医护一体化责任制合作模式对提高护士综合护理能力的影响

中华现代护理杂志2014/9/16第20卷26期 赵凤军 赵秀荣

山东省聊城市人民医院血液科规范了从“入院时-住院期间-出院后”的一套完整的医护合作流程：入院时主管医生与责任护士共同迎接患者；住院期间互动式交接班，各种评估、查房、疑难病例讨论、不良事件管理；出院后医护进行患者出院随访及复查等；我院在所有日光室内设置了电视，健康教育报栏及宣传册，提供了医护患活动的平台，也为患者提供了互助式优质服务，满足患者及家属的切身需求等。

实施医护一体化责任制护理模式，使医生、护士、患者三方间关系和谐，既减少了护理纠纷，保障了患者安全，又提高了医生、护士、患者满意度，增加了病房融洽地工作氛围，提高了高年资护理人员的信心，为低年资护理人员的成长，实施医护责任制护理模式必须得到上级领导的支持和理解。此模式仍存在不足之处，可深层次挖掘模式的展现形式，为临床医疗、护理奠定基础。

Baggs等认为医护合作是医生和护士通过公开讨论，共同解决问题和制定决策，并共同承担对患者实施治疗和护理责任的过程。

美国护士协会将其定义为：医护之间的一种可靠的合作过程，即在医护双方都能认可和接受各自行为和责任的范围内，保护双方的利益和实现共同目标。

经过20xx年5-6月小样预调查结果显示，90%以上的医护人员均有“医护一体化”的意识和认知，迫切希望能够充分发挥医护合作的精神，通过医护合作，最终达到患者满意。虽然目前医护合作得话题已被学术界广泛讨论，但尚未有一个明确的医护合作流程。

医护合作实施方法：

1入院时医护合作：患者入住本科时，主治医生和责任护士一起迎接患者。共同到床边了解患者的既往史、家族史、入院前的治疗、疾病症状、入院原因、心理状况等，获取患者主诉作为第一手资料，一同进行听诊、触诊、护理评估等体格检查，医护双方均可获得各自采取的信息，而后进行讨论，医护共同制定治疗护理方案。

2住院期间医护合作：

A互动式医护晨间交班方式 病危、转科、新入、手术、死亡患者，采取“一问一答”模式，由各自管床医生、责任护士主动提出自己所管患者目前存在及潜在的问题，由当班值夜班医生来回答，通过头脑风暴来互相刺激、补充、完善。通过此模式的长期执行，成为让年轻医护人员提升最快的途径之一。年轻护理人员从中可以系统学到专业、专科知识，年资高的护理人员也能在掌握现有知识的基础上，从诊断、治疗、用药、护理等拓宽学界，更好地为年轻护理人员做好传帮带的作用。

B入院、住院评估、跌倒坠床及压疮评估：通过以上各项评估，主动、正确了解患者的相关信息，并及时将结果向主治医生汇报，与其进行讨论，采取相应的预防措施避免和减少并发症的发生。

C排班模式的改变：采取病房、组长、组员固定制，每个治疗组均配备2名责任护士，其中一名为高年资N3、N2级护士，另一位为低年资护士。本组责任护士负责本组内所有治疗、护理操作，并参与晨间查房、疑难病例讨论，不良事件管理工作。

D医护参与疑难病例讨论

分两种情况：护理疑难病例：相关护理专家会诊、同时本组主治医师参与，共同讨论、分析患者出现的问题，从多个角度展开讨论，真正实现多学科医护合作的目的

医疗组疑难病例：相关科室医师会诊，责任护士参与其中，找出原因，促进患者早日康复 E医护共同查房：每组责任组长和医师共同查房，医师提出患者的相关问题，处理措施，组

长及时记录，而后与本组讨论、分析、学习、改进，达到全面了解病情，体现专业性，赢得医生的信任。

F医护配合共同完成有创操作：责任护士与主管医生共同完成有术前、术后指导、术中配合。 G医护共同解决重要护理问题：患者的营养、静脉炎的处理

3出院后的医护合作：

出院时由专人负责将患者住院期间的饮食、卧位、生化指标、治疗方法、入院时间、出院时间、出院带药、联系电话等录入电子档案。

由医护人员共同制定出符合患者的出院后用药、饮食、健康宣教等内容，并将其内容转变为通俗易懂的语言且在出院后3d内以短信的形式发至患者手机。出院7d左右由各组的主管医生和责任护士一起以电话随访或登门拜访。并在获得患者同意的情况下，将随访内容进行当场录音，记下重要的口述信息，而后将疑难问题进行重点分析、讨论，给予解决，真正实现早预防的目的。

