護(hù)理專(zhuān)業(yè)實(shí)踐描述

1、,趙文,護(hù)理專(zhuān)業(yè)實(shí)踐的未來(lái)--美國(guó)斯坦福護(hù)理專(zhuān)業(yè)實(shí)踐模型,美國(guó)加利福尼亞帕洛阿爾托斯坦福醫(yī)學(xué)中心,大事記：1858-在舊金山成立醫(yī)學(xué)院 1891-創(chuàng)辦斯坦福大學(xué) 1895-設(shè)立護(hù)理學(xué)院 1959-醫(yī)學(xué)院搬離舊金山

2、 1968-斯坦福醫(yī)院并入斯坦福大學(xué) 1968-完成美國(guó)首例成人心臟移植 1981-完成世界首例心肺聯(lián)合移植 1988-Lucile Packard兒童醫(yī)院動(dòng)工 1974-斯坦福護(hù)理學(xué)院最后一名護(hù)士畢業(yè)

3、 1993-斯坦福門(mén)診開(kāi)放 1994-斯坦福大學(xué)附屬醫(yī)院和斯坦福大學(xué)門(mén)診部合并組建斯坦福健康服務(wù)中心 2004-斯坦福癌癥中心大樓建成 2012-總住院天數(shù)-25164

4、 門(mén)診病人643806 急診病人-53908,認(rèn)證,Magnet Status(美國(guó)護(hù)理認(rèn)證中心，ANCC)Beacon獎(jiǎng)（美國(guó)急救護(hù)理學(xué)會(huì)，AACN)繼續(xù)教育和職業(yè)發(fā)展認(rèn)證中心（ANCC)NICHE認(rèn)證醫(yī)院（老人健康護(hù)理改善體系）一級(jí)創(chuàng)傷中心（美國(guó)外科醫(yī)師協(xié)會(huì)，ACS)兒科一級(jí)創(chuàng)傷中心

5、（ACS）急診科因卓越表現(xiàn)獲得Lantern獎(jiǎng)（急救護(hù)理協(xié)會(huì)）,怎樣提高護(hù)理參與度和病人滿(mǎn)意度,背景斯坦福護(hù)理歷史悠久，成績(jī)卓越。然而，我們針對(duì)護(hù)理的調(diào)查表明，她們更多地想?yún)⑴c到護(hù)理的管理，改善病人的預(yù)后中去。病人滿(mǎn)意度調(diào)查顯示，病人總體是滿(mǎn)意的，但是在滿(mǎn)足病人要求時(shí)我們還可以在以下方面做得更好。呼叫器的應(yīng)答讓他們清楚出院計(jì)劃滿(mǎn)足他們的個(gè)人要求效果護(hù)理領(lǐng)導(dǎo)意識(shí)到員工的參與度可以通過(guò)共同管理，創(chuàng)造專(zhuān)業(yè)實(shí)踐模型來(lái)改善。患者

6、希望多參與到護(hù)理工作中，因此我們成立了患者咨詢(xún)委員會(huì)來(lái)建議醫(yī)院如何處理患者的建議。制定了標(biāo)準(zhǔn)版的護(hù)理制度。,怎樣改變護(hù)理實(shí)踐,護(hù)士們需要參與到做決定的過(guò)程中來(lái)改變護(hù)理實(shí)踐斯坦福用分享管理的模式通過(guò)了Magnet認(rèn)證.傾聽(tīng)患者的訴求，讓我們?cè)谧鰶Q定時(shí)始終以患者為中心。通過(guò)角色練習(xí)營(yíng)造專(zhuān)業(yè)責(zé)任制，讓我們迎接護(hù)理實(shí)踐的挑戰(zhàn)，達(dá)到良好的結(jié)果。,,護(hù)理專(zhuān)業(yè)實(shí)踐模型,CARE DELIVERV A CLINICAL PRACTICE,E

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58、O CARE,TO CARE,護(hù)理專(zhuān)業(yè)實(shí)踐模型,信念、價(jià)值、理論以及系統(tǒng)貫穿于斯坦福護(hù)理實(shí)踐始終。對(duì)所有的護(hù)士來(lái)說(shuō)，此模型是“活的”，所以她們可以用利己利人的方式描述它。用這種模型可以保證護(hù)理實(shí)踐和組織是一致的。它預(yù)示著我們將來(lái)在護(hù)理實(shí)踐中扮演的角色。我們的宗旨圍繞在上面，價(jià)值放在下面，以一種強(qiáng)勁的擁抱聚在一起實(shí)踐的要素包括：傳遞關(guān)愛(ài)，臨床實(shí)踐專(zhuān)業(yè)的護(hù)理角色共同管理平的環(huán)境教育、研究,Magnet認(rèn)證,背景美

59、國(guó)護(hù)理認(rèn)證中心的Magnet認(rèn)證項(xiàng)目，是對(duì)那些提供卓越護(hù)理實(shí)踐，具有典范作用的健康組織的一種認(rèn)可。效果包括從Magent項(xiàng)目中挑選40名Magnet冠軍，35名Magnet設(shè)計(jì)成員，以及超過(guò)60名的內(nèi)容貢獻(xiàn)者組成多學(xué)科參與的團(tuán)隊(duì)，最后形成大約3700頁(yè)的文件重新提交。斯坦福是全美372所注冊(cè)醫(yī)院中獲得ANCC Magnet認(rèn)證的6.5%中的一員。Magnet醫(yī)院有更高的滿(mǎn)意護(hù)士比例，低的護(hù)士流動(dòng)性和空閑率，更好的臨床預(yù)后和患者滿(mǎn)

