In order to improve the overall quality of nurses in order to carry out holistic care, quality of care, I conducted a survey in Zhoushan City, the Third People's Hospital.
1, materials and methods
1.1 Survey object:
Zhoushan City, the Third People's Hospital subjects hospitalized 50.
1.2 Survey method
To take the form of questionnaires to provide the hospital's nursing department. There is a comprehensive understanding of the questionnaire, 50 cases of patients randomly selected by the person field survey, released one after another patient, fill out the instant recovery. Questionnaire 50 copies, 50 valid questionnaires, the validity rate of 100%, using the percentage of statistical processing. Shooting received a "gross" in the survey process, accompanied by the patient to complete the questionnaire to avoid the presence of nurses, eliminating the patient's psychological problems, so it reflects the inner thoughts as much as possible in order to ensure the objectivity of the survey. Literacy please its independently completed questionnaires, do not give up any hint of illiteracy I read, can only read the content of the questionnaire, without any explanation to avoid misleading patients, to ensure the authenticity and accuracy of the findings.
1.3 Content of the survey
Patients' level of awareness, etiquette, awareness of responsibility and motivation, psychological care, service attitude, quality service and life care aspects.
2, results
2.1 General
50 patients in the 10th event occurred in two families, 10 cases, 10 cases, surgery, pediatrics, surgery 10 cases, 10 cases, pediatrics, 20%
2.2 Findings
The overall satisfaction of the survey
surveyed 67.8% versus 22.2% satisfaction for the 90% of the total, 10% dissatisfaction, the overall situation is still good, specific to each item are shown in the table. 502856142881650100
Nurse inquired about the condition 5043865102450100
Uncomfortable, the nurse helped 50377411222450100
Nurse found the patient to talk to 502652173471450100
Nurse talked about health problems of the patient in 502856163261250100
Helping patients 5042846122450100
Service attitude 50387610202450100
Nursing 50408010200050100
Life care 5023461428132650100
DISCUSSION
3.1 The survey, as a whole, showed patient or caregiver satisfaction. In recent years, due to the importance of community nursing, hospital nurses to provide a variety of learning opportunities, training courses, education of field hospitals, in addition, also large-scale training of university nurses, such as Zhejiang Ocean Institute Hospital (Zhoushan Medical College) kinda secondary school nurses, many people are accepted to enter the University of nurses, and all aspects of nurses, thus improving the overall quality. Now a large number of university nurses are gradually replacing secondary school nurses, the emergence of highly educated nurses has also increased the patient's trust nurses, for nurses, the work carried out, but also walked out from completely passive to carry out the clinical nurses, not only to improve the quality of care with the nurses' factors, at the same time with the patient, which requires both the nurses and patients. Zhoushan City, the Third People's Hospital to implement holistic care, (hereinafter referred to as the city hospital), also off the relationship between nurses and patients. In the survey process, the most prominent is the evaluation of the patient's nurses nursing skills, 80% satisfaction compared to 20% satisfaction, dissatisfaction is 0, enough to prove the professional skills of the nurses, the patient affirms the importance of nursing care, and in recent years, the hospital is closely related to the city hospitals Nursing Department often organizes the theme of the nurses operating skills assessment and games. In addition, with the development of medical services, is that medical work is no longer a passive aspect of the implementation, with the development of medical careers, it has its own independence, especially nursing skills, "three parts of treatment, seven parts of care", patients can largely depend on whether the restoration of health care. Finally, with strong competitiveness, urban hospitals have implemented a competitive entry, director of the nursing department, the main body of the general nurses, head nurses compete for the post, whether the article first depends on whether skilled nursing techniques to relieve pain, restore physical health of the patient's most basic needs, and to meet the needs of the body needs and other aspects of the demand. The concept of nurses to strengthen the practice of deepening the understanding of the patient's nurses care about the overall satisfaction to meet the needs of patients.
