三级综合性医院护士绩效评价指标的定性研究

目的探讨三级综合性医院临床护士绩效评价指标的维度及评价指标。方法以质性研究中现象学的方法为指导,采用深度会谈法对11名护理专家进行访谈。结果访谈得出2个主题:绩效考核的必要性;临床护士绩效考核指标体系的维度和内容。综合专家意见构建了三级综合性医院护士绩效评价指标体系包括工作质量、工作数量、工作能力、工作态度4个一级指标11个二级指标的评价体系。结论评价护士个人绩效应从工作质量、工作数量、工作能力和工作态度4个方面进行,有助于提高护士工作积极性,完善护理质量。     

三级综合性医院护士绩效评价指标的定性研究

目的探讨三级综合性医院临床护士绩效评价指标的维度及评价指标。方法以质性研究中现象学的方法为指导,采用深度会谈法对11名护理专家进行访谈。结果访谈得出2个主题：绩效考核的必要性;临床护士绩效考核指标体系的雏度和内容。综合专家意见构建了三级综合性医院护士绩效评价指标体系包括工作质量、工作数量、工作能力、工作态度4个一级指标11个二级指标的评价体系。结论评价护士个人绩效应从工作质量、工作数量、工作能力和工作态度4个方面进行,有助于提高护士工作积极性,完善护理质量。     

ICU护理安全管理评价体系的构建

目的构建科学、有效的ICU护理安全管理评价体系,为ICU安全管理提供评价工具。方法研究小组初步拟定ICU护理安全管理评价体系,采用德尔菲法对45名专家进行3轮函询,对指标进行筛选和论证。结果最终形成的ICU护理安全管理评价体系有3个一级指标(安全氛围、理念支持、行为支持)、11个二级指标(领导能力、职业防护、人力配备、临床实践、感染控制等)、42个三级指标,三级指标的重要性评分3.02~4.97,专家权威程度分别为0.81、0.83、0.87,专家意见的协调程度系数为0.48。结论专家对指标评价结果的意见一致程度均较高,显示指标体系的可信度较高,可作为ICU护理安全管理的评价工具。     

运用Delphi法构建中医专科护士培训方案指标体系

目的 建立中医专科护士培训方案的指标体系,为中医专科护士规范化培训提供参考.方法 在文献回顾、专家访谈并结合临床实践经验的基础上形成指标体系草案,运用Delphi法对来自10个省市的19名护理专家进行2轮问卷咨询.结果 两轮问卷有效回收率分别为84.00％、90.48％,专家权威系数0.867.最终确立的方案包括4个一级指标、12个二级指标、36个三级指标,其重要性评分为3.68～4.89,变异系数为0.057～0.204.结论 研究结果具有可靠性、现实性和针对性,形成的指标体系对中医专科护士规范化培训的开展有指导作用.     

专科护士主导的临床护理专业学组考核评价指标体系的构建

目的 构建专科护士主导的临床护理专业学组考核评价指标体系,进一步发挥专业学组的管理效能,加强专科护理人才培养。方法 在文献回顾及半结构访谈的基础上,拟定评价指标的条目池,选取20名护理专家开展2轮专家函询,最终确定评价指标体系并进行临床应用。结果 确定的临床护理专业学组考核评价指标体系包含一级指标3个,二级指标8个,三级指标23个;各级指标的变异系数为0.063～0.144,二、三级指标专家协调系数分别为0.682、0.569。结论 构建的临床护理专业学组考核评价指标体系具有较好的科学性与实用性,可为后期专业学组系统化建设提供理论参考。     

ECMO专科护士培训方案的构建

目的 构建体外膜肺氧合(ECMO)专科护士培训方案,为ECMO专科护士培养提供参考。方法 基于文献回顾、半结构式访谈,初步拟定ECMO专科护士培训方案初稿,采用德尔菲法对17名专家进行2轮函询。结果 2轮专家函询问卷回收率均为100%;专家权威系数为0.921;第2轮专家协调系数为0.235～0.400(均P<0.01)。最终形成ECMO专科护士培训目标11个,培训方案包括培训内容、培训方法、准入条件和考核评价4个一级指标、17个二级指标和86个三级指标。结论 ECMO专科护士培训方案可作为ECMO专科护士培养的参考。     

应用层次分析法构建重症监护质量评价指标体系

目的构建重症监护质量评价体系,促进重症监护病房的规范管理。方法在文献回顾与理论研究的基础上,拟定重症监护质量评价指标体系,进行专家咨询,确立各层次指标权重,应用层次分析法分析,进行一致性检验。结果获得3个一级指标,11个二级指标,35个三级指标。一级指标权向量为0.105～0.638,最大特征值为3.039;二级指标的权向量值为0.060～0.637,最大特征值为3.039～4.228;三级指标的权向量为0.044～0.875,最大特征值为2.000～6.740。各判断矩阵的CI值为0～0.0845,CR<0.1。结论该指标体系指标合理,内容全面,体现了专业特点,可用于重症监护质量测评。     

