看图对话工具在糖尿病专科护士健康教育培训中的应用

<正>糖尿病专科护士的专业素质对于就医糖尿病患者健康教育具有重要意义~([1]),因此医院应该加强对于糖尿病专科护士的健康教育培训~([2]),可以改善糖尿病患者的治疗效果,传统的护理中糖尿病健康教育有一定缺陷,将看图对话工具应用到糖尿病健康教育健康培训中。1资料与方法 1)调取参加我们医院培训的糖尿病专科护士100例,随机平分为对照组护士50人,男2人,女48人,年龄22～28(25. 34±1. 23)岁,工作年限1～3(2. 21±0. 56)年,其中大专24人,本科21人,专科5人;观察组护士男3人,女4 750人,年龄分布为21～29(25. 64±1. 35)岁,工作年限1～4(2. 61±0. 32)年,其中大专26人,本科     

我国糖尿病教育者培训项目实施情况调查

了解参加中华医学会-中国疾病控制中心-强生糖尿病学院糖尿病教育培训并结业的学员目前糖尿病教育工作开展的情况和面临的困难.采用问卷调查的方法对197名学员和55名管理者进行项目开展情况调查.通过电子邮件收发调查问卷,学员填写《糖尿病教育者培训调查表》,管理者填写《糖尿病教育者培训后工作满意度调查表》.学员中,89.0％对培训效果的整体评价很满意,28.0％具有糖尿病专职教育者的岗位,78.0％的学员认为没有足够的时间和精力从事糖尿病教育.91.0％的管理者对学员回科室后开展的健康教育工作表示满意.该培训项目总体满意度较高、较成功,大部分地区还未设立专职健康教育者岗位.应尽快建立一套教育者后续的考核认证制度、设立专职健康教育者岗位.     

糖尿病并发症模拟体验教育模式在糖尿病专科护士培训中的应用

目的探讨糖尿病并发症模拟体验教育模式应用于糖尿病专科护士培训的效果。方法将该院2015—2017年招收的糖尿病专科护士学员共96名,随机平均分为对照组和干预组,每组48名。培训共计320学时,包括理论教学160学时和临床实践教学160学时。对照组采用常规培训方式,干预组采用常规培训方式+糖尿病并发症模拟体验教育模式。结果比较对照组和干预组理论考核成绩、健康教育考核成绩,干预组均高于对照组,差异有统计学意义(P0.05)。干预组的患者健康教育评分调查显著高于对照组,差异有统计学意义(P0.05)。结论糖尿病并发症模拟体验教育模式应用于糖尿病专科护士培训,有助于提高糖尿病专科护士对糖尿病并发症知识的掌握程度及健康教育能力,有效提高糖尿病专科护士人文关怀能力,更好地发挥糖尿病专科护士在患者自我管理中的作用。     

我国糖尿病专科护士工作现状及职业满意度影响因素分析

目的探讨全国各省市糖尿病专科护士培训后的工作情况和职业满意度及其影响因素。方法采用便利抽样法自2018年10月至12月选取全国31个省、自治区、直辖市已取得各地区糖尿病专科护士合格证书的3918名护士作为研究对象。应用问卷星进行问卷调查,内容包括人口统计学资料、目前糖尿病专科护士工作现状、职业满意度。二分类变量间的比较采用独立样本t检验,多分类变量间的比较采用单因素方差分析,两个连续变量的相关分析采用Pearson相关分析,采用多重线性回归法分析糖尿病专科护士职业满意度的影响因素。结果糖尿病专科护士的护理工作中,1920名(49.0%)护士大部分时间从事糖尿病相关工作。职业满意度非常满意者仅975名(24.9%)。多重线性回归分析显示,地区(β=-0.210)、科室(β=0.046)、职称(β=-0.101)、从事糖尿病护理的年限(β=-0.008)、培训后总体工作能力提升现状(β=0.075)、医院专科护士管理办法(β=-0.160)、糖尿病相关工作所占比例(β=-0.200)、从事“糖尿病临床/社区的护理工作”所占比例(β=0.051)、从事“糖尿病教育门诊”所占比例(β=-0.039)、从事“糖尿病会诊”所占比例(β=-0.046)和“指导基层糖尿病护理工作”所占比例(β=-0.065)为专科护士职业满意度得分的影响因素(均P<0.05)。结论糖尿病专科护士从事糖尿病相关工作时间的比例和其职业满意度均有待进一步提高。     

