45例住院自杀患者病例特征分析及预防对策
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摘要
目的总结住院患者自杀的状况,分析住院患者自杀的特征,从医院、管理者、医护人员、患者家属方面提出住院患者自杀的预防对策。方法回顾性分析某三级甲等医院主院区病案科2008年11月—2018年9月45例关于住院自杀患者的完整病历。结果 45例住院自杀患者中,女性25例(56%),45～60岁20例(44%);初中及以下文化程度27例(60%);已婚40例(90%);父母一方去世或者双方已故者36例(80%);无业34例(76%);住院天数≤7 d 21例(47%);住院总次数≥3次30例(67%);癌症及慢性病33例(73%);住院期间有手术者14例(31%);住院期间有病重通知书10例(22%);住院期间精神状况差23例(51%),住院期间饮食状况差20例(44%),住院期间睡眠状况差27例(60%);春夏季自杀28例(62%);2:00-6:00时间段自杀患者占17例(38%);跳楼自杀患者27例(60%),其中21例(81%)患者跳楼自杀死亡;自杀结局中患者死亡占26例(58%)。结论预防对策包括:管理者关注自杀高危人群,做好环境安全管理,培训心理护士;医护人员评估科室环境安全,进行安全告知、保护性观察和有效沟通;患者家属提供良好的社会支持、保持警惕等。
Objective To analyze the features of hospitalized patients who committed suicide and to propose preventive measures from the perspective of hospital, managers, medical staff and families of the patients. Methods Data of 45 cases of hospitalized patients who committed suicide in one tertiary grade A hospital from November 2008 to September 2018 were analyzed. Results Of the total, there were 25 females(56%), 20 cases(44%)aged from 45 to 60, 27 cases(60%)with education of junior high school or below,40 cases(90%)of married ones, 36 cases(80%)with deceased father or mother or both, 34 unemployed ones(76%), 21 cases(47%)with hospital stay shorter than 7 d, 30 cases(67%)with 3 or more hospitalization times, 33 cases(73%) of cancer patients or with chronic diseases, 14 cases(31%) with surgeries during the hospitalization, 10 cases(22%) having notice of critical condition, 23 cases(51%) with poor psychological condition, 20 cases with poor appetite(44%) and 27 with poor sleep(60%) during the hospitalization.Spring and summer witnessed 28 cases of suicide(62%) and there were 17 patients committing suicide from 2:00-6:00, accounting for38%. Twenty-seven cases(60%) jumped to death and 21 of them died(81%). As to the suicide outcome, 26 cases(58%) died eventually. Conclusion More attention to high risk population, environment safety management, help from psychological nursing,safety education, protective observation and effective communication and good social support are all conducive to the prevention of suicide in hospitalized patients.
Objective To analyze the features of hospitalized patients who committed suicide and to propose preventive measures from the perspective of hospital, managers, medical staff and families of the patients. Methods Data of 45 cases of hospitalized patients who committed suicide in one tertiary grade A hospital from November 2008 to September 2018 were analyzed. Results Of the total, there were 25 females(56%), 20 cases(44%)aged from 45 to 60, 27 cases(60%)with education of junior high school or below,40 cases(90%)of married ones, 36 cases(80%)with deceased father or mother or both, 34 unemployed ones(76%), 21 cases(47%)with hospital stay shorter than 7 d, 30 cases(67%)with 3 or more hospitalization times, 33 cases(73%) of cancer patients or with chronic diseases, 14 cases(31%) with surgeries during the hospitalization, 10 cases(22%) having notice of critical condition, 23 cases(51%) with poor psychological condition, 20 cases with poor appetite(44%) and 27 with poor sleep(60%) during the hospitalization.Spring and summer witnessed 28 cases of suicide(62%) and there were 17 patients committing suicide from 2:00-6:00, accounting for38%. Twenty-seven cases(60%) jumped to death and 21 of them died(81%). As to the suicide outcome, 26 cases(58%) died eventually. Conclusion More attention to high risk population, environment safety management, help from psychological nursing,safety education, protective observation and effective communication and good social support are all conducive to the prevention of suicide in hospitalized patients.