3.2 in the survey, reflecting the patient's motivation and responsibility of the nurse is also satisfactory. Points of the questionnaire results show that 86% of the nurses will often ask the patient's condition, 10% of the nurses rarely ask the patient's condition, only 4% of the nurses did not ask the patient's condition. It begins to be closely related to holistic nursing. "Patient-centered" holistic care nurses make it their responsibility to meet the needs of their patients. But soon after the overall care, there are still many problems, therefore, hospitals should often hold training courses to improve the nurses' overall care under the guidance of the correct theory, rational understanding, and can better carry out the "patient-centered holistic care" "Patient-centered, the nurse's work from the simple The nurse's work from the simple injection, infusion with the doctor's treatment to the full completion of the expansion. The overall depth of care, strengthen the sense of responsibility and initiative of nurses. The survey found that most of the nurses in the city hospital can be more proactive in order to inquire about the patient's condition, to take the initiative to help patients alleviate physical pain, in order to actively cooperate with the doctor to do the work of treatment, nursing in an active position is no longer simply physicians in order to perform. City hospital branches to implement the accountability system of nursing, recently launched the people assured that the hospital's service concept, the transformation, the Department of Nursing launched a hotel-style service, the organization of nurses in the hotel internships in the hospital, the more enhanced sense of responsibility of the nurses patient intimacy, but also conducive to give full play to the potential of the nurses and professional standards in order to improve the quality of care. Field survey found that most patients have a new understanding of nurses, nurses, nurses also have a certain degree of trust, change the phenomenon of contempt for nurses, which is inextricably linked with the nurses' solid theoretical knowledge and rich clinical experience.
3.3 The results of this survey look at the patient to provide satisfactory service attitude of the nurse's services, 76% of the patients nurse attitude of satisfaction, 20% satisfaction, 4% dissatisfaction. "Nurses are the unity of the beautiful soul and physical beauty." Meet the patient's nurses, nurses in recent years, the city hospitals to recruit the appearance of nurses, in addition to their own theoretical knowledge and practical skills assessment, its appearance is also listed as one of the assessment. Here refers to what we usually say looks different appearance, mainly including etiquette, dress, rather than "angel nurse", which requires nurses angel of speech and behavior, including decent clothes, appropriate makeup, and meet the etiquette of the identity. Municipal hospitals, except in the recruitment process, while nurses learn about etiquette and manners of nurses, most nurses have changed far from the hospital "cold face" to treat patients with a smile to accept, but there are 4% of patients satisfied with the nurses' service attitude, the main reason is the lack of manpower hospitals, nurses in addition to the commitment of the nursing operation also often Require patients to pay medical expenses, which will inevitably mean that the patient's dissatisfaction with the nurses, require patients to pay medical expenses of the task should be completed by the hospital logistics staff to assume responsibility, so that the relationship between nurses and patients can be improved. But in any case the service attitude of the nurse should be done so that the patient with a hundred percent satisfaction, because the attitude is there is no ability to make a difference, the service attitude is good or bad depends directly on the subjective factors of the nurse, in addition to the part of the objective factors. As a nurse must have noble sentiments, so take the initiative to take care of the patient, just like a patient thinks, anxious patients are anxious to serve, patients need basic professional qualities to provide positive care, but the specific embodiment of noble professional ethical standards. The attitude of service directly affects the relationship between nurses and patients, and affects the quality of patient care, nurses must create a good rest, so that the patient to maintain a good state of acceptance of the treatment, the health of the patient's back, the early for the *** with the responsibility of the doctors and nurses. Since nurses never live with the disappointment brought by Florence Nightingale said nursing is an art, a good nurse must be warm and welcoming to the patient, which is in the highest state of good service attitude, nurses must tolerate all the patients, even if it is not understandable? Understand the words and deeds, but their words and deeds hurt themselves or the surrounding crowd, must stop, can not be tolerated, so in dealing with patients to master a degree, but neither the patient's order, can not resist thousands of miles, to try to meet the reasonable requirements, must be prepared to explain the work of unreasonable requests, can not be sarcastic. There are still many people can not correctly understand the nursing work, there are high expectations, so sometimes there will be some harsh attitudes nurses prejudice or medical effects, but the nurse must tolerate the nurse's own rights, the nurse has the right to refuse, but the right attitude, rather than with the patient's jeopardy of really have openness to pack tolerate the patient to pay for the confrontation. Nurses, patients will eventually understand and respect the nurse, thus establishing a harmonious nurse-patient relationship.
