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上汉下英　　头脑风暴法在急诊死亡病例护理讨论中的应用　　【摘要】 目的 提高护理人员的急救技能和护理质量。方法 将头脑风暴法应用于死亡病例的护理讨论中，充分发挥各护理人员的智慧，提出问题，解决问题。结果 头脑风暴法充分调动了护理人员的积极性，有效地提升了护理质量。结论 将头脑风暴法引入死亡病例的护理讨论中，有利于规范护理行为，保障护理安全，提高急救、护理质量。　　【关键词】 头脑风暴法；死亡病例；护理讨论　　Brain storming in nursing discussion of dead cases in emergency section　　ZHOU J　　Nursing Section,Songjiang District Central Hospital of Shanghai,Shanghai 201600,China　　【Abstract】 Objective to improve the first�aid skills of nurses and enhance nursing Methods We apply brain storming in nursing discussion of dead cases,all the nurses do their best to put forward the problems and find the way to solve Results Brain storming can effectively improve the nurses� positivity,as a result,nursing quality is effectively Conclusion The application of brain storming in nursing discussion of dead cases is beneficial for standardizing nursing activity,ensuring nursing safety,enhancing first�aid skills and nursing 　　【Key words】 brain storming;dead cases;nursing discussion　　随着医疗法规的不断完善，在“以病人为中心”的呼声不断增高的今天，人们对护理质量的要求亦日益增高，在对抢救过程中规范护理行为、完善抢救技术、提高抢救质量显得尤为重要。我院按照医疗质量管理要求，结合王小花等〔1〕报道的做法，组织全体护士，用头脑风暴法对急诊死亡病例进行护理讨论，充分发挥每位护士的智慧与才能，从中寻找差距与不足，从而提高急救技能与护理质量，取得良好效果。现将体会报告如下。　　1 头脑风暴法的含义　　头脑风暴法（brain storming）〔2〕又称智力激励法，是由现代创造学的奠基人美国学者阿历克斯·奥斯本于1939年首次提出、1953年正式发表的激发创造性思维的方法。种方法采取会议的形式，让所有参加者在自由愉快、畅所欲言的气氛中，毫无顾忌地发表自己的观点，创造性地解决问题。头脑风暴的特点是让与会者敞开思想,激发他们的创意与灵感，使各种设想在相互碰撞中激起脑海的创造性风暴，以产生多的创意。　　1 头脑风暴法的原则　　1 拒绝批判 认真对待每一与会者的观点，不管其意见、观点、设想、方案是否可行，会议中决不加以评论、批判。对各种观点的评判必须放到最后阶段。　　2 欢迎各抒己见，畅所欲言 创造一种自由愉快、毫无拘束的气氛，激发与会者提出各种新奇的想法。　　3 追求数量而不是质量 观点越多越好，每一个观点都有潜力成为好的观点。　　4 取长补短和改进观念 除提出自己的意见外，鼓励与会者激发自己的灵感，对他人已经提出的设想进行补充、改进和综合。　　2 头脑风暴法的基本程序〔3〕　　1 确定议题 会前明确目标，阐明议题，使与会者明确该会议要解决的问题。　　2 会前准备 准备会场、组织者、记录人及必要的工具。会前可收集一些资料发放给与会者，使其了解议题的相关背景，以便有充裕的时间来思考。　　3 确定人选 一般以8～12人为宜,也可略有增减(5～15人)。　　4 明确分工 确定1名主持人,1～2名记录员(秘书)。　　5 规定纪律 根据头脑风暴法的原则,规定几条纪律,要求与会者遵守。　　6 掌握时间 会议时间由主持人掌握,以几十分钟为宜。　　2 头脑风暴法在病例讨论中的应用　　1 病例资料 选取2005年8月～2006年4月急诊的25例死亡病例，采用头脑风暴法进行护理讨论，男17例，女8例；年龄2～88岁。其中15例车祸死亡，3例脑出血死亡，3例心肌梗死死亡，2例失血性休克死亡，1例糖尿病酮症酸中毒死亡，1例误服药物死亡。　　2 方法　　1 讨论制度 建立死亡病例讨论制度，每月1次，并做好死亡病例讨论记录。　　2 讨论前准备 讨论前布置好会场及相关用物，并将该患者的姓名、性别、诊断、病情、抢救过程做成资料，提前发送给每位与会人员。　　3 参加人员 由护士长主持，教学干事记录，科内全体护士参与。可邀请科主任、护理部领导参加。　　4 讨论形式 护士长宣布会议须遵守的纪律，创造自由愉快的会议氛围，鼓励每位与会护士就议题积极发表自己的观点，放飞思维，畅所欲言，做到知无不言、言无不尽，尽可能多地提出观点。由当班护士汇报病情、诊断、抢救过程，与会者展开自由不羁的讨论，教学干事负责记录讨论要点。会中不对任何一个人的观点提出评论性批判。　　5 讨论内容 各与会护士从不同角度、不同层次、不同方面去分析抢救过程中遇到的问题。如：护士自身的急救技能，护患配合，医护协作，与其他科室的协作，家属配合情况，患者的心理反应，护士的心理素质，抢救仪器的备用状态，抢救药物和物品的备用情况，抢救记录的书写，尸体料理等。　　3 效果及体会　　1 激励了护士的工作热情，提高了护士学习业务知识的进取心 头脑风暴法这种自由畅谈的会议方式为每位与会护士提供了一个展现自我的平台，让其在自由愉快、毫无拘束的氛围中大胆表达自己独创性的观点与看法，提高了每位护士的主人翁意识，大大地激励了其工作热情。而这种自由不羁的讨论方式更能让护士发现自身素质的有限，从而激发其不断的充电学习以提高自身的业务水平。　　2 提高了护士观察病情的能力及急救技能 灵活的讨论方式产生了大量的来自不同角度和层面的观点，这些观点是每位护士在抢救工作中的心得与经验，促使每位护士在以后的工作中更密切地观察患者病情，加强各项急救技能的训练，促使以后的抢救工作忙而不乱、有条不紊，从根本上提高抢救及护理质量。　　3 提高了年轻护士的心理素质和心理护理水平 年轻护士由于资历较浅，缺乏抢救经验，在抢救重危患者时难免紧张。活跃的讨论是年轻护士学习的平台，她们参考了资深护士的工作经验，更好地将理论联系实际，加强自身修养，急救技能与心理素质并重训练，不断完善自身的心理素质，在抢救过程中注意患者的心理护理，保证抢救工作有条不紊。　　4 培养了护士的创造性散发性思维 用头脑风暴法进行病例的护理讨论，每位与会护士不受条条框框的限制，让思维自由驰骋，活跃的讨论方式激发了护士的灵感，勇于发表自己的观点与见解，培养了护士灵活的思考能力，并将这种灵活的思维方式运用于护理工作中，规范护理行为，有效提高护理质量。　　5 提高了护士的自我保护意识，避免护理纠纷 抢救过程紧张急迫，护理人员往往注重急救，而对抢救记录不够重视，为护理纠纷埋下了隐患。护理记录是具有法律效应的医疗文件，在实行举证倒置的今天，完善抢救记录，对护理人员有保护作用，避免护理纠纷或在护理纠纷时不处于被动地位，而客观的抢救记录也是保护患者合法权益的依据〔4〕。通过护理讨论，护理人员能从法律的高度认识到护理职责，提高自我保护的意识，完善抢救记录书写。　　6 提高了管理者对下属护士业务水平的了解程度 护士畅所欲言的讨论中透示了其护理工作中的实际问题及其自身的综合素质和解决实际问题的能力，护士长可更确切地了解护理工作中的缺陷和薄弱环节，了解下属的不足与长处，有针对性的让其进行培训或进修，打造TOP团队，有利于流畅管理工作。　　3 讨论　　日本石川馨教授指出:在质量管理活动中调动人的积极性,充分发挥人的无限能力，创造尊重、充满生气和活力的工作环境,有助于提高企业素质〔5〕。运用头脑风暴法,能充分发挥人的聪明才智和发掘人的潜能,考虑问题更详细,解决问题更具体、明确、有效〔6〕。自由的讨论方式引导护理人员毫不拘束地发表自己独到的见解，调动了每个人的积极性，培养护理人员的创新性散发性思维，让其自我价值得到充分实现，提高了自身的素质。集体的智慧能从各层面发现问题所在，并确定整改措施，从而提高护理人员的急救技能，规范抢救过程中的护理行为，最终有效提升护理质量。　　