引文
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[7]吴改平,胡德英,汤运红.住院病人自杀死亡原因心理解剖分析与启示[J].护理研究,2017,31(10):1224-1227.DOI:10.3969/j.issn.1009-6493.2017.10.020.
[8]Logan J E,Crosby A E,Hamburger M E.Suicidal Ideation,Friendships with Delinquents,Social and Parental Connectedness,and Differential Associations By Sex:Findings A-mong High-risk Pre/Early Adolescent Population[J].Crisis,2011,32(6):299-309.DOI:10.1027/0227-5910/a000091.
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[11]石少波,杨波,梁锦军.抑郁症与室性心律失常[J].中国心脏起搏与心电生理杂志,2012,26(5):386-388.DOI:10.13333/j.cnki.cjcpe.2012.05.006.
[12]罗军萍.急诊经皮冠状动脉介入治疗急性心肌梗死后的护理体会[J].实用心脑肺血管病杂志,2011,19(6):887.
[13]卢昌懿,谢红珍.某院19起住院患者自杀事件特征分析[J].解放军医院管理杂志,2014,21(5):488-490.DOI:10.16770/j.cnki.1008-9985.2014.05.018.
[14]胡德英,丁小萍,熊宇,等.19例住院患者夜间自杀现状分析与防范对策[J].护理学报,2015,22(3):62-65.DOI:10.16460/j.issn1008-9969.2015.03.062.
[15]望运丹,胡德英,孙瑞.综合医院住院病人经窗户坠楼自杀的现况分析及安全防护管理[J].护理研究,2018,32(10):1601-1603.DOI:10.12102/j.issn.1009-6493.2018.10.028.
[16]朱秀琴,陆丽娟,余媛,等.根本原因分析法在综合医院住院患者自杀事件预防中的运用[J].护理管理杂志,2015,15(8):594-596.
[17]熊宇,胡德英,胡灵芝.《护士伦理准则》背景下护士履行自杀守门人多重角色的思考[J].中国医学伦理学,2016,29(6):1036-1039.DOI:10.12026/j.issn.1001-8565.2016.06.35.
[18]望运丹,胡德英,刘义兰,等.某三级甲等医院住院患者自杀环境安全因素分析及管理对策[J].护理学报,2017,24(18):9-12.DOI:10.16460/j.issn1008-9969.2017.18.009.
[19]吕仲群.认知行为疗法对社区抑郁症患者的影响[J].现代临床护理,2006,5(3):18-19.
[20]Hughes J L,Asarnow J R.Enhanced Mental Health Interventions in the Emergency Department:Suicide and Suicide Attempt Prevention in the ED[J].Clin Pediatr Emerg Med,2013,14(1):28-34.
[21]Kleiman E M,Riskind J H,Schaefer K E,et al.The Moderating Role of Socialsupport on the Relationship Between Impulsivity and Suicide Risk[J].Crisis,2012,33:273-279.DOI:10.1027/0227-5910/a000136.
[22]濮益琴.9例恶性血液病患者疾病缓解期自杀原因分析及干预对策[J].护理学报,2014,21(1):65-67.DOI:10.16460/j.issn1008-9969.2014.01.022.
[23]陈月梅,皮远萍,唐玲,等.根本原因分析法在住院癌症患者自杀管理中的应用[J].护理学报,2014,21(18):13-14.DOI:10.16460/j.issn1008-9969.2014.18.010.
[2]Riblet N,Shiner B,Mills P,et al.Systematic and Organizational Issues Implicated in Post-hospitalization Suicides of Medically Hospitalized Patients:A Study of Root-cause Analysis Reports[J].Gen Hosp Psychiatry,2017,46:68-73.DOI:10.1016/j.genhosppsych.2017.03.009.
[3]Tseng M C,Cheng I C,Hu F C.Standardized Mortality Ratio of Inpatient Suicide in a General Hospital[J].J Formos Med Assoc,2011,110(4):267-269.DOI:10.1016/S0929-6646(11)60040-5.
[4]Borges G,Nock M K,Haro Abad J M,et al.Twelve Month Prevalence of andRisk Factors for Suicide Attempts in the WHO World Mental Health Surveys[J].J Clin Psychiatry,2010,71(12):1617-1628.DOI:10.4088/JCP.08m04967blu.
