纤维支气管镜介入联合雾化吸入治疗支气管内膜结核的疗效观察

目的:观察纤维支气管镜(纤支镜)介入联合药物雾化吸入治疗支气管内膜结核(EBTB)的疗效。方法:对35例确诊EBTB病人在全身抗痨基础上行纤支镜介入局部注药和药物雾化吸入治疗,疗程2个月,与同期11例确诊EBTB(对照组)仅行常规全身抗痨病人比较。结果:临床症状缓解时间观察组为13.5d,对照组为23.3d,两组比较差异有显著性(P<0.05)。观察组纤支镜下症状明显改善。结论:纤支镜介入联合药物雾化吸入能较好治疗支气管内膜结核。     

经气管导管旁路行纤支镜肺泡灌洗术及吸痰36例观察与护理

目的:探讨经气管导管旁路行纤支镜肺泡灌洗术(BAL)和吸痰在机械通气危重患者中的临床疗效及护理体会。方法:将72例机械通气下行纤支镜BAL和吸痰患者随机分为观察组和对照组各36例,分别经导管外(旁路)和导管内插入纤支镜进行BAL和吸痰,并对其实施有效的护理;观察比较两组患者纤支镜治疗前、术中5 min、20 min、术毕和术后1 h生命体征和血气分析等指标。结果:观察组术中心率(HR)、血氧饱和度(Sa O2)、吸入氧浓度(Fi O2)、气道峰压(PIP)等指标明显优于对照组(P0.05),不良反应发生率低于对照组(P0.05)。结论:从气管导管旁路行纤支镜吸痰和BAL,过程更加平稳,刺激性小、安全、有效,纤支镜治疗过程的顺利完成及疗效与正确实施护理措施有密切的关系。     

目标性镇静护理联合治疗性沟通法在纤支镜肺泡灌洗术中的应用效果评估

目的探讨目标性镇静护理联合治疗性沟通法在纤支镜肺泡灌洗术中的应用价值。方法选取2019年3月～2020年6月我院接受纤支镜肺泡灌洗术治疗的患者135例,根据手术干预方法不同将其分为对照组65例和观察组70例。对照组采用常规干预方法,观察组采用目标性镇静护理联合治疗性沟通法干预。术前术后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者负面情绪并进行比较,记录两组治疗依从性良好率和并发症发生率。结果术前两组SAS和SDS评分比较差异无统计学意义(P0.05),术后观察组SAS和SDS评分均低于对照组,差异均有统计学意义(P0.05)。观察组治疗依从性良好率高于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论目标性镇静护理联合治疗性沟通法能够改善接受纤支镜肺泡灌洗术治疗的患者负面情绪,提高治疗依从性,减少并发症发生率。     

SBAR沟通模式在激光美容治疗护患沟通中的应用

[目的]探讨SBAR沟通模式在激光美容治疗护患沟通中的应用效果。[方法]选取2017年6月—12月在我院行激光美容治疗的病人126例为研究对象,随机分为两组。对照组采用常规沟通方式与病人沟通;干预组采用SBAR沟通模式,按照S(现状)、B(背景)、A(评估)、R(建议)流程与病人沟通。比较两组病人在治疗开始前及治疗结束后焦虑自评量表得分及离院前对护患沟通方式的满意度评价。[结果]治疗后干预组病人焦虑评分(53.78分±8.24分)明显低于对照组(60.60分±8.89分),两组比较差异有统计学意义(P0.05);干预组病人对护患沟通满意度高于对照组(P0.05)。[结论]SBAR模式应用于激光美容治疗病人的护患沟通中,可以改善病人的焦虑情绪,提高病人对护患沟通的满意度。     

护患沟通技巧在帕金森病病人脑深部电刺激术治疗中的应用及效果观察

[目的]探讨护患沟通技巧在帕金森病病人脑深部电刺激术治疗中的应用效果。[方法]选择60例采用脑深部电刺激术治疗的帕金森病病人为研究对象,随机分为观察组和对照组各30例。对照组采用常规手术全期护理,观察组在常规护理的基础上将护患沟通技巧应用于手术全期。对两组病人血压、心率、焦虑评分、抑郁评分和护理满意度进行比较。[结果]将护患沟通技巧应用于观察组手术全期护理,与对照组病人相比,观察组病人在局部麻醉手术期的血压、心率显著降低(P0.01),第5天回访焦虑、抑郁评分显著降低(P0.05);在手术室环境、解决问题能力、护理服务态度、护理技术等护理满意度显著提高(P0.01)。[结论]将护患沟通技巧应用于帕金森病病人脑深部电刺激术全期护理中,可以明显缓解病人的紧张、焦虑、抑郁负性情绪,提高了护理质量及病人对护理工作的满意度。     

