综合医院开展个性化护理的做法和效果

目的 :开展个性化护理 ,深化整体护理内涵。方法 :确立个性化护理服务理念 ,制定护理质量标准和目标 ;护理信息化管理及流程改造 ;建立护理支持系统 ,整合资源。结果 :个性化护理体现了整体护理的内涵和发展延续 ,护理满意率保持在 97%的高水平 ;为病人提供了既科学又能满足病人个性需求的安全护理 ,提高了护理工作自身的价值 ;信息化管理和护理支持系统的建立 ,提高了护理技术质量。结论 :实践证明个性化护理是先进的服务理念 ,是促进整体护理深化的重要内涵 ,符合医疗市场经济发展需求。     

服务型领导管理特征与人性化护理管理

服务型领导管理以"服务第一"为理念,关注管理对象的需求,为满足最需优先考虑的需求提供护理服务;发挥个人潜能并促进个人成长,引导护士参与决策、创造群体合力.服务型领导管理对提高护士的工作满意度,落实以人为本的护理行为和规范,达到个人和机构目标具有重要意义.     

运用心理护理程序开展临床心理护理的现状

按心理护理程序实施步骤综述了临床开展心理护理的现状,提出应尽快拓宽临床护士心理学知识,提高心理护理技能水平,构建科学合理的临床心理护理模式。     

Nursing Care: A Concept Analysis

TOPIC. The term nursing care is widely used throughout nursing and allied health literature; however, the meaning of the term is not clear. PURPOSE. The purpose of this analysis is to explore the essence of the term nursing care and to develop an operational definition of the concept. SOURCES OF INFORMATION. Using the Walker and Avant (2005 ) method, dictionaries, thesauruses, and current nursing literature are studied for meanings, usages, and attributes. Model, borderline, and contrary cases are also presented. CONCLUSIONS. Intended as a preliminary exploration of nursing care, this work serves as the foundation for further study of the concept.     

Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery

Aim and objectives. The aim of this study was to investigate the effects of head and neck positions on the cerebral blood flow velocity by transcranial Doppler ultrasound in patients who underwent cranial surgery. Background. Inappropriate head elevation and body positioning in patients who undergo cranial surgery may affect cerebral blood flow and cerebral perfusion pressure. Designed. Experimental clinical study. Method. Our sample consisted of 38 patients who underwent cranial surgery between October 2009 and May 2010. The measurments of mean cerebral blood flow velocity were taken by the transcranial Doppler ultrasound through the temporal window. The mean cerebral blood flow velocity of the patients was measured in supine position with 0° and 30° head elevations, right and left lateral positions, right and left lateral positions with head flexion and extension. The measurements were taken before surgery and within 72 hours after surgery. Results. The mean cerebral blood flow velocity of the middle cerebral arteries was increased in head elevations from 0° to 30°, in right and lateral positions with 30° head elevations, but the velocity was decreased in head flexion and extension positions in preoperative and postoperative periods. Discussion. Head and body positioning, which is one of the nursing care activities, may affect intracranial pressure and cerebral perfusion pressure. Our results are similar with those of previous studies, which showed that head elevation did not affect the cerebral blood flow velocity. Relevance to clinical practice. By the results of this study, the head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow. Right and left lateral positioning is safe and recommended for these patients if there is no medical contraindication.     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

护理成本效益不合理阻碍护理事业的发展

目的 :阐明护理价值的增值和补偿对护理事业发展的作用 ,呼吁构建护理成本核算管理体系 ,对护理成本进行综合性研究 ,建立起适合我国国情的护理成本模式。方法 :从 1998年沿用至今的《深圳市医疗收费标准》2 0 0 0余项中提出护理收费项目共 5 4项、2 0 0 1年卫生部颁发的《全国医疗服务价格项目规范 (试行 )》数千项中提出护理收费共 5 8项进行对比 ,结合目前全国护理成本研究的现状进行分析。结果 :深圳市和全国医疗收费标准中的护理收费存在着明显的不合理 ,漏收费严重。护理工作几乎是一项未计酬的技术性服务 ,护理价值无法体现。结论 :护理收费不合理、价格背离价值 ,违背市场价值规律 ,严重阻碍了护理事业的发展 ,须引起权威人士的高度重视。     

Examination of Nursing Diagnoses for Adults Hospitalized with Acquired Immunodeficiency Syndrome, 1982–1990

The literature on nursing care of the hospitalized adult with acquired immunodeficiency syndrome (AIDS) from 1982 to the present was examined, and 16 formal care plans were extracted. The nursing care plans were examined for commonalities of identified nursing diagnoses, which were then tabulated according to frequency. Analysis of the types of problems addressed shows that five of the nine highest-frequency problems were physiologic (altered nutrition: less than body requirements , respiratory problems, impaired skin integrity, diarrhea, potential for infection). The other four problems were cognitive (altered thought processes) , safety (potential for injury) , social (social isolation) , and a combination of physiologic and cognitive (pain). Validation of nursing diagnoses is needed as a solid foundation for nursing intervention research in the care of patients with AIDS.     

Correspondence Between NANDA International Nursing Diagnoses and Outcomes as Proposed by the Nursing Outcomes Classification

The accurate identification of the nursing diagnoses and the corresponding measurement of their indicators will depend on the elements in the standardized language systems.

