急诊护士与自杀未遂患者沟通能力的培训和效果

doi:10.3761/j.issn.0254-1769.2020.01.019

摘要/Abstract

摘要：

目的制订急诊护理人员与自杀未遂患者的沟通培训方案,并探讨其应用效果。方法在美国自杀预防资源中心指南和动机性访谈技术的指导下,构建了急诊护理人员与自杀未遂患者的沟通培训方案,对40名急诊护理人员进行三次沟通培训。采用护患语言与社会交往问卷和护士沟通培训反馈调查问卷评价培训效果。结果培训后急诊护理人员的沟通频率和重要性得分上升,难度得分下降,差异具有统计学意义（t₁=9.591,t₂=5.124,t₃=-4.494,P<0.05）,患者和医生对护理工作的认可度较培训前提高。结论沟通培训能提高急诊护理人员与自杀未遂患者的沟通能力,改善患者和医生对护理工作的认可度,降低患者的自杀意念,增加患者对生活的希望。

关键词: 急诊室, 医院, 自杀, 沟通, 在职培训, 护理

Abstract:

Objective To develop the communication training scheme for emergency nurses to respond to patients with attempted suicide,and to explore the effects of application. Method Under the guidance of American Suicide Prevention Resource Center’s guideline and incentive interview techniques,40 emergency nurses were selected to receive three sessions of communication training. The effectiveness of the training was evaluated by the verbal and social interaction questionnaire and nurses communication training feedback questionnaire. Results After training,communication frequency and importance scores of emergency nurses increased;difficulty scores decreased.The differences were statistically significant（t₁=9.591,t₂=5.124,t₃=-4.494,P<0.05）. The approval degree to nursing from patients and doctors approval was higher than before. Conclusion Communication training can enhance communication ability of emergency nurses to respond to patients with suicide attempt,improve recognition of patients and doctors towards nursing,reduce suicidal ideation of patients and promote the hope of life.

Key words: Emergency Service, Hospital, Suicide, Communication, Inservice Training, Nursing Care

刘秋平, 胡德英, 刘义兰, 刘志荣, 翁慧, 向莉, 冯霞, 邓先锋. 急诊护士与自杀未遂患者沟通能力的培训和效果[J]. 中华护理杂志, 2020, 55(1): 113-117.

LIU Qiuping, HU Deying, LIU Yilan, LIU Zhirong, WENG Hui, XIANG Li, FENG Xia, DENG Xianfeng. Study on capacity training and its effects of emergency nurses for communication with patients with attempted suicide[J]. Chinese Journal of Nursing, 2020, 55(1): 113-117.