养老机构老人入住评估指标体系的研制

目的研制一套养老机构老人入住评估指标体系。方法通过文献综述法、深度访谈法以及德尔菲法对养老机构老人入住评估指标体系进行筛选,采用层次分析法确定指标权重。结果 2轮咨询表的有效回收率为82.60%、86.84%,专家的熟悉系数为0.79、0.81,专家的权威系数为0.83、0.85。拟定出包括老人基本信息、身体状况、心理因素、生活习惯、家庭支持系统、照护需求6个一级指标、18个二级指标和62个三级指标构成的养老机构老人入住评估指标体系。结论研制的养老机构老人入住评估指标体系科学可靠,对各类养老机构实施老人入住评估具有指导作用。     

基于儒家思想的护理人文关怀能力评价指标体系研究

目的构建基于儒家思想的护理人文关怀能力评价指标体系(下称评价指标体系),用于评价中国护理人员的人文关怀能力。方法拟定3项一级指标、8项二级指标及75项三级指标的"评价指标体系"咨询表,采用Delphi法对分布于临床护理、护理管理、护理教育及医学人文教育领域的30名国内外专家进行3轮咨询,采用层次分析法确定权重。结果获得包含4项一级指标、8项二级指标和59项三级指标的评价指标体系;专家积极系数为93.3%～100%,权威系数为0.86,第2、3轮调查肯德尔协调系数为0.358、0.335,集中度好。结论评价指标体系与中国文化紧密结合,具有客观、系统、可操作的特点,可用于护理人员人文关怀能力的自我定性评价。     

Development of an index system for evaluating caring capacity of nurses based on Confucianism

目的 构建基于儒家思想的护理人文关怀能力评价指标体系(下称评价指标体系),用于评价中国护理人员的人文关怀能力.方法 拟定3项一级指标、8项二级指标及75项三级指标的“评价指标体系”咨询表,采用Delphi法对分布于临床护理、护理管理、护理教育及医学人文教育领域的30名国内外专家进行3轮咨询,采用层次分析法确定权重.结果 获得包含4项一级指标、8项二级指标和59项三级指标的评价指标体系;专家积极系数为93.3％～100％,权威系数为0.86,第2、3轮调查肯德尔协调系数为0.358、0.335,集中度好.结论 评价指标体系与中国文化紧密结合,具有客观、系统、可操作的特点,可用于护理人员人文关怀能力的自我定性评价.     

社区护士老年护理核心能力指标体系的构建

目的构建社区护士老年护理核心能力指标体系(下称指标体系),为社区护士老年护理能力培训及评价提供参考。方法参考相关文献,结合专家及社区实践者访谈,初步拟定社区护士老年护理核心能力指标体系,运用Delphi专家咨询法进行2轮专家函询。结果构建的指标体系包含7个Ⅰ级指标、15个Ⅱ级指标和32个Ⅲ级指标;重要性评分为4.20~5.00,变异系数为0.000~0.200;专家积极性为100%,专家权威系数为0.916,肯德尔和谐系数Ⅰ级、Ⅱ级、Ⅲ级指标分别为0.180、0.171、0.225(均P0.01)。结论指标体系内容涵盖了社区护士老年护理所具备的基本能力,具有可靠性与合理性,可作为老年护理培训需求调查工具,经信效度检验后可作为社区护士老年护理能力评价工具应用。     

终末期肾病患者对护理专业性社会支持体验及期望的叙事研究

目的了解终末期肾病患者住院期间对护理人员提供社会支持的体验及需求,为护士实施全面有效的社会支持提供依据。方法采用立意抽样法选取14例终末期肾病住院患者为研究对象,采用半结构式访谈提纲进行深入访谈并按三维度叙事分析法进行转录和分析。结果患者住院期间感受到的护理专业性社会支持主要有:护理帮助支持、情感支持、沟通和信息支持;患者期望获得及时的评价支持,更多的情感支持,针对性、多样化的沟通信息支持。结论护理人员为终末期肾病患者提供专业性社会支持时应关注患者的期望,提升护理服务效能。     

