(1) Factors of nursing personnel
Nurses are not strong in responsibility, and the implementation of rules and regulations and operating procedures is not strict, and they do not conscientiously carry out the system of shift handover and the system of checking in the workplace. Insufficient nursing human resources, for a long time due to the low social status of nurses, heavy work, irregular life, some nurses do not feel at ease with their work, find ways to change jobs or leave the post, resulting in a serious shortage of clinical nurses. Nurses' own comprehensive quality is low, due to social prejudice against nursing and the influence of the environment, hospitals do not pay enough attention to nursing, less investment, so that the nurses to participate in continuing education opportunities are small, the knowledge can not be updated in a timely manner, resulting in nurses' poor resilience, poor communication between nurses and patients. In addition, because most of the nurses in the clinical line of work are young nurses, seniority is shallow, lack of clinical experience, professional knowledge is not solid medical education|net collection, technical operation is not skillful, the work of the theory can not be linked to practice, easy to lead to operational errors and nursing errors.
(2) patient factors
Nursing is a patient and nurse **** with the participation of the activities, the normal development of nursing activities depends on the patient's close cooperation and support. Individual patients' non-compliance with medical behavior, non-standard medication or going out privately during hospitalization is also one of the factors contributing to nursing safety incidents.
(3) material factors
Nursing equipment is an important tool to complete the nursing task, the performance of the equipment and instruments is intact, whether the quality is over the top, will affect the normal play of nursing technology, affecting the resuscitation and treatment work, is the existence of one of the factors of insecurity in the nursing work.
(4) environmental factors
The hospital infrastructure and improper layout also potentially unsafe factors. Such as the ground is too slippery to cause injuries, the bedside without protection caused by the fall of the bed, the improper use of hot water bags lead to burns. Environmental pollution leads to hospital cross-infection; safety hazardous materials management system measures are not perfect, etc. are potential unsafe factors.
Question 2: What are the contents of nursing insecurity factors 1 Nursing insecurity factors on nursing management
Nursing work in the existence of many insecurity factors, these factors will have a direct impact on the effectiveness of care, affecting the recovery of the patient, affecting the hospital's image in the eyes of the patients and the public, to the hospital's credibility to create a negative impact, and even cause the rise in health care costs, increased material consumption, patients' economic burden increased. The patient's economic burden has increased.
The so-called safety management refers to the protection of the physical and mental health of patients, the effective control of a variety of insecurity factors [1], safety management is a necessary condition to protect the lives of patients, is to reduce the quality of defects, improve the level of care of the key links, is to control or eliminate insecurity, to avoid the occurrence of medical disputes and accidents of the objective needs.
1.1 Quality control management factors
Quality management is the management of functions and activities necessary to determine the achievement of quality requirements, quality management system is the core of nursing care safety, imperfect management system, poor quality control may cause nursing care insecurity is an important factor. The lack of effective professional ethics education for nursing staff, the establishment of sound rules and regulations, the binding force is not strong, the quality control measures are not effective, the lack of foresight on the potential unsafe factors for patients, as well as the lack of nursing staff, the ratio of health care disproportion, and many other factors, there will be the result of unsafe care.
1.2 Technical factors
This mainly refers to the fact that due to the low technical level of nursing staff, lack of experience, poor collaboration and other factors may pose a threat to patient safety. Especially with the introduction and development of new technologies and new programs in large quantities, the nursing work of high technical complexity, high technical requirements of more and more content, not only on the nursing staff to bring greater pressure on the work, but also may lead to the nursing work of the technical aspects of the risk increases, thus affecting the safety of nursing. Nurses nursing lack of business knowledge, lack of work experience, low level of technology or unskilled, poor cooperation with others, do not pay attention to learning and business and technical training, violation of technical operating procedures, will lead to operational errors or operational errors and thus accidents.