结果：医护一体化责任制护理模式提高了护士床边综合护理能力（护理评估、护理问题/关键点、护理计划、措施、护理理论知识），通过护士参与医生规范化查体，可以帮助护士深入理解和巩固护理评估的相关理论知识，提高护士床边综合能力，尤其是对患者突发病情变化、急危重症、紧急救治的护理能力。

通过与医生的合作，能够更好地了解患者病情、病因、发病机制、病情演变、合理用药、各项检查等，有针对性地提出护理问题及关键点，针对现存及潜在的护理问题制定出合理的护理计划及护理措施，同时拓宽护理的视野，丰富了医学常识，巩固了理论知识，实现了向边缘学科发展的可能，为成为专科护士，奠定了坚实的基础。

医护一体化责任制护理模式更好地增进医护合作；学科间的合作和互相支持是发展趋势。该模式不仅得到了医护人员的认可，且建立在互相信任的基础上，能大力提高医护合作效果，使医护关系逐渐成为并列、互补的协作关系。

该模式有利于深化优质护理服务：护理人员秉承“以患者为中心，关心、关爱患者，患者需求至上”的核心理念，力求为患者提供全面、全程、专业化的优质护理服务，同时落实一系列优质护理服务相关政策、制度、措施，在落实基础护理的同时努力发展专科护理。医护一体化责任制护理模式有利于提高护理服务效率，提升护理服务水平。

通过实施一体化护理模式后，护士从医疗的角度，储备临床诊断、用药、不良反应、评估患者的知识。同时医护之间密切联系、信息交换、沟通交流、相互协作、共同完成预期目标。发挥团队作用，主动参与医疗护理。

第二篇：读书报告

读 书 报 告

专业班级 学生姓名 指导教师

The Greatest Men

All of us hold dreams and America,seems is the country can makes our dreams come true.America is full of uncountable dreams.They are all achievable,touchable. Not to mention in the 20th century,Roaring Twenties,this magical era, known for unprecedented economic prosperity, the evolution of jazz music, flapper culture, and bootlegging and other criminal activity.Stocks reached record peaks and Wall street boomed in a steady golden roar.The buildings were higher.Parties were bigger.The shows were broader and ban on alcohol had backfired,making the liquor cheaper.Everything there were luring the young and ambitious.That?s when this story happened.

The Great Gatsby is a novel written by F. Scott Fitzgerald,an American author of novels and short stories who was born on September 24, 1896, in St. Paul, Minnesota,whose works are the paradigmatic writings of the Jazz Age. He is widely regarded as one of the greatest American writers of the 20th century.Fitzgerald is considered a member of the "Lost Generation" of the 1920s. He finished four novels: This Side of Paradise, The Beautiful and Damned, The Great Gatsby (his most famous), and Tender Is the Night. A fifth, unfinished novel, The Love of the Last Tycoon, was published posthumously. Fitzgerald also wrote many short stories that treat themes of youth and promise along with age and despair.And this story “The Great Gatsby” was inspired by the parties he had attended while visiting Long Island's north shore and began planning the novel in 1923, desiring to produce, in his words, "something new,something extraordinary and beautiful and simple and intricately patterned." and finally first published in April 1925, The Great Gatsby received mixed reviews and sold poorly; in its first year, the book sold only 20,000 copies. Fitzgerald died in 1940, believing himself to be a failure and his work forgotten. However, the novel experienced a revival during World War II, and became a part of American high school curricula and numerous stage and film adaptations in the following decades. Today, The Great Gatsby is widely considered to be a literary classic and a contender for the title "Great American Novel". In 1998 the Modern Library editorial board voted it the 20th century's best American novel and second best English-language novel of the same time period.

Among these,what I want to mention specially is that when this book was published,Fitzgerald is just 28 years old.Furthermore,his first novel's success made him famous and let him marry the woman he loved.But later he descended into drinking.After he published 2 novels This Side of Paradise and The Beautiful and Damned,2 Short story collections Flappers and Philosophers and Tales of the Jazz Age,he became the darling of the era.For after the first world war,American economy came to a unprecedented prosperity.The new culture and new time needed new hero.Fitzgerald is just the man who is needed.His handsome,fearless,gorgeous was exactly what the young wanted and he was also the literary symbol needed by the social.As we all known,in that century,most major countries women finally won the right to vote.For these young women,they were just liberated from the old concept,and enjoyed in the

material life and in their eyes Fitzgerald?s wife Zelda was very enviable.