医养结合机构脑卒中失能患者长期照护需求指标体系构建

目的 构建医养结合机构脑卒中失能患者长期照护需求指标体系,为脑卒中失能患者的长期照护提供参考。方法 基于文献研究法初步拟定医养结合机构脑卒中失能患者长期照护需求指标,结合德尔菲专家函询法对养老管理、老年护理研究、老年护理教育等专业领域的19名专家进行2轮函询,根据咨询结果调整指标并采取优序图法确定指标权重。结果 构建的指标体系包括医疗服务和养老照护2项一级指标、9项二级指标、57项三级指标。其中医疗服务和养老照护2项一级指标权重分别为0.409、0.591;排在前三的二级指标依次为医疗康复0.211、日常生活照料0.185、健康指导和环境安全并列第三0.148;排在前三的三级指标权重依次为认知功能康复0.078、辅助用餐和长期照护经费的来源和支持并列第二0.052、呼吸功能康复0.032。结论 构建的医养结合机构脑卒中失能患者长期照护需求指标体系较可靠,可为推进医养结合机构脑卒中失能患者长期照护服务建设提供参考。     

Marital Status Predicts Change in Distress and Well‐being in Women Newly Diagnosed With Breast Cancer and Their Peer Counselors

Abstract: We conducted a nonrandomized study matching 42 women newly diagnosed with breast cancer (sojourners) with 39 trained breast cancer survivors (navigators) who provided one‐on‐one peer counseling for 3–6 months. Because little is known about how marital status might impact participants in such an intervention, we tested whether being married/partnered buffered navigators and sojourners from distress at baseline and over time. We examined baseline and slopes over time for change in depression and trauma symptoms, and emotional well‐being. We were particularly concerned that being matched with a newly diagnosed breast cancer patient might trigger a re‐experiencing of trauma symptoms for the navigator, so we examined a re‐experiencing subscale. All participants completed baseline, 3‐, 6‐, and 12‐month assessments. Our hypotheses were tested in separate Analyses of Variance (married versus not) for the 39 sojourners and 34 navigators who provided baseline assessments, and the 29 sojourners and 24 navigators who were matched and provided at least one follow‐up. We found no significant baseline associations for navigators or sojourners. Being single/not married was associated with increasing depression symptoms over time in both navigators and sojourners compared with being married/partnered. By 12 months, these increases crossed above the clinical cut‐off for significant depression symptoms. Single status did not predict increasing trauma symptoms over time. However, being single/not married predicted a significant increase in navigators’ re‐experiencing of trauma symptoms. Over time, married sojourners increased significantly in emotional well‐being, whereas single/not married navigators did not differ from married navigators. In addition to providing ongoing training and emotional support to navigators, our findings indicate the importance of providing additional support for women who are not married or partnered.     

Coping with coping strategies: how distributed teams and their members deal with the stress of distance,time zones and culture

The changing world of work is increasing demands on workers through greater need for flexibility in global collaboration. This multiple‐case study uses a qualitative research approach to study context‐specific job stressors and coping in ten geographically distributed work teams. Results demonstrate the complex and dynamic nature of the stress‐coping process and how coping strategies, adapted to manage stress‐evoking uncertainty and ambiguity in distributed work, created secondary sources of psychological strain to individuals. The main strategies for managing the uncertainty and ambiguity in the studied teams were extensive emailing, travelling to face‐to‐face meetings and extending workdays to collaborate simultaneously across time zones. Continuously used, these coping strategies created work overload and strain. Experienced workers, who had good self‐management skills, succeeded in coping with these secondary sources of strain by prioritizing and setting clear limits for workload. Less‐experienced workers were overloaded and needed more social support from their leaders and teammates. The study proposes that distributed team members rely heavily on individual coping resources, because spatial and temporal distance hinders or even precludes the mobilization of social resources related to emotional, instrumental and informational social support. Copyright © 2010 John Wiley & Sons, Ltd.     

Decision-making in localized prostate cancer: lessons learned from an online support group

Study Type – Patient (preference/ecological)
Level of Evidence 2c What's known on the subject? and What does the study add? Social support plays a major role for decision‐making in localized prostate cancer and the importance of online resources has become increasingly recognized. However, so far most of the knowledge has been generated on formal and stylistic aspects. The study adds to understanding the content and the dynamics of peer‐to‐peer counselling in an online support group.

OBJECTIVE

? To investigate patient‐to‐patient communication with regard to decision‐making in localized prostate cancer; as most of it is done in private, online support groups are a unique means for this task.

PATIENTS AND METHODS

? Over a 32‐month period, we screened 501 threads in the largest German online support group for prostate cancer. ? Threads started by questioners newly diagnosed with localized prostate cancer and stating decision‐making as the key topic were included; in all, 82 (16.4%) threads met these criteria. ? Two independent investigators characterized every thread following a standardized protocol. ? Fisher’s exact test and Mann–Whitney U‐test were applied for group analyses. A complementary qualitative linguistic approach was chosen.