1.3 Human factors
Mainly refers to the quality of nursing staff and other reasons can not guarantee to meet the basic requirements of the work and the patient caused by unsafe factors or hidden danger. At present, the development of the nursing profession on the quality of nursing staff are required to have a greater increase in the quality of nursing staff, if you can not be timely according to the technological progress and professional development of the investigation, through effective ways and means to improve the quality of nursing staff, and a reasonable increase in the number of personnel.
1.4 Work accountability
Nurses have special occupational content, norms and standards of behavior, long-term engagement in heavy nursing work, repetitive night shifts, the burden of multiple roles, as well as some departments with unreasonable job setups, overloaded with work, so that a small number of nurses physically and mentally fatigued, boredom and fear, belittling nurses' work, and some even hope to get out of the nursing position. As a result, the work of responsibility is not strong, attention is not focused, emotional fluctuations, bad attitude towards patients, so that the occurrence of doctor-patient disputes, thus bringing unsafe consequences or insecurity to the patient.
1.5 Medical factors The language and behavior of health care workers are inappropriate or negligent to patients, causing insecurity or unsafe results. These factors are often important contributors to medical disputes.
1.6 Medication and equipment and facilities
Improperly formulated drugs, incorrect route of administration, improper use of equipment and facilities can cause the occurrence of insecurity, especially the large number of disposable hygiene products and the large number of use of auxiliary inspection equipment.
1.7 Patient Behavioral Management Factors
Patient management refers to the management of those individuals who have been identified as having a disease in the body, and the physical and mental changes that occur in the individual due to the cause of the disease are directly proportional to the awareness of the disease. Nursing work is a nurse and patient *** with the participation of management activities, the normal development of nursing work depends on the patient's intimate cooperation and support, if the patient's psychological tolerance is poor, the lack of a correct understanding of the disease, it is very easy to produce anxiety, fear, upset, worried and other psychological phenomena. Thus, they do not trust the doctor, suspect that the doctor's diagnosis is wrong and other factors leading to the occurrence of artificial insecurity.
1.8 Management factors
Due to the management system is not sound, business training is not in place, poor management of equipment and materials, professional ethics education is not enough, management supervision is not strict and other factors affecting the management of nursing safety organization, which is not only the occurrence of medical disputes and accidents of the main reasons, at the same time, is the biggest threat to the safety of patients.
2 Measures and suggestions to strengthen the management of nursing insecurity factors
2.1 Establishment of a unified and perfect nursing safety and quality management
To address the problems in the quality of hospital nursing safety, combined with the actual situation of the hospital, the system ...... >>
Question 3: What are the factors affecting patient safety There are many factors affecting patient safety, including
A nursing staff factors, including insufficient quality of nurses, poor sense of responsibility and insufficient human resources
Second, the environmental factors (the ground is slippery, no guardrail, etc.)
Third, the hospital equipment
IV Patient and family factors (patients do not cooperate, family members do not collaborate, lack of knowledge, not active in the treatment of patients, etc.)
etc.
Question 4: What are the factors that jeopardize the safety of nurses' practice Hazardous factors for the safety of nurses' practice are: 1. physical factors. 2. chemical factors. 3. biological factors. Protection: 1, the protection of needlestick injuries. 2, the protection of radiation. 3, the protection of chemical hazards. 4, the protection of biological hazards.
