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

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

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

4. Section 1 Introduction to Comfort

5. 4－54－5

6. Concept of Comfort Influencing Factors of Comfort Principles to Promote Comfort

7.  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

8. comfortable discomfortable

9. 9 What are the factors affecting in-patients’ comfort?

10. 10 Psychological Factors Social Factors Physical Factors Environmental Factors

11. 4 － 11  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

12. focus on prevention Reinforcement of observation interventions in accordance with various situation psychological support

14.  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.  Type of Client’s lying Position  Client’s lying Position  Moving and turning clients in bed

16.  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. 4 － 17  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. 4 － 18  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. 4 － 19  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. 4 － 20 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. 4 － 21 【 Use 】  coma client or client who is still unconscious after general anesthesia.  clients after intra-vertebral anesthesia or spinal puncture Supine position without pillow

22. 4 － 22 【 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

23. 4 － 23 【 use 】  abdominal examination  urinary catheterization  perineum rinse.

24. 4 － 24 [Use]  changing position to prevent pressure ulcer;  enema, anal examination, and gastro scope examination.  Gluteal intra-muscular injection

25. 4 － 25 [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.

26. 4 － 26 [Use]  severe dyspnea caused by heart failure  hydro pericardium,  asthma.

27. 4 － 27 【 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. 4 － 28 【 use 】  postural drainage of pulmonary secretions;  duodenal drainage;  premature rupture of fetal membrane;  Skeletal traction through calcaneus or tibial tubercle

29. 4 － 29 【 use 】  skull traction for clients with fracture of cervical spine;  lessening intracranial pressure and preventing cerebral edema;  post-operative period of craniocerebral operations.

30. 4 － 30 【 Use 】  anal and rectal examination or sigmoidoscope examination and treatment;  correction malpositions or retroversion of uterus;  facilitating involution of uterus.

31. 4 － 31 【 use 】  examination, treatment, or operation on perineum and anus  It is also used during childbirth (delivery).

32. Moving a client up in bed Turning a client to a lateral position

33. 4 － 33

34. 4 － 34

35. 4 － 35

36. 4 － 36

37. 4 － 37 Turning a client to a lateral position

38. 4 － 38 Turning a client to a lateral position

39. 4 － 39 Turning a client to a lateral position

40. 4 － 40 【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. 4 － 41

42. 42 3548 例严重医疗不良事件 ： 序号事件例数 1病人自杀464 2手术部位错误455 3手术或者手术后并发症444 4给药错误358 5由于治疗延误导致死亡269 6病人跌倒致伤189 7病人约束中发生死亡138 8病人被强暴121 9输血问题94 10失火65 11麻醉问题58

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

50. Sensuous Function Age Current Health Condition Familiar with Surrounding Diagnosis and Treatment Measures

52. Mechanical injuries Thermal injuries Pressure Injuries Radioactive Injuries

53.  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.

54. 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.

55. 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.

56.  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

57.  execute the disinfection & isolation system strictly

58.  Injuries include psychological or physical damage to clients result in inadvertent speaking and behavior of medical staff.

60.  To Keep clients in safety.  To ensure that the treatment and nursing process carry through smoothly.

61.  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

62.  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

63.  Restraint Broad Bandages

64.  Restraint Shoulder Restraint

65.  Restraint Knee Restraint: 4 － 65

66.  Restraint Waist Restraint: 4 － 66

67. Overbed Cradle

68. Are protective devices safe for patients ？

69. 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

70. Comfort and safety Active lying position Passive lying position Compelled lying position Supine position Lateral position Fowler’s Position Orthopneic position Prone position Protective devices Bedside rail restraint Restraint Overbed Cradle

71.  Assessment the high risk group of falling in hospital

72.  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

73. Any question??