RESULTS

? Threads were most commonly started to ask for therapy recommendations (66%), information on the course of treatment (46%) and emotional support (46%). ? Answers consisted of treatment recommendations (40%), emotional support (37%) and personal experiences (28%). ? A second opinion on the biopsy cores (51%) and additional imaging (40%) were common suggestions. ? The rate of advice for radical prostatectomy (RP) vs radiotherapy was 67 vs 82%. Thus, surgery was less recommended in our sample (P= 0.01); 75% of the men with an initial therapeutic preference were finally confirmed herein. ? Linguistic analysis showed that posters frequently use a tentative language style and that common language is avoided.

CONCLUSIONS

? Patients readily receive information, advice and emotional support as part of an online support group. ? The scientific evaluation of an online support group is a complementary way of getting to know our patients’ needs and worries. ? Patient–physician contact can benefit from this knowledge.     

COPD患者对护理专业性社会支持的体验及期望的质性研究

目的了解COPD患者对护理人员提供社会支持的体验及期望,以指导护士为患者提供全面有效的支持。方法采取立意取样法选择16例COPD患者作为研究对象,采用半结构式访谈提纲进行深入访谈,按现象学研究的方法整理分析资料。结果患者感受到的护理人员支持有医疗技术支持、沟通信息支持和情感支持;同时患者期望获得更全面的沟通信息支持、更具针对性的情感支持,以及适时的评价支持。结论护理人员为COPD患者提供有效的专业性社会支持时,应关注患者的期望,提高支持的针对性和有效性。     

Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory

OBJECTIVE: To develop and test a measure for assessing peer support for men attending prostate cancer support groups, and to describe socio-demographic, medical and adjustment characteristics of Australian men who attend these support groups. PATIENTS AND METHODS: In all, 1224 men (51% response) from 44 prostate-cancer support groups across Australia were recruited by mail. Men completed self-report measures that included the Prostate Cancer Peer Support Inventory (PCSI), the UCLA Prostate Cancer Index bother scales, psychological distress, quality of life (QoL), bother from pain and tiredness, perception of the clinician's support for group participation. Group-level variables were also included in the analyses. RESULTS: Peer support was rated positively by most men; a high satisfaction with support groups was related to better QoL, lower pain, younger age, higher perceived clinician support for group participation, use of alternative therapies, lower education, and regular attendance; dissatisfaction with support groups was related to higher psychological distress, lower QoL, and lower perceived clinician support for group participation. Group variables did not predict positive or negative support. Overall QoL was similar to community norms and psychological distress was low, with only 8% of men reporting high distress. The most common physical symptom was sexual bother, with 74% of men reporting moderate or high bother. CONCLUSIONS: The PCSI was a useful measure of peer support. Perception of the benefits of peer support was related to individual but not group differences. The clinicians' attitudes to participation in support groups influenced the men's experience of these groups, and this finding has implications for developing support services for these men.     

新生儿重症监护室家庭参与式照护现况调查

目的 了解我国新生儿重症监护室（NICU）家庭参与式照护实践现况，为制订针对性管理方案提供参考。方法 自制NICU家庭参与式照护实践现况调查问卷，对44所三级甲等医院的NICU进行调查。结果 44所医院NICU均鼓励和同意父母参与患儿照护，但介入时机、参与程度不等；患儿父母参与的操作技能有尿布更换、皮肤护理、眼部护理等20项；25所医院NICU（56.8%）组建了多学科团队；家庭参与式照护五大支柱实践中，实施医护人员培训35所（79.5%）、提供资源与环境支持44所（100%）、开展父母教育与支持42所（95.5%）、同伴支持16所（36.4%）、充分沟通43所（97.7%）。结论 我国NICU家庭参与式照护实践处于初级阶段，存在患儿父母参与照护受限、支持系统不完善等问题，需针对现有不足提出解决方案，以促进和完善家庭参与式照护方案与实践。     

Relationships between social support and student burnout: A meta‐analytic approach

This study is a meta‐analysis of 19 relevant studies, with 95,434 participants, investigating the relationships between various types of social support and 3 dimensions of student burnout. The overall results indicate that social support is negatively correlated with student burnout. Specifically, school or teacher supports have the strongest negative relationship to student burnout. Social supports from parents and from peers also have a significant negative relationship with student burnout. Among the 3 dimensions of student burnout, inefficacy was more strongly related to social support than emotional exhaustion or cynicism. The results of a moderation analysis suggest that the type of schools (secondary school and postsecondary school) affected the relationships between the overall social support and student burnout. We discuss the implications to ameliorate student burnout.