美国专家：教育病人参与感控的6个步骤
从基础开始使患者感到舒心帮助病人成为一个积极的参与者让患者知道他们的照顾应该是什么样子的不要忘记高危患者明白病人有受教育的权利SixSteps to Educating Patients About Infection ControlEducatingand empowering patients to actively participate in their care helps reduce apatient's risk of hospital acquired infections. Creating an open dialogue,however, can be a challenge in today's healthcare. So how can hospitals improvetheir patient education programs and help patients become empowered and activein their treatment?First,hospitals need to understand what accreditation standards require of hospitals.The Joint Commission established certain standards to protect patients' rightsand assist hospitals in patient education. These standards, while broad,provide the framework for healthcare providers to establish patient educationpractices."It'sgeneral enough that it can cover any case scenario that you've got," saysEmi Datuin-Pal, RN, BSN, MSHSA, MBA, associate project director at the JointCommission.One ofthe Joint Commission's general standards for patient education requires thehospital to provide patient education and training based on the patient'sneeds, Datuin-Pal says. This includes conducting a learning needs assessmentand then administers training to the patient based on the assessment. Thestandard provides examples of what hospitals should train patients on,includingbasic health practices and safety.Start with the basics. Healthcareproviders first and foremost should make sure patients are doing the simplestinfection control methods and doing them well, says Patricia McGaffigan, RN,MS, the interim president of the National Patient Safety Foundation. Thisincludes making sure people thoroughly wash their hands with soap and water fora thorough amount of time instead of just running their hands under water. "Eventhings like not sneezing into your hands but into your elbow - these are prettybasic but critical types of things patients can do in order to reduce the riskof spreading any type of infection," says McGaffigan.Inaddition, let patients know that they should be asking their healthcareproviders if they washed their own hands, McGaffigan says. Patients have theright to ask, especially when sinks and sanitation stations are located outsidetheir room, where they cannot see if the healthcare provider thoroughly washedhis or her hands. Placing sanitation stations or hand sanitizer within sight ofthe patient can help reassure the patient that their healthcare providers aretaking steps to minimize the risk of infection, according to McGaffigan.Make the patient comfortable. Thegeneral standard on patient education also requires that the hospital providethe patient with education on how to communicate concerns about patient safetyissues, Datuin-Pal says.Patientsmay feel cautious or apprehensive about asking questions because they do notwant to be considered a tough patient, but encouraging them to speak up can goa long way in preventing infections, McGaffigan says. Healthcare providers canhelp ease some of that apprehension by routinely asking patients if they haveany questions or concerns they want to discuss, McGaffigan says. By asking themfirst you open a whole new line of communication, making the patient morewilling to come forward if he or she notices a change."Itis very difficult for the patient to have the courage to speak up unless theyare invited to speak up by the system," McGaffigan added. When patients dospeak up thank them for raising a concern even if it leads to nothing. Onceagain this will help them feel more at ease and comfortable bringing up issuesin the future.Encouragepatients to also have an advocate—either a family member or someone else—whocan help look out for potential risks. These advocates can also look out forvariations in practice and may notice changes in the patient before healthcareproviders see a difference."Veryoften the patient is not only reluctant to speak up but they're not feelingwell or they may have trouble communicating for a variety of reasons, so thatthird party is vital,"according to McGaffigan.Help the patient become an active participant. Talkto the patient about what he or she can do to optimize care, instead offocusing solely on what the healthcare provider is going to do for the patient,McGaffigan says. "Patients want to be involved in their care. They want tobe an active participant. And family members want to be involved in any waythey can," McGaffigan adds.Encouragethe patient to ask questions regarding his or her treatment. Urinary tractinfections and central line infections are common in hospitals and can becostly to the patient. When it comes to certain things like catheters assurepatients that they can ask doctors and nurses, "Is it essential for mycare?" McGaffigan explains. Educating the patient on these practices mayreduce the risk of infection by eliminating a potential threat.Let patients know what their care should look likeas well. "A lot of bad things in healthcarehappen because of the variation in practice," McGaffigan says. "If wecan encourage patients to know what to expect then they can identify avariation in practice that is exposing them to a potential risk."Educatethe patient on what dressings or catheters need to be changed on a daily basisand what the process looks like. Showing the patient what to expect and whattechniques