自制护患沟通卡在ICU建立人工气道患者中的运用

目的通过护患沟通卡缓解建立人工气道的患者因语言交流受限导致的沟通障碍。方法选择两组即对照组和观察组各30例,对照组采用语言交流,自编手语、提供写字板等形式与其进行沟通,观察组采用护患沟通卡进行沟通。比较两组对沟通方式的满意度。结果观察组满意情况好于对照组,两组差异有统计学意义(P0.05)。结论自制护患沟通卡的临床使用,为建立人工气道的患者提供了人性化的服务,增进了护患关系,进一步减轻了护士工作负担,提高了整体护理质量。     

“三明治”教学模式在《内科护理学》临床见习中的应用研究

目的观察应用"三明治"教学模式在《内科护理学》临床见习中对护生批判性思维能力、护患沟通能力的影响及教学的效果。方法选取某大学2014级护理本科生为研究对象,采用便利抽样法,1班(33人)为对照组,2班(35人)为观察组。对照组采用传统临床见习教学方法,观察组在临床见习中应用"三明治"教学模式。见习结束时采用批判性思维能力测量表、护患沟通能力量表、教学效果评价表对两组护生进行测评。结果观察组护生的批判性思维能力总分及寻找真相、开放思想、分析能力、系统化能力、批判思维的自信心、求知欲6个维度得分高于对照组,观察组护生的护患沟通能力总分及基本语言沟通能力、基本非语言沟通能力、协调沟通网络能力3个维度得分高于对照组,观察组护生的课堂教学、学习促进、能力提高得分高于对照组,比较差异均有统计学意义(P0.05)。结论 "三明治"教学模式能提高护生批判性思维能力和临床沟通能力,有助于提升《内科护理学》临床见习教学效果。     

床头提示板在护患沟通中的应用效果观察

[目的]探讨床头提示板在护患沟通中的作用。[方法]选择住院病人809例,随机分为对照组392例和观察组417例,对照组采用口头语言告知注意事项,观察组采用口头语言加床头提示板告知。比较两组病人经护患沟通后检查或手术延期、后续医护矛盾例数、病人满意度差异。[结果]观察组发生检查或手术延期、后续导致医护矛盾例数两项指标均低于对照组,差异具有统计学意义(P<0.05)。[结论]提示板利用书面文字进行护患沟通,较口头语言更为可靠,能够提高病人遵医行为依从性,避免因沟通不足延误检查或手术,提高医疗护理质量及工作效率。     

纤维支气管镜诊疗术42例围术期护理

目的:探讨气管插管及气管切开患者行纤维支气管镜(纤支镜)诊疗术围术期护理方法.方法:回顾性分析42例气管插管及气管切开行纤支镜诊疗术患者的临床护理资料.结果:本组1例术中出现心律失常中断操作,给予退镜和对症处理后好转,其余均操作顺利,术后无并发症发生.结论:良好的围术期护理是提高治疗效果,降低纤支镜并发症的必要措施.     

CICARE沟通模式在口腔颌面外科护患沟通中的应用

[目的]探讨CICARE沟通模式在口腔颌面外科护患沟通中的应用效果。[方法]选取口腔颌面外科门诊就诊的病人200例,随机分为对照组和观察组,每组100例。对照组实施传统口腔四手操作技术,观察组在传统口腔四手操作技术基础上建立起CICARE沟通模式,通过培训全科护士后将沟通模式应用于临床护患沟通,比较两组病人的满意度。[结果]观察组病人拔牙前配合、术前护理、术中护理、术后护理、术后宣教、就医流程、护理质量、沟通能力方面满意度高于对照组(P0.05),护患沟通效果良好。[结论]CICARE沟通模式的使用能提升口腔颌面外科门诊护士的沟通能力和病人满意度,对优化护患关系起到重要作用。     

血清MMPs水平在腹腔镜大肠癌根治中表达的临床意义

目的通过对围手术期腹腔镜手术与常规手术时检测患者血清中基质金属蛋白酶(MMP-9)在大肠癌患者血清中水平表达的比较,探讨CO2气腹环境下是否会增加肿瘤根治的风险性。方法64例大肠癌患者随分为开腹组(32例),腹腔镜组(32例)及32例结肠息肉患者(对照组),于手术前后选择不同时段应用ELISA法检测血清中MMP-9的改变。结果大肠癌患者血清中MMP-9的水平显著高于对照组(P<0.01),腹腔镜组也明显高于开腹组(P<0.05)。结论LC手术中CO2气腹环境下尽管不会增加肿瘤根治的风险性,但是其疗效的确定还有赖于更多的研究和长期随访。     

Health visiting an elderly couple.

