湖南省创建无烟医疗卫生机构试点效果评价

[目的]评价湖南省创建无烟医疗卫生机构试点工作效果,为推广创建工作提供依据.[方法]依据卫生部制定的<监测工作方案>和<干预工作方案>开展干预和监测评估.从政策制定、场所干预、人群干预、社会动员四个方面开展干预活动.干预前后分别就试点机构无烟环境、机构内人员控烟相关知识、态度及戒烟服务、就诊者认同情况等进行基线调查和效...     

三级医院肿瘤科护士控烟知识态度行为的调查分析

目的 了解肿瘤科护士的控烟知识、态度和行为现状,为制订护士控烟培训课程提供依据.方法 采取便利抽样的方法选取10个省(直辖市)的10所三级甲等医院,抽取肿瘤科护士共206名,进行不记名问卷调查.结果 研究对象控烟知识得分为5～14(10.58±1.76)分;控烟态度得分为4～10(8.81±1.28)分;控烟行为得分为...     

我国各省心血管疾病相关健康资源分布评价

目的评价当前我国各省与人群心血管疾病密切相关的健康资源的分布现状。方法资料与数据来源于中国心血管健康指数（CHI）（2017）研究结果。 选取CHI（2017） 公共卫生政策与服务能力维度的相关指标进行测算和分析全国31个省（自治区、直辖市，不含港澳台地区）的具体情况，并对全国不同地区和分省的公共卫生政策与服务能力CHI得分进行排名比较。 CHI （2017）公共卫生政策与服务能力维度和各指标满分为100分，分数越高说明公共卫生政策与服务能力越好。结果2017年我国心血管病防控领域卫生政策与服务能力的得分平均分为50.96分。 南方地区公共卫生政策与服务能力得分（53.09分）高于北方地区（48.10分）；东部地区得分（60.52分）高于中部地区（41.51分）和西部地区（45.75分）。 上海得分最高（79.54分），其次是北京（77.09分）、江苏（75.62分）、浙江（68.93分）和天津（65.63分）。 黑龙江、山西、贵州、西藏自治区、内蒙古自治区得分较低。 2015年我国心血管疾病费用政府投入占比为29.96%，我国居民健康素养水平为10.25%，配有疾控人员1.39名/万人、全科医生1.37名/万人。 北京、天津、山东、上海和河北降压、降脂、降糖三类药物的每100万人口的消费量较高。 心血管病8类基本药物在基层医疗卫生机构的平均配备率全国平均水平为61.50%。 平均配备率最高为上海（96.95%），其次是北京（89.32%）、江苏（88.53%）、山东（84.20%）和浙江（80.32%）。结论我国区域间心血管防治健康资源分布不均，表现为东部地区优于中部和西部地区、南方优于北方的特点，体现出东部沿海地区公共卫生政策和卫生服务资源优于其他地区的特点。 基本药物在基层医疗机构的配备率和人均全科医生数量与降低心血管疾病负担相关。     

社区儿童家庭医护人员控烟相关知识及态度的质性研究

目的探索社区儿童家庭医护人员对控烟知识、政策的了解及其控烟态度。方法采用质性研究中的现象学研究法,对7位家中有14岁以下儿童的社区医护人员进行个人深度访谈,并运用内容分析法分析访谈资料。结果社区医护人员的控烟知识及态度可归纳为3个主题:具备一定知识和态度,但缺乏拒绝二手烟的行为;关注并支持无烟政策;无烟家庭的策略有利于控烟,但推广有一定的难度。结论社区儿童家族医护人员具备一定的控烟知识及态度,但却缺乏相应的行动力;无烟家庭可以作为一项社区控烟策略进行推广。     

