Comfort and Safety舒适与安全

王克芳山东护理学院

kefangwang@126.com

Hiao’s Double C Nursing Model

Cure

Care

Doctor

Nurse +Comfort

Introduction to Comfort

Client's Lying Position

Client's Safety

Pain management

Section 1 Introduction to

Comfort

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Concept of Comfort

Influencing Factors of Comfort

Principles to Promote Comfort

Comfort is a wellbeing state of physical and psychological health, no pain, no anxiety and relaxing at ease, it is a kind of high-individualized sense.

psychological comfort

physical comfort

environmental comfort

social comfort

人

comfortable discomfortable

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What are the factors affecting in-patients’ comfort?

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PsychologicalFactors

Social Factors

Physical Factors

EnvironmentalFactors

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Physical Factors

个人卫生 姿势或体位不当 保护具或矫形器械使用不当疾病影响

Social-Psychological Factors

害怕或焦虑角色适应不良 生活习惯改变 自尊受损缺乏支持系统

Environmental Factors

不适宜的社会环境不适宜的物理环境

focus on prevention

Reinforcement of observation

interventions in accordance with various situation

psychological support

lying Position

患者休息和适应医疗护理需要时采取的卧床姿势

Comfortable lying Position

能够使身体各部分处于轻松自在的舒适状态的卧位姿势符合人体力学的要求经常变换卧位活动机体各部位保护受压部位保护隐私

Type of Client’s lying Position

Client’s lying Position

Moving and turning clients in bed

根据卧位的自主性分为主动卧位（ active lying position ）被动卧位（ passive lying position ） 被迫卧位（ compelled lying position ）

根据卧位的平衡性分为稳定性卧位（ stable lying position ）不稳定性卧位（ unstable lying position ）

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主动卧位（ active lying position ）：患者根据自己的意愿和习惯采取最舒适、最随意的卧位，

并能随意改变卧床姿势

被动卧位（ passive lying position ）：患者自身无力变换卧位，躺卧于他人安置的卧位

被迫卧位（ compelled lying position ）：患者意识清晰，也有变换卧位的能力，但为了减轻疾病所

致的痛苦或因治疗需要而被迫采取的卧位。

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stable lying position ：支撑面大，重心低，平衡稳定，患者感到舒适

unstable lying position ：支撑面小，重心较高，难以平衡。为了保持一

定的卧位，患者极易造成肌肉紧张、疲劳和不适。

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仰卧位（ supine position ） 侧卧位（ side-lying position ） 半坐卧位（ fowler’s position ） 端坐位（ sitting position ） 俯卧位（ prone position ） 头低足高位（ trendelenburg position ） 头高足低位（ dorsal elevated position ） 膝胸卧位（ knee-chest position ） 截石位（ lithotomy position ）

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去枕仰卧位

（ Supine position without pillow ）

中凹卧位（休克卧位）

（ Shock position ）

屈膝仰卧位

（ Supine position with knees flexed ）

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【 Use 】 coma client or client who is still unconscious

after general anesthesia. clients after intra-vertebral anesthesia or spinal

puncture

Supine position without pillow

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【 Use 】 client is on shock condition

抬高头胸部，有利于保持气道通畅，改善通气功能，从而改善缺氧症状；

抬高下肢，有利于静脉血回流，增加心输出量而使休克症状得到缓解。

Shock position

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【 use 】 abdominal examination urinary catheterization perineum rinse.

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[Use] changing position to prevent pressure ulcer; enema, anal examination, and gastro scope

examination. Gluteal intra-muscular injection

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[Use]dyspnea caused by cardiopulmonary diseases.Post-operative period of operations on face or neck; post-operative period of operations on abdominal and pelvis organs; recovery stage of sickness.

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[Use] severe dyspnea caused by heart

failure hydro pericardium, asthma.

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【 Use 】 back and waist examination or

cholangiography; clients who can not lie on back such as after

spinal operation or having wounds on back, waist, or buttocks.

abdominal pain caused by gastrointestinal pneumatosis.

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【 use 】postural drainage of pulmonary secretions; duodenal drainage; premature rupture of fetal membrane; Skeletal traction through calcaneus or tibial

tubercle

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【 use 】 skull traction for clients with fracture of cervical spine; lessening intracranial pressure and preventing cerebral

edema; post-operative period of craniocerebral operations.

