67例护患纠纷原因分析及对策

www.cnkang.com 2007-4-21 16:51:00 中华康网

　　【摘要】目的探讨护患纠纷的原因及预防对策。方法采用统计学方法对我市8年来67例护患纠纷原因进行回顾性分析。结果原因主要包括医疗收费、服务态度、业务素质、法律意识、沟通障碍。结论加强法制、安全教育，提高服务意识，规范执业行为，改善服务态度，提高服务质量，加强护患沟通是减少护患纠纷的关键。

　【关键词】护患纠纷；原因；对策

　 Causes of nurses-patients conflicts and its countermeasures:a report of 67 cases

　 YANG Jinxian1,XU Feihong2.1.Ruian Peoples Hospital,Ruian 325200,China.2.Health Administration of Ruian,Ruian 325200,China

　【Abstract】 Objective To analyse causes of nurses-patients conflicts and its preventive countermeasures.Methods Sixty-seven cases of nurses-patients conflicts in 8 years were analysed retrospectively in the city.Results The main causes of nurses-patients conflicts were medical cost,attitude of medical personnel,professional quality,legal consciousness and communicating failure.Conclusion The key of decreasing of nurses-patients conflicts is strengthening law, order and security education, elevating servicing consciousness, regulating professional behavior, improving service attitudes and quality, and strengthening nurses-patients communicating.

　【Key words】 nurses-patients conflicts; causes; countermeasures

　 With elevating of living qualities,the health concepts is transformed and self-safety consciousness is strengthened.In this condition,the cases of nurses-patients conflicts are roaring.The patients or their relatives often complaints or take lawsuit,even disturbance medical institutes working place against medical professionals.This article is to explore how to prevent nurses-patients conflicts and improve relation between patients and medical professionals.We reviewed 67 cases of nurses-patients conflicts occurred from 1998 to 2005 to find ways to resolving the problem.

　 1 Clinical data

　 In 1998-2005,67 cases of medical conflicts relating to nursing service among 372 cases of medical conflicts according to municipal health administration statistics.The causes of nurses-patients conflicts were found by analysing primary cases files,identical documents and negotiating agreements.

　 2 Statistical results

　 In 67 cases,service problem occurred in 20 cases（29.85%）,medical costs in 15 cases（22.39%）,communicating failure in 13 cases（19.40%）,professional deficiency in 11 cases（16.42%）,operating error in 5 cases（7.46%）,medical facilities in 3 cases（4.48%）.By analysing,17 cases of complaints related to nursing faults （25.37%）,nursing fault existed in 21 cases（31.34%）,but irrelated to the unsatisfactory results,non-nursing faults in 29 cases（43.28%）. We found that the legal knowledge was insufficient in the nurses.The nursing documents fault or inconsistence with clinical data were in 25 cases（37.31%）.

　 3 Analysis

　 3.1 Social factor

　 3.1.1 Strengthened legal consciousness and selfprotective behavior The patients considered that they are special consumers in the course of medical process,they have the right to know of their health condition,examination,drug administration and medical costs, and have the right to permit what action should be done.If the nurses did not meet the requirements of the patients for their rights,suspicion and disbelieve would occur,the complaints against nurses could hardly be avoided.

　 3.1.2 Increased requests of services A long distance exists between the conditions of the nursing and the hope of the patients and their relatives because of medical limitation,medical risks and so on.In the rural area,the medical equipment out of date in the emergency condition can not help the patients further,but the patients do not accept that,the conflicts would be constituted.

　 3.1.3 Losing credibility from the public For years,medical institutes credibility from the public is losing,minor error can lead to complaints because of the preoccupied view of the patients.And many medical malpractice exposed on the media,the public eyed on the issues of faulty medical treatment.The concern and supervision by public opinion should be played a role in improving the quality of medical service.But,some reports on the media deviate from the facts for deficiency of medical knowledge or the determination has not been identify by the organ for management of medical conflicts in the early stage of issue.In this case,public opinion provoked and social hot spot shaped,hospital in an awkward situation. When the news workers report or evaluate the issues against objective in the case of medical knowledge deficiency or lacking medical details,they evoke a resounding response.

　 3.1.4 Be difficult to understand medical system in patients With strengthening economic sense of the patients,a bundle of conflicts occurred because of medical costs.The medical costs is the reflection of social economic transformation in the medical market.The nurses are responsible to booking and pressing patients for payment,the conflicts often occur between nurses and patients first.And the increased costs out of the patients burden with the importation of high technology or application of new drugs.If the payment items filled in error,patients may misunderstand.In this study,the complains for medical costs was 22.39%,91.7% was patients pay themselves.And 2 cases resulted in misunderstanding visit rule of the hospital.

　 3.2 Management fault

　 3.2.1 Legal system deficiency or enforcement lag Currently,only one regulation for management of nurses in China can regulate the practice of the nurses,but it has some limitation,so can not completely regulate nursing behavior.According to reports,management for nurses in local administration lack coordination.The nursing administrator lack responsibility for nursing works and legal consciousness in the management of nursing.In the rural area,the situation must not be optimistic.

　 3.2.2 Short of nursing resources The medical market is competitive,the hospital is eye on economic interests more than social interests.On the one hand the hospitals expanding increased,on the other hand the registered nurses decreased,the bed to nurse is less than 0.4:1（standard of Ministry of Health）.In this situation the nurses could not meet all requests of the patients.

　 3.2.3 Faulty of hospital administration An error in the management chain in hospital as a whole can influence the nursing practice.Nurses work in the first line,the patients complain first against the nurses,hospital security lacking,logistic lag and clinical lab decline examination would be the sources of conflicts between patients and nurses.

