Basic study on evaluation of the quality of emergency nursing care : Structuring the experiences of patients during emergency treatment to improve the quality of emergency nursing care

急诊护理质量评价基础研究：构建急诊患者救治体验，提高急诊护理质量

• 批准号: 16592159
• 负责人: MURAI Yoshiko
• 金额: $ 0.96万
• 依托单位: Ishikawa Prefectural Nursing University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2004
• 资助国家: 日本
• 起止时间: 2004 至 2006
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-16592159/
• 关键词: evaluation of nursing quality; emergency treatment; emergency nursing; communication oriented toward consensus building; nursing practice ability; 看護教育; 看護実践能力; 対象理解; 救急看護; 患者満足; 評価指標; 看護実践プロセス; 看護の質; 看護サービス; 家族看護

It may not be appropriate to evaluate the emergency care system in Japan based on indicators of structure and results alone, due to differences in form depending on regional characteristics and the fact that continuation of care following emergency treatment depends on patient characteristics. Therefore, we focused on indicators of processes, specifically the types of assistance provided to patients by nursing personnel during emergency treatment. Interviews regarding actual nursing care during emergency visits were conducted with secondary and tertiary emergency patients with cardiovascular disorders upon stabilization of overall condition. Matters indicated by these patients focused on their personal experiences during treatment, rather than the care provided by nurses. Analysis using the grounded theory approach was conducted after processing interview contents. Patient experiences comprised the following four categories : "entrusting the doctor with one's life" ; "sensation of not … More being oneself ; "shock of reality" ; and "desire for information on envisioning the future". In the struggle for survival during emergency treatment, which involved confusion and uncertainty, patients attempted to maintain their identity despite dependency on medical personnel, and to make sense of their experience. Nurses should thus support patients in critical condition by providing them with relief and comfort at each phase of emergency treatment, to enable patients to accept the continuing course of treatment. These findings deepened the understanding of the subjects of care in emergency nursing. In addition, these findings indicate the importance in emergency nursing of communication skills oriented toward consensus building for obtaining understanding and consent from patients in critical condition, as well as education for cultivating human understanding, which supports these skills. Unlike critical intensive care nursing, in which patients have already received definitive diagnoses, emergency nursing is characterized by the increased need for responses not only to present problems but also potential problems, as well as careful observations by nurses with caution and consideration for patients, due to the instability of overall condition caused by the lack of definitive diagnosis. Patients may experience anxiety and fear associated with physical pain, as well as confusion, upon the sudden onset of health problems, due to the inability to understand the situation. Nurses involved in initial treatment are responsible for paying attention and responding to these reactions, which may occur in patients in critical condition, and should ideally provide intervention from the time of initial treatment. While increased demands for promotion of functional differentiation and specialization among medical institutions have resulted in a greater emphasis on the role played by emergency care, various problems have been indicated. The present study is a basic study that aims to elucidate indicators for evaluating the quality of emergency nursing care from the perspective of deepening the understanding of the subjects of care by elucidating the actual conditions of patients undergoing initial treatment, and providing effective nursing practice. Less

仅根据结构和结果的指标来评估日本的急救系统可能并不合适，因为根据地区特征，形式存在差异，而且急诊治疗后的护理继续取决于患者的特征。因此，我们将重点放在过程指标上，特别是护理人员在紧急治疗期间向患者提供的援助类型。对整体病情稳定后的二级和三级心血管疾病急诊患者进行急诊期间的实际护理访谈。这些患者指出的问题集中在他们在治疗期间的个人经历，而不是护士提供的护理。对访谈内容进行处理后，采用扎根理论方法进行分析。患者体验包括以下四类：“将自己的生命托付给医生”；“感觉不是……更多的是做自己；“现实的冲击”；以及“对展望未来的信息的渴望”。在紧急治疗期间的生存斗争中，病人感到困惑和不确定，尽管他们依赖医务人员，但他们试图保持自己的身份，并试图理解他们的经历。因此，护士应该支持危重患者，在急救的每个阶段为他们提供缓解和安慰，使患者能够接受持续的治疗过程。这些发现加深了对急诊护理中护理主体的认识。此外，这些研究结果表明，在急诊护理中，以建立共识为导向的沟通技巧，以获得危重患者的理解和同意，以及培养人类理解的教育，支持这些技能的重要性。与病人已经得到明确诊断的重症监护护理不同，急诊护理的特点是不仅需要对目前的问题作出反应，而且需要对潜在的问题作出反应，由于缺乏明确诊断导致的整体状况不稳定，护士需要谨慎地仔细观察，并为病人着想。由于无法理解情况，患者在突然出现健康问题时，可能会经历与身体疼痛有关的焦虑和恐惧，以及混乱。参与初始治疗的护士有责任关注和应对这些可能发生在危重患者身上的反应，最好从初始治疗开始就进行干预。虽然对促进医疗机构之间的功能区分和专业化的需求增加，导致更加强调急诊护理的作用，但也指出了各种问题。本研究是一项基础性研究，旨在通过阐明初始治疗患者的实际情况，从加深对护理主体的认识出发，阐明急诊护理质量的评价指标，并提供有效的护理实践。少