護理專業(yè)實踐描述

1、,趙文,護理專業(yè)實踐的未來--美國斯坦福護理專業(yè)實踐模型,美國加利福尼亞帕洛阿爾托斯坦福醫(yī)學中心,大事記：1858-在舊金山成立醫(yī)學院 1891-創(chuàng)辦斯坦福大學 1895-設立護理學院 1959-醫(yī)學院搬離舊金山

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

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

4、 門診病人643806 急診病人-53908,認證,Magnet Status(美國護理認證中心，ANCC)Beacon獎（美國急救護理學會，AACN)繼續(xù)教育和職業(yè)發(fā)展認證中心（ANCC)NICHE認證醫(yī)院（老人健康護理改善體系）一級創(chuàng)傷中心（美國外科醫(yī)師協(xié)會，ACS)兒科一級創(chuàng)傷中心

5、（ACS）急診科因卓越表現(xiàn)獲得Lantern獎（急救護理協(xié)會）,怎樣提高護理參與度和病人滿意度,背景斯坦福護理歷史悠久，成績卓越。然而，我們針對護理的調(diào)查表明，她們更多地想?yún)⑴c到護理的管理，改善病人的預后中去。病人滿意度調(diào)查顯示，病人總體是滿意的，但是在滿足病人要求時我們還可以在以下方面做得更好。呼叫器的應答讓他們清楚出院計劃滿足他們的個人要求效果護理領導意識到員工的參與度可以通過共同管理，創(chuàng)造專業(yè)實踐模型來改善。患者

6、希望多參與到護理工作中，因此我們成立了患者咨詢委員會來建議醫(yī)院如何處理患者的建議。制定了標準版的護理制度。,怎樣改變護理實踐,護士們需要參與到做決定的過程中來改變護理實踐斯坦福用分享管理的模式通過了Magnet認證.傾聽患者的訴求，讓我們在做決定時始終以患者為中心。通過角色練習營造專業(yè)責任制，讓我們迎接護理實踐的挑戰(zhàn)，達到良好的結果。,,護理專業(yè)實踐模型,CARE DELIVERV A CLINICAL PRACTICE,E

7、DUCATION A RESEARCH,COLLABORATIVE ENVIRONMENT,SHARED COVERNANCE,PROFESSIONAL DEVELOPMENT,PROFESSIONAL NURSING ROLE,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,TO EDUCTAE,TO CARE,TO DIACOVER,HONESTYEXCELLENCEA

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19、D COVERNANCE,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,COLLABORATIVE ENVIRONMENT,EDUCATION A RESEARCH,CARE DELIVERV A CLINICAL PRACTICE,PROFESSIONAL NURSING ROLE,PROFESSIONAL DEVELOPMENT,SHARED COVERNANCE,HONES

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24、ONAL DEVELOPMENT,SHARED COVERNANCE,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,護理專業(yè)實踐模型,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,COLLABORATIVE ENVIRONMENT,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,EDUCATION A

25、RESEARCH,COLLABORATIVE ENVIRONMENT,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,CARE DELIVERV A CLINICAL PRACTICE,EDUCATION A RESEARCH,COLLABORATIVE ENVIRONMENT,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,PROFESSIO

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42、ORATIVE ENVIRONMENT,HONESTYEXCELLENCEADVOCACYHESPECTTEAMWORK,,SHARED COVERNANCE,PROFESSIONAL DEVELOPMENT,PROFESSIONAL NURSING ROLE,CARE DELIVERV A CLINICAL PRACTICE,EDUCATION A RESEARCH,COLLABORATIVE ENVIRONM

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58、O CARE,TO CARE,護理專業(yè)實踐模型,信念、價值、理論以及系統(tǒng)貫穿于斯坦福護理實踐始終。對所有的護士來說，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理實踐和組織是一致的。它預示著我們將來在護理實踐中扮演的角色。我們的宗旨圍繞在上面，價值放在下面，以一種強勁的擁抱聚在一起實踐的要素包括：傳遞關愛，臨床實踐專業(yè)的護理角色共同管理平的環(huán)境教育、研究,Magnet認證,背景美