　 3.2.4 Irrational arrangement of medical resources For economic reason,some hospitals can not distribute departments and therapy site rationally.In this study,a case of gastric carcinoma was injected venously in the outpatient,leaking occurred.A nurse forgot this is a chemotherapy patient,injected continuously on the other site of the hand resulting that his hand was necrotized in large size.In this case,the nurse can not shove off responsibility,but the irrationally distributed therapy site should be an important cause.

　 3.3 Nursing factor

　 3.3.1 Lagged service concept of nurses The quality of medical service and establishment of professional mode in medical market is a hotspot of publics concern.But some nurses can not get that the patients is the center of the medical service.The working negatively,bad service attitude and rude speaking are the representation.Did not carry out hospitalizing introduction and health education seriously;careless of critical patients care of living,negative monitor;the patients relatives execute physical temperature lowering,suck sputum,turn over,take temperature,change drug and so on,often lead to adverse effects,so the nurse is the first one become the target of complaints.

　 3.3.2 Violating medical regulation Violating medical regulation and nursing operation protocol are the main causes of the conflicts.Someone may violate regulation of hospital,protocol of nursing operation or do not execute prescription of doctors,agreements or fail to provide enough care or violate 3-7 checking rule,or carelessly observe patients condition and fail to make a round of a ward timely.Unskilled operation would lead to making wrong shot,oxygenating,drawing blood or leaving something in the patients body and inserting urinary catheter into vagina.In this study,a nurse in a health-center administed cytochrome C on a patient omitting skin test,allergic reaction occurred and the patient died.Newcomers and student nurses are not familiar with ward practice what could be a cause of conflicts.In this article,a nurse from obstetrical department to pediatric department injected estradiol in an infant.

　 3.3.3 Legal consciousness deficient and neglect the right of the patients Legal consciousness lacking can be sourced to school education stage since rare legal subjects in the teaching arrangement.The nurses dont know registering is the base of the practice,right and responsibility or faulty in practice.And some nurses are failed to communicating with patients,and violated the right of private.

　 3.3.4 Carelessness of self-protective in nurses In the nursing practice,the nurses pay more attention on patients physical condition,omit related legal problem,for example,record nursing lag behind or incomplete.The nursing record is inconsistent with clinical record or nursing level is inconsistent with physicians decision.Sometimes,nurses execute lagged behind doctors prescription.The patients condition changed,but nurses and doctors failed to react in time,which often happened in critical case or in night duty.In this study,we found that the nursing recording exist defect,such as omitting record or incomplete record;temporary prescription signed by non-execution nurses;nursing diagnosis didnt occur;different record wrote by the same nurse to meet inspection need;record temperature in advance,when the patient are discharged,the temperature record still exist.A case was died,but record was normal breathing and blood pressure,2 level nursing to 3 level.
The regulation for settlement of medical accident stipulates the patients have the right to copy the medical ecord,altering,fabricating,concealing,destroying,seizing and stealing record are strictly forbidden.The Supreme Peoples Court interprets the regulation for settlement of medical accident,one of the most important rule is show evidence by medical professionals to prove they correctly complete the operation.But recording not in detailed and fabricate set risks to complaints.

　 3.3.5 Communication gap between patients and nurses By now the holistic nursing is not expand widely,a communicating gap exists between patients and nurses.Some nurses communicate unskillfully with patients,such as do not explain nursing operation to patients.

　 3.3.6 Unskilled operation In the rural area,a large number of nurses are non-nursing speciality,they are lack of theoretical knowledge,professional technic and operation skill.In emergent situation,they can not meet the requirements to handle the critical cases.The student nurse carry out venous puncture usually failing many times.What are you predict the reaction of the patients in this case?

　 3.3.7 Others The negligence of the nurses or accident may cause complaints,such as fall of the patients.A case of intraperitoneal hemorrhage went operation room without accompany,the patient fell and caused intracranial hemorrhage.

　 4 Countermeasures

　 4.1 Establishment of sound regulation for nursing professionals Drafting a law for registered nurses and professional protocol to stipulate responsibility of nurses,rules for management,register,documenting rule and right.To esteem the personality and right of the nursing professionals,reevaluate the value of the work of nurses to improve the quality of nursing.

　 4.2 Set up image of angel in white-hospital nurses Purifying inside and outside environment,receiving critics frankly,correcting defects actively,establishing example of excellent nurses to get supports from public.

　 4.3 Strengthening the nursing staffs basic intellectual attributes （1）Renewing view of nursing service,all action based on the concept of the patients are the center of the medical service to improve service attitude.（2）Strengthening the legal education and self-protective consciousness of the nurses,regularly study the regulation for settlement of medical accident to protect the right of the patients.（3）Strengthening safety education of nurses to elevate ability of avoid conflicts.（4）Strengthening continuous education and related discipline learning,improving three-basic exercise to improve the ability of observation and problem-solving to elevate quality of nursing.

　 4.4 Improving the rules and strengthening quality control Regulating nursing based on law,improving working process,elevating efficiency.Improving regulations and executing strictly,complying with 3-7 check rule,shifting rule,3-clear rule,and never administering without basis.Implementing the system of personal responsibility,knowing clearly about the conditions of critical patients,new patients,critical surgery patients,shifting at bed.

　 4.5 Strengthening communicating The nurses carry out health education thoroughly,careful understand condition of physical and mental health of the patients,grasp any chance to do health education.The nurses must inform the risks of the treatment to the patients to get the permission from the patients and signature is never omitted.

　 4.6 Regulating nursing record The nursing record should be accurate,timely,continuous,integrity and never alter and avoid subjective.Every cases record is one of a legal document,the nurses must record seriously because the record is to as proof in the possible lawsuit.