help prevent infections empowers him or her to look out forpotential risks when shifts change and someone else begins changing his or herdressings.TheJoint Commission, in addition to their standards, recognizes the importance ofhealthcare providers encouraging their patients to speak up and ask about theircare, according to Datuin-Pal.Toassist in the process, the Joint Commission launched the national Speak Upcampaign in 2002, and since then hospitals and other healthcare providers havebeen using the brochures and videos to help patients understand their right tospeak up. The brochures and videos provide easy-to-understand information oncertain issues that healthcare providers may find lacking in their own patienteducation programs."FiveThings You Can Do To Prevent Infection," one of the Speak Up brochures,provides patients with the information needed to help them remember properinfection control, including proper hand washing techniques and information on vaccinations."Know Your Rights" also gives patients critical information onunderstanding their rights in the healthcare setting. It includes moreinformation on selecting an advocate, questions for patients to ask to optimizecare and what patients have the right to know about their care. When patientsunderstand their rights they will feel more comfortable opening up aboutconcerns with their care. These brochures should be placed in waiting rooms orother areas of the hospital, easily accessible to patients and their families.TheJoint Commission provides all of the Speak Up videos and brochures for free ontheir website, http://www.jointcommission.org/speakup.aspx.Don't forget about high-risk patients. Hospitalsneed to improve their patient education and infection control training withhigh risk patients, McGaffigan says."Thereare a number of patients out there who have diabetes, and if there aresignificant changes in their blood sugar that can increase their chances ofinfection, whether they are in the hospital or not," McGaffigan says.Forpatients at a higher risk of infection, such as those who are diabetic,overweight or smokers, healthcare providers need to discuss how these issues heightentheir risk for infection. Patients in the intensive care unit are alsoconsidered high risk. Healthcare providers should encourage ICU patients to getup and out of bed, McGaffigan says."Alot of people think 'I'm in the ICU. I can't get up. I can't get out ofbed,'" McGaffigan explains. "The irony of it is getting them out ofbed is and should be a routine practice in the prevention of infection."Incertain cases, alerting high risk patients to the heightened risk of infectioncan lead to proactive measures to prevent infection. Inform patients of theirrisk and work with them to lower the risk whenever possible.Understand the patient's rights to education. TheJoint Commission purposely does not call for a specific format in patienteducation, but they provide certain requirements healthcare providers need tounderstand.Accordingto Joint Commission standards, the patient possesses the right to receive informationin a manner in which the patient understands. In certain cases the hospital mayneed to provide interpreting or translation services to accommodate thepatient's communication needs. These needs should be determined during theinitial learning needs assessment.Makingsure that healthcare providers record all patient safety and infection controleducation helps the entire healthcare team stay informed about the patient'scare and alerts them to what still needs to be discussed with the patient. Patienteducation is an ongoing process, Datuin-Pal says. There is no set time frame orformat for providing education, but it should be considered part of thepatient's daily care. As treatment proceeds or becomes modified patients needto remain informed about the care being provided.Hospitalsshould make patient safety and education a key concern at every level, from thetop administration down, McGaffigan says, adding, "If we were able tominimize hospital acquired infections alone in a manner where we haveengagement from the staff and from the patient and families, we could bereducing risk and cost substantially, let alone the mortality rate." TaraBoyd is a writer for ICT.
各国的国情不一样，文化不一样，在美国能做的事，不一定在中国行，因中国的医闹太多了，想搞钱的太多了。个人意见，仅供参考，谢谢！ 很好的工作思路，这对预防和控制医院感染很有帮助。也能使“保障病人安全，你我共同参与”真正落到实处。只是，国情与文化差异，在国内实施起来可能会有一定难度。相信在不久的将来会开展起来的。 同样的担心，会让病人有更多的把柄可抓，单就一个手卫生依从性就够让人头疼的，据说已经有因为手卫生不到位产生的医疗纠纷了。 个人认为：在教育病人之前，先把医务工作者教育好，免得病人都参与了，有的医务工作者还不懂。 让患者参与患者安全的几个方面：从简单开始，让患者感到舒适，帮助患者积极参与，让患者知道接受的诊疗情况，关注高危患者，患者接受教育的权利。
目前的国情让患者参与也许会引发不少的矛盾和纠纷，但这是无法回避的，与其刻意回避，不如让患者参与进来，进而解决由此引发的问题？
同意楼上的观点，目前的国情让患者参与也许会引发不少的矛盾和纠纷，但这是无法回避的，与其刻意回避，不如让患者参与进来，进而解决由此引发的问题，有些问题越是刻意回避越会陷入僵局，不如透明点，让患者参与来得好！
今年，我对家属和患者进行了院感知识的培训，当时我也有顾虑，怕他们知道有关政策我们会有麻烦，为此我避重就轻说了一些规范，更多讲了我们平时应该正确做好的各项工作，如：医疗废物的收集，手卫生，抗生素的使用，防护用品的使用，培训以后效果很好，能达到预期效果 提高患者感控的依从性，才能提高患者预防的主动性。 我也有这个 想法，如果让病人和家属来监督我们的医生，肯定是事半功倍 同意6楼的观点：在教育病人之前，首先要把医务工作者教育好，免得病人都参与了，有些医务工作者还不懂得或者不到位。这样才能更好地避免医疗纠纷。 很人性化的服务。我们总是担心病人抓把炳，为什么不从患者角度考虑问题呢？换位思考，也许就会不同了，毕竟多数病人是善良的，病人也有被尊重的权力！如果我们做的到位，无理取闹的毕竟是极少数！ 先教育好医人员，才教育病人，否则纠纷不断。 非常同意胡教授曾经对PFPS提出的要求，其中有一条就是“一定不能增加临床工作的负担；一定不能增加医患矛盾风险” 患者拥有知情权，由于医务人员的不当导致感染理应让患者知道。我觉得更多的纠纷是因为患者对医疗活动一知半解造成的，患者对医疗懂得越多，就越理解我们医务人员，纠纷不多反少。所以我觉得教育患者与教育医务人员同等重要。
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