurgical nursing is constantly developing and improving to provide higher-quality nursing services.
    OBJECTIVE: To explore the effects of different types of high-quality nursing care on clinical nursing quality and patient satisfaction in neurosurgical nursing.
    METHODS: Eighty patients who received neurosurgical treatment in the Affiliated Hospital of Southwest Medical University from June to December 2020 were selected as study participants and categorised into study and control groups. The study group comprised 40 patients who received 4 different types of high-quality nursing care, whereas the control group comprised 40 patients who received conventional nursing care. After a specific period, nursing satisfaction levels and adverse event and complication rates were compared between the two groups.
    RESULTS: Satisfaction with high-quality care was higher than that with conventional care, and high-quality health services and regional services showed the highest satisfaction levels, with an average score of 12 on the Glasgow scale. The satisfaction levels of the study and control groups were 75% and 57%, respectively, with a statistically significant difference (t = 7.314, P < 0.05). During the nursing period, the adverse event and complication rates were the highest in patients with level III pathology grade and those who underwent neurosurgery (40.02% and 85.93%, respectively), and the difference was statistically significant.
    CONCLUSIONS: In neurosurgical nursing, employing appropriate high-quality nursing methods can effectively reduce adverse event and complication rates in patients, thereby improving the quality of nursing care and increasing clinical nursing value.
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  • 文章类型: Journal Article
    背景:国际上,不断努力开发患者投诉渠道,以了解患者对护理的体验和期望,从而指导卫生服务质量的提高。尽管患者反馈的价值是一致的,对使用患者反馈来预测和促进实际质量改进举措的关注有限。
    目的:确定从公共反馈热线收集的患者反馈是否可用于预测医院优质服务改进措施的效果。
    方法:对某三甲医院2018-2021年患者投诉资料进行回顾性分析。首先通过澳大利亚医院患者体验问题集的标准分类方法对患者投诉进行编码。然后通过频率和列联表分析分析患者投诉的特征。最后,通过非参数Mann-Kendall检验和Joinpoint回归模型,测试了每个投诉特征的趋势。
    结果:在收到的771起针对临床医生的投诉中,其中约有75%与医生有关。“伤害和痛苦”是投诉的主要原因,接着是“不关心”,\'缺乏自信\',\'需要未满足\'和\'未通知\'。2021年,与医生造成的中度“伤害和困扰”有关的投诉数量比2020年增加了667%。\'未通知\'的类别,“不关心”和“伤害和痛苦”也在上升,具有统计学意义。此外,与缺乏尊重有关的投诉,还记录了护士(n=83)和医生(n=121)表现出的不良态度和不专业行为。
    结论:通过公共反馈热线收集的患者反馈为深入了解患者的护理体验提供了一个有用的平台,这对于指导优质护理改进是有价值的。为了提高护理质量,临床医生需要在早期阶段参与质量改进策略的制定.需要努力改善医生与患者之间的沟通和互动,以改善患者的护理体验并发展患者对临床医生和医疗服务的信任。该研究强调了使用公共反馈热线来产生可以指导医院服务改善的证据的价值。
    BACKGROUND: Internationally, continuous efforts have been put into developing patient complaint channels to understand patients\' experience and expectation of care, which can guide the improvement of health service quality. Despite agreement among the value of patient feedback, limited attention has been paid to using patient feedback to predict and promote the actual quality improvement initiatives.
    OBJECTIVE: To determine whether patient feedback collected from a public feedback hotline can be used to predict the effect of hospital quality service improvement initiatives.
    METHODS: A retrospective analysis of patient complaint data of a tertiary hospital from 2018 to 2021 was performed. Patient complaints were first coded by the standard classification method of the Australian Hospital Patient Experience Question Set. The characteristics of patients\' complaints were then analysed by frequency and contingency table analysis. Finally, through Nonparametric Mann-Kendall test and Joinpoint regression model, the trends of each complaint characteristics were tested.
