Comfort and Safety 舒适与安全

1. Comfort and Safety 舒适与安全 王克芳 山东护理学院 kefangwang@126.com

2. Hiao’s Double C Nursing Model Cure Care Doctor +Comfort Nurse

3. Introduction to Comfort • Client's Lying Position • Client's Safety • Pain management

4. Section 1 Introduction to Comfort

5. Section 1 Introduction to Comfort

6. Section 1 Introduction to Comfort • Concept of Comfort • Influencing Factors of Comfort • Principles to Promote Comfort

7. physical • comfort • psychological • comfort 人 • environmental • comfort • social • comfort Concept of 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.

8. comfortablediscomfortable

9. Influencing Factors of Comfort What are the factors affecting in-patients’ comfort?

10. Influencing Factors of Comfort Psychological Factors Physical Factors Social Factors Environmental Factors

11. Influencing Factors of Comfort 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 • Physical 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 • Social-Psychological Factors 不适宜的社会环境 不适宜的物理环境 • Environmental Factors

12. Principles to Promote Comfort • focus on prevention • Reinforcement of observation • interventions in accordance with various situation • psychological support

13. SectionⅡClient’s lying Position

14. SectionⅡClient’s lying Position • 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

15. SectionⅡClient’s lying Position • Type of Client’s lying Position • Client’s lying Position • Moving and turning clients in bed

16. Type of Client’s lying Position • 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）

17. Type of Client’s lying Position • 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。

18. Type of Client’s lying Position • 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。

19. Client’s lying Position • 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）

20. 仰卧位（supine position） • 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）

21. Supine position without pillow 【Use】 • coma client or client who is still unconscious after general anesthesia. • clients after intra-vertebral anesthesia or spinal puncture

22. Shock position 【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。 200-300 100-200

23. Supine position with knees flexed 【use】 • abdominal examination • urinary catheterization • perineum rinse.

24. 侧卧位（side-lying position） [Use] • changing position to prevent pressure ulcer; • enema, anal examination, and gastro scope examination. • Gluteal intra-muscular injection

25. 半坐卧位（Fowler’s position） [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. 300-500

26. 端坐位（sitting position） [Use] • severe dyspnea caused by heart failure • hydro pericardium, • asthma. 700-800

27. 俯卧位（prone position） 【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.

28. 头低足高位 【use】 • postural drainage of pulmonary secretions; • duodenal drainage; • premature rupture of fetal membrane; • Skeletal traction through calcaneus or tibial tubercle 15-30cm

29. 头高足低位（dorsal elevated position） 【use】 • skull traction for clients with fracture of cervical spine; • lessening intracranial pressure and preventing cerebral edema; • post-operative period of craniocerebral operations. 15-30cm

30. 膝胸卧位（knee-chest position） 【Use】 • anal and rectal examination or sigmoidoscope examination and treatment; • correction malpositions or retroversion of uterus; • facilitating involution of uterus.

31. 截石位（lithotomy position） 【use】 • examination, treatment, or operation on perineum and anus • It is also used during childbirth (delivery).

32. Moving and turning clients in bed • Moving a client up in bed • Turning a client to a lateral position

33. Moving a client up in bed

34. Moving a client up in bed

35. Moving a client up in bed

36. Moving a client up in bed

37. Turning a client to a lateral position

38. Turning a client to a lateral position

39. Turning a client to a lateral position

40. 变换卧位法 【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

41. WHO:Patient safety is the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. Section Ⅲ Client’s Safety

42. 3548例严重医疗不良事件：

49. Safety Related Factors • Unsafe Factors and Precautions in Hospital • The measures Protect Clients in Safety

50. Safety Related Factors • Sensuous Function • Age • Current Health Condition • Familiar with Surrounding • Diagnosis and Treatment Measures