59、國護理認證中心的Magnet認證項目，是對那些提供卓越護理實踐，具有典范作用的健康組織的一種認可。效果包括從Magent項目中挑選40名Magnet冠軍，35名Magnet設計成員，以及超過60名的內(nèi)容貢獻者組成多學科參與的團隊，最后形成大約3700頁的文件重新提交。斯坦福是全美372所注冊醫(yī)院中獲得ANCC Magnet認證的6.5%中的一員。Magnet醫(yī)院有更高的滿意護士比例，低的護士流動性和空閑率，更好的臨床預后和患者滿

60、意度。,O’Rourke病人關懷模型,,,,臨床實踐,標準化管理,標準化教學,標準化執(zhí)行,管理實踐,病人關懷模型,實踐演練,熟悉的角色練習,背景重新調(diào)整專業(yè)護理的期望，將護理實踐從以任務為主向以角色為導向轉變。我們讓護士參加多周項目，對照最好的實踐標準，來重新檢查自己的實踐行為。提升角色能力，批判思維，轉換思路，加強協(xié)作，提高質量和患者安全。護士在護理實踐上的繼續(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)學中

61、心有超過160名的護士和護理領導參與了此項目。2011-2013年，此項目被迅速推廣到其他住院病區(qū)。,保持90%患者滿意度歷程,呼叫器應答C-i-care每小時巡查床邊教學床邊團隊教學,我們要問，為什么我們的患者對護理不滿意？,Why?,住院患者的護理實踐框架：全方位分析,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,患者滿意度高于90%,,,監(jiān)督/認證C-I-CARE查房C-I-CARE服務補救當天反饋患

62、者經(jīng)驗展示,構建基礎靈活的日常管理統(tǒng)一的制服以病區(qū)為單位的工作場所改善托管,時時服務每位患者C-I-CARE團隊查房目的性查房床邊交接班,,C-I-CARE--患者滿意度,C-I-CARE是以患者為中心框架的首字母縮寫C：呼喊患者的常用名來聯(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：立即回答問題或請求E：有禮貌地離開C-I-CARE執(zhí)行制定常規(guī)操作的模板用C-

63、I-CARE培訓員工專業(yè)與患者交流C-I-CARE監(jiān)督所有領導參與到日常管理中領導每天參與管理查房&病區(qū)查房中,C-I-CARE,團隊-查房,背景：通常，患者不清楚自己的治療計劃，與醫(yī)務人員溝通后與自己的預期不符，就會想出院。提高團隊的協(xié)作、溝通能力，減輕延遲出院，讓患者/員工/醫(yī)生都滿意，營造一個高質量的護理氛圍，最終讓斯坦福醫(yī)學中心有能力服務更多患者效果對患者的合理布局是一個機會團隊查房涉及多學科的所有成員

64、多學科查房不是同時發(fā)生的，包括不局限于常規(guī)的主要參與者—團隊查房為多學科查房提供了參考框架?；颊吒杏X到自己享受到的服務是協(xié)調(diào)一致的，他們?yōu)槌鲈鹤龊脺蕚洹?為科室創(chuàng)造增長和服務更多患者的能力，讓患者、員工和醫(yī)生的利益最大化,團隊查房—目的,討論團隊查房的要點今天的目的估計出院日期患者還需要監(jiān)護儀么？出院須知可否移動移動或出院的障礙患者或家屬是否知道診療計劃？患者在出院前是否有?？瓢才?？跟蹤昨天的討論，據(jù)今天的討論制定計

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準流程主動詢問病人有無疼痛不適、位置如何、個人需求（衛(wèi)生間）防止跌落個性化護理感情上多溝通營造一個有利于檢查的環(huán)境詢問有無其他需求告訴患者何時再來,床邊交接班,制定床邊交接班模板（用C-I-CARE）所有護士交班時要在床邊做好交接和接班護士談論患者的情況患者告訴我們，他們聽到護士交接班時感覺更安全。,床邊交接班—效果,推廣床邊交接班后明顯提高了執(zhí)行力