2.支持性护理环境的构建-朱陈萍

Giving You Sincerity, Confidence and Love2012年护理国际研讨会优化护理职业环境支持性护理环境的构建Development of a Supportive Nursing System浙江大学医学院附属邵逸夫医院朱陈萍Giving You Sincerity, Confidence and Love支持Support关怀care关注focus协作分享sharing善待提醒肯定参与鼓励指导扶持“支持”相关词条“Support”-Related TermsTeam workBe kindremindingconfirmparticipationencouagementguidanceassistanceGiving You Sincerity, Confidence and Love支持的要素Elements of SupportSystemCultureStaffProcess文化人员过程系统Giving You Sincerity, Confidence and Love支持性的护理文化Culture of Supportive Nursing1•护理支持性资源•Supportive Nursing Resource2•医院支持系统•Hospital Supportive System3•护理工作流程•Nursing Work Process4•护理质量支持体系•Supportive System for Nursing QualityGiving You Sincerity, Confidence and Love护理副院长Vice President 科护士长Director科护士长Director 病房护士长Nurse Manager病房护士长Nurse Manager带教护士Nurse Educator责任组长Team Leader责任护士Primary Nurse病房护士长Nurse Manager科护士长Director 行政秘书Secretary护理委员会Nursing Committee护理管理组织架构Nursing Organizational StructureGiving You Sincerity, Confidence and LoveCaring 理念Philosophy of Caring1、Caring 理念在实践中的体现Caring in nursing practice2、关爱我们的护士,护士才能更好的关爱病人Caring for nurses so that they can care for patients in a better way 安全Safety 温馨Warmness 尊重Respect沟通CommunicationGiving You Sincerity, Confidence and Love新员工支持系统Supportive System for New Employees•员工岗前培训•Hospital-level new staff orientation医院层面Hospita l•护士新手培训•Program for newgraduates护理部Nursing department•一对一支持•One to one support同事间支持委员会Peer-support committee•科室岗前培训•Unit based orientation护理单元Nursing unitGiving You Sincerity, Confidence and Love员工分层管理与评价Hierarchial Management andEvaluation for Staff●分层管理--岗位职责、培训、使用、评价Hierarchical management --Job Description,Training,Practice & Performance appraisal●评价方式---360°评价Performance appraisal ---360°●遵循原则---一致性、一贯性、区别性相互尊重、促进合作、明确目标Principals ---Consistency,Persistance, Distinctives,Mutual Respect, Team-work and Clarified goalsGiving You Sincerity, Confidence and Love护理资源---护理委员会Nursing Resources---Nursing Committees护理专业委员会Professionalcommittee伤口造口护理委员会Wound Ostomy糖尿病教育委员会Diabetes Education 静脉输液管理委员会IV Infusing 健康教育委员会Health Education 护理科研—循证委员Research ＆EBN 疼痛护理委员会Pain Care护理人文委员会Humanity committee同事间支持委员会Peer -Support护理交流委员会Communication哀伤护理委员Grief Care护理礼仪委员会Nursing Etiquette 心理评估干预委员会Psychiatric Intervention 志愿者委员会V olunteerGiving You Sincerity, Confidence and Love专业委员会的支持Support from Professional Committee同质化服务的促进、追踪、提升Promoting, tracking and improving uniform service 支持对象Targeted population 支持依据Evidence source 支持方式Methods患者Patients制度、流程、护理常规Policy, Nursing procedures and Nursing routine护理会诊Nursing consultation委员会成员Committee members委员会职责Committee responsibility 例会分享、培训Regular meetings for training and sharing 全院护士Staff Nurses培训计划Training programs分层培训Hierarchical trainingGiving You Sincerity, Confidence and Love委员会—促进文化共识Committee—Promoting Cultural Consensus内部资源的开发由相似文化背景和社会背景的个体组成提升护患沟通能力，促进内部交流，打破部门间障碍To improve communication skills between nurses and patients, promote internal communication and break down the barrier among departmentsTo be loved, cared and respected in a mutual interpersonal relationship 同事间支持委员会Peer-support交流委员会Communi -cation专业心理的支持psychological supportExploitation of Internal ResourcesIndividuals with similar cultural and social background被爱、被关心、被尊重，处在彼此联系相互帮助的人际关系中Giving You Sincerity, Confidence and Love语言与交流Language and Communication语言是沟通的桥梁，所以我们必须学会使用它，这可不是粗略地学会，而是精确地学会。