OBJECTIVE

To analyze the correspondence between elements of four NANDA‐I nursing diagnoses and outcomes suggested by the nursing outcomes classification (NOC) for the resolution of these diagnoses.

METHOD

A methodological study consisting of cross‐mapping was performed in the first stage between definitions, defining characteristics (DCs), and related factors (RFs) of impaired oral mucous membrane, impaired tissue integrity, spiritual distress, and delayed surgical recovery and outcome definitions and indicators to measure results of diagnoses resolution and an analysis of its relevance by experts in the second stage.

RESULTS

It found partial correspondence between outcome indicators, DCs, RFs, and definitions.

CONCLUSION

The data evidence the relevance of this review for a reliable application of these taxonomies and demonstrated partial correspondence between concepts analyzed. A identificação precisa dos diagnósticos de enfermagem e a medida correspondente dos seus indicadores dependerá dos elementos nos sistemas de linguagem padronizados.

OBJETIVO

Foi analisar a correspondência entre os elementos de quatro NANDA‐I diagnósticos de enfermagem e os resultados sugeridos pelo NOC para a resolução destes diagnósticos.

MÉTODO

um estudo metodológico que consiste em cross‐mapping foi realizado em uma primeira fase entre as definições, características definidoras e fatores relacionados de Mucosa oral prejudicada, Integridade tissular prejudicada, Sofrimento espiritual e Recuperação cirúrgica retardada e as definições dos resultados indicados para a resolução destes diagnósticos; na segunda fase, foi realizada uma análise desta concordância por especialistas.

RESULTADOS

correspondência parcial entre as definições dos diagnósticos e dos resultados, características definidoras e fatores relacionados.

CONCLUSÃO

Os resultados evidenciam a relevância dessa avaliação para uma aplicação confiável destas taxonomias e demonstrou a correspondência parcial entre os conceitos analisados.     

儿科专科护理质量管理实践及效果评价

目的：探索儿科专科护理质量管理改革对提升儿科专科护理质量及患儿满意度的作用。方法：通过实施专科护理岗位规范化培训、定期组织典型专科护理病例讲评比赛、推行专科护理小查房、设计并发放《护理指导手册》、常态化进行护理满意度调查等,改进儿科专科护理质量,并比较专科护理质量管理改革实施前后护理质量检查评分和患儿满意度。结果：儿科专科护理质量管理改革实施后病房管理、基础护理、护理文书、护理过程、急救药械、消毒隔离及患儿满意度评分均有提高,护理缺陷发生率下降,差异均有统计学意义。结论：实施专科护理质量管理改革,可以提升儿科护理质量及患儿满意度,降低护理缺陷发生率,改善医患关系,值得推广。     

428篇危重病护理论文分析

目的:分析近年我国危重病护理领域护理研究的现况,存在的问题。方法:手工查阅2000～2005年发表于国内4种护理核心期刊的428篇危重病护理论文,就论文研究内容、研究方法等进行分析。结果:目前国内危重病护理研究论文数量呈逐年增长趋势,以经验性论文为主,占60%;机械通气与气道管理为研究的热点问题;实验性研究论文增长较快;需要在科学性和有效性方面进一步提高。结论:危重病护理研究水平有待进一步提高,应发挥学科优势,促进危重病护理研究的发展。     

Examination of Nursing Diagnoses for Adults Hospitalized with Acquired Immunodeficiency Syndrome, 1982–1990

The literature on nursing care of the hospitalized adult with acquired immunodeficiency syndrome (AIDS) from 1982 to the present was examined, and 16 formal care plans were extracted. The nursing care plans were examined for commonalities of identified nursing diagnoses, which were then tabulated according to frequency. Analysis of the types of problems addressed shows that five of the nine highest-frequency problems were physiologic (altered nutrition: less than body requirements, respiratory problems, impaired skin integrity, diarrhea, potential for infection). The other four problems were cognitive (altered thought processes), safety (potential for injury), social (social isolation), and a combination of physiologic and cognitive (pain). Validation of nursing diagnoses is needed as a solid foundation for nursing intervention research in the care of patients with AIDS.     

Coming and staying: a qualitative exploration of Registered Nurses' experiences working in nursing homes

Aim. This paper reports on a qualitative study that explored the reasons why Registered Nurses (RNs) chose to work in nursing homes in Southern Ontario, Canada and what factors attracted them to remain.
Background.  There is a paucity of information about factors associated with the recruitment and retention of RNs within long-term care (LTC) in Canada. As the population of older people is growing in Canada and elsewhere, it is essential that we better understand what attracts RNs to work and remain in this setting.
Design and method. A case study approach was used in this study of nine RNs working in three nursing homes. Data were collected through in-depth interviews.
Findings. Six sub-themes were identified: 'Job of Choice', 'Job of Convenience', 'Caring for the Residents', 'A Supportive Environment', 'Heavy Workload' and 'Supervisory Role of the RN'.
Conclusion. Nurses chose to work in the nursing home because it was a 'Job of Convenience'. However, characteristics of the organizational environment played a major role in their remaining. Also, the caring relationship with residents played a role in the nurses remaining in this setting.
Relevance to clinical practice. Strategies are provided that nurse managers may consider when planning recruitment and retention activities for LTC settings.