《卓越护理》ppt课件

1、Art or Science艺术或科学Nursing is an art which is supported by science and practiced for the enhancement of human health护理是一门以提高人们的安康为目的的科学与实际结合的艺术Nursing involves a somewhat mystical ability to communicate and have a relationship with people for the purpose of improving their health and is supported by

2、 science护理需求一种独特的才干,这种才干即为改良人们安康为目的,在科学的指点下与人进展交流和建立关系的才干 A skill acquired by experience, study or observation; for example, the art of making friends 经过阅历学习或察看而获得的一种技术如交朋友的艺术 An art implies a personal unanalyable creative power, such as the art of choosing the right word 艺术意味着个体无需分析的创新才干如选择适宜字的艺术Pe

3、rformance Communication that Works有效的任务交流 Regardless of our position in life, we all have more similarities than differences 在生活中无论我们的位置如何,我们之间一样多于不同 Single economy and ecology 同一经济,同一人类 Single family同一家庭 Increasing interdependence 不断添加相互依赖 Single boat on level sea 在大海里的同一条船上This approach is rooted

4、in the notion that effective person to person communication is a cornerstone of excellent performance and a good work climate and that is it also a key to deep personal satisfaction and success in todays very complex, changing and often crazy work environment. 这种方式植根于这样的含义有效的人与人之间的交流是杰出任务的中心,良好的任务气氛

5、也是当前复杂,不断变化,充溢压力下任务的人们深层的个人称心度和胜利的钥匙Mr. Wu, I am Xiao Lin and I will be your nurse today. I know you just got back from surgery about an hour ago and your surgeon removed your gall bladder this morning. How are you feeling now?吴先生，叫小林，我是他今天的责任护士，我知道1小时前，他刚手术回来，今天早上他的医生把他的胆囊切除了，如今他觉得如何？I am a little

6、sleepy and I hurt some in my abdomen right here. It is also a little painful if I take a deep breath.我有点想睡，腹部这里有点痛，深呼吸时也有点痛。Yes it is always a little painful right after surgery but we will help you and your doctors have given you medicine for pain. This will make it easier to breathe deeply and get

7、 out of bed. I will help you sit up and take a deep breath right now. This may be a little painful but it will help prevent your getting pneumonia.是的，刚手术后总是会有点痛，但我们可以帮他，医生已为他开了一些止痛药，这会使他更容易深呼吸和起床，如今我要帮他坐起来做深呼吸，这能够会有些痛，但能协助他防止肺炎的发生。 Earned, not assumed 博得而不是假定的 Built on honest direct communication 基于

8、老实的直接交流 Equal rights of expression of views同等表达观念的权益 Does not allow intimidation, denigration and abuse of all kinds 不允许有要挟, 破坏名声,滥用权益 Assumes every human being has value and their own unique contribution 假定每个人都是有价值的，有他们独特的奉献Dr. Zhong, your staff ordered TPN for Mr. Wu, bed three, room 6, Tomorrow,

9、patient is going to have the surgery,the physician suggest to put a central line, but our APN nurse feel it is the difficulty case for her to do this procedure because the patients short. Could one of your staff help us?钟医生，外科医生为吴先生，6号房间3号病床，开了TPN医嘱，病人后天要手术，医生说今天就要给病人深静脉留置进展TPN治疗，但我的护士觉得这一病人头颈短，在病区内

10、做深静脉置管较危险，因此，他能否请他的麻醉师帮我们一下Thank you for mentioning the problem. I will ask our anesthesiologist to deal with the issue. Please ask your nurse staff send the patient to the operating room in a few minutes.谢谢他提出这个问题，我会叫我的麻醉师协助他们，请马上把病人送到手术室。Dr.Li, Your staff ordered intravenous antibiotics for Mr.Wu,

11、bed three, room 6, for his cholecystitis, but our staff has not been able to start an IV.Actually we tried several times and we were thinking a central line might be preferable in this patient anyway. Our advanced practice nurse who usually would put in a central line is away this week with the Gobi

