Nursing management is a process that requires long-term clinical accumulation, but if there are some masters of the guidance, I think it will also be able to take some detours.
In my own management process, in how to use limited resources to enhance nursing management capabilities, and in the work of this scenario for the systematic application, to enhance the quality of care in the department of these aspects, I have the honor to read three books, and they recommend them to you, and now also recommended to you, you can according to their own situation to choose their own reading.
1, "Nursing Management Case Essentials": jumping out of the daily minutiae to read the theory of nursing management
At the beginning of the year when reading this book, I thought that the case book must be to say that the clinical story, and then guided by how to do it, however, this book breaks the previous knowledge of the case book, which is in the actual operation of the level of guidance from the care of the nursing and management before the theoretical knowledge, the fact that the nursing care is taught to managers not to be a clinical headache. Managers should not be trapped by the thousands of clinical minutiae, and learn to use scientific management theory to guide the management framework, and integrate the methodology involved in nursing, open the vision of nursing managers, and enhance the ability of nursing management.
The 44 clinical nursing management stories in the book are close to the clinic, close to the patient, and close to the empirical evidence. Throughout the main line are the four major principles of management (system, people-oriented, dynamic, efficiency principle); nursing management five basic functions (planning, organizational management, leadership, human resources, control, etc.); the current hot spots and difficult issues of nursing in China (position, performance, culture, crisis, information, innovation management).
Each chapter begins with a brief overview of the definition of management, then tells a story and poses a question, lends links to related knowledge, analyzes and interprets the question, and then extends and expands on this.
Case 22 is a nurse scheduling, in the nursing human resource management chapter, the title is everyone concerned about the "headache of the Spring Festival shift", through the story of a private hospital neurosurgery Spring Festival scheduling face:
1. 100% bed utilization;
2. 50% of young nurses;
3. The number of patients with first-degree nursing care are 30 people Above;
4. Scheduling three shifts;
5. Older nurses asked for a Chinese New Year vacation, and newer nurses, fearful of being on duty, also asked for a Chinese New Year vacation or else threatened to quit;
Three management questions were posed in response to this case:
1. What is the average number of hours of nursing care per patient per day required on this ward? What is the full-time equivalent (FTE)?
2. Should the nursing department establish scheduling rules for the Chinese New Year period? Should veteran or new nurses be taken care of?
3. How does the nursing department evaluate whether the nurse manager's scheduling is reasonable?
On the knowledge link, common nursing work patterns, scheduling principles, factors affecting scheduling, nurse scheduling cycle, and types of scheduling are described.
In the case study, three management questions are answered, such as the selection of self-scheduling after screening the three scheduling options, and the guidance of the nurse manager in the implementation and the final audit and coordination are highlighted.
The experience sharing session not only elaborated on different scheduling modes such as three shifts, two shifts, fixed scheduling, and flexible scheduling; it also provided new perspective references for nursing managers on the nurse scheduling decision support system.
Individuals through the study of the book and its subsequent clinical practice, in the whole principle of separation and integration, the principle of relative closure, the feedback mechanism, training, the principle of flexibility of the principle of dynamics, the management of power change, informal organization, the five stages of team building, the relationship between the system and the humane, situational leadership, flexible scheduling, incentives, career planning, control of the three loci, the nursing quality control indicators, the nursing adverse event management, the nursing culture implementation art and methodology. management, nursing culture implementation art and methods, job analysis, crisis management system construction, nursing research and innovation methods and processes, specialized nurse training, health care integration and other aspects have a new understanding.
In 2016, the book learning content for the systematic practice, and practice experience written into a series of management articles to share.
However, now when I encounter related management confusion, every time I reread this book, I still have new insights, just like a person who comes to the beach every time, always picking up new shells.
This is a great book for care managers to read again and again.
2. Clinical Nursing Case Analysis and Prevention of Unusual Events: A Systematic Approach to Nursing Safety Management
In recent years, the idea of patient safety management has begun to be widely accepted by clinical workers. Existing research findings show that patient safety problems are usually caused by multiple interlocking factors.
Against this background, my hospital has also launched a nursing safety campaign, and the management of nursing adverse events has entered the daily affairs of the nurse manager; however, there are still many doubts about how to create a non-punitive environment, encourage nursing staff to take the initiative to report, analyze the root causes of adverse events, and learn from mistakes.
Fourteen chapters in the book*** In addition to the overview section in Chapter 1, which describes the classification of nursing abnormal events, the reporting system, and the case analysis methodology, the remaining thirteen chapters systematically collect 194 cases involving thirteen aspects of the following two categories:
1. Identification, falls, medication errors, burn events, and injuries;
2. Blood transfusions, surgeries, restraints, plumbing, medical equipment and facilities, the hospital physical environment, and other nursing anomalies;
Each chapter begins with a description of the systems and principles of care involved in that chapter and the consequences of errors, and in each case, the story of what happened is told, then categorized, and then systematically analyzed in terms of direct and other causes, corrective action is proposed, and preventive action is extended, with clear labels on the systems and norms involved.
