Society’s demand for nurses continues to increase, and the requirements for nurses continue to improve. However, the turnover rate of the nursing team has remained high, resulting in a serious shortage of nursing human resources. Below is the undergraduate thesis from the Department of Nursing that I compiled for your reference. Sample 1 of the undergraduate thesis of the Department of Nursing: Clinical observation and psychological care of elderly patients with fractures
Keywords: Psychological care of elderly patients with fractures
Thesis abstract purpose: To explore the clinical characteristics and psychological care of elderly patients with fractures Psychological nursing interventions. Methods: A retrospective analysis was conducted on 116 elderly patients with fractures admitted from January 2006 to December 2007. Results: The patient's primary disease condition was stable, no nursing complications occurred, his mental state was good, and his anxiety and depression were improved. Conclusion: Understanding the psychological needs and characteristics of fractures in the elderly and providing complete psychological care and rehabilitation guidance are effective guarantees for the comprehensive recovery of fractures in the elderly in physical, psychological and social activities.
With the improvement of medical standards and the extension of human life span, the proportion of elderly patients treated in orthopedics and traumatology is gradually increasing. Due to the long treatment time and limited activities of elderly patients in orthopedics, a series of complications are prone to occur during bed rest treatment. Most patients are worried about limb disability and often show different emotional reactions and psychological needs. Therefore, in clinical care, we Among them, we should strengthen psychological care based on the characteristics and psychological conditions of elderly fractures, give patients as much care and comfort as possible, patiently explain the precautions for long-term bedridden patients, and enhance the patients' confidence and courage to overcome the disease. The report is as follows.
Materials and Methods
From January 2006 to December 2007, our department treated 116 elderly patients with fractures, including 49 males and 67 females, aged 66 to 98 years old. The average age is 73. Fracture site: femoral neck and intertrochanteric fractures accounted for 81 cases, and forearm fractures accounted for 19 cases. The patients were all accompanied by varying degrees of medical history such as hypertension, heart disease, and cerebral thrombosis.
Psychological care: Since elderly patients with fractures leave their families and workplaces after being hospitalized, and are unfamiliar with their surroundings, most patients will develop a sense of loneliness and show stress, anxiety, depression, pain, etc. psychological, worry about pain, inability to take care of themselves in life, accidents, etc. For this reason, our nursing staff must create a good environment for elderly patients. Nurses must pay attention to their own words and deeds, and treat patients with enthusiasm, concern and seriousness. Patiently and carefully explain the work, inform patients of various treatment methods and the significance of care, and remind patients that they must cooperate with the precautions during treatment. Through opportunities for treatment and care, nurses should calmly introduce themselves to patients, keep their appearance elegant, and have natural expressions, and guide patients to produce positive psychological reactions and related optimistic behaviors, so as to gain the trust of patients and their families and build confidence in overcoming the disease.
Care and care: For elderly patients in new hospitals, nurses must greet and care for them with high nursing ethics and a good psychological state. They can use smiles, conversations, massage, Provide rehabilitation guidance and assist patients with necessary functional exercises to make them feel happy and satisfied.
Establish a good social support system: In addition to the care of medical staff, elderly hospitalized patients also need support from family, friends, colleagues and society, and should provide more positive guidance, persuasion, encouragement and comfort. etc., to help patients get through the most difficult period and truly experience the care and warmth of society and relatives, which is conducive to the patient's early recovery. At the same time, successful cases should be introduced to elderly patients, and patients with good results in the same ward should be asked to give personal accounts of their treatment experiences and cooperation methods to enhance their confidence, relieve their worries, and actively cooperate with treatment and care.
Patient explanation and careful observation: The elderly often cannot describe their experience of disease clearly and specifically, so nurses cannot wait for the patient’s active response and must carefully examine a series of physiological and pathological symptoms of the patient. Changes, collect detailed information about the condition of elderly patients, so as to accurately estimate the condition, make correct nursing judgments and take correct nursing measures.