    RESULTS: Amongst the 771 complaints received against clinicians, approximately 75% of them were concerning doctors. \'Harm and distress\' was the key reason of complaints, followed by \'not cared for\', \'lack of confidence\', \'needs unmet\' and \'not informed\'. In 2021, the number of complaints received in relation to moderate \'harm and distress\' caused by doctors increased by 667% from 2020. The categories of \'not informed\', \'not cared for\' and \'harm and distress\' were also on the rise with statistical significance. In addition, complaints related to the lack of respect, bad attitude and unprofessional behaviour demonstrated by nurses (n = 83) and doctors (n = 121) were also recorded.
    CONCLUSIONS: Patient feedbacks collected via a public feedback hotline provides a useful platform to gain insight into patient experience of care which are valuable to guide quality care improvement. To improve the care quality, clinicians need to participate in quality improvement strategies development at an early stage. Efforts in improving communication and interaction between doctors and patients are needed to improve patients\' experience of care and developing patients\' trust in both of the clinicians and the medical services. The study highlights the value of using public feedback hotline to generate evidence that can guide hospital service improvement.
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  • 文章类型: Meta-Analysis
    系统评价优质护理对烧伤患者创面疼痛和焦虑的影响。PubMed的电脑搜索,谷歌学者,科克伦图书馆,Embase,万方,从数据库开始到2023年10月,对中国生物医学文献数据库和中国国家知识基础设施数据库进行了关于优质护理在烧伤患者中应用的随机对照试验(RCT)。根据纳入和排除标准,由两名研究人员筛选和评估文献。并从最终纳入的文献中提取数据。采用Stata17.0软件进行数据分析。总的来说,包括15例RCT和1115例烧伤患者,包括优质护理和常规护理组的563和552。结果发现,与常规护理相比,实施优质护理的烧伤患者伤口疼痛明显减轻(SMD:-1.79,95%CI:-2.22至-1.36,p<0.001),焦虑(SMD:-2.71。95%CI:-3.49至-1.92,p<0.001)和抑郁(SMD:-1.74,95%CI:-2.35至-1.14,p<0.001)水平在创伤后明显降低。
    To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: -1.79, 95% CI: -2.22 to -1.36, p < 0.001), anxiety (SMD: -2.71. 95% CI: -3.49 to -1.92, p < 0.001) and depression (SMD: -1.74, 95% CI: -2.35 to -1.14, p < 0.001) levels were significantly reduced post-trauma.
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  • 文章类型: Evaluation Study
    背景:在中国,卒中护理质量的差异仍然存在,实施质量改进仍是一项挑战.
    目的:确定上海卒中服务系统(4S)的干预措施是否有助于提高对卒中护理指南的依从性和患者预后。
    方法:4S是一个区域性卒中网络,在上海的61个卒中中心中进行实时数据提取。共评估了11项关键绩效指标(KPI)。主要结果是对11个KPI的依从性的综合测量和全无测量。次要结果是住院时间和住院死亡率。
    结果:该研究纳入了92,395名患者(平均年龄69.0±12.5岁,65.2%的男性)在2015年1月至2020年12月在上海发病7天内住院的急性缺血性中风。与2015-2017年相比,2018-2020年期间接受指南推荐护理的患者更多(综合测量为87.1%vs83.6%;绝对差异2.9%,95CI[2.7%至3.2%],P<0.001;全或无测量49.2%vs44.8%患者;绝对差异3.5%,95CI[2.7%至4.2%],P<0.001)。对单个KPI的进一步分析显示6个KPI的绝对增加范围为3.4%至8.9%(所有比较P<0.001)。与2015-2017年相比,住院时间更短(10.95vs11.90天;绝对差异-1.08,95CI[-1.18to-0.99],P<0.001),2018-2020年住院死亡率显着降低(RR0.88,95%CI[0.79-0.98];P=0.01)。
    结论:4S干预与卒中护理指南的依从性增加相关,这进一步转化为改善的临床结果。
    背景:ClinicalTrials.gov标识符:NCT02735226。
    In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge.
    The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome.
    The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality.
    The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015-2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference -1.08, 95% CI = [-1.18, -0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018-2020.