[5]Dai J,Chiu H F,Conner K R,et al.Suicidal Ideation and Attempts Among Rural Chinese Aged 16-34 Years-sociodemographic Correlates in the Context of a Transforming China[J].J Affect Disord,2011,130:438-446.DOI:10.1016/j.jad.2010.10.042.
[6]Li Y,Cao J.Factors Associated with Suicidal Behaviors in Mainland China:A Meta-analysis[J].BMC Public Health,2012,12:524.DOI:10.1186/1471-2458-12-524.
[7]吴改平,胡德英,汤运红.住院病人自杀死亡原因心理解剖分析与启示[J].护理研究,2017,31(10):1224-1227.DOI:10.3969/j.issn.1009-6493.2017.10.020.
[8]Logan J E,Crosby A E,Hamburger M E.Suicidal Ideation,Friendships with Delinquents,Social and Parental Connectedness,and Differential Associations By Sex:Findings A-mong High-risk Pre/Early Adolescent Population[J].Crisis,2011,32(6):299-309.DOI:10.1027/0227-5910/a000091.
[9]Duleba T,Gonda X,Rihmer Z,et al.Economic Recession,Unemployment and Suicide[J].Neuropsychopharmacol Hung,2012,14(1):41.
[10]Hung C I,Liu C Y,Liao M N,et al.Self-destructive Acts Occurring During Medical General Hospitalization[J].Gen Hoso Psychiatry,2000,22(2):115-121.
[11]石少波,杨波,梁锦军.抑郁症与室性心律失常[J].中国心脏起搏与心电生理杂志,2012,26(5):386-388.DOI:10.13333/j.cnki.cjcpe.2012.05.006.
[12]罗军萍.急诊经皮冠状动脉介入治疗急性心肌梗死后的护理体会[J].实用心脑肺血管病杂志,2011,19(6):887.
[13]卢昌懿,谢红珍.某院19起住院患者自杀事件特征分析[J].解放军医院管理杂志,2014,21(5):488-490.DOI:10.16770/j.cnki.1008-9985.2014.05.018.
[14]胡德英,丁小萍,熊宇,等.19例住院患者夜间自杀现状分析与防范对策[J].护理学报,2015,22(3):62-65.DOI:10.16460/j.issn1008-9969.2015.03.062.
[15]望运丹,胡德英,孙瑞.综合医院住院病人经窗户坠楼自杀的现况分析及安全防护管理[J].护理研究,2018,32(10):1601-1603.DOI:10.12102/j.issn.1009-6493.2018.10.028.
[16]朱秀琴,陆丽娟,余媛,等.根本原因分析法在综合医院住院患者自杀事件预防中的运用[J].护理管理杂志,2015,15(8):594-596.
[17]熊宇,胡德英,胡灵芝.《护士伦理准则》背景下护士履行自杀守门人多重角色的思考[J].中国医学伦理学,2016,29(6):1036-1039.DOI:10.12026/j.issn.1001-8565.2016.06.35.
[18]望运丹,胡德英,刘义兰,等.某三级甲等医院住院患者自杀环境安全因素分析及管理对策[J].护理学报,2017,24(18):9-12.DOI:10.16460/j.issn1008-9969.2017.18.009.
[19]吕仲群.认知行为疗法对社区抑郁症患者的影响[J].现代临床护理,2006,5(3):18-19.
[20]Hughes J L,Asarnow J R.Enhanced Mental Health Interventions in the Emergency Department:Suicide and Suicide Attempt Prevention in the ED[J].Clin Pediatr Emerg Med,2013,14(1):28-34.
[21]Kleiman E M,Riskind J H,Schaefer K E,et al.The Moderating Role of Socialsupport on the Relationship Between Impulsivity and Suicide Risk[J].Crisis,2012,33:273-279.DOI:10.1027/0227-5910/a000136.
[22]濮益琴.9例恶性血液病患者疾病缓解期自杀原因分析及干预对策[J].护理学报,2014,21(1):65-67.DOI:10.16460/j.issn1008-9969.2014.01.022.
[23]陈月梅,皮远萍,唐玲,等.根本原因分析法在住院癌症患者自杀管理中的应用[J].护理学报,2014,21(18):13-14.DOI:10.16460/j.issn1008-9969.2014.18.010.