【参考文献】　　1 王小花，丁小容，王英蓉28例死亡病例护理讨论分析护理学报，2006，13（2）：32-　　2 薛亮妙用头脑风暴法企业研究，2005，5：61-　　3 柯浚哲头脑风暴法中国研究生,2003,4：50-　　4 胡敏，王敏，李玉梅通过病例讨论有效规范临床护理行为的探讨上海护理，2005，5（4）：61-　　5 蒲伦昌全面质量管理基础教程北京:中国经济出版社,1999,　　6 黄漫容，文向东，郭少云头脑风暴法在护理质量改善中的作用现代护理，2002，8（9）：　　Brainstorming in the deaths of emergency care to discuss the application　　Abstract The purpose of the emergency nursing staff to improve skills and quality of Brainstorming ways to apply the death care discussion, and give full play to the wisdom of the nursing staff, ask questions, solve the The results of brainstorming to fully mobilize the enthusiasm of the nursing staff, to enhance the quality of Conclusions will be brainstorming the introduction of the death care discussion will help standardize care, care and protection of safety, first aid to improve, the quality of 　　Key words brainstorming; deaths; care discussion　　Brain storming in nursing discussion of dead cases in emergency section Brain storming in nursing discussion of dead cases in emergency section　　ZHOU J ZHOU J　　Nursing Section,Songjiang District Central Hospital of Shanghai,Shanghai 201600,China Nursing Section, Songjiang District Central Hospital of Shanghai, Shanghai 201600, China　　【Abstract】 Objective to improve the first�aid skills of nurses and enhance nursing Methods We apply brain storming in nursing discussion of dead cases,all the nurses do their best to put forward the problems and find the way to solve Results Brain storming can effectively improve the nurses� positivity,as a result,nursing quality is effectively Conclusion The application of brain storming in nursing discussion of dead cases is beneficial for standardizing nursing activity,ensuring nursing safety,enhancing first�aid skills and nursing Abstract】 【Objective to improve the first � aid skills of nurses and enhance nursing Methods We apply brain storming in nursing discussion of dead cases, all the nurses do their best to put forward the problems and find the way to solve Results Brain storming can effectively improve the nurses � positivity, as a result, nursing quality is effectively Conclusion The application of brain storming in nursing discussion of dead cases is beneficial for standardizing nursing activity, ensuring nursing safety, enhancing first � aid skills and nursing 　　【Key words】 brain storming;dead cases;nursing discussion Key words】 【brain storming; dead cases; nursing discussion　　With the constant improvement of medical laws and regulations, the "patient-centered," the voice rising today, about the quality of care requirements are also increasing in the rescue of the process of standardizing care, improve the technical Rescue and improve the quality of rescue is particularly I Hospital medical quality management in accordance with the requirements of the combination of flowers such as Wang 〔〕 1 report, the organization of all nurses, with brainstorming on emergency care for cases of death, nursing each give full play to the wisdom and ability, to look for gaps and shortcomings So as to enhance the quality of care and first aid skills, good The experience of the report are as 　　1 brainstorming meaning　　（brain storming）Brainstorming (brain storming) 〔〕 2, also known as the Law on intellectual stimulation, by the founder of modern science to create an American scholar Alex Osborne in 1939 for the first time, officially released in 1953 to stimulate creative thinking M 种Ways to take the form of the meeting, all participants in the free happy and free atmosphere, with impunity to express their views in a creative way to solve the Brainstorming is characterized by open so that the participants thought, a creative mind and inspiration, so that the ideas in a collision with each other in the storm stirred up the creative minds to produce more 　　1 brainstorming principles　　1 refused to take seriously the criticism of each participant's point of view, regardless of their opinions, views, the idea of the feasibility of the program, the meeting will not comment, Various points of view must be judged on the final 　　2 welcome to express their opinions and speak their minds free to create a happy atmosphere, there is no binding, was put forward to stimulate a variety of novel 　　3 pursuit of quantity rather than quality, the better the view, every point of view has the potential to become a good point of 　　4 In