Health visitors play an important role in their involvement with the elderly population. As Parkinson's disease becomes increasingly prevalent among elderly people, a multidisciplinary approach to treatment and care is essential in the holistic assessment and management of the condition. The importance of the carer in the life of the elderly person with Parkinson's disease cannot be overemphasized. Effective two-way communication and involvement of both the sufferer and main carer in decisions about treatment and care are essential. Effective communication between all members of the primary healthcare team is necessary for continuity of care and support. The use of the Neuman System Model in this case demonstrates the way in which tools of assessment can influence our perception of the client, the type of information obtained and the care and support clients receive.     

循证护理在预防妇科腹腔镜术后并发症中的应用研究

目的:将循证护理的方法应用于妇科腹腔镜术后患者的护理中,总结出有效的护理预防措施.方法:将妇科腹腔镜手术后患者306例分为对照组和观察组.对照组150例,给予常规护理;观察组156例,采用循证护理方案,提出护理问题,针对问题查阅相关资料和文献,找出解决问题的理论依据,并进行分析、归纳,结合临床实践,制订出相应的护理方案并实施.结果:观察组术后恶心呕吐、腹胀、尿潴留、血压下降等并发症的发生率明显低于对照组(P<0.01,P<0.05).结论:循证护理在妇科腹腔镜手术后应用,能使患者获得最佳的治疗和护理效果,减少并发症的发生,提高了术后患者的生活质量,同时也提高了护理质量.     

同理心在冠心病重症监护室患者家属沟通中的应用

目的总结同理心在冠心病重症监护室（CCU）患者家属沟通中的应用及效果。方法选择2010年4月-5月入住CCU的患者100例,按入院先后顺序前50例设定为对照组,后50例设定为观察组;对照组采用传统常规方法与患者家属进行沟通,观察组应用同理心理念与患者家属沟通。观察两组患者家属在非探视时间到访次数、纠纷次数和CCU护理工作满意度情况。结果观察组患者家属较对照组在非探视时间到访次数、纠纷发生次数少,而满意度较对照组高,两组比较差异有统计学意义（P〈0.05）。结论应用同理心与CCU患者家属进行沟通,可增加医患间的理解和信任,减少非探视时间内家属到访次数,有利于维护医院正常的工作秩序,同时减少纠纷的发生,提高了护理服务满意度。     

术前疼痛教育对腹部手术病人疼痛控制满意度调查与分析

目的:通过对腹部手术病人进行疼痛教育,提高病人对术后疼痛及疼痛控制的认知度,改善术后镇痛质量,提高病人的舒适度及满意度,为探索提高病人术后生活质量的宣教方案提供科学依据。方法:采用问卷方式对我院普外科、妇科择期手术病人120例进行调查,将其随机分为实验组和对照组,各60例。实验组术前给予疼痛相关知识教育,术后疼痛控制及疼痛镇痛药物相关知识教育;对照组采取常规术前教育。评估并比较两组病人对术后疼痛控制满意度的变化。结果:两组病人对疼痛的期望基本一样,分别为(85.0%,83.3%),希望手术后是轻度疼痛;在目前疼痛控制方面,实验组无痛及轻度疼痛的比例占75.0%,对照组占51.6%,实验组的疼痛控制较对照组好,疼痛程度较对照组低;实验组对疼痛教育的满意度为100%,对照组满意度为66.7%,实验组的满意度明显高于对照组(均P0.01)。结论:对病人进行术前疼痛教育可提高其术后疼痛控制的满意度及对手术室护理服务的满意度。     

E XPERIENCE AND M ENTORING R EQUIREMENTS FOR C OMPETENCE IN N EW /I NEXPERIENCED P ARAMEDICS

A paramedic may be unprepared to practice alone or with an inexperienced partner immediately following completion of training. Emergency medical services systems have not generally set standards to ensure that a newly-licensed paramedic is competent to practice alone. Many other trades and professions, including health care providers, require many hours of mentoring or apprenticeship prior to working in an unsupervised environment. This paper summarizes mentoring requirements for other clinical professions and reviews studies from the out-of-hospital and hospital literature that demonstrate a positive correlation between experience and outcome and/or competence. The author recommends specific benchmarking and supervision by a training officer or an experienced paramedic to ensure competence in new and inexperienced paramedics.     