Language is the bridge of communication, so we must learn how to use it, not roughly, but precisely .---美戴尔.卡耐基---Dale Carnegie, USGiving You Sincerity, Confidence and LoveWhat Is SBAR?SBAR 是医护人员之间关于患者病情交流的一种标准的信息传递方式。

SBAR is a standard way for communicating between nurses and doctors.S—Situation 患者目前存在的问题B—Background 临床背景A—Assessment 患者评估R—Recommendation 建议目的：医护人员之间准确、快速地传递患者信息，减少错误的发生。

Aim: precisely and rapidly communicate between nurses and doctors in order to eliminate errors.Giving You Sincerity, Confidence and Love医院系统的支持Hospital System Support●急救系统First-aid system ●中心监护Central monitoring●围手术期管理Peri-operative management ●IT中心IT●临工科Clinical Engineering Department ●发送调配部Dispatching Department ●清洁部House-keeping Department ●输液中心化配置PIV ASGiving You Sincerity, Confidence and Love制度的支持System Support●医院制度Hospital policies●护理实践指南（制度、操作规程、常规）Nursing practice guideline （policy, nursing procedure and nursing routine)●护士必读Unit mandatory reading materials ●部门服务计划Department service program ●部门制度Department regulations●部门应急预案Emergency management plans ●专科护理Nursing specialtyGiving You Sincerity, Confidence and Love标准化评估、记录、反馈和宣教Evaluating, recording, feedback and education规范的配置和发送流程Standardized preparing and dispatching process会诊、方案制定、知情同意、不良反应的处理Consultation, plan making, informed consent, and disposal of adverse events评估并提出申请Assess and apply制度规范下的连贯服务Continuity of Care Service例：大剂量镇静、镇痛药物镇痛泵维持使用管理本制度适用于静脉使用吗啡剂量≥500MG/日e.g. management of large doses of sedative or anesthesia drugs (applied to morphine iv ≥500MG/day)主管医生Physician 麻醉科Anesthesia药房Pharmacy 楼层护士NurseGiving You Sincerity, Confidence and Love应急的支持Emergency Management Support急救系统First-aid system院内任何区域发现需抢救（心肺复苏）的患者if any patient need CPR within the hospital——第一目击者拨打9或3999告知总机总机通知急救小组成员立即组织抢救First witness call 9 or 3999to inform the central switchboard Switchboard Call the emergency teamStarting CPRGiving You Sincerity, Confidence and LovePatient Situation Change●呼吸＞28或＜8次/分(R ＞28 or ＜8次/分)●给氧，SPO2 ＜90 ( O 2，SPO2 ＜90)●收缩压＜90或低于基础值20%Systolic BP ＜90 or <20% basline ●心率＞130或＜40,(HR ＞130 or ＜40)●意识改变Conscious change ●T ＞39 or ＜35.5，WBC ＞12000or ＜4000Call 快速反应小组及主管医生快速决定处置方案Call Rapid Responsive Team and physicians to immediate treatment重症患者服务支持ICU Service患者病情变化Giving You Sincerity, Confidence and Love医院信息化的支持InformaticsGiving You Sincerity, Confidence and Love环境设施的有效管理Effective Facility ManagementFacility committeeSafety management planQuality control Routine maintenance医疗设备管理计划Medical equipments management plan有害物质管理计划Hazards material management plan消防安全管理计划Fire disaster plan治安管理计划Public security plan紧急事件管理计划Emergency event management planGiving You Sincerity, Confidence and Love医嘱管理流程Management of Medical Orders电子医嘱核查确认药房接收药师审核中心化配置护士刷码接收护士刷码执行Electronic ordersNurse checkPharmacy receivedPharmacist verify PIV ASReceiving by scanning ExecutingGiving You Sincerity, Confidence and Love患者身份确认ID Verification●患者身份核对：至少使用两种患者身份识别方法--扫描条码身份腕带，询问患者姓名●ID check ：Using at least two ways to confirm a patient—ID wristband and the name.