Question 5: What are the unsafe factors in nursing? The factors affecting nursing safety are: (1) the factors of nursing staff Nurses are not strong in responsibility, the implementation of rules and regulations and operating procedures are not strict, and do not conscientiously carry out the system of shift handover and the checking system at work. Insufficient nursing human resources, for a long time due to the low social status of nurses, heavy work, irregular life, some nurses do not feel at ease in their own work, find ways to change jobs or leave the post, resulting in a serious shortage of clinical nurses. Nurses' own comprehensive quality is low, due to social prejudice against nursing and the influence of the environment, hospitals do not pay enough attention to nursing, less investment, so that the nurses to participate in continuing education opportunities are small, the knowledge can not be updated in a timely manner, resulting in nurses' poor resilience, poor communication between nurses and patients. In addition, because most of the nurses in the clinical line of work are young nurses, seniority is shallow, clinical experience is insufficient, professional knowledge is not solid medical education|net collection, technical operation is not skillful, the work of the theory can not be linked to practice, which can easily lead to operational errors and nursing errors. (2) patient factors Nursing is a nurse and patient *** with the participation of the activities, the normal development of nursing activities rely on the close cooperation and support of patients. Individual patient's non-compliance, non-standard medication or going out privately during hospitalization is also one of the factors causing nursing safety events. (3) Material factors Nursing equipment is an important tool for completing nursing tasks, whether the performance of equipment and instruments is intact, whether the quality is over the top, will affect the normal play of nursing technology, affecting the rescue and treatment work, is one of the insecurity factors in nursing work. (4) Environmental factors Hospital infrastructure and improper layout are also potential unsafe factors. Such as the ground is too slippery to cause injuries, no guards next to the bed caused by the fall of the bed, the improper use of hot water bags lead to burns, and so on. Environmental pollution leads to hospital cross-infection; safety hazardous materials management system measures are not perfect, etc. are potential unsafe factors.
Question 6: What is the most common occupational injury risk factors affecting nursing occupational safety (1) Sharps injuries: Sharps injuries are the most common occupational injuries to nursing staff, the survey found that 87.5% of the nursing staff have experience of sharps injuries, and the size of the nursing workload and the frequency of needlestick injuries there is a certain relationship. The invasion of pathogenic microorganisms after sharps injury is the main way of transmission of blood-borne diseases, it has been confirmed that there are more than 20 kinds of pathogens can be transmitted through sharps injury, of which the most harmful is hepatitis B virus (HBV), followed by hepatitis C virus (HCV), human immunodeficiency virus (HIV).HBV exists in large quantities in the blood of patients with hepatitis B, and each milliliter of blood has almost 100 million viral microparticles per milliliter of blood. According to the Center for Disease Control's prospective study of needlestick injuries, the probability of infection after one needlestick injury contaminated with HBV is 6% to 30%, and after a needlestick injury, only 0.004mL of blood contaminated with HBV is enough to make the injured person infected with HBV; if contaminated with HCV blood, the probability of infection is 3% to 10%; if contaminated with HIV, the probability of infection is 0.3% to 0.3%; if contaminated by HIV, the probability of infection is 0.3% to 0.3%; and if contaminated by HIV, the probability of infection is 0.3% to 0.3%. The probability is 0.3% to 0.5%, and at least 0.1mL of blood is needed. The occurrence of sharps injuries is mainly related to sharps-related work behaviors, such as drawing blood, intramuscular injection, intravenous injection, etc.; in addition, poor personal operating habits, such as re-capping needles after use and breaking ampoules with bare hands, are also common causes of sharps injuries. A large number of clinical investigations have found that nurses are a high-risk occupational group for the occurrence of needlestick injuries, infections and blood-borne diseases, with an annual incidence of 24.0% to 35.3%, of which 8.2% to 18.0% are infectious. Statistics from the U.S. Centers for Disease Control show that as of the end of 2000, 57 people in the U.S. medical workforce had been definitively infected with HIV, and 48 people were infected by skin-prick wounds, 24 of whom were nurses. China conducted a questionnaire survey of 1075 nurses, of which 866 had needle-stick injuries, the incidence rate of 80.6%, of which 645 were stabbed by contaminated needles. (2) Hazards of antitumor drugs: certain occupational hazards can occur during the preparation, injection or handling of chemotherapy drugs by nurses. When oncology nurses draw bottles of liquid or open ampoules of frozen powder, there is an invisible spillage of liquid or powder, which enters the body through the respiratory tract and the skin, and contaminates the environment. Studies have shown that peripheral blood lymphocyte sister chromatid exchanges, aberration rates, and