糖尿病护理小组开展专科护理服务实践与效果

目的探讨糖尿病护理小组开展专科护理服务实践的效果,以期提高糖尿病的专科护理水平。方法对2012年2月—2013年4月来该院接受治疗的102例糖尿病患者进行专科护理服务,主要包括咨询门诊、护理问诊以及安全管理等,对糖尿病护理小组32名护理人员进行糖尿病专业知识培训,护理周期结束后,评价糖尿病护理小组开展工作的效果。结果糖尿病患者的遵医嘱行为、接受治疗配合性和自我管理能力均有明显提高,护理小组护理人员的糖尿病专业知识与技能也得到了明显提高,与开展专科护理活动前相比存在明显差异,差异有统计学意义(P0.05)。结论医院开展糖尿病护理小组,可以有效提高医院糖尿病专业护理的水平,对提高糖尿病患者临床康复率具有重要意义。     

非糖尿病专科护士胰岛素相关知识掌握情况调查分析

目的了解非糖尿病专科护士胰岛素相关知识的掌握情况,为提高胰岛素的正确、安全使用水平,保证糖尿病患者的治疗效果及有效防治并发症的发生提供参考。方法采用自制调查问卷对我院非糖尿病专科护士的胰岛素相关知识掌握情况进行调查。结果共发放调查问卷300份,收回295份,获得有效问卷280份(93.3%),有效调查护士280名。调查结果显示,非糖尿病专科护士胰岛素相关知识掌握情况较差,学历、职称对非糖尿病专科护士胰岛素相关知识的掌握影响较大,护龄、工作科室对护士胰岛素相关知识的掌握影响不大。结论非糖尿病专科护士胰岛素相关知识掌握情况较差,医疗单位加强对非糖尿病专科护士胰岛素相关知识的培训非常必要,具有十分重要的现实意义。     

普及糖尿病教育势在必行

面对糖尿病发病率逐年增高的现实，应引起政府、卫生部门、社会各个行业的关注和重视。笔者通过临床观察发现，目前大多数人对糖尿病的危害认识不到位，预防糖尿病意识不够；已诊断糖尿病的患者，对治疗认知差，医务专业人员对糖尿病的认识也不足；糖尿病防治专科人员，不同地区专业水平差距也很大，很多地区未能完善开展工作。因此开展糖尿病教育势在必行。     

糖尿病联络在非糖尿病病区糖尿病护理中的作用

目的探讨糖尿病联络在非糖尿病病区护理风险管理中的作用.方法在全院的各病区选取护士2～4人,共64人组成一个糖尿病联络护士小组,在其接受系统的培训之后由这些护士负责对本病区的护士开展再培训,对于患者开展健康教育与管理,结果在干预之后全院的护士对于糖尿病的相关知识以及操作技能的掌握程度都有显著的提高(P<0.01),非专科的住院糖尿病患者对于糖尿病的相关知识的掌握情况也有显著改善(P<0.01),糖尿病的护理缺陷自2011年6起下降到2012年0起。结论糖尿病联络的进行有利于提高非糖尿病病区的糖尿病护理水平.     

云南省艾滋病专科护士临床专业能力调查及影响因素分析

目的 调查云南省艾滋病专科护士临床专业能力现状并分析影响因素,发现艾滋病专科护士临床专业能力提升面临的问题,并探讨其改善和建设的对策和建议。方法 在2020年1-4月,以云南省艾滋病专科护士为调查对象,采用自制的基本情况调查表和艾滋病专科护士临床专业能力评价量表进行网络问卷调查。结果 共计调查100名艾滋病专科护士,女性97例,男性3例;80.00%来自综合医院,20.00%来自专科医院,其中三级甲等医院占39.00%,三级乙等医院占6.00%,二级甲等医院占49.00%,其他医院占6.00%。艾滋病专科护士临床专业能力由高到低依次为：职业防护能力（3.59±0.89）分、法律伦理知识（3.13±0.87）分、临床技能（2.87±0.85）分、理论知识（2.85±0.68）分。经过多元回归分析得出医院级别、医院类别与艾滋病专科护士临床专业能力相关（P<0.05）。结论 云南省艾滋病专科护士理论知识和临床技能还有待提升,在将来的工作中应对艾滋病专科护士的培养建立有效的管理机制,做好人才管理和岗位管理,注重前期培训的同时,还需重视其后续的管理。     

以“智慧医疗”为核心的糖尿病管理团队智慧服务创新与实践

有效的糖尿病自我管理教育与支持是糖尿病良好控制的基础。该文详细介绍了以糖尿病专科护士为主导、借助糖尿病智慧管理平台开展的信息“互联、互通、共享”的“互联网+”糖尿病智慧一体化健康管理模式创新与实践,阐述了有效的糖尿病自我管理教育支持闭环的形成、延伸和随访,介绍了实现闭环管理的各临床、护理服务智慧创新实践要点,以实现规范化、信息化、系统化的糖尿病自我管理。     

Nurse-led heart failure clinics in Sweden

OBJECTIVE: The aim of this study was to describe the nurse-led heart failure care in Sweden. METHODS: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes. RESULTS: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare. CONCLUSION: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.     