12、 March. Could one of your staff help us?护士长: 李医师,他医生为6号房间3号床病人开了静脉内抗菌素治疗，但我的员工无法开通静脉，现实上我们已试了几次。但我想对这个病人来说做深静脉置管更好，我们的临床高级护士通常能置深静脉，但这次她不在医院，他们的医生能帮我们一下吗？I heard about the problem. Could one of your staff help us?李医生: 我已听到了这个问题，我们能到办公室去谈一下吗？Yes, of course护士长:当然可以Dr. Li speaking: I just came from the

13、 patients room and the family is quite unhappy with the new nurse who could not start the IV. Do you know why none of our more experienced nurses were available to able to help here after her first attempt when the family began complaining?李医师：我刚从病房里出来，对我们新护士不能开通静脉，家属很不李医师：我刚从病房里出来，对我们新护士不能开通静脉，家属很不

14、开心，他知道为什么新护士一针不胜利时，在家属开场埋怨前，没有开心，他知道为什么新护士一针不胜利时，在家属开场埋怨前，没有老护士去帮那位新护士。老护士去帮那位新护士。Nurse Manager: Actually, I was there and did try to help but the patients veins are very small and we just could do it. The family did say they were upset while I was there.护士长：现实上，我在那儿，也尝试过尽能够的开通静脉，但病人的护士长：现实上，我在那儿，也尝

15、试过尽能够的开通静脉，但病人的静脉真实太细，我们无法开通，我在那里的时候，家属曾经不高兴了。静脉真实太细，我们无法开通，我在那里的时候，家属曾经不高兴了。Doctor: Sounds like I may not have gotten the story straight. Let me see if I can get one of the anesthesiologist to start a central line 李医师李医师: 听起来我得到的信息有所偏向，我看我能否叫我们的一名医听起来我得到的信息有所偏向，我看我能否叫我们的一名医生来做深静脉穿刺生来做深静脉穿刺Xiao Lin,

16、 Mrs. Wu in bed 4, room 5 should have gotten her insulin at 3 pm, what happened?小李：5号房间4号床的吴女士在3PM该当注射胰岛素了，为什么没打？出了什么事？Dr. Li, the endocrinologist was here just before three pm and recommended we change her control to oral medicine only. Here is their note on the chart. The diabetic education nurse

17、was here too and she feels it is probably unrealistic to expect this family to give insulin at home. Actually here blood sugars have not been very high except twice when they were drawn from the dame arm she was getting her IV which had glucose in it小李：三点之前内分泌科医生李医生在这里，建议我们只用口服降糖药，这是病人病历上的记录，刚刚我们的糖尿

18、病APN护士也在这里，她觉得病人回家后让病人家属注射胰岛素不现实，现实上，她的血糖除了二次由于手臂上挂葡萄糖而抽得的血结果血糖比较高外，其他几次都不太高， 。 Sure enough . Hmmm, I will need to call Dr .Li and get this cleared up .I told the family she would need insulin. I would appreciate it if the nurse would call me if there is an apparent 好，我会打给李医师廓清这一事情，我已通知病人家属病人需求打胰岛素，

19、当医生对病人的医嘱分歧较大时，他们护士该当打通知我，我将非常赞赏。 I agree that would have been helpful. We will keep that in mind 我赞同这样会更有益一些。我们会记住的Shared commitment for implementation of decision分享努力实施决策分享努力实施决策Assumes both parties to the communication have shared in the planning假定双方在方案时分享交流假定双方在方案时分享交流Expecting people in authori

20、ty to have all the answers is irresponsible期望权威人有一切的答案是不担任任期望权威人有一切的答案是不担任任Expecting to have all the answers yourself is demagoguery期望他本人有一切的答案是非理性的期望他本人有一切的答案是非理性的On the Level communication does not allow, “The committee met and I decided平等的交流不允许平等的交流不允许“委员会开会，我决议委员会开会，我决议On the Level communication

21、 does not allow, “It is a bad plan, but I didnt want to say anything“平等交流不允许那时一个坏方案，但我不想说任何事Failure as well as success is almost always collective, not singular失败胜利几乎总是集体的，而非个体的。We need to stop blaming the people “down there for lack of motivation and the people “up there for the abuse of power and