门诊病人对医院控烟认知现状调查

目前,我国吸烟人数超过3亿人,居世界各国之首,遭受被动吸烟危害的人数超过5.4亿,其中15岁以下1.8亿人,每年约有100万人死于吸烟导致的疾病。2010年10月我院被定为首家市级无烟医院,医院积极制定、实施控烟方案,开展多种形式的控烟健康教育活动,编印和发放控烟宣传资料,开辟创建无烟医疗卫生单位活动宣传专栏,举办控烟知识讲座。为了     

南通市养老机构护理员工作满意度及离职意愿相关性分析

[目的]调查南通市养老机构护理员工作满意度、离职意愿现状,分析其相关性。[方法]2016年5月采用便利整群抽样方法,对南通市8家养老机构的199名护理员进行一般资料、工作满意度及离职意愿调查及相关性分析。[结果]27.64%护理员对工作收入满意,77.89%护理员对工作环境满意,78.39%护理员对人际关系满意,43.22%护理员对工作时间满意,57.29%护理员对工作培训满意;离职意愿较高及很高者占38.69%;离职意愿总分为2.00分(1.33,2.50),辞去目前工作的可能性得分为2.00分(2.00,5.00),寻找其他工作的动机得分为2.00分(2.00,4.00),获得外部工作的可能性得分为6.00分(4.00,6.00);工作收入、工作环境、人际关系、工作时间、工作培训5个方面的满意度均与离职意愿呈负相关(P0.01)。[结论]针对南通市养老机构护理员离职意愿的相关因素,可以通过改善环境、完善制度、增加岗位含金量和吸引力、强化舆论引导、吸引新生代员工入职、发挥低龄老人优势、重视培训等举措,降低其离职意愿,使南通市养老机构护理员队伍的持续性稳定发展得到保障。     

全国24个省市住院病人对护理工作满意度的调查分析

目的 调查全国24个省、直辖市的三级甲等医院住院病人对护理工作的评价,并为护理质量改进提供依据.方法 采用便利抽样的方法选取了全国24个省和直辖市的71家三级甲等医院,每家医院各抽取住院病人60名.采用根据我国台湾大学医院病人对护理服务满意度调查表修订的问卷进行调查.结果 71家医院平均满意率为93.69%,各维度平均得分最高的维度是护理人员的态度和责任心,得分最低的是基础护理维度.结论 住院病人对护理服务总体及各维度的评价较高.护理人员应提高基础护理质量,满足病人的基本生理需求,同时加强健康教育和沟通交流,满足其对知识的需求;护理管理者应将满意度测评结果充分利用于护理质量改进过程.     

无烟医院医生控烟知信行调查分析及对策

目的了解医生吸烟情况,控烟知识、态度及行为,为创建无烟医院提供科学依据。方法采用医务人员控烟知识、态度、行为调查表。抽取399名医生进行吸烟状况,控烟知识、态度及行为调查。结果本组调查的医生中,吸烟者58名,均是男性,吸烟率为14．5％。对被动吸烟、吸烟成瘾的危害及吸烟与肺部疾病、冠心病的关系掌握较好,同意医院内所有室内禁烟的医生占93．23％,59．15％医生在诊疗活动中建议患者戒烟,70．18％的医生听说过戒烟药物,1．07％听说过戒烟药物的医生使用过戒烟药物。结论医生吸烟状况较严重,吸烟者对烟草及吸烟危害认识相对不足,但对院内禁烟的支持率高,根据实际情况,加大禁烟管理力度,普及烟草及吸烟危害知识,进行控烟干预及培训,诊疗活动中吸烟者应加强其自律教育及相关惩戒措施,设立戒烟门诊,必要时使用戒烟药物,全面改善医生对禁烟的态度及行为,创建无烟医院。     

老年医疗护理机构护士老化知识掌握现状及影响因素分析

目的调查上海市老年医疗护理机构护士老化知识掌握现状及其影响因素,为针对性地开展培训提供依据。方法采用一般资料问卷和老化知识量表对46所老年医疗护理机构的510名护士进行调查。结果上海市老年医疗护理机构护士老化知识平均得分为(11.44±3.05)分,工作年限、是否与老年人经常往来是影响老化知识得分的主要因素。结论上海市老年医疗护理机构护士老化知识水平偏低,亟需采取针对性的措施,加大老年护理人才的培养力度,提高老年护理整体水平。     

