Research and analysis of defects and precautions in nursing
At present, the nursing management system is not perfect part of the rules and regulations are unsound, imperfect, and binding, then the study of defects and precautions in nursing.
1 nursing safety overview
Nursing safety refers to the patient in the whole process of receiving care, does not occur outside the scope of the law and statutory regulations allow psychological, organism structural or functional damages, obstacles, defects or death. In recent years, with the development of modern nursing management, people's medical and health knowledge level, the enhancement of legal awareness, the soundness of the legal system, medical care risk everywhere, has become the medical care community **** knowledge. Nursing safety also includes practice safety, that is, in the process of practicing without the influence and damage of adverse factors outside the permissible scope and limits. Nursing safety is the basic needs and protection of patients, but also an important measure of the level of hospital management.
2 Nursing work in the existence of unsafe factors
2.1 Insufficient human resources overload workload state to meet the social demand for medical services, and increase the workload, resulting in a relative shortage of personnel, equipment, space in some departments. Shortage of manpower, work overload, most nurses can not adapt to the transition of multiple roles, role conflict, so that nurses are physically and mentally exhausted, excessive work and fatigue caused by a decline in attention and vigilance, is an important reason for constituting the unsafe nursing work.2.2 Nursing staff lack of love of work and dedication from the statistical analysis of low seniority nurses are prone to unsafe nursing events, due to their professional knowledge is not rich enough, the Technical operation is not skilled enough, lack of effective communication skills, lack of legal knowledge, disconnection between theory and practice, violation of technical operation procedures, which can easily lead to operation failure or operation errors, and errors occur. Nursing managers should often check and urge nurses to strictly implement the operating procedures, and strengthen the business quality training, constantly enrich and update knowledge, improve the quality of nursing safety.
2.3 Management factors safety nursing management is the core of nursing quality management, can directly affect the quality of medical care, patient safety and hospital reputation. The management system is not perfect, the monitoring lack of strength, the lack of foresight of potential unsafe factors, the education and training of human resources do not pay attention to the shortage of nursing staff, the low treatment of nurses will lead to the consequences of unsafe care. Should be from a holistic point of view, taking into account personal and environmental factors, timely feedback, from the essence of the reduction and elimination of safety accidents, so that the issue of nursing safety is really by everyone's attention.
2.4 Other factors Errors, accidents, identification and processing does not have a mechanism to make both doctors and patients trust. Society, the media and other medical institutions, personnel are still a lack of fair evaluation, the hospital survival of the environment is unsatisfactory, as well as a direct impact on the safety of nursing care factors also include nosocomial infections, burns, falls and falls, infusion oozing and necrosis, environmental pollution, food contamination, and so on. In conclusion, in today's increasingly competitive healthcare market, the quality of care safety is one of the criteria for patients to choose to seek medical treatment. Nursing quality and nursing safety is the core content and eternal theme of hospital management. We should learn from foreign experience, through continuous, preventive management and improvement, to ensure the safety of nursing care, to adapt to the needs of the general public on the high standard of medical services.
3 reason analysis
3.1 Nursing management system is not perfect part of the rules and regulations are not sound, imperfect, binding; rewards and penalties are not clearly distinguishable, the performance of the payroll distribution is unreasonable, especially between high-risk departments and idle departments is more obvious. Reflecting the idle department nursing staff's 'own value, thus causing some nursing staff psychological imbalance, poor work initiative.
3.2 Quality management system is not sound implementation is not enough, management measures are not in place, quality control is not effective are important factors causing nursing insecurity. The lack of foresight of potential unsafe factors, so that nurses in the daily nursing work without rules to follow, arbitrariness is greater, there is a hidden danger of safety.
3.3 human resources allocation is unreasonable nurses' marriage leave, maternity leave, go out for further study, academic exchanges, and the frequent addition of beds in the department, etc., will lead to the absolute or relative shortage of nursing staff, and sometimes overtime overload, physical and mental fatigue, easy to cause the work of the responsibility of the poor, attention is not focused on the service is not in place, which is also an important factor constituting the insecurity. In addition, the hospitals due to lack of personnel advocated flexible scheduling is also an important factor leading to nursing insecurity.
3.4 education and training of nurses do not pay attention to the main performance only focus on the completion of the nurse's work and ignore the improvement of on-the-job training of nurses, the nurse's business training is not in place, the professional ethics of education is weak, and the management and supervision is ineffective, etc.. When new nurses first enter clinical work, they are prone to nursing errors due to the complexity of clinical nursing work and the underestimation of the patient's condition, psychology, etc., inadequate explanations, and insufficient self-protection ability.7 With the introduction and development of a large number of new technologies and programs, there are more and more technically complex and technologically demanding elements of nursing work, which not only bring about a greater work pressure on nursing staff, but also may lead to an increase in the risk of technical aspects of nursing work, thus affecting the safety of nursing.