图/表 5

表1 急诊护理人员与自杀未遂患者沟通能力培训方案

表2 急诊科护理人员一般资料（n=40）

表3 培训前后急诊护理人员护患语言与社会交往能力的比较（n=40,分,$\bar{x}$±s）

表4 培训后护患语言与社会交往问卷沟通频率、重要性和难度得分最高的5个条目（n=40）

表5 培训后护患语言与社会交往问卷沟通频率、重要性和难度得分最低的5个条目（n=40）

参考文献 26

[1]	WHO. Suicide mortality rate（per 100 000 population）,by WHO region,2016[EB/OL].[2019-07-01]. http://www.who.int/mental_health/suicide-prevention/en.
[2]	徐东, 张学立, 曹孔敬 , 等. 农村地区农药与非农药自杀医疗费用负担分析[J]. 中国心理卫生杂志, 2008,22(4):308.
[3]	Zhang J, Sun L, Liu YX , et al. The change in suicide rates between 2002 and 2011 in China[J]. Suicide Life Threat Behav, 2014,44(5):560-568.
[4]	董雪松, 王蕊, 孙大壮 , 等. 2746例急性中毒患者流行病学调查[J]. 临床急诊杂志, 2016,17(3):211-213,216.
[5]	de Beurs DP, de Groot MH, de Keijser J , et al. The effect of an E-learning supported train-the-trainer programme on implementation of suicide guidelines in mental health care[J]. J Affect Disord, 2015,175:446-453.
[6]	吴才智, 谌燕, 孙启武 , 等. 心理解剖及其在自杀研究中的应用[J]. 心理科学进展, 2018,26(3):503-517.
[7]	胡德英, 熊宇, 丁小萍 , 等. 自杀风险管理方案在综合医院住院患者中的应用[J]. 中华护理杂志, 2018,53(8):971-974.
[8]	熊宇, 胡德英, 颜巧元 , 等. 对消化内科护士开展住院患者自杀认知与防范行为培训[J]. 护理学杂志, 2014,29(11):39-42.
[9]	吕军城, 王莹莹, 卓来宝 , 等. 急诊及住院自杀未遂者危险因素的病例对照研究[J]. 中国心理卫生杂志, 2019,33(2):81-86.
[10]	Suicide Prevention Resource Center. Prevention suicide in emer-gency department patients[EB/OL].[2019-07-01]. https://training.sprc.org.
[11]	闫江楠, 金昌德, 段晓佳 . 动机性访谈的研究及应用现状[J]. 护理研究, 2015,29(2):147-150.
[12]	Hoy J, Natarajan A, Petra MM . Motivational interviewing and the transtheoretical model of change:under-explored resources for suicide intervention[J]. Community Ment Health J, 2016,52(5):559-567.
[13]	Spitzer RL . Validation and utility of a self-report version of PRIME-MD.The PHQ primary care Study[J]. JAMA, 1999,282(18):1737.
[14]	The Columbia Lighthouse Project. Identify risk,prevent suicide[EB/OL].[2019-07-01]. http://www.cssrs.columbia.edu/
[15]	Registered Nurses’ Association of Ontario. Assessment and care of adults at risk for suicidal ideation and behaviour[R]. Toronto:Registered Nurses’ Association of Ontario, 2009.
[16]	Kuthcher S, Chehil S . 自杀风险管理手册[M]. 西英俊泽. 北京: 人民卫生出版社, 2011.
[17]	卢森堡, 阮胤华译 . 非暴力沟通[M]. 北京: 华夏出版社, 2012.
[18]	Rask M, Brunt D . Verbal and social interactions in Swedish forensic psychiatric nursing care as perceived by the patients and nurses[J]. Int J Ment Health Nurs, 2006,15(2):100-110.
[19]	葛莉, 王冠东, 张敏 , 等. 护患语言与社会交往问卷的中文修订及信效度检验[J]. 护理学杂志, 2018,33(11):62-65.
[20]	高一虹, 孟玲 . 自杀倾向的话语表述:大学生“走饭”微博分析[J]. 外语与外语教学, 2019(1): 43-55, 145-146.
[21]	许珂, 胡德英, 谭蓉 , 等. 患者自杀风险筛查与评估的研究进展[J]. 中华护理杂志, 2019,54(3):467-471.
[22]	李桂林, 陈炯华, 张玉琦 , 等. 认知行为干预对抑郁症患者自杀意念的影响[J]. 中华护理杂志, 2014,49(10):1202-1206.
[23]	熊宇, 胡灵芝, 刘媛 . 消化内科护士住院患者自杀预防系统化培训措施与成效[J]. 护士进修杂志, 2016,31(15):1428-1432.
[24]	兰美娟, 孟羽飞, 王淑卿 . 患者对护士执业能力期望的调查[J]. 中华护理杂志, 2014,49(7):878-880.
[25]	Shand FL, Batterham PJ, Chan JKY , et al. Experience of health care services after a suicide attempt:results from an online survey[J]. Suicide Life Threat Behav, 2018,48(6):779-787.
[26]	曾桂珍, 胡媛, 李东娜 , 等. 268名急诊医护人员对自杀患者的态度调查[J]. 护理学报, 2017,24(20):38-40.