Managing type 2 diabetes in Soweto—The South African Chronic Disease Outreach Program experience

Diabetes (DM) and its resultant complications are a problem worldwide, and especially in developing countries like South Africa (SA). Risk factors associated with DM are potentially modifiable, but DM control is poor. Problems in SA include high prevalence of morbidity from DM and hypertension (HTN), lack of recognition of the importance of chronic kidney disease (CKD), late presentation to health care services, lack of education of health providers and patients, and poor quality of care in primary health care settings (PHC). In response, there has been growing advocacy for prevention strategies and improved support and education for primary health care nurses (PHCNs). A Chronic Disease Outreach Program (CDOP), based on the chronic care model was used to follow patients with DM and HTN, support PHCN, and improve health systems for management in Soweto. A group of 257 DM patients and 186 PHCN were followed over 2 years, with the study including the evaluation of ‘functional’ and clinical outcomes, diary recordings outlining program challenges, and a questionnaire assessing PHCNs’ knowledge and education support, and the value of CDOP. CDOP was successful in supporting PHCNs, detecting patients with advanced disease, and ensuring early referral to a specialist center. It improved early detection and referral of high risk, poorly controlled patients and had an impact on PHCNs’ knowledge. Its weaknesses include poor follow up due to poor existing health systems and the programs’ inability to integrate into existing chronic disease services. The study also revealed an overworked, poorly supported, poorly educated and frustrated primary health care team.     

Incidence of childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England, 1975-1996.

AIMS: To determine the incidence of Type 1 diabetes mellitus (DM) in children aged 0-15 years in the far south-west of England between 1975 and 1996. METHODS: Patient information was collected to set up the Cornwall and Plymouth Children's Diabetes Register (CPCDR) through two main data sources; hospitals and the general practitioners in all surgeries in the study region. All children under 16 years living within Cornwall and the Isles of Scilly, and the former Plymouth Health Authorities and diagnosed as having Type 1 DM during the study period were included. The case ascertainment was estimated by a capture-recapture method. Trends and differences in incidence of sex, age, time period and district of diagnosis were analysed by Poisson regression analysis. Roger's method was used to estimate the seasonal variations. RESULTS: A total of 522 subjects aged between 0 and 15 years were identified from 01/01/1975 to 31/12/1996, giving an overall crude incidence of 14.9/ 100 000 population/year. The case ascertainment was 94.4% (95% confidence interval (CI) 91.4- 97.6%) for the whole register. Poisson regression analysis showed that a significant increase of incidence (2.49% per year) was observed throughout the 22-year study period, which was mainly a result of the significant increase in the 0-4 year age-group (6.29% per year). The incidence significantly differed among the 22-years (P = 0.007), the three age groups (0-4, 5-9 and 10-14 years, P<0.001) and different sexes (P=0.049). The significant seasonal variations were detected with peak incidence appearing in autumn and winter. CONCLUSIONS: The first validated childhood-onset diabetes register has been set up in the far south-west of England. The incidence of childhood Type 1 DM in this region has increased significantly over the past two decades, especially in children under 5 years.     

Type 2 diabetic patients attending a nurse educator have improved metabolic control

To investigate if routine education by nurses is associated with improved metabolic control in type 2 diabetic (DM2) outpatients, we randomly selected 143 patients (81 women), not using insulin, at the Endocrine or Internal Medicine clinics, to be interviewed and submitted to a clinical and laboratory evaluation. Age was 59.1+/-10.1 years; duration of DM2 7.5+/-6.3 years; BMI 29.7+/-5.2 kg/m(2). Patients were grouped according to HbA(1c) (<7.0% or > or =7.0%). Age, gender, DM2 duration, BMI, and lipid profile were not different. Patients with HbA(1c)> or =7.0% (n=49) were more likely to be taking oral agents, and to be treated by internists rather than endocrinologists (P=0.04). Nurse education was associated with a greater proportion of patients with HbA(1c)<7.0%, especially among those attending the Internal Medicine clinic. In logistic regression, education by nurses remained associated to HbA(1c)<7.0% (OR: 3.29, P=0.005), after controlling for use of oral agents (OR 0.067, P=0.01), attending the Endocrine clinic (OR 4.11, P=0.002), self-reported adherence to diet ("yes" or "no"), known DM duration, and instruction level (NS). Nurse education contributes significantly and independently for better metabolic control in DM2 outpatients in a teaching hospital.     