3.4 In the course of the survey, 70% of the patients know that they are responsible for 14% of the nurses, 16% of the patients sometimes know, do not know, this result can be seen in the patients and nurses, it is fair to say that every patient should know the responsible nurse understands very little, this problem can be targeted to find the responsible nurse. Responsible nurse is currently realized in hospitals is to give the patient a nurse, responsible nurse to provide continuous care of the whole, and therefore each responsible nurse is responsible for a more comprehensive understanding of the patient's own situation, more accurately solve the problem, to assist the doctor to do therapeutic work, the current city hospitals, 14% of the patients do not know their own responsible nurses, which inevitably affects the treatment of the process of the disease. There are two main reasons: on the one hand, due to the implementation of primary care for a very short period of time is still immature, nurses shallow understanding, can not be flexibly applied, in practice, the relationship between nurses and patients is distant, nurses rarely have time to reflect in the current survey, some patients in the ward nurses are aware of seldom see the nurse in the morning nursing checkups, infusion nurses, and the rest of the time, you can rarely see a nurse, which may be closely related to the shortage of nursing staff and heavy workload. On the other hand, due to the different understanding of the range of patients in the cultural level of the nurse patients, coupled with the wear of the mask of the nurse in the operation process, so that it remembers the name of the nurse for the illiterate or elderly patients, there is indeed a difficulty that some patients do not understand the nurse refuses to breastfeed, and even exclude the nurses, which also leads to the patients do not know their own responsibility to the nurses. However, this is relative, the patient does not remember or exclude the nurse, the nurse's own factors related to the nurse less next ward or attitude of hardening the distance between the nurse and the patient, the patient will inevitably lead to strange and exclude the nurse, the establishment of a good nurse-patient relationship is to improve the level of awareness of the patient's foundation, in contact with the patient, the nurse must have a positive sense of communication and patience in thinking. Whatever the case, the patient's interest. Must establish a good nurse-patient relationship to improve the level of patient awareness can be from the following points:
(1) patient environment on the first day of the patient hospitalization, the nurse is responsible for the introduction of hospital wards set up and medical staff, and clearly inform the patient that they are responsible for the nurses, so that the patient has a general understanding of the basic situation of the hospital.
(2) Nurses in the ward, the patient with more than one chat session, including not only the patient's situation, including life events and inner thoughts.
(3) contact with the patient, the nurse needs to maintain a good image, dress should be clean, amiable, elegant demeanor, give the patient intimacy.
(4) Whether the clinical nursing operation or conversation, the attitude must be better, avoid raw, hard, cold, push.
(5) requires that the patient must have a reasonable call, can not be replaced, bed number, if the patient is in a certain social status call their identity, "manager", "director", inadvertently shorten the distance between the nurse and the patient. Patients are even willing to take the initiative to raise the level of awareness with the nurse patient contact.