Fitzgerald lived a luxurious life.Even so,he has his ambition:to write a novel can describe the time.He can lived by writing short novels,but just like today,an author can?t be approved without an outstanding novel.In1922,when he was 26 years old,he moved form New York to the Long Island.He had planned to write without hullabaloo,but he obviously can?t get used to this coziness for he is lively and extravagant,so again he went on the previous days.Like Nick in The Great Gatsby, Fitzgerald found this new lifestyle seductive and exciting, and like Gatsby, he had always idolized the very rich. However,for Fitzgerald,those days is not completely useless.Those sensuous days and nights became the background of The Great Gatsby. Today there are a number of theories as to which mansion was the inspiration for the book. One possibility is Land's End, a notable Gold Coast Mansion where Fitzgerald may have attended a party.Many of the events in Fitzgerald's early life are reflected throughout The Great Gatsby. Fitzgerald was a young man from Minnesota, and like Nick, he was educated at an Ivy League school (in Nick's case, Yale.)Fitzgerald belongs to the author that his books is based on his real experiences.So maybe we can say,without those showy,ostentatious in Long Island,we can not have The Great Gatsby this classic work,or it may became a totally different work.The parties,the luxurious life of the rich that described in the novel also would not exist.

In 1924,in order to find another quieter place to write and reduce their increasing expenses,Fitzgerald and his wife moved again.They left Long Island,went to the Riviera located in the south of French.In this beautiful place,he (rarely) determined to devote himself in the writing.However,his wife,Zelda,got tired of the days without her husband?s company,she didn?t know how to spend those boring time.While Fitzgerald absorbed writing The Great Gatsby. Zelda became infatuated with a dashing young French pilot, Edouard Jozan.She spent afternoons swimming at the beach and evenings dancing at the casinos with Jozan. After six weeks, Zelda asked for a divorce.In that hot summer.

Actually Zelda already had flighty affairs with some young boys when she was young. A newspaper article about one of her dance performances quoted her as saying that she cared only about "boys and swimming."She is “that” girl,hard to please and can?t get on well.After Zelda asked for divorce,Fitzgerald was so shocked that he stopped his work. Fitzgerald at first demanded to confront Jozan(like Tom did in the book),but instead dealt with Zelda's demand by locking her in their house, until she abandoned her request for divorce. Jozan did not know she'd asked for a divorce. He left the Riviera later that year, and the Fitzgerald never saw him again.When Zelda finally can thought carefully(like Daisy did),she had to stay with Fitzgerald,but just like Fitzgerald wrote in his notebook "That September 1924, I knew something had happened that could never be repaired."However,for Fitzgerald,this pain,misery,suffering,may influenced how he built “Daisy”this character or to say it properly,the shock he suffered during his writing,became another “nutriment” that helped him to become a novelist.

The novel's events are filtered through the consciousness of its narrator, Nick Carraway,a Yale graduate and World

War I veteran from the Midwest takes a job in New York as a bond salesman on the summer of 1922,who is both a part of and separate from the world he describes,within and without of the whole story. He rents a small house on Long Island, in the (fictional) village of West Egg, a wealthy but unfashionable area populated by the new rich, a group who have made their fortunes too recently to have established social connections and who are prone to garish displays of wealth,and Nick is next door to the lavish mansion of Jay Gatsby, a mysterious millionaire who holds extravagant parties but does not participate in them. Nick drives around the bay to East Egg for dinner at the home of his cousin, Daisy Fay Buchanan, and her husband, Tom, a college acquaintance of Nick's. They introduce Nick to Jordan Baker, an attractive, cynical young golfer begins a romantic relationship. She reveals to Nick that Tom has a mistress, Myrtle Wilson, who lives in the "valley of ashes":an industrial dumping ground between West Egg and New York City. Not long after this revelation, Nick travels to New York City with Tom and Myrtle to an apartment they keep for their affair. At the apartment, a vulgar and bizarre party takes place. It ends with Tom breaking Myrtle's nose after she annoys him by saying Daisy's name several times.