addition to each other and improve the concept put forward their views, was encouraged to stimulate their own inspiration to others that have already been made for the idea to add, improve and 　　2 brainstorming basic procedures 〔〕 3　　1 will determine the issues before the clear objective of clarifying issues, so that the meeting was a clear problem to be 　　2 will be pre-prepared meeting, the organizers, and record the necessary Can be pre-paid to collect information on some of the participants to understand the issues related to the background in order to have sufficient time to 　　3 General to determine the candidates for 8 to 12 is appropriate, but also a slight increase or decrease (5 to 15)　　4 to determine a clear division of presenters, from 1 to 2 recorder (Secretary)　　5 According to the disciplinary provisions of the principle of brainstorming, several provisions of discipline and compliance with the requirements of the 　　6 make good use of time from host Conference have to dozens of minutes is 　　2 brainstorming in the case on the application　　1 cases selected information in August 2005 to April 2006 deaths of 25 emergency cases, the use of brainstorming for care, male 17 cases, 8 females; age 2 to 88 years 15 cases in which a car accident deaths and 3 cases of cerebral hemorrhage died and 3 cases of heart attack deaths, 2 cases of hemorrhagic shock death, 1 case of death of diabetic ketoacidosis, 1 case of drug wrongly 　　2 Methods　　1 discuss the establishment of deaths on the system monthly, and do a good job deaths on 　　2 discuss the pre-pre-arranged to discuss the venue and well-used and the patient's name, sex, diagnosis, the patient's condition made the rescue process information sent in advance to the participants 　　3 participants chaired by the head nurse, teaching record of the Director-General, Division of the nurses involved in Director of the Division may be invited, to participate in the leadership of the Department of N　　4 The meeting was to discuss the form of a head nurse subject to discipline, the freedom to create a pleasant atmosphere of the meeting, the participants encourage each nurse on the positive issues to express their point of view, flying ideas, speak out, so that made all know, reserve, to make More likely to put forward the By the nurses on duty to report the disease, diagnosis, emergency treatment process was carried out free of uninhibited discussion, Director-General in charge of teaching record the main points of Will not in any one's point of view of critical 　　5 discuss the contents of the nurses attending the meeting from different angles and at different levels, different aspects of the rescue process to analyze the problems Such as: nurse's own first-aid skills, with nurses and patients, health care, in collaboration with other sections of cooperation, their families cope with the situation and the psychological reaction of patients, nurses and mental quality of the standby rescue equipment, medicine and rescue back-up materials, rescue Written records, body care and so 　　3 and the effect of experience　　1 inspire the enthusiasm of nurses, nurses study to improve the knowledge of the entrepreneurial spirit of the brainstorming meeting about this freedom for every Nurses attending the meeting provided a platform for self-display, so happy in a free, no Bound in an atmosphere of daring to express their unique perspectives and viewpoints, and increased the sense of ownership for each nurse, greatly inspired the enthusiasm of their And uninhibited discussion of this freedom can be more nurses found that the quality of their own limited, so as to stimulate the constant charge of their own learning in order to enhance the level of 　　2 improves the ability of patients to observe nurses and first-aid skills in a flexible way to discuss a number of different angles and dimensions from the point of view, the view is that every nurse in the rescue work experience and experience to every nurse in the After work more closely observed in