Are paramedic students ready to be professional? An international comparison study

IntroductionThe last decade has seen rapid advancement in Australasian paramedic education, clinical practice, and research. Coupled with the movements towards national registration in Australia and New Zealand, these advancements contribute to the paramedic discipline gaining recognition as a health profession.AimThe aim of this paper was to explore paramedic students' views on paramedic professionalism in Australia and New Zealand.MethodsUsing a convenience sample of paramedic students from Whitireia New Zealand, Charles Sturt University and Monash University, attitudes towards paramedic professionalism were measured using the Professionalism at Work Questionnaire. The 77 item questionnaire uses a combination of binary and unipolar Likert scales (1 = Strongly disagree/5 = Strongly agree; Never = 1/Always = 5).ResultsThere were 479 students who participated in the study from Charles Sturt University n = 272 (56.8%), Monash University n = 145 (30.3%) and Whitireia New Zealand n = 62 (12.9%). A number of items produced statistically significant differences P < 0.05 between universities, year levels and course type. These included: ‘Allow my liking or dislike for patients to affect the way I approach them’ and ‘Discuss a bad job with family or friends outside work as a way of coping’.ConclusionsThese results suggest that paramedic students are strong advocates of paramedic professionalism and support the need for regulation. Data also suggest that the next generation of paramedics can be the agents of change for the paramedic discipline as it attempts to achieve full professional status.     

A cross-institutional analysis of Australian undergraduate paramedic students’ attitudes towards interprofessional collaboration

Interprofessional collaboration (IPC) continues to gain much momentum with recognition and evidence that improved communication and collaboration between healthcare workers leads to better delivery and access to care. The objective of this study was to examine the self-reported IPC among Australian paramedic undergraduate students over two years. A two-year cross-sectional study involving undergraduate paramedic students from multiple Australian Universities was undertaken. Students’ IPC levels were measured using the Interdisciplinary Education Perception Scale (IEPS). Responses were collected from 1,264 students during the 2011 and 2012 academic years. During the study females tended to outnumber males enrolled in paramedic studies across all universities, which was consistent across 2011 and 2012 (overall, n = 748 or 59.2% and n = 516 or 40.8% for females and males, respectively). Factor results revealed mean = 23.63 (Competence/Autonomy), mean = 9.65 (Perceived need for Cooperation), and mean = 23.78 (Perception of Actual Cooperation). There were no differences in self-reported perceptions between students assessed in 2011 and 2012 for any of the three factors. The current study provides the first multi-institutional normative data for paramedic students for the IEPS within Australia. Initial findings tend to suggest that paramedic undergraduates are positive about the concept of IPC and their ability to work as part of a collaborative healthcare team.     

子宫全切术患者实施健康教育及康复训练的效果观察

目的：探讨健康教育及康复训练对子宫全切术患者的愈后效果的影响。方法：将41例子宫全切手术患者分常规组20例和观察组21例。常规组按妇产科护理常规进行术前术后常规护理及相关注意事项的讲解;观察组对患者进行术前术后常规护理同时实施健康教育及康复训练。结果：常规组患者自我认知能力稍差,有缺失感,住院时间稍长;观察组患者术后乐观,配合术后康复训练较为积极,住院时间稍短。结论：认为做好子宫全切术后患者的健康教育并进行及时的康复训练,对其术后康复并提高生活质量起着至关重要的作用。     

Prehospital Transcutaneous Cardiac Pacing for Symptomatic Bradycardia

We studied patients with symptomatic bradycardia to determine the importance of presenting hemodynamic status and prehospital transcutaneous cardiac pacing (TCP) upon patient survival. Of 51 patients with witnessed cardiovascular decompensation and initial bradycardia, 27 (53%) received TCP. There were no significant differences between the paced patients and those without TCP for mean times from collapse until cardiopulmonary resuscitation, paramedic arrival and a paceable rhythm, or from paramedic arrival until a paceable rhythm. Overall, emergency department arrival with a palpable pulse (26% in paced vs 13% in nonpaced group; P = 0.20) and survival to hospital discharge (15% in paced vs 0% nonpaced group; P = 0.07) tended to be better for the paced group. No patient without a palpable pulse on paramedic arrival survived to leave the hospital. Of patients with a palpable pulse upon paramedic arrival, survival to hospital discharge was greater for the paced group (80% in paced vs 0% in nonpaced group; P = 0.024). TCP appears to be most beneficial in those patients with bradycardia who have a palpable pulse when first seen.