3.5 In the use of the process of investigation, a nurse's concept of etiquette service is still very fuzzy, only 56% of the nurses in the work of greeting patients, 28% of the nurses have a few, there are 16% of the patient's nurses did not greet. Hospitals advocate etiquette services, the popular thing is civilized manners. In the modern society, between people, the difference between the larger countries are respected by the civilization, civilization is a developed civilization based on the conditions of stability, must learn to respect. Similarly, the hospital is a microcosm of society, between different levels of people, different personalities, but one thing is the same, are eager to get the respect of others, respect for others, must get the respect of others, "angel" nurses should know how to respect the patient. Most patients are unable to successfully enter the patient's role, especially the patient's independence, all of a sudden become passive inevitably let not accept its refusal of treatment, the patient is unable to enter the patient's role often refuses to health care workers, weak willpower, and even produce the idea of suicide, it will seriously affect the effectiveness of treatment, it will seriously affect the effectiveness of treatment. Suicide, it will seriously affect the therapeutic effect, or even worse, because this will cause the condition to deteriorate or patient suicide is absolutely not allowed to occur in the hospital, otherwise, it is a serious dereliction of duty of medical staff nurses can not greet the patient's reasons are twofold. An objective factor, nursing work is quite heavy, every department has a shortage of nurses, many nurses. Morning report each ward morning care, often the morning shift. Before it could be completed, the subsequent rounds, blood transfusions, injections, the morning hours were run out, an afternoon's work was measuring vital signs and records, checking doctor's orders, copying your doctor, writing nurses, patient records, and there was not a lot of free time. Subjective Despite the heavy nursing workload of two nurses, with proper, scientific organization of work or you can set aside free time. Many nurses emphasize hard work because it is the core of the indicators is nursing work, thus neglecting the soft, or even there is no need to do. Soft work is no indicator, do not like the hard work so quickly reflect the long-term benefits of flexible work effect, but may also be a waste of energy, so many nurses do not want to do so, and do not have enough ability to do. To change this situation must start from the following points:
(1) to change the objective reasons, I recommend appropriate hospitals to effectively recruit additional nurses to alleviate the need for nurses, so that nurses have enough time to ward patients to talk to better promote etiquette services of the hospital, shaping a good image.
(2) hospital care patients should be timely feedback, managers have more contact with patients to understand the situation, it is best to avoid letting the nurses know, in order to eliminate patient concerns and take timely and effective measures to standardize the etiquette of the service system system, such as as hospitals, financial and human resources allow the supervision can also create a group.
(3) patients on the nursing work of the head nurse reasonable arrangements, fully mobilize the enthusiasm of nurses, while leading by example of the power of example is endless, trying to make a polite, civilized ward environment, so that the nurse's every move are embodied in the etiquette of the service, become conscious of the politeness of politeness unconscious.
(4) The nurses' respective arrangements to strengthen politeness, civilization of thought, always self-supervision, carry forward the spirit of prudence, treatment of patients as a good friend, know how to be considerate, caring, and always with a smile to treat people.
3.6 In the survey, from the patient's words and deeds and questionnaire results, the patient's psychological care, there is quite a big dissatisfaction there, only 52% of the nurses in the patient's psychological upset or concern to the patient found to speak, 34% of the nurses there are are a few, where 14% of the nurses to do without. With the improvement of people's living standard, the definition of health has also changed, from the past purely physical illnesses expanded to physical illnesses and mental illnesses, requiring nurses not only to cooperate with doctors to complete the treatment of physical illnesses and do all the nursing operations, but also the psychological care, eliminate the patient's psychological barriers, and have a good psychological state, is very important for the treatment of the disease and recovery. There are many patients refuse to accept treatment because of psychological problems, leading to deterioration of the condition will even cause irreparable harm, sometimes the harm of mental illness is far greater than the physical disease, serious mental illness can lead to a person's death, this lesson has been a large number. Psychological care is not well executed, mainly due to the subjective factors of the nurses: (1) there is still many nurses are only concerned about the actual operation of the nursing, operational excellence, serious neglect of psychological care, will be the patient's psychological problems turn a blind eye to, or did not find the patient's psychological problems. Some nurses also exist in the patient's anxiety because it should be the wrong idea. (2) City hospital nurses, in addition to a few who receive special psychological, ethical, legal and related disciplines, such as education, little is known that most of the psychological care, not to mention psychological care techniques, resulting in the heart is weak, only on the surface, the patient's comfort can not be grasped by the origin of the problem, the use of appropriate psychological methods to solve the patient's psychological problems, some nurses have a wrong understanding of the psychological care Some nurses have a wrong understanding of psychological care, it is an independent procedure, such as infusion independent of the same needs, and does not have a correct understanding of the entire nursing operation of psychological care. Otherwise there is no heavy work and care behind, psychological care prerequisite must be to ensure the life and health of the patient, must first be accomplished a lot of hard work, psychological care in the whole nursing operation, but there must also be a certain amount of time to carry out. Finally, with the patient, with the patient's age, cultural level, social status, personality, the need for psychological care is different from patient to patient, psychological care patient to unfold the conditions. Psychological care is an important part of the nursing process, directly related to the quality of care, which requires nurses to all aspects of psychological care, psychological care, the following points contribute to a better implementation:
(1) hospitals to carry out training courses, or send nurses to hospitals to a good education, nurses contact and mastery of the knowledge of psychology and psychological care provides the theoretical basis for the implementation of the psychological care skills, can also be more appropriate. Nursing skills, can also be more appropriate to recruit some knowledge of learning nurses specializing in psychology.
(2) nurses take the initiative to change their minds, change the concept of nursing, clear tasks, combined with the care of disease and psychological care.
(3) nurses need to understand the knowledge of humanities and social sciences, aesthetics and humanities nutrition is the nurse's career, in addition to mastering a large amount of nursing knowledge, should correctly grasp the fringe disciplines, enrich themselves, improve their overall quality of deep understanding and awareness of people living in different social strata of thought and behavior in order to communicate effectively, its more suitable for the implementation of the Psychological care, improve the patient's psychological state and psychological care throughout the work, independently, when necessary.
(4) Cultivate the quality of care and patience. Hidden psychological problems that can not be objective indicators of performance, there is no physical disease is as clear, direct and simple, mental illness is integrated in all aspects, and psychological problems of each patient is different, and the patient's personality is closely related to marriage and family, work, which requires nurses to be careful, good to find the problem, good communication, which is the basis for the implementation of psychological care. Secondly, in the process of psychological care must be the patient, psychological problems are often related to the patient's privacy, in the majority of patients in the initial state of resistance, so the nurse should be patient and careful explanation of the patient, so that the patient to produce a sense of trust, a good sense of good application of a variety of techniques, not to be impatient, step by step, to give the patient the process of understanding and acceptance, in order to better implement psychological care.
3.7 This survey, the nurse's health education work is not enough place, 56% of nurses tend to be able to health education, 32% of the time, 12% did not have health education and health maintenance problems, many patients are sick because of a lack of medical knowledge, to help patients solve health problems, at the same time, but also have to explain the relevant knowledge of the patient, so that the patient has a basic knowledge of prevention, or will come to naught. Otherwise it will come to naught. Fundamentally the responsibility of medical personnel lies in the non-treatment of diseases to maintain health and prevention of disease, but not sound enough medical careers coupled with a variety of social factors that lead to the responsibility of medical personnel to treat the disease of the main reason for the nurses health education work in place, now many nurses will position themselves in the injections, to carry out the clinic, dispensing medication, infusion, and ignoring the other tasks, ignore the health education importance. Followed by patients, many patients believe that nurses are medical accessories have always been, do not trust the nurses, doctors to help solve the problem when this problem often occurs, rarely look for nurses, nurses lose the task of health education. Finally, the heavy work of nurses, three-member families in the city have nurses overloaded with work, no time and energy for health education, but no matter how, nurses must strengthen health education: first of all, to make clear that health education is the responsibility of nurses, followed by the use of a wealth of medical knowledge to enrich themselves and improve the patient's trust of nurses; Finally, you have to contact more patients, health education, which should be easy to understand! And use less medical terminology, health education missionary bar
3.8 in the survey reflects the lack of nursing life care, only 46% of nurses take the initiative to carry out life care, there are 28%, 26% did not, leading to this phenomenon is caused by a variety of reasons: (1) many nurses also have a misunderstanding of the understanding of life care nurses do not have the responsibility, but should be the caregiver's tasks and their families. of the family. (2) Nurses shirk their responsibilities and have the fear of dirty and tired thinking. (3) The nurse's work is too heavy, don't have too much time to consider the life care. (4) Due to the improvement of the standard of living, many patients, especially elderly patients to hire nannies, nannies for the complete natural life care, and no nurse to do the reason is the multifaceted life care deficiencies, it must begin to change the status quo from multiple perspectives, the nurse first of all to make clear that the life care is the nurse's responsibility, such as disease care, life care. Secondly and finally it must be in place, absolutely not superficial, to solve the actual problems of the patient. In addition, despite inviting babysitters to the patient, the nurse must also life care, instructing the babysitter how to life care to meet the patient's comfort level. Nurses must develop a sense of active service and initiative in order to meet the needs of patients.