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【 Use 】 anal and rectal examination or

sigmoidoscope examination and treatment; correction malpositions or retroversion of

uterus; facilitating involution of uterus.

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【 use 】 examination, treatment, or operation on

perineum and anus It is also used during childbirth (delivery).

Moving a client up in bed

Turning a client to a lateral position

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Turning a client to a lateral position

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Turning a client to a lateral position

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Turning a client to a lateral position

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【注意事项】

◦ 协助患者更换卧位时，应注意节力原则；◦ 协助患者翻身时，应将患者身体稍抬起再行翻

身，切忌拖、拉、推等动作，以免擦伤皮肤；◦ 协助患者更换卧位时，应注意观察病情与受压

部位情况；◦ 为有特殊情况的患者更换卧位时，应特殊对待

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3548例严重医疗不良事件：

序号序号 事件事件 例数例数11 病人自杀病人自杀 464464

22 手术部位错误手术部位错误 455455

33 手术或者手术后并发症手术或者手术后并发症 444444

44 给药错误给药错误 358358

55 由于治疗延误导致死亡由于治疗延误导致死亡 269269

66 病人跌倒致伤病人跌倒致伤 189189

77 病人约束中发生死亡病人约束中发生死亡 138138

88 病人被强暴病人被强暴 121121

99 输血问题输血问题 9494

1010 失火失火 6565

1111 麻醉问题麻醉问题 5858

Safety Related Factors

Unsafe Factors and Precautions in Hospital

The measures Protect Clients in Safety

Sensuous Function

Age

Current Health Condition

Familiar with Surrounding

Diagnosis and Treatment Measures

Mechanical injuries

Thermal injuries

Pressure Injuries

Radioactive Injuries

Use bedside rail restraints and protective device

Assist clients and providing assistant device Keep the daily articles at the bedside and easy reach

of clients Make the floors clear, dry Provide handrails in corridor, bathroom and toilet Provide the call device in bathroom and toilet Place the instrument such as knife in suitable area in

psychotic ward.

Nurse should notice to the chief complaint of clients and observe the changes of local skin when applying heat and cold under the strict operation rules. Any discomfort should be timely handled.

Reinforcing the administration of the flammable & explosive articles and fireproofing education

Checking and maintaining electrocircuit and all kinds of electric apparatus in the hospital periodically.

Lead aprons and gloves are used for staff

Control the radioactive time and dosage accurately.

Lessen unnecessary body exposure and keep the sign in radioactive field.

Educating clients to keep the skin of radioactive field clean and dry, avoiding to clean forcibly, using soap, and scratch.

nurses possess the pharmacology knowledge

execute medication administration strictly.

‘Three Check-ups’ and ‘Seven Verifications’

noticing the matching contradiction of medicine

observing the reaction

interpreting related knowledge to clients

execute the disinfection & isolation system strictly

Injuries include psychological or physical

damage to clients result in inadvertent

speaking and behavior of medical staff.

To Keep clients in safety.

To ensure that the treatment and nursing process carry through smoothly.

Identify client’s age, state of illness, present level of consciousness, vital sign and mobility……

Evaluate the ability of client’s understanding, accepting and cooperating to usage of protective device and client’s reactions

床档（ bedside rail restraint ） ◦主要用于预防患者坠床。

－多功能床档

－半自动床档

－木杆床档

Restraint Broad Bandages

Restraint Shoulder Restraint

Restraint

Knee Restraint:

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Restraint

Waist Restraint:

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Overbed Cradle

Are protective devices safe for patients ？

Identify the appropriate applying situation of the protective device

Restrain device just suitable for short-term using.

Place a pad under the restraint while using, Fixing with appropriate degree of tightness and loosing regularly.

Recording the purpose, time of using and loosing, observing result and nursing consideration.

Evaluation about the protective device at any time

Comfort and safety Active lying positionPassive lying positionCompelled lying position Supine position Lateral position

Fowler’s Position Orthopneic position

Prone positionProtective

devicesBedside rail

restraintRestraint Overbed Cradle

Assessment the high risk group of falling in hospital

掌握舒适、主动卧位、被动卧位、被迫卧位的概念

掌握各种卧位的适用范围 能正确安置卧位并扶助病人更换卧位 能正确使用床档及约束具

Any question??