micronucleus rates are significantly higher in nurses exposed to chemotherapeutic drugs than in non-oncology nurses, and that lymphocyte DNA is damaged to varying degrees. The serum of oncology nurses was used as the culture medium, and the culture of rat embryos showed that the average number of nodes and protein content of embryos were significantly lower than that of normal rat embryos; other investigations showed that oncology nurses had a significantly higher rate of spontaneous abortion than those with normal pregnancies and a high rate of congenital defects, and that their adverse pregnancy outcomes increased with the probability of exposure to chemotherapeutic drugs. Yang Huiyun and other investigations show that nurses occupational exposure to oncology drugs can lead to blood leukocyte and platelet reduction, menstrual disorders, hair loss and other toxic reactions. (3) the hazards of disinfectants: hospitals are a variety of pathogenic microorganisms gathered in the place, the nurse is a variety of disinfectants directly formulated with the user, in the disinfection of instruments and the environment, nurses wash their hands, treatments, dressing change and other operations in contact with a variety of disinfectants can be due to its volatility, corrosiveness, *** sex and cause contact with the allergy, asthma, contact dermatitis, cancer, and so on. If the human body long-term exposure to high concentrations of disinfectants, continuous *** skin mucosa, will lead to respiratory tract damage, reduce the body's immunity. At the same time, patients apply antibiotics in large quantities, bacterial resistance increases with it, and this resistance has been extended to disinfectants, so that the use of disinfectants has increased significantly, and the result will inevitably make drug-resistant bacteria become a potential risk factor for the spread of hospital infections. In the use of chlorine-containing disinfectants, the human sense of smell of chlorine is 35mg / L, and stay in the 40mg / L environment for 1 hour, can cause poisoning. Because of the high concentration of chlorine disinfectant on the respiratory mucosa and skin has a strong *** sex, overuse is easy to produce trichloromethane, carbon tetrachloride and other difficult to degrade carcinogenic substances harmful to human health. Peroxyacetic acid has a strong *** sex, overuse can appear nausea, headache, eye edema. (4) the harm of interventional radiotherapy: X-ray is the human tissue organs, glands and blood cells damage to the larger radioactive substances, and has the accumulation of long-term excessive radiation, so that people produce fatigue, dizziness, insomnia, lack of appetite symptoms, so that the body's immunity to decline, serious endocrine dysfunction can be caused by endocrine disorders and hematopoietic system damage. Interventional therapy and traditional X-ray examination is different, in the operation process, interventional radiology workers long exposure to X-ray dose higher radiation field ...... >>
Question 7: What are the four elements of risk management in nursing safety education? The four elements of risk management include:
First, education: the establishment of a perfect publicity and education system, popularization of safety awareness;
Second, responsibility: the establishment of a perfect safety responsibility assessment system, adhere to the heavy rewards and heavy penalties;
Third, the implementation of: the construction of a strong, effective responsibility for the implementation of the mechanism, that is, a series of important deployments of production safety work decision-making, the various work and the corresponding Responsibility for the smooth realization of transmission, to ensure that the layers in place;
Fourth, safety: the establishment of a perfect safety assessment system to improve the intrinsic safety.
Safe production refers to the production and operation activities, in order to avoid accidents causing personnel injury and property damage and take corresponding accident prevention and control measures to ensure the personal safety of employees, to ensure that production and operation activities can be carried out smoothly in the relevant activities.
Question 8: How to prevent and reduce the occurrence of nursing adverse events 1 Nursing error accidents correctly assessed
Nursing error accidents are divided into two kinds of incidental nursing errors and accidental nursing error accidents. The so-called incidental nursing error refers to the occurrence of the former can be stopped or did not cause harm to the patient. Accidental nursing error accident refers to the nursing error accident caused by some reason, bring pain or life-threatening to the patient. Nursing error accidents can be divided into five levels for assessment: 0 degree level: although for the implementation of a nursing operation to the patient, once the implementation of the nursing error will bring harm to the patient; 1 degree level: the nursing error did not cause harm to the patient, through the observation will not occur; 2 degree level: due to nursing errors caused by an abnormal change in vital signs, and bring psychological trauma to the patient or the need to do Related checks; 3 degree level: due to nursing errors, accidents and the need to implement treatment, as well as the need to increase the number of hospitalization days or the number of visits; 4 degree level: due to accidents causing serious harm to the patient or difficult to recover from the harm; 5 degree level: due to accidents resulting in the death of the patient.