60、意度。,O’Rourke病人關(guān)懷模型,,,,臨床實(shí)踐,標(biāo)準(zhǔn)化管理,標(biāo)準(zhǔn)化教學(xué),標(biāo)準(zhǔn)化執(zhí)行,管理實(shí)踐,病人關(guān)懷模型,實(shí)踐演練,熟悉的角色練習(xí),背景重新調(diào)整專(zhuān)業(yè)護(hù)理的期望，將護(hù)理實(shí)踐從以任務(wù)為主向以角色為導(dǎo)向轉(zhuǎn)變。我們讓護(hù)士參加多周項(xiàng)目，對(duì)照最好的實(shí)踐標(biāo)準(zhǔn)，來(lái)重新檢查自己的實(shí)踐行為。提升角色能力，批判思維，轉(zhuǎn)換思路，加強(qiáng)協(xié)作，提高質(zhì)量和患者安全。護(hù)士在護(hù)理實(shí)踐上的繼續(xù)教育，明確在其中扮演的角色效果截止2010年9月，斯坦福醫(yī)學(xué)中

61、心有超過(guò)160名的護(hù)士和護(hù)理領(lǐng)導(dǎo)參與了此項(xiàng)目。2011-2013年，此項(xiàng)目被迅速推廣到其他住院病區(qū)。,保持90%患者滿(mǎn)意度歷程,呼叫器應(yīng)答C-i-care每小時(shí)巡查床邊教學(xué)床邊團(tuán)隊(duì)教學(xué),我們要問(wèn)，為什么我們的患者對(duì)護(hù)理不滿(mǎn)意？,Why?,住院患者的護(hù)理實(shí)踐框架：全方位分析,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,患者滿(mǎn)意度高于90%,,,監(jiān)督/認(rèn)證C-I-CARE查房C-I-CARE服務(wù)補(bǔ)救當(dāng)天反饋患

62、者經(jīng)驗(yàn)展示,構(gòu)建基礎(chǔ)靈活的日常管理統(tǒng)一的制服以病區(qū)為單位的工作場(chǎng)所改善托管,時(shí)時(shí)服務(wù)每位患者C-I-CARE團(tuán)隊(duì)查房目的性查房床邊交接班,,C-I-CARE--患者滿(mǎn)意度,C-I-CARE是以患者為中心框架的首字母縮寫(xiě)C：呼喊患者的常用名來(lái)聯(lián)系患者I：介紹自己和扮演的角色C：交代在干什么，要持續(xù)多久等等A：先征得同意再操作R：立即回答問(wèn)題或請(qǐng)求E：有禮貌地離開(kāi)C-I-CARE執(zhí)行制定常規(guī)操作的模板用C-

63、I-CARE培訓(xùn)員工專(zhuān)業(yè)與患者交流C-I-CARE監(jiān)督所有領(lǐng)導(dǎo)參與到日常管理中領(lǐng)導(dǎo)每天參與管理查房&病區(qū)查房中,C-I-CARE,團(tuán)隊(duì)-查房,背景：通常，患者不清楚自己的治療計(jì)劃，與醫(yī)務(wù)人員溝通后與自己的預(yù)期不符，就會(huì)想出院。提高團(tuán)隊(duì)的協(xié)作、溝通能力，減輕延遲出院，讓患者/員工/醫(yī)生都滿(mǎn)意，營(yíng)造一個(gè)高質(zhì)量的護(hù)理氛圍，最終讓斯坦福醫(yī)學(xué)中心有能力服務(wù)更多患者效果對(duì)患者的合理布局是一個(gè)機(jī)會(huì)團(tuán)隊(duì)查房涉及多學(xué)科的所有成員

64、多學(xué)科查房不是同時(shí)發(fā)生的，包括不局限于常規(guī)的主要參與者—團(tuán)隊(duì)查房為多學(xué)科查房提供了參考框架。患者感覺(jué)到自己享受到的服務(wù)是協(xié)調(diào)一致的，他們?yōu)槌鲈鹤龊脺?zhǔn)備。,為科室創(chuàng)造增長(zhǎng)和服務(wù)更多患者的能力，讓患者、員工和醫(yī)生的利益最大化,團(tuán)隊(duì)查房—目的,討論團(tuán)隊(duì)查房的要點(diǎn)今天的目的估計(jì)出院日期患者還需要監(jiān)護(hù)儀么？出院須知可否移動(dòng)移動(dòng)或出院的障礙患者或家屬是否知道診療計(jì)劃？患者在出院前是否有專(zhuān)科安排？跟蹤昨天的討論，據(jù)今天的討論制定計(jì)

65、劃。,目的查房—每天 每位患者,一貫的/有組織的目的查房的標(biāo)準(zhǔn)流程主動(dòng)詢(xún)問(wèn)病人有無(wú)疼痛不適、位置如何、個(gè)人需求（衛(wèi)生間）防止跌落個(gè)性化護(hù)理感情上多溝通營(yíng)造一個(gè)有利于檢查的環(huán)境詢(xún)問(wèn)有無(wú)其他需求告訴患者何時(shí)再來(lái),床邊交接班,制定床邊交接班模板（用C-I-CARE）所有護(hù)士交班時(shí)要在床邊做好交接和接班護(hù)士談?wù)摶颊叩那闆r患者告訴我們，他們聽(tīng)到護(hù)士交接班時(shí)感覺(jué)更安全。,床邊交接班—效果,推廣床邊交接班后明顯提高了執(zhí)行力