3.5 Legal awareness is weak, self-protection awareness is not strong nurses only focus on solving the patient's health problems, ignoring the potential legal problems in the work, the lack of nursing risk cognitive ability, the nursing disputes that may be caused by insufficient knowledge. Such as the implementation of treatment and care for patients, did not fulfill the obligation to inform, ignoring the patient's right to informed consent; do not pay attention to the protection of patient privacy, randomly talk about the patient's condition and regression; blindly implement the doctor's verbal medical advice, etc. 8. insufficient awareness of the importance of nursing document writing, nursing records are not enough to be correct and timely; in the case of the resuscitation of patients with expired medicines, equipment failure, delayed resuscitation; resuscitation of patients, the Family members are watching from the sidelines, the language of medical personnel is not standardized, and even complain to each other, the existence of defects are exposed in front of the patient's family.
3.6 Poor service consciousness attitude hard nursing staff attitude is not good, to answer the question of the language is hard or not answer, and even conflict with patients and their families; did not communicate effectively with patients and their families, resulting in patient misunderstanding, resentment, etc.; the patient observation is not in place, but blame the family will not observe 9.
3.7 Occupational hazards of nursing staff in the working environment by a variety of Biological, physical, chemical factors threaten the safety, such as pregnant nurses at work, worried about the process of refilling, whether it will be indirectly inhaled _ some powder; use of computers whether there will be radiation, frequent contact with the patient's bodily fluids, blood so that patients with hospital infections as well as infections of viral hepatitis, AIDS and other diseases, ultraviolet light, X-ray irradiation, chemical disinfectant stimulation and burns, noise pollution, medical waste pollution and psychological damage, etc., all on nursing and psychological damage, etc., are on the health of nursing staff to varying degrees of harm.
3.8 Other factors social factors society's demand for hospitals has gradually increased, the concern for hospitals is increasingly close, health regulations and policies in the implementation of the need to improve. Individual media one-sided coverage of medical disputes, so that patients lose trust in the hospital, increasing the difficulty of nursing. Patient factors: pressure ulcers are the main safety hazards, as well as falls and falls out of bed and other unsafe factors. In the process of treatment and care, patients do not cooperate with the treatment and care, against medical advice, non-compliance behavior, such as non-compliance with hospital rules and regulations, without permission to leave the ward; not according to the doctor's instructions to take medication, diet control, smoking and alcohol cessation, regular review, etc.; unauthorized changes in the number of drops of infusion of the caregiver adjusted; abuse of medicines and prescriptions, etc.; part of the patients appeared to be suicidal ideation and quasi-suicidal behavior. Certain patients or family members of the change of values, quality and cultivation of the lack of, easy to caregivers for no reason to pick, difficult, serious damage to the dignity of the caregivers, nursing staff placed in an unfavorable situation, affecting the completion of the nursing work. The hospitalized environment, the use of instruments and the management of dangerous goods and other factors that can easily lead to the patient's life, treatment and rescue safety hazards.
4 preventive research progress
4.1 Standardize the writing of nursing records, to protect the legitimate rights and interests of nurses Nursing records are an important part of the inpatient medical documentation records, which records the whole process of patient treatment and care, reflecting the evolution of the patient's condition, and has an important legal effect on ensuring the safety of patients. He Caifen et al [11] believe that the nursing record is expected to be widely promoted in clinical nursing because of the following advantages: (1) Record utility, which can reflect the changes in condition in a timely and dynamic manner. (2) Simplify nursing history writing. (3) Comply with legal requirements and protect the legal rights of nurses. (4) Sound legal awareness and improve the quality of nursing care.
4.2 Reasonable deployment of nursing human resources to reduce the overloaded work state clinical nearly 70% of the treatment, care, life services are completed through the nurses, nurses in the hospital bear the patient's protector, knower, reliant on the role of the listener, the role of the teacher, and in the family and play the role of daughter, daughter-in-law, wife, mother. And when the nursing staff is small, heavy workload and overload, most nurses cannot adapt to the transformation of multiple roles, and role conflict occurs. In the long run, it will cause damage to the physical and mental health of nurses, but also constitute an important cause of hospital insecurity, therefore, as a hospital administrators must pay great attention to the physical and mental health of nursing staff, rational allocation of human resources, to provide protection for the physical and mental health of nurses, so that the nurses are fully aware of the importance of the role of the self in hospitals, to work harder, to realize the value of life, and to make a significant improvement in the quality of care.