As the summer progresses, Nick eventually receives an invitation to one of Gatsby's parties. Nick encounters Jordan Baker at the party, and they meet Gatsby himself, an aloof and surprisingly young man who recognizes Nick from their same division in the war. Through Jordan, Nick later learns that Gatsby knew Daisy from a romantic encounter in 1917 and is deeply in love with her. He spends many nights staring at the Green Light at the end of her dock, across the bay from his mansion, hoping to one day rekindle their lost romance. Gatsby's extravagant lifestyle and wild parties are an attempt to impress Daisy in the hope that she will one day appear again at Gatsby's doorstep. Gatsby now wants Nick to arrange a reunion between himself and Daisy. Nick invites Daisy to have tea at his house, without telling her that Gatsby will also be there. After an initially awkward reunion, Gatsby and Daisy reestablish their connection. They begin an affair and, after a short time, Tom grows increasingly suspicious of his wife's relationship with Gatsby. At a luncheon at the Buchanans' house, Daisy speaks to Gatsby with such undisguised intimacy that Tom realizes she is in love with Gatsby. Though Tom is himself involved in an extramarital affair, he is outraged by his wife's infidelity. He forces the group to drive into New York City and confronts Gatsby in a suite at the Plaza Hotel, asserting that he and Daisy have a history that Gatsby could never understand. In addition to that, he announces to his wife that Gatsby is a criminal whose fortune comes from bootlegging alcohol and other illegal activities. Daisy realizes that her allegiance is to Tom, and Tom contemptuously sends her back to East Egg with Gatsby, attempting to prove that Gatsby cannot hurt him.

When Nick, Jordan, and Tom drive through the valley of ashes on their way home, they discover that Gatsby's car has struck and killed Tom's mistress, Myrtle. Nick later learns from Gatsby that Daisy, not Gatsby himself, was driving the car at the time of the accident but Gatsby intends to take the blame anyway. Myrtle's husband, George, falsely concludes that the driver of the yellow car is the secret lover he recently began suspecting she has, and sets out on foot to locate its owner. After finding out the yellow car is Gatsby's, he arrives at Gatsby's mansion where he fatally shoots

both Gatsby and then himself. Nick stages an unsettlingly small funeral for Gatsby, ends his relationship with Jordan, and moves back to the Midwest, disillusioned with the Eastern lifestyle.

The title of this book is “The Great Gatsby.”However,what makes Gatsby Great indeed?

For some people they may think what makes Gatsby great is his love for Daisy that he can sustained for almost 5 years and finally died for this.However,I think it is not.

Why we always talked about American dream and Jazz Age when we talked about this novel?

The idea of the American Dream is rooted in the United States Declaration of Independence which proclaims that “all men are created equal” and that they are “endowed by their Creator with certain inalienable Rights” including “Life, Liberty and the pursuit of Happiness.”However all of these beautiful words were based on the one word “equal”.And for Jazz Age,as I talked earlier,this book was written in the 1923,before the Great Depression,the golden period of America economy to make a spurt of progress.However,with the development of society,the gap between rich and poor is growing,it is getting more and more difficult for those poor to be rich.When personal struggle can?t lead to the life of the “old money”,the American Dream is just disillusioned and became a huge sarcasm.Many young people lived in the age of the 20th ,they are just can experience the good material conditions,the prosperity of that age,but in the same time,they are deeply despaired and lost.The rich in the material and the poor in the mental makes the young generation want to oppose all the traditional concepts.So they engaged in decadent activities,spent money like water.Under this environment,Fitzgerald portrayed Gatsby as “He was a son of God—a phrase which, if it means anything, means just that—and he must be about His Father?s business, the service of a vast, vulgar, and meretricious beauty.”His Dream can?t explain the youth in that age any more.