Potential for development of haemophilia link nurse role within UK hospitals

Link nurses are practising nurses with an expressed interest in a given specialty, with formal links to clinical nurse specialists and other specialist staff. The role involves attending meetings to discuss ideas and new developments, and relaying findings to other ward nurses to improve their practice. Such nurses are common in many specialties such as diabetes and tissue viability. In haemophilia, the role has the potential to enhance the care of haemophilia patients on general hospital wards. In April 2012, a focus group of five haemophilia nurses was convened to discuss their experiences of ‘link nurse’ programmes within district general hospitals and the potential value of developing the haemophilia link nurse role, and to consider the materials needed to support such role development. It was agreed to test whether other haemophilia nurses perceived such a need by means of a short five‐item questionnaire devised by the group and made available to all members of the UK's Haemophilia Nurse's Association via Survey‐Monkey. Final responses from 59 haemophilia nurses across the UK have been analysed. Most nurses agreed that there was value in the development of a haemophilia link nurse role within UK hospitals and thought their trusts would support it. While barriers and potential downsides were acknowledged, this was seen as a useful way of sharing information and knowledge with colleagues from different specialties and of raising awareness of bleeding disorders among the general nursing community. Haemophilia nurses should coordinate the development of a Haemophilia Link Nurse training and education pack.     

Access to diabetes treatment in northern Ethiopia

Treatments for diabetes in Ethiopia are at present only available in hospitals so many patients must travel great distances to obtain insulin, tablets, and diabetes education. We reviewed all 496 people with diabetes attending the diabetic clinic at Gondar Hospital (281 with Type 1 (insulin-dependent) diabetes mellitus (DM) and 215 with Type 2 (non-insulin-dependent) DM. Half of the patients came from rural areas, all but 3 of them travelling more than 20 km, one-quarter of them more than 100 km and 33 patients (13 %) more than 180 km. It is likely that many patients who fail to attend from the more distant areas have died. We are developing a scheme which would enable diabetic patients to be treated at rural health centres by nurses trained in the principles of diabetes care which could greatly improve the outlook for diabetic patients in Ethiopia. © 1998 John Wiley & Sons, Ltd.     

Diabetes self-management education in a high-income developing country: survey of the opinion of nurses and dietitians

To assess the views of nurses and dietitians on diabetes self-management education and the preparedness of their work places for implementing diabetes self-care. 1,057 (71 %) of the estimated 1,498 qualified nurses and dietitians employed in the services of the Regional Health Authorities between November 2011 and April 2012 completed the self-administered research questionnaire previously pre-tested on a cohort of student nurses. The questionnaires did not contain any personal identifiers but were serially numbered to avoid receiving duplicate copies from a participant. The questionnaires were distributed to all public hospitals and health centres within the regional health authorities. The head nurse in each facility assisted in the distribution and collection of completed questionnaires from the volunteers. One thousand thirty-two nurses and 25 dietitians participated in the study. While the majorities of the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, 68 % and 58 % of them respectively did not think that there was adequate diabetes health education for the patients in their places of work. Furthermore, 73 % of the nurses and dietitians think that the health care system was not prepared for diabetes self-management education given that there were not enough qualified health personnel, educational facilities and economic resources. Although the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, inadequate healthcare personnel, economic resources and educational facilities constitute significant barriers. We recommend that governments in the developing countries should invest human and material resources into healthcare education.     

The impact of dedicated medication nurses on the medication administration error rate: a randomized controlled trial

BACKGROUND: Concerns about hospital medication safety mount as the pace of new drug releases accelerates. METHODS: We performed a randomized study at 2 hospitals (A and B) to examine whether the medication administration error rate could be decreased by having "dedicated" nurses focus exclusively on administering drugs. "Medication nurses," after receiving a brief review course on safe medication use, were responsible solely for drug delivery for up to 18 patients each. "General nurses," who did not attend the course, provided comprehensive care, including drug delivery, for 6 patients each. A direct observation technique was used to record drug errors, process-variation errors, and total errors. RESULTS: At both hospitals combined, the total error rate was 15.7% for medication nurses and 14.9% for general nurses (P<.84). Comparing hospitals, the total error rate for medication nurses at hospital B was significantly higher than it was at hospital A (19.7% vs 11.2%; P<.04). At hospital A, there was a significantly lower error rate for medication nurses than for general nurses in the surgical units (P<.01) but no significant differences in total errors comparing nurse types in the medical units (P<.77). CONCLUSIONS: This trial suggests that use of dedicated medication nurses does not reduce medication error rates. However, subgroup analysis indicates that medication nurses might be useful in some settings. The differences in findings at the 2 hospitals and their differences in medication-use processes reinforce the concept that medication errors are usually related to systems design issues.     