patients with the disease and strengthen the first-aid skills training to help the rescue work after the chaos without, in an orderly and fundamentally improve the quality of care and emergency 　　3 improved the quality of the young nurses in mental and psychological level of care young junior nurses due to lack of experience of rescue, emergency treatment in critically ill patients when the tension is Active discussion is a platform for young nurses to learn, they refer to the senior nurses working experience, will be to better integrate theory with practice and strengthen their own training, first aid skills with equal emphasis on psychological training, and constantly improve the psychological quality of their own, in the course of rescue Attention to the patient's psychological care to ensure the orderly rescue 　　4 trained nurses in the distribution of creative thinking by brainstorming for care cases, each participating nurses from outside the box, allowing freedom of thinking, he said, to stimulate active discussion of the nurse's inspiration, the courage to express their With the view point of view, the training of nurses and flexible thinking and flexible way of thinking applied to nursing work, standardize care, improve the quality of 　　5 increased self-protection awareness of nurses, nursing dispute to avoid tension in the process of urgent rescue, first aid care workers often pay attention to, and the records do not pay enough attention to the rescue, care for the dispute potential 〔4〕。 Nursing is a record of the medical effects of legal documents, as a result of today, the Juzhengdaozhi, improve emergency treatment records, a protective effect on the nursing staff so as to avoid disputes or nursing care in the dispute are not in a passive position and objective record of the rescue is to protect legitimate patients 4 based on the rights and interests of Through care, nursing staff from a high degree of awareness of the legal duties of care to enhance self-protection awareness and improve the written record of the 　　6 improved the nurse manager of the subsidiary business of the level of understanding of the extent of nurses speak out on the show through in the care of their practical problems in its own comprehensive quality and the ability to solve practical problems, the head nurse can be a more precise understanding of Deficiencies in the care of the weak links and, under the understanding of the strengths and shortcomings, targeted to education or training, to build TOP team is conducive to smooth 　　3 discussion　　Professor Shi Chuanxin Japan: in quality management activities to mobilize the enthusiasm of the people and give full play to people's unlimited ability to create respect, full of life and vitality of the working environment and help enterprises to improve the quality of 〔6〕。 The use of brainstorming, to give full play to human ingenuity and explore human potential, to consider the issue in more detail, to solve the problem more specific, clear and effective The free discussion guide nurses not to be bound to express their original insights, the mobilization of everyone's enthusiasm and training of nursing staff to disseminate innovative thinking, self-worth to be fully realized, to improve the quality of their The collective wisdom of all levels can find the problem and to identify reform measures to improve nursing skills in first aid, rescue norms in the process of care, effectively enhance the quality of 　　References 【】　　1 Wang Xiao-Hua, Ding Xiao-rong, Wang Rong 28 cases of deaths in nursing analysis of the Journal of Nursing, 2006,13 (2) :32-　　2, Xue L Magical ,2005,5:61-62 research 　　3, Ke Jun- B ,2003,4:50-51 Chinese graduate 　　4, Hu, Wang, Li Y Discuss the case through the effective norms of conduct of clinical Shanghai care, 2005,5 (4) :61-　　 The basis of total quality management Beijing: China Economic Publishing House, 1999,　　6 Huang Yong Man, the east, Shao-Yun G Brainstorming to improve the quality of care in the Modern care, 2002,8 (9):