珍惜工作教育对护士离职意愿的影响研究

目的 了解珍惜工作教育对护士离职意愿的影响.方法 对140名护理人员进行珍惜工作教育,并在教育前后采用离职意愿量表(ITL)进行效果评定.结果 接受珍惜工作教育前,调查对象离职意愿平均得分为(3.12±1.18)分.其中,40%以上的护理人员有较强烈的离职意愿.接受珍惜工作教育后,护士离职意愿平均得分较教育前显著降低.结论 对护士提供珍惜工作教育,可以降低其离职意愿.     

北京市疾病预防控制中心系统控烟现状调查

目的　了解北京市疾病预防控制中心（CDC）系统工作人员控烟能力及控烟环境现状,为CDC系统开展控烟工作提供参考依据。 方法　采用普查的方法,对北京CDC系统所有在职工作人员进行问卷调查,同时,对每个 CDC室内外环境的吸烟情况进行3 d现场观察,以了解控烟规定的执行情况。结果　北京市CDC系统工作人员的吸烟率为21.6%,其中男性45.2%,高于女性5.2%;无论男性还是女性,吸烟率均随年龄的增加而增加;被动吸烟率为49.0%;烟草危害健康核心知识的知晓率普遍较高,为77.1%～98.9%;非吸烟者和吸烟者支持中心全面禁烟的比例差别较大,分别为87.6%和51.2%;北京市12个CDC有全面禁止吸烟的规定,6个CDC有部分场所禁止吸烟的规定,另有2个CDC对吸烟行为没有任何限制;CDC内吸烟现象比较普遍,其中62.5%的吸烟者在非吸烟区吸烟,且在非吸烟区吸烟遇到劝阻的比例只有30%。结论　北京市CDC系统的控烟工作有一定的基础,但仍需在吸烟者教育和政策制定及有效执行方面做大量工作。     

Application of Statistical Process Control to Physician‐specific Emergency Department Patient Satisfaction Scores: A Novel Use of the Funnel Plot

Objectives: Emergency department (ED) patient satisfaction remains a high priority for many hospitals. Patient surveys are a common tool for measuring patient satisfaction, and process improvement efforts are aimed at improving patient satisfaction scores. In some institutions, patient satisfaction scores can be calculated for each emergency physician (EP). ED leaders are faced with the task of interpreting individual as well as group physician scores to identify opportunities for improvement. Analysis of these data can be challenging because of the relatively small numbers of returned surveys assignable to a single physician, variable numbers of surveys returned for each physician and high standard deviations (SDs) for individual physician scores. The objective was to apply statistical process control methodology to analyze individual as well as group physician patient satisfaction scores. The novel use of funnel plots to interpret individual physician patient satisfaction scores, track individual physician scores over two successive 8‐month periods, and monitor physician group performance is demonstrated. Methods: Patient satisfaction with physicians was measured using Press Ganey surveys for a 65,000‐volume ED over two successive 8‐month periods. Using funnel plots, individual physician patient satisfaction scores were plotted against the number of surveys completed for each physician for each 8‐month period. Ninety‐fifth and 99th percentile control limits were displayed on the funnel plots to illustrate individual physician patient satisfaction scores that are within, versus those that are outside of, expected random variation. Control limits were calculated using mean patient satisfaction scores and SDs for the entire group of physicians. Additional funnel plots were constructed to demonstrate changes in individual physicians’ patient satisfaction scores as a function of increasing numbers of returned surveys and to illustrate changes in the group’s patient satisfaction scores between the first and second 8‐month intervals after the institution of process improvement efforts aimed at improving patient satisfaction. Results: For the first 8‐month period, 34,632 patients were evaluated in and discharged from the ED, with 581 surveys returned for 21 physicians. The mean (±SD) overall group physician patient satisfaction score was 81.8 (±24.7). Returned surveys per physician ranged from 2 to 58. For the second period, 34,858 patients were evaluated and discharged from the ED, with 670 patient satisfaction surveys returned for 20 physicians. The mean (±SD) overall physician score for all surveys returned during the second period was 85.0 (±22.2). Returned surveys per physician ranged from 8 to 65. Conclusions: The application of statistical control methodology using funnel plots as a means of analyzing ED group and physician patient satisfaction scores was possible. The authors believe that using funnel plots to analyze scores graphically can rapidly help determine the significance of individual physician patient satisfaction scores. In addition, serial funnel plots may prove to be useful as a means of measuring changes in patient satisfaction, particularly in response to quality improvement interventions.     