Strengthen training and master nursing skills: Nurses should actively participate in various nursing-specific learning exchanges, receive training on nursing knowledge, continuously improve nursing capabilities, and fully trust elderly fracture patients in professional skills. Every move, word and deed of the nursing staff will have a great impact on the elderly patients. If the movements are careless during the operation of a certain nursing technology, they will be considered to be experimenting on them, which will cause some psychological changes in the elderly patients. , so nurses should behave steadily, operate skillfully, operate gently, respond quickly, and care about and pay attention to their various treatments and examinations. If some patients need intravenous injection after surgery, the hard and slippery blood vessels of the elderly bring certain difficulties to the puncture. In addition, the psychological effects of the elderly always worry that the new nurse cannot hit the nail on the head. In this case, it is best to Let the new nurse operate on other patients in the same ward first, so that the elderly patients can understand the new nurse's excellent intravenous injection skills from the side, so that they can develop a sense of trust and security. Results
The patient's primary disease condition was relatively stable, and there were no complications in nursing care. The patient's mental state was good and he was able to proactively cooperate with clinical treatment and care. The vast majority of patients suffered from anxiety, depression, loneliness, The dependence psychology has been improved accordingly, and I am very satisfied with the nursing work. Discussion
Due to the poor physical fitness of elderly patients and the characteristics of fractures, which generally include a longer course of disease, poor efficacy, difficulty in healing, slowed metabolic function, osteoporosis and decalcification, fractures in the elderly are The patient's healing time is usually twice or longer than that of younger patients, and complications are prone to occur. Fractures in elderly patients are usually femoral neck and intertrochanteric fractures. Treatment requires traction. Patients need to stay in bed for 2-3 months before they can move out of bed. During this period, most elderly patients are more likely to develop complications. In this group of data, most elderly patients suffer from high blood pressure, heart disease, diabetes and other chronic diseases. These diseases undoubtedly bring many difficulties to orthopedic treatment and care in clinical practice, often due to post-fracture pain, mental stress, long-term Bedridden, etc., leading to the recurrence and aggravation of these chronic diseases. To this end, nurses should understand the psychological needs and characteristics of elderly patients with fractures, and provide complete psychological care and rehabilitation guidance. This is an effective guarantee for the comprehensive recovery of elderly patients with fractures physically, psychologically and socially. This is important for widespread implementation of Systematic overall care is also crucial. Only with good psychological and rehabilitation care can integrated care be implemented. Nursing undergraduate thesis sample two: Hidden dangers and strategies in emergency nursing work in community hospitals
The emergency room receives all emergency and critical patients and impatient family members, and the emergency room is also a hot spot for medical disputes. In emergency work, it is often due to the insufficient technical level of nurses, inadequate services, malfunctions of rescue equipment, and lack of communication skills; patients’ legal awareness has increased, and some patients have poor quality and high requirements; dissatisfaction with certain services in the hospital will Venting on nurses can lead to doctor-patient conflicts and medical disputes. In order to enable the emergency nursing work in primary hospitals to adapt to the needs of the development of modern society and move the emergency nursing work towards a standardized, institutionalized and standardized management track, in response to the above realistic situation, a series of preventive measures have been adopted to enable our hospital to Satisfactory results have been achieved, and the incidence of errors and disputes has been significantly reduced. The hidden dangers and countermeasures are discussed below.
1 Difficulties and hidden dangers in nursing
1.1 The division of labor among departments is unclear and responsibilities are not in place. Due to the small scale of grassroots community hospitals and even the imperfect departments, the outpatient and emergency departments of clinical departments are not separated, which makes Many emergency patients go to outpatient clinics, leaving real emergency patients without timely and rapid treatment.
1.2 A considerable number of patients have low overall quality and poor communication between nurses and patients. Most of the patients rescued by grassroots hospitals are car accidents, fights, pesticide poisoning, alcoholism, drowning, etc.; they are young and have language communication barriers, etc.
During the rescue process, it is difficult to cooperate with nurses. They often put their grievances against the person who caused the accident, the patient's pain, family conflicts, and mental losses on the nurses, causing tension in the nurse-patient relationship, high work pressure for nurses, and poor nursing work. It is difficult to carry out.
1.3 The emergency response ability of nursing staff is low, the awareness of safety precautions is insufficient, and there are few high-quality comprehensive talents among nursing staff. The professional basic knowledge is not solid, the nursing technology operation is not standardized, the assessment ability of critically ill patients is poor, there is a lack of publicity and notification obligations to patients and their families, there are few signatures for fulfilling promises, and there is insufficient awareness of safety precautions.
