手术室护士胜任特征模型的研究

[目的]构建手术室护士胜任特征模型,了解手术室护士为胜任临床工作需要应具备的综合能力.[方法]根据文献分析和专家咨询法,建立"手术室护士胜任特征要素词典",采用自编问卷调查手术室护士对各胜任特征要素重要程度的态度评价,利用因子分析法建立"手术室护士胜任特征模型".[结果]手术室护士胜任特征模型包括专业基本技能、人际关系能力、职业发展能力和个人特质4个因子及其所属的17项具体特征.[结论]研究建立的手术室护士胜任特征模型对手术室护士个人及护理管理机构都有重要的应用价值.     

基于岗位胜任力的手术室低年资护士规范化培训指标的构建

目的 构建基于岗位胜任力的手术室低年资护士规范化培训指标，为手术室低年资护士培训和评价提供参考。方法 以岗位胜任力模型和国家《新入职护士培训大纲(试行)》为理论框架，结合手术室护理专科特点，通过文献回顾法、德尔菲专家函询法以及层次分析法，确定手术室低年资护士岗位胜任力培训各级指标及权重。结果 手术室低年资护士岗位胜任力评价指标体系包含专业知识、专业技能、专业能力和个人特质4项一级指标、11个二级指标和103个三级指标。2轮函询专家积极系数均为100%,意见提出率分别为45.83%和20.83%。专家权威系数分别为0.891和0.912,肯德尔协调系数为0.314～0.377(P<0.05)。结论 构建的基于岗位胜任力的手术室低年资护士规范化培训指标体系具有较高的科学性和可靠性，可为手术室低年资护士规范化培训和考核提供客观参考。     

手术室护士胜任特征模型自身评价研究

目的 构建手术室护士胜任特征模型.方法 根据文献分析和专家咨询法,建立"手术室护士胜任特征项目词典",采用自编问卷调查255名手术室护士对各胜任特征项目重要程度的态度评价,利用因子分析和层次分析法建立"手术室护士胜任特征模型".结果 手术室护士认为手术室护士胜任特征模型由专业基本技能(包括专业知识与技术、知识更新及应用能力、医疗仪器及手术器械的使用)、人际关系能力(包括人际沟通力、团队协作精神、人际洞察力)、职业发展能力(包括求知欲、概念性思维、职业防护意识、判断和应变能力、关注工作质量与秩序)和个人特质(包括自信心、关注细节、灵活敏捷、自我控制、道德责任感、主动积极性)4个因子、17项具体特征组成,4个因子的权重依次为0.282、0.272、0.187、0.261.结论 手术室护士认为手术室护士胜任特征模型包括专业基本技能、人际关系能力、职业发展能力和个人特质4个因子及其所属的17项具体特征.     

手术室护士急救能力评价指标体系的构建

目的构建手术室护士急救能力评价指标体系,为科学评价手术室护士急救能力、合理设置手术室急救护理培训方案提供依据。方法于2019年6月成立研究小组,通过文献回顾形成手术室护士急救能力评价体系草案,编制咨询问卷。于2019年7—9月通过电子邮件方式发放问卷进行专家函询,采用半结构访谈、德尔菲法及层次分析法构建手术室护士急救能力评价指标体系并确定各指标权重。结果2轮专家函询的积极系数分别为100.0%、95.5%;专家权威系数为0.94、0.92;肯德尔和谐系数分别为0.348、0.405。最终构建的手术室护士急救能力评价体系包括5项一级指标、23项二级指标。结论本研究构建的手术室护士急救能力评价体系可全面评估手术室护理人员的急救能力,具有较强的严谨性,可为科学设置手术室护士急救能力培训课程及考核体系提供参考。     

介入手术室护士胜任特征的研究进展及启示

胜任特征是指能将某一工作中有卓越成就者与表现平平者区分开来的个人的深层次特征［1］,是真正影响工作业绩的个人条件和行为特征［2］。对胜任特征模型的研究是目前人力资源管理领域的前沿问题之一。随着介入放射学的发展,介入手术室护士逐渐成为介入治疗团队的重要力量,在促进护理学科专科化、提高介入治疗疗效等方面发挥着不可替代的作用［3］。但是由于国内缺乏介入护理相关的实践标准及从业资质标准,加之介入手术室护士需要长期在放射线环境下工作,职业风险高于其他领域护士,使介入手术室护士出现专业化程度低、人员流动大的局面［4］。而发展介入手术室护士又面临着一系列问题：如何才能成为介入手术室护士？如何对介入手术室护士进行配置？如何培养与提高其专业技能？……所有问题的答案,都聚焦于介入手术室护士的准入标准问题。而胜任特征的提出很好地将这些问题与实际需求结合起来,研究介入手术室护士的胜任特征模型,不仅可以进行基于胜任特征的选拔招聘和绩效考核,还可以促进护理人力资源的优化配置,为科学、合理地使用和培养介入手术室护士提供依据。本文就相关研究进展综述如下。     