In order to achieve his dream(some people understand this as Daisy),Gatsby tried ever since he was born in a poor family—his parents were shiftless and unsuccessful farm people,he persisted in setting strict demands on himself.He spent his youth with Dan Cody to learn everything he needed,he changed his name from Jimmy Gatz to Jay Gatsby,he invented just the sort of Jay Gatsby that a seventeen-year-old boy would be likely to invent,and to this conception he was faithful to the end.Then he met Daisy when he just want to take her at first,but he eventually fell in love with her. “I can?t describe to you how surprised I was to find out I loved her,old sport.I even hoped for a while that she?d throw me over,but she didn?t,because she was in love with me too.”But he certainly taken her under false pretences,he let Daisy believed that he was fully able to take care of her.As a matter of fact,he had no such facilities—he had no comfortable family standing behind him,and he was liable at the whim of an impersonal government to be blown anywhere about the world.Then he went abroad,when he came back,he found that Daisy already got married.In order to achieve his dream,to repeat the past,he chose to became partner with the cheater Meyer Wolfshiem,and earned money by liquor dealing which is forbade.When he finally became the new rich within few years,he bought the house at the West Egg so that Daisy would be just across the bay and he had big parties every night just expected Daisy to wander into one of his parties

some night. After he got the money,which is not earned by keeping pegging to reach success.He tried to be a different man,a gentleman.He always use “old sport”to show that he has been in the Oxford,he carried the picture of Oxford and the metal that written with “Major Jay Gatsby,For Valour Extraordinary.”

After Gatsby died,one of the few guests—his father brought his SCHEDULE and GENERAL RESOLVES.From these we can see that he was frugal,strict with himself,studied hard,took exercises everyday.All those were the traditional struggle requirements needed in the American Dream.They fully demonstrated a positive outlook on life,which is just opposite to his actions after he grown up.In order to gain power,fortune,position and Daisy?s love,he betrayed himself.

In Gatsby?s eyes,Daisy is not only a woman,but also a symbol of the “Old Money”,a link between Gatsby and the upper society.Gatsby himself also knew what kind of woman Daisy is. “ ?She?s got an indiscreet voice,?I remarked. ?It?s full of—?I hesitated.

?Her voice is full of money,?he said suddenly.”

Even so,Gatsby also always accommodated himself to Daisy.As for Gatsby,he can only got the entire life with Daisy within.

However,the reality is callous.No matter how rich he is,he can?t have the privilege that held by the property-owning classes.The sumptuous parities—although they indeed attracted all kinds of celebrities,but those people just thought it as a place for fun.They seeking every chance to show their scorn.The lawn and drive had been crowded with the faces of them,they guessed at Gatsby?s corruption,spread his rumors when they are having pleasure freely in Gatsby?s.Hence one can see that Gatsby was not only pushed aside by Tom,but also the entire upper class.Until he was shot died at his yard,there were only three guests went to his funeral.Nobody thanked his hospitality.What he got was only nothing.

“I have an idea that Gatsby himself didn?t believe it would come,and perhaps he no longer cared.If that was true he must have felt that he had lost the old warm world,paid high piece for living too long with a single dream.He must have looked up at an unfamiliar sky through frightening leaved and shivered as he found what a grotesque thing a rose is and how raw the sunlight was upon the scarcely created grass,A new world,material without being real,where poor ghosts,breathing dreams like air,drifted fortuitously about...like that ashen,fantastic figure gliding toward him through the amorphous tress.”

When I finally got into this chapter, what makes me sob is not only Daisy?s careless,Gatsby?s tragedy,but the feeling that we are so powerless,we can?t change our fate,can?t resist the reality.I finally understood,what makes Gatsby “Great”is not his Love for Daisy,but his different,he can still believe in “future”in that age.

Gatsby IS different.He is so different from those “Old Money”.He can always concealing his incorruptible dream,he always creating something,surpassing himself.But the Old Moneys,they were arrogant,careless,no gratitude,no

passion.

?They?re a rotten crowd? I shouted across the lawn. ?You?re worth the whole damn bunch put together.?This is the only compliment that Nick gave Gatsby.Also is what I want to describe Gatsby. “If personality is an unbroken series of successful gestures,then there was something gorgeous about him,some heightened sensitivity to the promises of life,as if he were related to one of those intricate machines that register earthquake ten thousand miles away.This responsiveness had nothing to do withe that flabby impressionability which is dignified under the name of the ?creative temperament?- it was an extraordinary gift for hope,a romantic readiness such as I have never found in any other person and which it is not likely I shall ever find again.”

“Gatsby believed in the green light,the orgastic future that year by year recedes before us.It eluded us then,but that?s no matter—tomorrow we will run faster,stretch out our arms farther...And one fine morning—

So we beat on,boats against the current,borne back ceaselessly into the past.”

This last sentence finally became Fitzgerald and his wife?s the epitaph.Fitzgerald used his whole life to explain the Jazz Age.Both he and Gatsby are the GREATEST men.