1.4 There is a shortage of nursing staff, and there are many hidden dangers. With the full implementation of the new rural cooperative medical system, the number of patients has increased, but the number of nursing staff is insufficient; there are many non-staff nurses, and the turnover of nurses is high; the work of young nurses Insufficient initiative and poor work adaptability; these are factors that cause hidden safety hazards. Since the word "emergency" is highlighted in nursing care when rescuing patients, rescue personnel need to be skilled and have sufficient personnel to ensure the quality of rescue. However, due to personnel constraints in primary hospitals, there is only one nurse on duty most of the time, who must not only participate in the rescue of critically ill patients, but also take care of routine treatments such as outpatient injections. Sometimes the rescue of critically ill patients is delayed because the injection is in progress and cannot be ensured in time, causing unnecessary quarrels between the patient's family and the nurse, and even family members beating someone; at the same time, there is no one to attend to the outpatient injection room (such as when the skin test time is up and the intravenous injection is finished) ), so busy nurses are rushing around; in addition, due to busy work and few nurses, they often neglect to observe the conditions of other patients, and do not record the conditions in a timely and comprehensive manner, which leaves hidden dangers for medical care.
1.5 Insufficient infrastructure affects rescue efficiency. Measure whether a hospital’s first aid work is in place. One is to have a highly skilled medical team, and the other is to have a series of advanced medical rescue equipment to ensure quality and rescue success rate. The working environment of emergency departments in grassroots hospitals is poor. Insufficient instruments and equipment required for work, and aging personnel are a source of stress for emergency department nurses. Some rescue equipment are not commonly used. When encountering critical patients, failure of rescue equipment may occur, such as attracting The device is weak, the water inlet and outlet of the gastrointestinal machine is malfunctioning, the ECG monitor is difficult to start, etc. Not only will the rescue time be delayed, but it will also cause unnecessary medical disputes.
1.6 Due to human feelings, the principle is lost. Since the rescue room and the infusion hall are not far away from each other in grassroots hospitals, some nurses do not act according to the rules and regulations due to human feelings. When they do not rescue patients, they usually have some acquaintances and friends inside and outside the hospital. Infusion in an empty bed in the rescue room, accompanied by a large number of family members, prevents the rescue bed from being in an emergency state at any time, and affects the indoor environment and equipment application. Once an abnormality occurs in the infusion patient, or a rescue patient suddenly comes, it may Cause conflicts between doctors and patients and cause unnecessary disputes.
1.7 Constrained by the bonus distribution system, the relationship between doctors and nurses is uncoordinated. In recent years, because the principle of bonus distribution for doctors is to get paid according to work and get more for more work, the humanitarian awareness of saving lives and healing the wounded has weakened. It often happens that emergency patients go to the emergency room first, and then the nurse calls for a doctor. There is a situation where doctors only prescribe prescriptions and check-ups for outpatients, but seldom take the initiative to cooperate with nurses to participate in emergency treatment immediately, and rarely provide psychological counseling and conflict resolution for patients. Therefore, nurses in primary hospitals often suffer abuse from patients’ families and even receive unfair accusations. Nurses' work and psychological pressure gradually increase.
2 Countermeasures for rescue care
The working characteristics of the rescue room are: there are many urgent, critical, and severe patients, the work pace is fast, and the patients and their families are impatient. Therefore, nurses in the emergency room must have strong emergency response capabilities, proficient rescue techniques, quick work, high work efficiency, and good communication skills. In many cases, preliminary treatment must be carried out before the doctor arrives, such as establishing intravenous access, inhaling oxygen, suctioning sputum, and stopping bleeding. At the same time, rescue records and verification work must be done well. In order to protect the safety of patients, avoid medical disputes, promptly discover hidden dangers in nursing care, and effectively strengthen safe medical care, we now summarize the practical experience of undergraduate work over the years and make the following preventive measures against hidden dangers in emergency emergency care.