Heart failure units in Spain: state of the art

Heart failure is a huge public health problem. Heart failure units provide better care for patients with this condition. The establishment of such units in hospitals varies greatly between countries. To date, no specific data are available on the current situation with these units in Spain. A short questionnaire was used to evaluate the present-day implementation and characteristics of heart failure units in Spanish hospitals. Of the 110 hospitals surveyed, 45 (41%) had a heart failure unit. The percentage varied significantly with the technological sophistication of the hospital: level 1 (lowest) 8%, level 2 38%, and level 3 (highest) 76%. Some 91% of units were run by cardiology departments. In 78% of the units surveyed, nurses were involved in patient care, though only on a part-time basis in the majority (63%). Their task was primarily patient education, although, in 34%, they only performed basic support tasks (i.e., ECG and monitoring vital signs).     

The importance of the examination of, education on, and infection control of tuberculosis in medical school hospitals in Japan

Since the incidence of tuberculosis (TB) has markedly decreased over the last half-century, dedicated TB hospitals in Japan have been reducing the beds or have been merging with other hospitals. In accordance with this situation, less than 30% of medical school hospitals (MSHs) have facilities for infectious TB patients. In the meantime, and contrary to the previous trend, elderly TB patients or those who have serious underlying diseases have been increasing. MSHs have therefore not only to take care of these patients, but at the same time they have to reform their TB education system in addition to upgrading TB infection control. To elucidate the current problem regarding TB in MSHs, the survey in the current study was performed for 80 MSHs in Japan in January 2002. Two sets of questionnaires were prepared and delivered to doctors in these hospitals. One set mainly asked about the status of TB examination and education, and was aimed at doctors in the division of respiratory diseases of the department of internal medicine (Rs); and the other mainly asked about the status of TB infection control and was aimed at doctors in the divisions of infectious diseases, or whoever in charge of hospital infection control (Is). Response rates from Rs and Is were 75.0% (60/80) and 65.0% (52/80), respectively. Seventy-three point three percent (44/60) of Rs and 73.1% (38/52) of Is were working in hospitals without TB beds. Because of the current incidence of TB, the number of TB patients they examined in a year was small (35/60 of hospitals examined less than 20 TB patients in a year). Although there were some experienced doctors on TB in each hospital, most MSHs had only a small number of experienced nurses. Nevertheless, 89.3% of doctors in MSHs (a total of 100/112 Rs and Is) believed that they required TB rooms exclusively for TB patients who have some underlying diseases, and for TB education. Regarding the role of MSHs for TB patients care, the majority of doctors (70.5% of Rs and 68.4% of Is) considered MSHs should be able to offer treatment to TB patients with underlying complications. As to the educational aspect, most medical schools (MSs) devoted little time to lectures on TB (the median was 1 to 1.5 hour); on the other hand, some MSs (31.8%: 14/44 of MSHs without TB rooms) included a clinical practices in TB hospitals for TB education, although its term was short. Regarding TB infection control issues, most of the MSHs had active infection control committees in their hospitals and TB was thought to be one of the most important targets for these committees. About 40% (20/51) of these hospitals over the past few years had experienced nosocomial TB infection due in part to the so called "Doctor's delay". As one of the strategies to prevent nosocomial TB infection, special education sessions, not only for staff and residents but also students, were therefore performed in 60.8% (31/51) of MSHs. As to the evaluation of the tuberculin skin test (TST) status of medical students, the two-step TST was performed in 47.1% (24/51) of MSs (as most Japanese underwent their BCG vaccination in their childhood) and 54.9% (28/51) of MSs had a BCG revaccination policy for TST negative students. Although steps toward reforms in TB issues in MSHs were slow, some minor progress had been made as compared with previous surveys performed by us and others. Even though the numbers of TB patients examined in MSHs have been smaller than before, MHSs still have to take care of some TB patients with some complications. A great deal of effort still needs to be expended to establish efficient and effective TB education and infection control systems. Even though many ideas have been put forward to improve the current situation, one of the most successful answers is to set up small number of special rooms, not only for TB patients but also for other airborne infectious diseases, in all MHSs. The other clue is to establish an intimate collaboration between MSHs and TB hospitals with regard to clinical TB education not only for medical students but also for medical staff.