    The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes.
    ClinicalTrials.gov identifier: NCT02735226.
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  • 文章类型: Journal Article
    UNASSIGNED:本研究的目的是探讨老年股骨颈骨折患者应用医疗优质护理模式的护理效果及负面心理应激反应。
    UNASSIGNED:将我院2020年1月至2021年6月收治的130例老年股骨颈骨折患者随机分为对照组和观察组,每组65例患者。对照组采用常规护理模式,观察组采用优质护理模式进行医疗护理。本研究选取的观察指标为护理满意度,术后1、15和30天的髋关节屈曲活动,受影响的肢体主动从床上抬起的时间,以及患者的焦虑和抑郁。
    UNASSIGNED:在手术后的1、15和30天,两组患者的屈髋活动和患肢离床时间比较,差异有统计学意义(P<0.05)。观察组的护理满意度为95.38%,与对照组的80.00%比较,差异有统计学意义(P<0.05)。治疗后,观察组抑郁自评量表(SDS)和焦虑自评量表(SAS)评分均低于对照组(P<0.05)。
    UNASSIGNED:医疗护理的优质护理模式可有效促进老年股骨颈骨折患者的康复,减少患者的负面心理应激反应,提高护理满意度,对股骨颈骨折患者的护理具有重要的应用价值和指导意义。
    UNASSIGNED: The objective of this study was to explore the nursing effect and negative psychological stress response of elderly patients with femoral neck fracture by applying the high-quality nursing mode of medical care.
    UNASSIGNED: A total of 130 elderly patients with femoral neck fractures hospitalized in our hospital from January 2020 to June 2021 were randomly divided into the control group and observation group, with 65 patients in each group. The control group adopted the conventional nursing mode, while the observation group adopted the high-quality nursing mode of medical care. The observation indexes selected in this study are nursing satisfaction, hip flexion activity on the 1, 15, and 30 days after the operation, the time when the affected limb was lifted off the bed actively, and the anxiety and depression of patients.
    UNASSIGNED: On the 1, 15, and 30 days after the operation, there were statistically significant differences between the two groups in hip flexion activity and the time when the affected limb was lifted off the bed (P < 0.05). The nursing satisfaction of the observation group was 95.38%, which was statistically significant compared with the 80.00% of the control group (P < 0.05). After treatment, the self rating depression scale (SDS) and self rating anxiety scale (SAS) scores in the observation group were lower than those in the control group (P < 0.05).
    UNASSIGNED: The high-quality nursing model of medical care can effectively promote the rehabilitation of elderly patients with femoral neck fracture, reduce the negative psychological stress reaction of patients, and improve nursing satisfaction, which has important application value and guiding significance for the nursing of patients with femoral neck fracture.
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  • 文章类型: Journal Article
    OBJECTIVE: To improve perinatal management for hypertensive disorders in pregnancy (HDP) using checklists.
    METHODS: A pre-post evaluation of the implementation of checklists was performed. The checklist for HDP was adapted for the local context through expert consultations and had been used within peripartum since September 2017. Data of 763 women with singleton pregnancies diagnosed with HDP were collected between April 2016 and March 2019 at the Obstetrics & Gynecology Hospital of Fudan University. The monitoring and control groups consisted of 394 and 369 cases, respectively. Analysis was carried out by intention-to-treat with respect to maternal and fetal complications and delivery outcomes.
    RESULTS: After the implementation of the checklists, patients had a significant reduction in anti-hypertensive treatment both orally (P = 0.028) and intravenously (P = 0.003), and increased utilization rate of MgSO4 management (P < 0.001). Gestation was prolonged in the expectant treatment (P = 0.012) and the rate of elective and intrapartum cesarean delivery decreased (P < 0.001 and P = 0.001, respectively). The neonates of these patients had a low rate of admission to the neonatal intensive care unit (P < 0.001).
    CONCLUSIONS: National clinical guidelines complied critically after the implementation of the checklists. These checklists could be used for improving the quality of the clinical strategy and treatment, which benefitted perinatal management.
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