Tisch
"High-quality nursing service" refers to taking patients as the center, strengthening basic nursing, fully implementing the nursing responsibility system, deepening the connotation of nursing specialty and improving the level of nursing service as a whole. ""patient-centered "refers to thinking about patients everywhere in ideology and medical behavior, and putting patients first in all activities; Closely around the needs of patients, improve service quality, control service cost, formulate convenience measures, simplify workflow, and provide patients with "high quality, high efficiency, low consumption, satisfaction and rest assured" medical services. According to the requirements of the Ministry of Health for high-quality nursing service, all staff actively participate in changing the service concept, so that patients can spend the operation period in the best physical and mental state, and the specific measures for high-quality nursing service are formulated as follows:
First, the preoperative visit extends to the patient's family.
1. Preoperative visits are generally conducted on 1 afternoon before operation, and the visitors are visiting nurses who cooperate with the patient's operation. Try to avoid eating or other treatment time, and control the visiting time at 10 ~ 15 min, so as to provide a quiet and comfortable visiting environment as much as possible and reduce noise.
2. Read the medical records and nursing records carefully before seeing a doctor to understand the operation and anesthesia, illness and various biochemical test results. Understand the patient's general situation, mental mood, sensory state, motor nerve state, excretion, respiration, circulation, body temperature, skin, water and electrolyte balance, etc. And do preoperative evaluation (including pressure sore evaluation and bed rest evaluation). Predict the possible problems in the operation from the perspective of nursing, understand the whole process of the operation, and take active and effective measures to prevent them.
3, enter the ward should take the initiative to introduce yourself, eliminate the strangeness between nurses and patients, and then explain the purpose. For infants and other patients, do a good job of communication with their families. Introduce the operating room environment and medical facilities for operation; Some sounds that will be made during the operation. At the same time, the anesthesia mode and anesthesia site are introduced.
4. Encourage patients to express their wishes and concerns, and inform them of the posture, possible discomfort and necessary cooperation during the operation, as well as the precautions before entering the room: the time of fasting and drinking water; Change clean clothes on the day of operation; If there are valuables, ornaments and dentures, please give them to your family for safekeeping. Female patients should not wear makeup.
5. According to patients' different psychological state, sensitivity, living habits and family background, comfort and encourage patients with warm words, carry out targeted psychological care, pay attention to protecting patients' privacy, and enhance patients' confidence in overcoming diseases.
6, according to the content of the return visit record carefully recorded, in order to take corresponding measures. After the preoperative visit, I thanked the patient for his cooperation and told him that I would stay with him the next day to calm the patient's nervous mood.
7. Preoperative visit should not only relieve patients' nervousness, but also communicate with their families. The more family members know about the operation, the more they can help patients to reduce their preoperative anxiety. Some problems that are inconvenient to explain to patients can be clearly explained to their families to gain their trust and cooperation. On the day of the operation, instruct the family members to wait in the family lounge outside the operating room, so that they can communicate directly with their families when there are special circumstances during the operation and when they look at the specimens after the operation, and win valuable time to ensure the patient's life and the smooth operation. To conduct humanized, systematic and standardized preoperative visits to family members.
Second, intraoperative care
1. On the day of operation, after the patient was sent to the operating room, the visiting nurse took the initiative to hand over to the ward nurse yesterday. After checking according to the relevant requirements, he led the patient into the operating room to prepare anesthetic supplies.
2. Before anesthesia, the visiting nurse checked the patient information with the operator and anesthesiologist again, and cooperated with the anesthesiologist for anesthesia.
3. Assist the doctor to set the patient's position, guide the patient to coordinate the position according to the position mentioned in the preoperative visit, make full use of the position pad, make the surgical patient more comfortable, expose the surgical field more clearly, and maintain the thoracic movement and limb function.
4, pay attention to psychological care, timely understand the needs of patients and meet their needs. Special attention should be paid to several time periods: for example, during anesthesia, at the beginning of surgery, when the patient feels uncomfortable and vital signs change, it is emphasized that the visiting nurse must be around the patient to comfort and encourage him.
5. Hand-holding service for the elderly, children and women. Communicate with the patient during operation and hold the patient's hand if necessary. For example, before anesthesia, the visiting nurse will say to the patient, "Please hold my hand and I will accompany you through this special moment. If you feel uncomfortable, please tell me and we will help you solve it. "
6. For conscious nervous patients, not only do psychological counseling, but also hold the patient's hand and let them do deep breathing exercises with themselves to relax their nervous mood.
7. Strictly carry out tripartite verification before operation, and check relevant information again.
8, after the start of the operation, pay attention to adjust the room temperature. Pay attention to keep warm, put a scarf around the patient's neck, cover the abduction arm with a warm cover, and remove the quilt from the patient when the doctor is ready to disinfect; After the operation, when sending the patient out of the operating room, help the patient dress neatly, pay attention to protecting the patient's privacy and keep warm. When the weather is cold, warm infusion and peritoneal lavage fluid to prevent hypothermia during operation.
9. Closely observe the changes of patients' vital signs during the operation, pay attention to ECG monitoring, and keep the infusion unobstructed. And carefully observe the patient's facial expression and the use of various instruments to ensure the smooth operation and the safety of patients.
10, after the operation, during anesthesia, operating room nurses should guard the patient's bedside to prevent the patient from falling out of bed, ensure the patency of drainage tube and venous indwelling needle, and prevent accidents such as tube detachment.