手术室专科护士胜任力指标的初步构建

目的构建手术室专科护士胜任力的指标。方法通过查阅文献、设计咨询问卷,选取三级甲等医院手术室护理、管理专家、临床外科医疗专家,以及赴港培训1年并取得中国香港医管局颁发的手术专科护士证书的广东省手术室专科护士等20名医护专家,进行Delphi法专家咨询,调查结果应用SPSS13．0进行统计学分析。结果2轮专家咨询后,其积极系数为100％、权威系数为0．79、协调系数为0．31（x。=37．09,P=0．000）,手术室专科护士的胜任力指标包括职业素质、专业态度、手术护理专业能力、手术室临床教学与培训能力、沟通协调能力、手术团队合作能力、个性特征7个一级指标以及责任心、主动性等26个二级指标。结论参与构建手术室专科护士胜任力指标的专家积极性高、代表性强、权威系数和协调系数好：Delphi专家咨询法等构建的7个一级指标和26个二级指标,可作为手术室专科护士的人员选拔、培训体系设置、考核标准制定及资格认证的参考依据。     

基于岗位胜任力的达芬奇机器人手术室护士培训方案的构建

目的 构建科学、实用的机器人手术室护士培训方案。方法 以岗位胜任力为基础，通过文献回顾、小组讨论拟订达芬奇机器人手术室护士培训方案，采用德尔菲法对25名专家进行2轮专家咨询。结果 2轮专家咨询问卷有效回收率均为100%,2轮专家权威系数分别为0.932、0.942。最终确立的达芬奇机器人手术室护士培训方案包括准入条件、培训内容、培训方法、考核方法 4个部分，其中包含了17个二级条目，65个三级条目。结论 基于岗位胜任力的达芬奇机器人手术室护士培训方案构建过程科学、可靠，可为机器人手术室护士的培训提供借鉴。     

基于柯式模型构建手术室专科护士培训效果评价体系

目的构建科学、系统的手术室专科护士培训效果评价体系。方法以柯式模型理论为指导,采用德尔菲法从全国范围内选取专家40名进行两轮函询,分析专家对手术室专科护士培训效果评价体系设置的建议。结果专家函询的群体权威系数分别为0.82、0.90,各级指标的协调系数分别为0.51、0.35、0.28。最终构建的手术室专科护士培训效果评价体系包含4个一级指标、14个二级指标及38个三级指标。结论专家对手术室专科护士培训效果评价体系的协调程度较高,表明该评价体系对今后手术室专科护士的培训和评价具有一定的指导意义和参考价值。     

基于案例教学法构建介入手术室专科护士的教学案例库

目的基于案例教学法构建适合介入手术室专科护士培训的教学案例库,提高介入专科护士培训质量、优化案例教学法教学流程、节约护理教育资源。方法结合文献分析、小组讨论以及介入护理专家访谈结果,选择典型案例,初步组成案例库;运用Delphi专家咨询法筛选案例,构建适用于介入手术室专科护士培训的教学案例库。结果通过两轮专家咨询,构建6个维度46个案例的教学案例库。结论咨询专家的积极性和权威程度很高,对指标评估意见有较好的一致性,构建介入手术室专科护士的案例教学法教学案例库结果可信。     

基于胜任力的手术室低年资护士临床培训模式的构建

[目的]构建基于胜任力的手术室低年资护士临床培训模式,为不断完善手术室低年资护士规范化培训,形成专科护士自我发展的多元化平台提供理论与实践依据。[方法]运用文献查新、开放式问卷调查、专业咨询等方法初步建立基于胜任力的手术室低年资护士临床培训模式。采用德尔菲法选取15名专家对该模式内容进行3轮意见调查,针对初级模式指标项目、指标覆盖面提出意见和建议。[结果]3轮专家咨询问卷的有效回收率均为100.0%,选择的专家涉及手术室护理、护理教育、护理管理、流行病学调查、统计学领域,专家具有较好的学科代表性;专家对指标的权威系数均在0.88以上;确立了师资要求、培训周期、培训内容、培训方式、效果评价等基本内容。[结论]初步构建的基于胜任力的手术室低年资护士临床培训模式,专家评议的积极性和权威性均较高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."