疗养护理病历存在的缺陷分析及防预对策

目的调查疗养护理病历存在的缺陷,探求提高护理疗案质量的改进措施。方法对2002年10月至2004年10月的护理病历检查结果进行归纳分析。结果医嘱记录单存在的质量缺陷146次,一般护理记录单存在的质量缺陷142次,体温单存在的质量缺陷68次。结论注重护士的在职培训、实施有效的监督管理是护理疗案质量的保障。     

Ultrasonography evaluation during the weaning process: the heart,the diaphragm,the pleura and the lung

Purpose

On a regular basis, the intensivist encounters the patient who is difficult to wean from mechanical ventilatory support. The causes for failure to wean from mechanical ventilatory support are often multifactorial and involve a complex interplay between cardiac and pulmonary dysfunction. A potential application of point of care ultrasonography relates to its utility in the process of weaning the patient from mechanical ventilatory support.

Methods

This article reviews some applications of ultrasonography that may be relevant to the process of weaning from mechanical ventilatory support.

Results

The authors have divided these applications of ultrasonography into four separate categories: the assessment of cardiac, diaphragmatic, and lung function; and the identification of pleural effusion; which can all be evaluated with ultrasonography during a dynamic process in which the intensivist is uniquely positioned to use ultrasonography at the point of care.

Conclusions

Ultrasonography may have useful application during the weaning process from mechanical ventilatory support.

     

临床护士心理压力源与工作满意度调查分析

目的了解临床护士面临的主要心理压力源,为护理管理者有效地帮助护士减轻和消除心理压力提供依据。方法采用自评式问卷调查的方法 ,对内江市2所三级乙等医院287名从事临床护理工作的护士进行问卷调查。结果临床护士的心理压力源依次来源于工作强度、职业需求、工作环境、人际关系、家庭经济收入等方面。其中来源于工作强度、人际关系及家庭方面的压力源,不同年龄组护理人员在其压力程度上差异有统计学意义(P0.05)。结论从事临床护理工作的护士存在着多种心理压力源,这些压力源是导致护士工作不满意的主要原因,也是护理的安全隐患之一,护理管理者应予以足够的重视,并定期针对不同的人群进行心理健康知识培训,建立有效的支持系统,及时帮助他们调整心理状态,减轻和消除压力,从而提高护士对本职工作的满意度和患者对护理服务的满意度。     

应用临床路径对抑郁症患者实施健康教育的实践与体会

目的:探讨抑郁症患者最有效的健康教育方法,提高患者依从性和患者满意度,增强患者治愈的信心,和谐医患关系。方法:选择60例抑郁症患者,随机分为观察组(30例)和对照组(30例),对照组实施常规健康教育,观察组应用临床路径实施健康教育,出院前进行患者依从性比较及满意度调查。结果:观察组患者依从性、满意度明显高于对照组,差异有显著性差异(P<0·01)。结论:应用临床路径对抑郁症患者实施健康教育可提高患者依从性和满意度,探讨有效的健康教育方式对和谐医患关系、提高患者治愈率具有积极意义。     

提高供应室工作质量预防疗养院感染

消毒供应室负责全院的医疗器械、敷料的消毒灭菌工作。其工作质量的好坏直接影响着疗养院医疗护理质量 ,也与疗养院感染的发生有着密切关系。因此 ,提高消毒供应室工作质量是预防疗养院感染的重要一环。1　加强培训、提高对疗养院感染的管理意识针对供应室护理人员对感染管理重要性认识不足 ,缺乏系统的消毒灭菌知识这一薄弱环节 ,组织护理人员认真学习《消毒技术规范》,提高感染管理意识和增强消毒灭菌新知识。提高护士的知识水平 ,变被动执行标准为主动完成 ,同时完善硬件设施 ,使护理工作在预防疗养院感染基础上走向规范化、科学化。2　…     

超声心动图评价吲达帕胺对急性心肌梗塞左室功能的影响

目的 观察急性心肌梗塞患者应用吲达帕胺对左室收缩及舒张功能的影响,及其在预防左室重构中的作用。方法 急性心肌梗塞患者６６例,随机分为吲达帕胺治疗组（３１例）和对照组（３５例）。用脉冲多普勒超声心动图测定等容舒张时间（ＩＶＲＴ）、二尖瓣口血流频谱、肺静脉血流频谱和左室射血分数。结果 吲达帕胺治疗组的ＩＶＲＴ、ＥＤＴ和ＡＲ波时间明显缩短,Ｅ／Ａ比值、Ｓ／Ｄ比值和ＥＦ明显升高,ＡＲ波幅明显降低（Ｐ〈０．     

Bridging the distance between the objectivism of research and the subjectivity of the researcher

A phenomenological study of researchers' experience of their work is presented. The disparity between researchers' subjective experience and the inherent objectivism of science and research is discussed. Bridging the distance between the immediate experience of research and the positivistic/objectivistic nature of research is proposed as a way to keep the research community cognizant of values and beliefs that may get pushed aside in the clamor for factual information and material gain. A synthesis of intentionality is discussed as a method for disclosing a researcher's constitutive part in phenomenological research. Expanding the traditional format for research reports to include a brief biographical account of the inception of the research is proposed and an example included.     

探讨机械通气患者吸痰的最佳时机

目的：探讨机械通气患者最佳吸痰时机，确保机械通气效果。方法：采用随机观察法将吸痰240例次随机分为4种时机（Ⅰ：肺部听疹痰鸣音时；Ⅱ：呼吸机压力报警时；Ⅲ：患者咳嗽时；Ⅳ：主观方面）。结果：不同时机吸痰，机械通气效果不同。结论：肺部听诊痰鸣音时和呼吸机压力报警时作为最佳吸痰时机，效果最好。     

聘用制护士自尊水平、社会支持与焦虑状况相关性研究

目的 了解聘用制护士自尊水平、社会支持与焦虑状况的特点及其相关性,为促进聘用制护士身心健康提供依据.方法 采用自尊、社会支持和焦虑量表对上海某综合性二级甲等医院聘用制护士135名进行调查,并与124名正式护士进行比较.结果 聘用制护士的自尊水平及社会支持中社会支持总分、主观支持、客观支持得分均低于正式护士;聘用制护士焦虑的检出率为40%,高于正式护士;聘用制护士的自尊水平与社会支持总分、客观支持呈正相关,自尊水平与焦虑状况呈负相关,焦虑与社会支持总分、客观支持、主观支持及支持利用度呈负相关.结论 社会支持是维护身心健康的重要因素,良好的社会支持可以提高聘用制护士的自尊水平,减少焦虑状况出现.     

Exposing the body--baring the soul

It is often considered important that clothing should not be visible in a good medical photograph. Medical illustrators offer the clinical professionalism to allow most of their patients to feel comfortable being photographed. For some patients, however, consenting to medical photography involves more than a temporary embarrassment. This paper seeks to explore some of the religious and cultural beliefs that the medical photographer may be asking the patient to compromise in the studio.