2 Factors related to nursing error accidents
Japan's medical malpractice investigation committee proposed the SHEL accident analysis method. s (software part): including the operational quality and competence of the operational staff. h (hardware part): refers to the place where the nurses work. e: the clinical environment. l: the parties and others. According to this accident analysis method can have the following relevant factors.
2.1 Psychosomatic Exhaustion Syndrome A syndrome dominated by extreme exhaustion and emotional depletion due to the fact that the mental energy has been taken too much during the long period of dedication to others.
2.2 Insufficient psychosocial support Long-term social prejudice, the value of nursing labor is not recognized and respected, the uneven division of compensation, reflecting the realization of self-worth.
2.3 Lack of conventional legal knowledge With the rapid progress of medical care technology, a variety of difficult surgery, nursing tasks are increasingly heavy and responsible, involving more and more legal issues.
2.4 Nursing independence, blindness and medication safety Nursing is an independent discipline, due to the long-term dependence on medical care, making the scope of responsibility of nursing unclear, the ward work and as a running operation, the doctor prescribes, the nurse executes the medical prescription.
2.5 Nursing staffing Nursing clinical front-line nurses are understaffed, new nurses are unfamiliar with the hospital environment, business and the existence of a number of adverse psychological conditions; older nurses have knowledge of the slow updating of the absence of opportunities for further study and learning; due to the long-term overload of work, so that the psychological overfatigue, nervousness. Some studies have shown that excessive tension and fatigue make nurses physical and mental and immune system are affected, reduce the quality of work, so that the chances of errors and accidents increase.
2.6 Nursing personnel's own factors Nurses in the operation of the operation can be strictly three checks and seven pairs and the principle of aseptic operation, record documents can be timely and accurate, true and effective, can grasp the basic theories, skills, new technologies, new business and medical-related sociology, fall morality and so on.
3.1 Strengthen the self-examination of nursing work, found errors and accidents in a timely manner to report the system Nursing staff in the work of once an error or accident, should immediately notify the doctor and the head nurse, and reported to the next level, *** with the discussion to attract attention to prevent similar errors and accidents.
3.2 Improve the various qualities and abilities of nurses The quality of nurses includes the quality of medical ethics, professional quality, technical quality and physical quality. Only when the level of professional knowledge is constantly improved, nursing technology can be better utilized flexibly.
3.3 Study relevant nursing regulations and strengthen the cultivation of professional ethics Understand the potential legal problems in nursing, self-care guidance errors, carelessness, tort, malpractice nursing documents. Learn the medical malpractice regulations, understand the rights of patients, their own rights, and have a basis to follow the law.
3.4 Adjustment of the physical and mental health of nursing staff Various epidemiological statistics show that occupational stressors have a negative effect on both the state of health and cause disease.
3.4.1 Rationalize work and rest time Nurses have no biological routine due to the nature of their work. Research has shown that parents of newborns and night shift workers accept the ability to be slower, people usually in 24h should maintain more than 8h of sleep, the less sleep the more fatigue, will be more prone to errors. At the same time, it is recommended that no more than two consecutive night work, if you can not sleep for 3h after work, 3h sleep before work is more important.
3.4.2 Improve the ability to withstand a variety of pressures, calm state of mind Nurses are faced with patients, some from the patient's unhappiness and dissatisfaction, should be treated positively. One of the main methods is humor, humor can reduce tension and anxiety, play a role in venting anger and dissatisfaction, but should pay attention to the place and environment.
3.5 Establish a good working environment Nursing managers at all levels should try to provide nursing ...... >>
Question 9: Diagnostic nurses occupational risk factors, what are the safety protection Emergency Department nurses due to the nature of the work is often exposed to a variety of occupational risk factors, in a variety of diagnostic and therapeutic activities are prone to a variety of occupational injuries. Improve the awareness of their own protection, pay attention to infection management, do a good job of safety protection, is the key to preventing occupational injury.