In this survey, either from the reflection of the patients or from the results of the questionnaire, there is a big gap and is different. From the 2nd floor of the 3rd floor of the two families of the 6th floor pediatrics as a whole, the average of the 3rd floor is much higher than the 6th floor, from the questionnaire, the content of each of the third floor should be more than the 6th floor, which is due to a variety of reasons, in addition to the nurse factors, this department, this patient, talking about the reasons in the following areas:
(1) most patients due to chronic illnesses, hospitalization for a longer period of time hospitalization, and, therefore, the time spent by the Nurses than long, better understand and recognize the nurses will be deeper, the nurses' feelings. Nurses work hard, they can understand, and sometimes the nurses can take the initiative to reduce the workload of nurses contain questionnaires that will be a little more subjective factors of the patient, the relationship between the medical patient and the nurse, they tend to be biased in favor of the nurse and say that they are well hidden. Quite fast turnover rate of pediatric patients, patients and nurses get along with a very short time, many children live only four or five days, hospitals, nurses are unfamiliar with the impact of bias, coupled with the old concepts of children's families nurses, leading to the alienation of the relationship with the nurses, due to the impact of subjective factors often lead to the patient's nurses to reflect more of their views on the questionnaires scored a decline.
(2) the city hospital Zhoushan maternal and child health hospital, pediatric specialty hospitals, which allows many children are treated in the city's hospitals, coupled with pediatric resistance is not often repeated hospitalization, vascular injuries, scalp needles itself is a difficult nursing skills, both of which tend to lead to scalp needles for nurses to play repeatedly, nurses skills of the non-medical staff tend to think that this is not enough, therefore, the nurse dissatisfaction. Nowadays many families have only one child and love children, it is conceivable that nurses tend to have higher, higher injection expectations than other patients, and it is often difficult to tolerate the views of the nurses of the second injection. Medical elderly patients with only one child family nurses at risk, despite the aging of blood vessels, often leading to repeat the nurse's needle, but the harmonious nurse-patient relationship, patients often do not have too much care, sometimes comfort nurses. BR /> (3) 3,6 F, there will be such a big difference and cost. 3rd floor, the majority of medical patients are paid by the state, so they tend to focus on the issue of the cost of medicines, but due to the cost of the problem and the contradiction between the nurse. Pediatric patients, in addition to the medical costs of self-care, due to the need for adult health care, often make their parents lose time to earn money, more on the payment of large sums of money so the parents of children with less total costs, but more expensive medical equipment, but also consider the economic interests of the hospital, often higher medical costs, patients with a high degree of dissatisfaction. In addition, due to the lack of manpower in hospitals, nurses are often needed, urging patients to pay, which tends to damage the relationship between nurses and patients. In favor of the child's parents, so that they can not appear to the child is not comfortable, the negative pole for the low, so that the parents of the child's emotional people