In the first place, the company's products and services will be used in a variety of ways.
In the 29th case - handwritten doctor's orders and computerized doctor's orders entered into the doctor's orders due to inconsistency of medication errors, mentioned a few key points after the incident:
1, the doctor mistakenly handwritten doctor's orders of "hydroprednisone" computerized entry for "hydrocortisone "
2. "Hydrocortisone" had been used previously;
3. The nurse in charge on the first day did not identify the problem with the order, the handwritten order checked by the clinical nurse on the first day of implementation was not incorrect, and the problem with the order was not identified during the first day's general checking, resulting in the printed treatment orders, visit cards, and vials on the second day of implementation. The nurse who added medication on the second day was the nurse in charge on the first day, and did not double-check the treatment sheet, visiting card, and bottle label, but still added medication according to the handwritten medical advice of "hydrocortisone" that was checked on the first day, and there was no error in the medication that was infused, and no problem with the medical advice was found during the checking on the second day, which resulted in the printed treatment sheet and visiting card of the third day being incorrect. The third day of treatment orders, visiting card, bottle tag drug error;
5, the third day of medication nurses according to the treatment order, visiting card, bottle tag drug "hydrocortisone" to add drugs to the patient input, input drug error, the third day of the total checking found that the problem of the doctor's advice, so that the third day of treatment orders printed, visiting card, bottle tag drug error;
In the event classification, for preventable clinical care adverse events;
For the event j analysis, found that the direct cause is:
1 doctor error will be handwritten "hydrocortisone" "computer entry for" hydrocortisone ". "hydrocortisone";
Other causes were:
2 change of medication without notification
3 failure of the nurse in charge to fulfill her duty of checking when handling medical orders,
4 failure of the nurse to effectively implement the daily general checking system, and failure to strictly implement the "three checks, seven checks" system when arranging and dispensing medication. "three checks and seven pairs";
It is worth noting that, when analyzing the causes, the Code of Nursing Practice (Fourth Edition) Medical Order Execution System was mentioned in the direct cause 1; the intravenous drug (liquid) infusion system in the Safe Use of Medications System of the Code of Nursing Practice (Fourth Edition) was mentioned in 2; and the intravenous drug (liquid) infusion system was mentioned in 4. Nursing management work specification (fourth edition) refers to the nursing management work specification (fourth edition) checking system; in 5 mentioned "three checks and seven pairs"; to achieve the reason can be investigated, there is a system to follow;
corrective measures, in the patient scene situation disposal (stopping drugs, assessment of medication harm, communication and explanation, reporting), the incident itself (organizing discussion, etc.), the incident itself (organizing discussion, etc.), the incident itself (organizing discussion), the incident itself (organizing discussion, etc.).
Corrective action was taken in the areas of patient situation management (stopping medication, assessing medication harm, communicating and explaining, reporting, etc.), the incident itself (organizing discussion, documenting), training (doctors and nurses), and medication management (labeling and managing "sounding" and "looking" medications);
Lastly, preventive action was taken to eliminate the recurrence of the behavior:
1, stop using handwritten medical advice, medical advice directly into the computer;
2, training to implement the professionalism of doctors, nurses, business training and systematic assessment, professional ethics, etc.;
3, high-risk drugs, listen to the similarity, seemingly, a product of multi-specification drugs labeling management;
Our department for the case of the book involves in the daily morning meeting to organize learning, for example, in the morning meeting of the book. Daily morning meeting to organize learning, for example, in the identification of the incident case analysis and prevention: intern nursing students nearly 30 bed patients liquid infusion to 25 bed patients, drug risk into another homophonic different words in the body of the slow, emergency rescue room John Doe patient identification error;
medication errors: ceftriaxone sodium wrongly issued as cefotaxime, sticking the wrong vial label risk of medication errors, infusion of fluids after the lack of a signature to the Aminophylline duplication; the nurse did not check the dose of intramuscular injection of drugs, resulting in the injection of 1.5 times more drugs, expired medicine into the child's body by mistake;
Medical facilities and equipment: intravenous indwelling needle cannula broken surgical removal, syringe pump rate abnormality;
Adverse communication incident case study and prevention: the bad language hurt people, advice is more effective than instructions, anxious family members, angry patients, internship Nursing students unsuccessful venipuncture caused family dissatisfaction, inappropriate language disputes, insufficient information to the family asked for a reduction in bed fees, waiting time for medication change is too long, resulting in friction between nurses and patients, viral cardiomyopathy child repeated crying sudden respiratory cardiac arrest;
In the monthly department of nursing adverse events reported, I always look through the book, and from time to time, will be able to get a more systematic approach to the management of the Department of the year.