22、get on with building a workplace based on shared responsibility我们需求停顿埋怨那些 在我们 “下面 人们缺乏任务自动性和那些在我们“上面高高在上乱用权益，开场以分享责任为根底来建立我们的任务环境。 Nurse unit manager: Xiao Lin, would you get Mr. Wu up today and be sure he breathes deeply and coughs? 病房护士长：小林，他能否叫吴先生起床，让他做深呼吸和深咳嗽吗？ Xiao Lin: But Mr. Wu is not my pat

23、ient today. 小林：但是吴先生今天不是我的病人 Unit manager: I know he isnt, but three of your patients are going home and Mr. Wus nurse has more than she can handle today, so I thought you could help with Mr. Wu. 病房护士长：我知道他不是，但是他的三个病人就要出院了，吴先生的护士今天忙不过来，因此，我想他可以帮帮吴先生。Xiao Lin, this means you have to make a nutritiona

24、l assessment on every patient you admit and if there is a problem place your report form on the front of the chart before you finish your shift.小林，这意味着对每一位入院病人要做营养评价，假设有问题，在他下班前就把报告放在病历的前页。I can see this is important and I will do my best to do it but I think the doctors should be the one to do this

25、, we are already too busy.我能了解这很重要，我会尽我最大的努力做的，但我想这该当是医生做的事，我们曾经太忙了Yes, the nurses are often short handed, but the doctors are also busy and we have agreed to help in this way. Since this is a new requirement I will try to remind all of the nurses and help you as much as I can.是的，我的护士总是那么忙，但是医生也很忙，我

26、们曾经赞同这样做了，由于这是一个新要求，我会努力提示一切的护士，我会尽我所能帮他。Communication is focused and purposeful交流该当是集中,有目的的Oriented to a specific result围绕特定的结果 Purpose not so rigid as to prevent change if new information indicates the need目的不是生硬一成不变的Final solution to question or problem not always necessary, merely a better under

27、standing of the issues could be an adequate purpose对问题的最终处理或答案并不总是需求的，只是对事物的更好了解也是一种恰当的目的。Nursing director: Xiao Lin, as you know, your patient, Mr. Wu was taken to ICU during the night. This was necessary because he was having trouble breathing and required a respirator. The nursing record shows yo

28、u were aware of and recorded a rapid respiratory rate at the end of your shift but there is no record you informed either the doctor or the nurse manager. Can you tell me what happened from your point of view?护理部主任：小林，他知道，他的病人吴先生在晚上被转到ICU，由于病人有呼吸困难，要用呼吸机，护理记录单上显示下班前他认识到这种变化,并记录病人呼吸频率很快，但没有记录他通知了医生或护

29、士长，从他的角度他能通知我发生什么。Xiao Lin: That is correct. I did notice his respiratory rate had gone up to 24 per minute so I wrote it down. I was going to call the resident but then I got a phone call from my friend and I forgot to call or tell anyone before I left. But other nurses knew he was breathing fast t

30、oo. 小林：是这样的，我留意到病人的呼吸上升到24次/分，因此我就把它记录下来了，我正要传呼或通知其他人的时候，我接了一个朋友来的,当我下班前,我忘记叫医生或其他人了,但其他护士也该当知道病人呼吸很快。Nursing director: Xiao Lin, you know it was your responsibility to pass on this information. Is it not true you and the nurse manager have had two similar discussions in the past three months?护理部主任：

31、小林，他知道这是他的责任将这些信息通知他人，在过去三个月里，类似的问题护士长曾与他讨论过 Xiao Lin: Yes, and I am really very sorry.小林：是的，我很负疚。 Nursing Director: I understand we are having a problem with the new policy on nutritional assessment, is that why you wanted to see me? 护理部主任：我了解到对营养评价新制度实施方面有些问题，这是他想见我的缘由吗？Nurse Manager: I am not sure whether it is a compliance problem or a lack of staffing. The dieticians say they are willing to come and consult but the reality is they are not coming to consult on all the patients with