4.3 Create the evidence system of nursing services in the strict requirements of the nurses to implement rules and regulations and nursing technical operation routines at the same time, it is necessary to strengthen the collection and management of evidence, to create the evidence system of nursing services. Such as the development of a unified, detailed nursing operation procedures, quality standards, evaluation methods, the provisions of _ some key operations to leave a written record. In the specified time to carry out activities to talk with hospitalized patients or families, important information and education content to be reflected in the nursing record.
4.4 Strengthen the training and education of laws and regulations in nursing education to increase the law course, starting from the source of school students, in order to make future legal awareness of the nursing team from the fundamental improvement. In clinical nursing management, managers should start from professional ethics education, improve the nursing team's self-discipline and law-abiding conscientiousness, comprehensive knowledge and understanding of the relevant measures and bylaw specifications formulated on the basis of laws and regulations. While respecting and maintaining the legitimate rights and interests of patients, know how to use legal weapons to protect their legitimate rights and interests.
4.5 Strengthen supervision, grasp the key points of safety management should pay special attention to grasp the key points, that is, those who are likely to affect the overall situation or the most problematic aspects of the nursing managers should be good at identifying these key points, focusing on supervision and management. If the hospital operating room, ICU, CCU, emergency department and other comprehensive technical strong, risky departments, hospital infection control, the use of drugs and equipment supply and other work involving a wide range of influence is to cause managers to pay attention to and strengthen the focus of supervision.
4.6 The whole process of monitoring and control, safety and quality (1) items purchased off. The quality of medical supplies plays an important role in preventing and ensuring nursing safety. In the procurement of disposable infusion or syringe and other items should pay attention to the quality, performance is in line with the safety requirements; whether the patient and the operator constitute a potential danger, check the items with or without trademarks, factory addresses, certificates of conformity, etc., in order to prevent the purchase of counterfeit and shoddy products. (2) Nursing routine off. The nature of nursing work determines that each nursing work is by no means a simple process, but contains many complex links, each link has a scientific, rigorous laws and regulations. Nurses should be strictly in accordance with the operating procedures and routines, familiar with the performance of medical instruments, familiar with the mastery of the operation steps, in order to correctly complete the nursing tasks. (3) Link quality. The link quality includes the implementation of medical advice, condition observation, basic nursing care, intensive care, nursing documents, sterilization and isolation and other management links, which must be _ ring _ ring from the foundation, the implementation of sub-items, sub-parts, subsections of the strict prevention of fine management, clear responsibilities, the real source to plug the loopholes, keep a good gate, improve the quality of care. (4) End quality. End quality refers to the final result of the process of nursing service activities. Nursing end quality each have specific indicators and standards. Summarized mainly include: ① nursing safety is not safe; ② nursing effect is good; ③ work efficiency is not high; ④ patient satisfaction is not satisfied.
4.7 The positive effect of the SHEL model on safety prevention The prevention of nursing errors is? a more complex process, it is closely related to the quality of personnel, technology and management level, etc., and is affected by many factors, therefore, Japan's Medical Accident Investigation Committee, put forward the SHEL accident analysis method, S: the software part, including the nursing staff's business quality and competence; H: the hardware part, refers to the place where nurses work; E: the clinical environment; L: the parties and others. The formation of the accident of a variety of factors to analyze, in order to identify countermeasures, in order to reduce the occurrence of accidents play a positive role.
4.8 Establishment of Nursing Committee Xiang Weilan et al. actively introduced advanced nursing management concepts in the United States, combined with the management system of the hospital committee system, the committee system is used in nursing management practice. Nursing committees include regular nursing committees and nursing committees with irregular activities: regular nursing committees are composed of the nursing executive committee (nursingexecutivecommittee), nursing quality assurance committee (nursingqualityassurancecommittee), nursing quality improvement committee (nursingqualityimprovementcommittee), and nursing quality management committee (nursingqualityimprovementcommittee). The nursingexecutivecommittee, nursingqualityassurancecommittee, nursingqualityimprovementcommittee, nursingeducationcommittee, and nursingpolicy&procedurecommittee. The active nursing committee consists of the nursingformcommittee, the nursingproductcommittee, and the nursingdayconmfittee. She believes that the committee system fully embodies the democratic and scientific nature of nursing management; the committee system enables nursing management to be more objective and impartial; the committee system enables nursing management to be more proactive and practical; the committee system fully mobilizes the work of the majority of nurses, so it is recommended that the safety of nursing management work is widely promoted.
In short, in the increasingly competitive medical market today, the quality of nursing safety is one of the criteria for patients to choose to seek medical treatment. Nursing quality and nursing safety is the core content of hospital management and eternal theme. We need to learn from foreign experience, through continuous, preventive management and improvement, to ensure the safety of nursing care, to adapt to the needs of the general public on the high standard of medical services.
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