2.1 Improve hardware facilities, ensure that the safety medical and nursing department pays attention, strive for support from hospital leaders, and equip and improve various rescue facilities. The rescue facilities that need to be replaced must be replaced to make them standardized and normalized, and the handover and management of the rescue equipment must be done carefully. The equipment must be taken care of by a dedicated person, and the equipment must be checked every shift. If problems are found, they must be repaired in a timely manner to ensure that the integrity rate of the first aid equipment reaches 100%. Enable nurses to operate skillfully during first aid, so as to improve the quality of rescue, reduce medical risks and disputes, and win the hospital's reputation.
2.2 Transform the service model and standardize service behavior. With the transformation of the modern medical model, patient care no longer relies solely on superb professional skills, but should pay more attention to the care of comprehensive factors such as psychological, social and emotional factors. Advocate humanistic care and carry out humanized services, so as to "treat patients' hearts and cure their diseases". Improve the understanding and trust of patients and their families in nursing work. Insert the "people-oriented" service concept and practice throughout the entire clinical nursing work, care for every patient with love and responsibility, implement humane and humanized nursing services, and continuously promote and improve the overall nursing quality.
2.3 Strengthen the standardized training of emergency department nurses and comprehensively improve the overall quality of nurses. Provide professional and standardized training to emergency nurses so that they can master the use of various instruments and the key points and methods of observing common diseases. , rescue techniques for critically ill patients, etc. Senior nurses do a good job of communicating, helping and guiding. The nursing department organizes nurses to learn new knowledge and new technologies from time to time, and regularly assesses their theoretical knowledge and emergency response capabilities. Such as cardiopulmonary resuscitation, oxygen inhalation, gastric lavage, etc., to improve the emergency response and response capabilities of emergency nurses. Only by being smart, quick in response, not panicking when encountering difficulties, and calmly responding to challenges can they complete high-quality nursing tasks.
2.4 Strengthen the education of legal concepts and improve the legal awareness of nurses. Nursing staff are required to learn the law, understand the law, use it, and strictly abide by the legal norms. When carrying out various nursing activities, they should be strictly limited to the scope of the law. Within, improve work responsibility and reduce the occurrence of nursing errors and accidents. First aid work involving legal disputes such as alcoholism, suicide by taking poison, etc. requires nurses to observe and record the condition in a timely and accurate manner. The vomitus or washed stomach contents of patients who have taken poisons are preserved and sent for examination. Various hazardous nursing operations must be explained to patients and their families under strict operating procedures, explaining the necessity and danger of the operation, seeking their understanding, and signing for support. This not only relieves the concerns of rescuing patients, but also protects oneself and safeguards one's legitimate rights and interests.
2.5 Strengthen nurses’ sense of responsibility, strictly perform their duties as nurses, stick to their posts, and be ready for war at any time. Whenever they encounter rescuing patients, adhere to the principle of first treating urgent cases first, then treating minors, and then paying fees. And delay rescue treatment, and write various rescue care records accurately, timely and completely. Do not give up your principles because of acquaintances and friends, causing medical disputes.
2.6 Pay attention to language arts and improve nurse-patient communication. We must establish a "people-oriented" service concept in nursing work, warmly receive every patient, have a sincere attitude and civilized language. Avoid raw, cold and hard food. When patients or family members show impatience, they must patiently explain and comfort them, truly embodying the patient-centered and nursing quality-centered care management of clinical nursing work, and strictly implement various nursing operating procedures and procedures. Nursing rules and regulations will gradually solve the problem of insufficient nursing human resources, so that each nursing staff can start from the patient's immediate interests, think from the perspective of the patient, enhance communication, change passive service to active service, win the praise and trust of patients, and nurse patients. Disputes will be reduced.
2.7 Handle the relationship between medical and nursing care and enhance collective cohesion. In hospital work, although medical care and nursing are independent systems, they serve the same target. Doctors and nurses should work in different positions. Establish a communication-collaboration-complementary relationship. Patients' information should be exchanged with each other. Especially when conflicts or even disputes between doctors and patients or nurses and patients occur, they should communicate with each other to find out the reasons, study and take measures in a timely manner to resolve the conflicts as much as possible. They must not blame, blame or provoke each other.
Establish a good team spirit and nip potential safety hazards in the bud.