唯一号：病历号One set of No. for one patientGiving You Sincerity, Confidence and Love●麻醉药---处方的电子化改进Narcotic ---electronization of prescription ●备用药物---取消高浓度电解质、口服药物的备用Medication backups---high concentration electrolytes and oral drugs backup are withdrawn●化疗药物---中心化配置、密闭保存、双人核对Chemotherapy agents ---centrally prepared, safely transfered and be doublechecked●药物使用中资源的整合优化-----大剂量镇静镇痛药物使用管理Integration and optimization of resources -----management of large doses of sedative or anesthesia drugs●药物过敏管理流程Management of medications allergies规范特殊药物的管理Special Drug Management警示相似药物Warning Similar MedicationsGiving You Sincerity, Confidence and Love我们如何感知病人？How Do We Perceive Patient?Giving You Sincerity, Confidence and Love系统评估,收集资料Systematic assessment and Data collection 找出护理问题/关键点Indentify problems/key point 按优先次序制定护理方案Prioritize the nursing interventions依赖性、合作性、独立性的护理措施Dependent, collaborative, and independent nursing interventions 持续评估On-going assessment护理评估Assessment 护理诊断Nursing Diagnosis 评价Evaluation措施Implement 护理计划Nursing Plan 护理程序的工作和思维框架Nursing Process and FrameworkGiving You Sincerity, Confidence and Love系统化的护理评估Systematic EvaluationGiving You Sincerity, Confidence and Love健康教育Standardized Health EducationGiving You Sincerity, Confidence and Love JCI 框架下的质控支持Quality Management Support within theJCI Frame ●完善的制度、流程的设计Well-designed regulation and procedures●各护理单元参与促进建设Unit-based nursing quality management ●多部门合作质量改进Quality improvement by collaboration ●在相互信任的基础上交流和行动Communicating and acting based on mutual trust ●对质量和安全重要性的普遍认同Consensus for the importance of quality and safety ●相信预防性措施的价值Believe in the value of preventions质量是过程和标准之间的连接Quality Is Linking Processes and StandardsGiving You Sincerity, Confidence and Love呈报分享Reporting and sharing电子呈报体系Electronic reporting system多部门分享Sharing资料的收集Data collection护理QA Nursing QA 护理专项巡查Nursing inspection护理敏感指标Nursing sensitive parameter 意外事件Event 近似错误Near miss分层改进Hierarchical improvement 各护理单元Nursing unit 护理部层面Nursing department 全院性质量改进Hospital资料反馈Feedback护理单元质量委员会Unit-based quality committee护理质量委员会Nursing quality committee 医院质量管理办公室Quality management office质量保证支持体系Supportive System for Quality ManagementGiving You Sincerity, Confidence and Love持续性驱动---流程的优化Continuously Engaged in Process Optimization●电子体温计改进项目Electrothermometer improvement project●检验临床联系电子化Electronized linkage between clinical labs and the nurse station ●给药流程修正机制的改进Modification of medication delivery processGiving You Sincerity, Confidence and Love 相信支持的力量Believe in the Power of Support争取支持的力量Strive for the Power of Support珍惜支持的力量Treasure the Power of Support给予您真诚、信心和爱Giving you sincerity, confidence and loveGiving You Sincerity, Confidence and Love 共勉Mutual Encouragement---《向世界最好的医院学管理》---《Management Lessons from Mayo Clinic 》提供值得论道的护理Provide Accountable Care。