某二级甲等医院医患沟通现状及影响因素调研

　　摘 要

　　随着医药卫生体制改革的深入发展，其中的不平衡性开始凸显。医生和患者间的新矛盾逐渐产生，医患关系紧张已成为新闻热点事件，医生受到患者人身伤害的事件时有发生，这样的矛盾对医患之间的关系构成了新威胁。医生们的处境很不乐观，紧张的医患关系打击了医生从事医疗事业的积极性，遏制了医学事业的发展，使得人民的健康幸福、社会的安定发展有了新的问题。对此，我们必须重视和改善医患之间的关系，转变思想观念，加强医生与患者之间的沟通理解，使被动转变为主动，让医患之间的关系紧张的形势得到改善，把建立友好的医患关系作为学习和贯彻党的群众路线教育实践活动的首要建设路线。

　　医患沟通贯穿于整个医疗活动中，是提高医疗质量、减少和防范医疗纠纷，改善医患关系的有效途径。本文以 J 医院为例，重点从非技术性医患沟通方面对该医院医患沟通现状及影响因素做了调查研究。J 医院，二级甲等医院，作为全县最大的医疗服务救治中心，承担着为全县 70%即 35 万人口看病的重任。该医院自上世纪 90 年代进行过整体重建后，由于各种客观因素，一直未再进行装修改造，多种医疗器械也相对落后于附近地域同级别的医院，人才引进工作也一直停滞不前。近 5 年，J 医院医疗事故仅 2 例，但年均上访纠纷 60 人次，年均增幅 10%,其中因医患沟通引起的纠纷占 83%.本文研究医患沟通就是希望找到有效的沟通方法，使医院适应优胜劣汰的市场竞争法则，让医患关系变得和谐，减轻医患双方的心理负担，提高医疗质量，提高医院自身的生存和发展能力。

　　文章在绪论部分提出了研究背景、研究现状以及研究目的和意义。然后根据管理沟通理论，通过问卷调查的形式从患者和医务人员的视角来了解 J 医院医患沟通的现状，在对医患调查问卷结果的统计分析后发现造成 J 医院医患沟通效果不佳的主要原因是因沟通障碍产生的医患信任危机，针对问题，本文分析原因，提出了构建“以病人为中心”的医患沟通文化、完善医患合作机制、建立医患沟通评价制度、重视知情同意权的执行等改进建议。

　　关键词：沟通管理，医患沟通，现状调查

　　ABSTRACT

　　With the development of medical and health system , which began to highlight theimbalance. New conflicts between doctors and patients gradually produced , thedoctor-patient relationship has become strained hot news events, personal injury doctors bypatients when an event occurs , such as the relationship between doctors and patientscontradiction constitutes a new threat. Doctors are very optimistic about the situation , tensedoctor -patient relationship hit a career in the medical enthusiasm to curb the developmentof the medical career , making the health and happiness of the people, social stability andthe development of a new problem. In this regard, we must pay attention to and improve therelationship between doctors and patients , changing ideas , enhance communicationbetween doctors and patients to understand that passive to active , so that the relationshipbetween doctors and patients tense situation improved, the establishment friendlydoctor-patient relationship as a study and implement the Party's mass line educationalpractice primary construction route.

　　Patient communication throughout the medical activities is to improve the quality ofcare, reduce and prevent medical malpractice, an effective way to improve thedoctor-patient relationship. In this paper, J Hospital, for example, focuses on doctor-patientcommunication from the non -technical aspects of the hospital patient communicationstatus and influencing factors do research. J Hospital, secondary level hospitals, as thecounty's largest health care treatment centers, are responsible for the county's 70 percent or35 million people in the doctor's. After the hospital since the 1990s been the overallreconstruction , due to various objective factors, has not been further renovation , a varietyof medical equipment is relatively backward areas in the vicinity of the hospital the samelevel , talent introduction has been stagnant. The past five years, J hospital malpractice onlytwo cases, but the average annual petition disputes 60 passengers, with an average annualgrowth rate of 10%, due to a dispute which caused patient communication accounted for83 %. In this paper, doctor-patient communication is hoping to find an effective way tocommunicate , so that hospitals adapt to market competition, survival of the fittest rules , sothat becomes a harmonious doctor-patient relationship , reduce the psychological burden ofboth doctors and patients to improve the quality of care, improve the hospital 's ownsurvival and development capacity .

　　In the introduction part article presents research background, purpose and significanceof the status quo as well. Then according to the management of communication theory,through a questionnaire from the perspective of patients and medical staff to understand thestatus of J hospital patient communication in the doctor-patient questionnaire results afterstatistical analysis found that the effect of causing J hospital poor doctor-patientcommunication the main reason is a crisis of confidence because of doctor-patientcommunication barriers generated for the problem , this paper analyzes the reasons putforward to build a “ patient-centered” culture of patient communication , improvedoctor-patient cooperation mechanism established patient communication evaluationsystem , emphasis on informed improved implementation of the recommendations , such asconsent.

　　KEY WORDS:Communication management, patient communication, Survey

    目 录

　　摘 要

　　第一章 绪 论

　　1.1 研究背景

　　1.2 研究现状

　　1.2.1 国外研究现状

　　1.2.2 国内研究现状

　　1.3 研究目的与意义

　　第二章 理论依据

　　2.1 沟通的相关概念

　　2.2 医患沟通的相关概念

　　2.2.1 医患沟通中的言语沟通

　　2.2.2 医患沟通中的非言语沟通

　　2.2.3 医患沟通的过程

　　2.3 医患沟通障碍分类及表现

　　2.3.1 按沟通程度与后果分类

　　2.3.2 按医疗过程分类

　　第三章 J 医院医患沟通现状调查

　　3.1 J 医院简介

　　3.2 问卷设计与下发

　　3.3 调查结果统计与分析

　　3.3.1 调查对象的基本情况

　　3.3.2 J 医院医患双方对医患沟通重要性的认知一致

　　3.3.3 患者对医生的信任度评价医患双方存在认知差异

　　3.3.4 患者对医患沟通满意程度及影响因素分析

　　3.3.5 医务人员对患者的相关告知不足，未充分尊重患者的知情同意权

　　3.3.6 医务人员缺乏对患者的人文关怀

　　3.4 调查结果小结

　　第四章 J 医院医患沟通障碍产生的原因分析

　　4.2 知识结构的差异

　　4.3 利益调整的差异

　　4.4 权利分配的差异

　　第五章 J 医院医患有效沟通的改善对策

　　5.1 针对医患思想观念差异的问题，J 医院应构建“以病人为中心”的医患沟通文化

　　5.1.1 树立医学与人文融通的理念

　　5.1.2 加强医生沟通技巧培训

　　5.2 针对医患知识结构差异的问题，J 医院应完善医患合作机制

　　5.2.1 实施患方医学与健康知识宣传教育

　　5.2.2 加强医务人员的伦理和职业素质教育

　　5.3 针对利益调整差异的问题，J 医院可建立医患沟通评价制度

　　5.4 针对医患权利分配的问题，J 医院应重视知情同意权的执行

　　第六章 研究结论和展望

　　6.1 论文的研究结论

　　6.2 研究不足与展望

　　参考文献

　　致 谢