1 1, strictly implement the operating room nursing operation procedures. Carefully make all kinds of nursing records. Requirements: All kinds of nursing should be steady, accurate, light and fast. During the operation, we don't talk about topics unrelated to the operation, and we don't make any noise, which reflects the humanistic care.
12. Establish patient handover register and rapid pathology register, and improve handover process and writing of handover register. Carefully fill in the surgical nursing record sheet and improve the filling and keeping of the antibiotic execution sheet. Strengthen the handover between visiting nurses and nurses in resuscitation room, investigate potential safety hazards and ensure the nursing safety of surgical patients.
Second, the postoperative visit
1. After the operation, the anesthesiologist, the surgeon and the visiting nurse will send the patient back to the ward, arrange the correct posture, make a good handover with the ward nurse, and make a detailed handover of the patient's intraoperative situation, fluid input, skin condition and various pipes. Explain the posture and requirements required by anesthesia methods and the management of various wound drainage tubes to family members in order to obtain cooperation. 、
2. The time of postoperative return visit is generally chosen on the second day after operation. If the patient has a large surgical scope and other special circumstances, the time for seeing a doctor can be appropriately delayed. When you enter the ward, you should greet the patient first. By talking with the patient, you can understand the attitude and psychological state of the patient and his family, as well as their understanding and acceptance of the operation, and introduce the general situation of the operation and the necessary postoperative precautions to the patient in a more understandable way, so that the patient can recover with peace of mind.
3. Handle, appease and explain the nursing problems raised by patients, and communicate with the head nurse to solve and rectify the problems that cannot be handled in time.
4. Follow up patients after operation, patiently answer patients' questions, give words of encouragement, and send heartfelt wishes to patients; To understand patients' satisfaction with the work service of nursing staff in operating room.
5. Feedback to the surgeon, understand the aspects that need to be improved during the operation, serve the clinic, and make the cooperation between doctors and nurses more tacit.
6. Ask the ward nurse about the matters that need to be improved in the handover. Through these feedbacks, we can understand the shortcomings in the nursing work in the operating room and carefully complete the record of post-operative return visits. Formulate rectification measures to better serve patients.
extreme
1. 1 general information
Sixty patients who came to our operating room for surgery from June 20 17 to June 20 18 were taken as the research object, and were randomly divided into control group and observation group according to the way of random grouping, with 30 patients in each group. The control group was male 17 and female 13. The age ranged from 22 to 71year, with an average of (44.8 9.1) years. The observation group was male 16 and female 14. The age ranged from 265438 0 to 72 years, with an average of (44.7 8.8) years. Through comparison, it was found that there was no significant difference in the basic data between the two groups (P & gt0.05), which could be compared clinically.
1.2 nursing mode
Patients in the control group received routine nursing in the operating room, while patients in the observation group received high-quality nursing intervention measures on the basis of the control group, as follows.
1.2. 1 Preoperative visit
1 On the day before operation, the nurse in charge should know the medical record in detail and master the basic situation of the patient. Including name, sex, age, examination results, diagnosis, anesthesia methods, etc. And asked the doctor in charge about the equipment and surgical methods needed for the operation. Then introduce the surgical precautions to the surgical patients in advance and communicate with the patients patiently.
1.2.2 preoperative preparation
Before operation, arrange the responsible nurse to make good preparations, including welcoming patients, communicating with patients, understanding patients' preparations, encouraging patients and improving patients' confidence in surgery. In the preparation area, provide a comfortable environment for patients, reduce the pressure of patients, try to meet the needs of patients, encourage patients and establish a good nurse-patient relationship.
Strengthen the scientific management of nursing in operating room.
The nursing class should set up a management team, improve the nursing work system, establish a standardized nursing system, standardize the grouping management system, establish a nursing assessment system, and regularly assess nursing staff to promote the enthusiasm of nursing staff and improve the quality of nursing.
1.2.4 Strengthen nursing training
First of all, make a good nursing training plan, strengthen the training of theoretical knowledge and clinical skills, and improve the professional knowledge and technical level of nursing staff. Nurses should actively solve the difficult problems in the nursing process through preoperative consultation and rounds, so as to improve work efficiency and nursing quality. Pay attention to the cultivation of nurses' professional quality, communication ability and health education.
1.2.5 improving nursing service in operating room
According to the content of patients' surgery, targeted nursing methods are adopted to provide patients with more professional, comprehensive and humanized services [2]. 65438+ 0 days before operation, medical staff should communicate with patients, eliminate patients' bad emotions, encourage patients' self-confidence, comprehensively evaluate patients' specific conditions, and carry out targeted nursing programs according to patients' own conditions.
1.2.6 Strengthen communication with patients.
Medical staff should strengthen communication with patients, promote harmonious communication between nurses and patients, and create a good communication atmosphere between nurses and patients. It is beneficial to patients' bad mood and increases their self-confidence in treatment.
1.2.7 postoperative care
After the operation, the blood on the patient's skin should be cleaned up, and new clothes and sheets should be replaced for the patient's hospital bed to keep the patient's ward environment comfortable and dry. Pay close attention to the changes of patients' vital signs, and notify the superior doctors for treatment and treatment in time if there is any abnormality. Postoperative nursing staff should patiently answer the questions of patients and their families, give guidance to patients, and inform patients that their daily diet should be light and their nutritional intake should be balanced [3].
1.3 observation index
The nursing quality, patient satisfaction and nursing safety of the control group and the observation group were compared and observed.
1.4 data processing
Statistical software SPSS20.0 is used for statistical research, and the measurement data adopts mean standard deviation (? +/-s), with t test, with p.