Learning is never-ending, only to learn and then use, use and then learn, in order to continuously improve the clinical nursing safety management ability, this is the "clinical nursing abnormal event analysis and prevention" to bring me the greatest feeling.
3. Nursing Sample: Best Practices in Holistic Nursing
Before reading Nursing Sample, I had been thinking about how to improve the level of high-quality nursing care when nursing resources are limited, such as geography and human resources, and how to shift from a "functional" model of care to a "responsibility" model of care that is centered on the patient. What kind of metamorphosis does it take to shift from a "functional" model of care to a patient-centered model of "accountable" care? The practice of Yuxi People's Hospital in Yunnan Province - The Nursing Sample - provides me with the best ideas for practice.
The book from seven aspects: 1, nursing should be examined: the nursing answer sheet in the three A big test; 2, thought turn: from shampooing to brainwashing; 3, scheduling to open the way: from the functional system to the responsibility system; 4, the foundation of the reform: from the human resources to the support system; 5, the care of the ground: from the tiered training to the quality of supervision; 6, the long-term mechanism: from the post management to the performance of the change; 7, nursing re-start: from the "one bed" to pushing back on doctors. In the seven chapters of the narrative, in-depth analysis of the hospital located in the plateau border, how to use limited resources, the level of quality care services among the first domestic three major reasons:
1, the hospital leadership in place, attaches great importance to: quality care services to carry out in the hospital has been elevated to the strategic high level, become a veritable "a hand"!
1, the leadership of the hospital to recognize the importance of: quality care services in the hospital is elevated to a strategic height, become a real "hand" project.
2, hospital administrators strive to understand the connotation of quality nursing services, find the direction of nursing reform: scheduling reform as an entry point. The implementation of flat nurse package responsible for patients, tightening the implementation of post management;
3, the hospital nursing team good execution.
In Chapter 5 of the book, Nursing on the ground: from stratified training to quality supervision, there is a subsection that impressed me, and that subheading is - Turning to the "use-based".
This section describes the challenges and changes that the hospital's nurse manager, Ms. Liu Zhaoxian, has experienced in her role as a full-time training director.
Under the "use-based" training concept put forward by the Ministry of Nursing, it is necessary to remove the previous drawbacks of emphasizing theoretical explanations and disconnecting nursing demonstrations from clinical practice, and to base the training on the actual needs of nursing positions and work.
Under the guidance of this concept, "use-based" training more from the simulation of the classroom to the bedside of the actual demonstration and explanation, the training content is mainly based on the workflow. The Nursing Department in 2011 organized the whole hospital nurses to carry out six specialized disease responsibility system overall nursing process training, training using simulated patients and nurses in the daily work of the way, in the tactical choice of a single disease clinical care path entry.
Liu Zhaoxian first from a department to select 2 ~ 3 diseases, one by one to develop a detailed operating procedures, and then gradually expand the scope of coverage of the department, with a view to covering the common 5 ~ 10 diseases of various departments.
And to the neurology department common cerebral infarction quality care path, for example, from the patient's admission to the discharge of the entire stage, the nurses every day for those who want to assess the patient's condition, the implementation of which treatment measures, what should be informed to the patient's content of health education, what should be accomplished to the life of the care service program, what should be done to rehabilitate the guidance of the matter, are divided into a list, the nurse against this quality care path. The nurse will check the completed items against this quality care pathway table.
The single-disease clinical nursing pathway is disease-specific, and through mandatory repetition of the process, it helps young nurses to quickly familiarize themselves with the work content, avoids the possibility of omitting the work content and aspects of human negligence, and also points out the direction for nurses to further improve their professional skills. This idea of providing content guidelines through process refinement and nurse training has also inspired imitation and innovation in various departments.
Subsequently, I in the department of health care every month to implement the emergency drill, based on the actual diagnosis and treatment level of the department, to the second hospital accreditation standards mentioned in the acute trauma, pesticide poisoning, emergency delivery, acute myocardial infarction, acute stroke, acute craniocerebral injury, high-risk pregnancy, high-risk neonatal emergency services process as a model for the exercise, according to the city on these major types of emergency medical services The process of rehearsal, review after each rehearsal, annual summary, to identify gaps, for the Department of medical staff in the rescue process of the standard with the framework of the actual combat.
As Chen Xiaohong of the China Hospital Association's Medical Institution Evaluation Center said, the book "Nursing Sample" on the Yuxi People's Hospital's implementation of high-quality care reform course of the real record and in-depth analysis, both the experience of the refinement, but also a summary of the lessons learned, and because of this, the case of its nursing reform is more of a sample of the significance of the reference.
The Spring Festival is approaching, on-duty nursing managers, not on-duty nursing managers, if the book mentioned in this article is interested in, may be the next holiday break, quietly read a book, follow the footsteps of the teachers, taste the fragrance of the nursing management of the hundred, in the new year to practice and forge ahead, and walk together!