我国分省心血管病救治的现况评价—中国心血管健康指数解析

目的评价我国整体及分省心血管疾病的救治情况现状。方法本研究涉及的资料与数据来源于中国心血管健康指数（CHI）（2017）研究结果。 选取CHI“疾病救治情况”维度的15个指标测算和分析全国31个省、自治区、直辖市（不含港澳台地区）的具体情况,并对全国和分省心血管疾病的救治情况CHI得分进行排名比较。 CHI（2017）“疾病救治情况”维度各指标满分为100分,得分越高提示心血管疾病的救治情况越好。结果2017年我国心血管疾病救治情况得分平均分为44.04分。 区域分析结果显示,我国南方地区心血管疾病的救治情况得分为47.29分,高于北方地区（39.51分）;东部地区得分为46.93分,高于中部地区（41.08分）和西部地区（42.48分）。 分省数据显示,北京市得分最高（62.01分）,其次是浙江省（61.73分）、上海市（61.72分）、湖南省（60.96分）和海南省（60.39分）。 宁夏回族自治区得分最低（27.11分）,其他得分较低的省份有辽宁省（28.16分）、安徽省（34.56分）、云南省（35.09分）、内蒙古自治区（35.23分）。结论我国区域间心血管疾病救治情况存在差异,体现出南方优于北方,东部、南部沿海地区心血管疾病救治情况优于其他地区的特点。     

Tobacco dependence curricula in U.S. baccalaureate and graduate nursing education

The overwhelming majority of nurses express a desire to help patients stop smoking but most nurses report a lack of training in tobacco dependence treatment. The purpose of the study was to assess tobacco content and extent of tobacco education and intervention skills among a national sample of baccalaureate and graduate U.S. nursing programs. A cross-sectional survey design was implemented. A questionnaire that measured tobacco content curriculum was sent to 909 baccalaureate and graduate nursing program associate deans who were member institutions of the American Association of Colleges of Nursing. The majority of tobacco content curricula focused on the health effects of tobacco. Nursing students, especially undergraduates, lacked curricular content in the area of clinical tobacco cessation techniques. Increased instructional efforts concerning the clinical treatment of tobacco dependence are critical for achieving a nationwide reduction in tobacco use prevalence.     

成都市城乡社区吸烟环境及相关知识调查研究

目的了解成都市城乡社区居民吸烟环境、相关知识的认知及差异。方法2010年12月随机抽样选取城市和农村社区各1个,被选人群中35～70岁常住居民按年龄和性别1：1配对,城乡各30例,男女各15例,共60例。采用问卷调查方式了解被调查者就吸烟环境、相关知识的看法及认知程度。结果成都城乡居民48．3％（29／60）认为家庭室内可以随意吸烟,其中农村为56．7％（17／30）高于城市40．0％（12／30）;仅13．3％（8／60）城乡居民认为室内所有区域应禁止吸烟。城乡居民86．7％～98．3％知晓吸烟可引起心脏病、脑卒中、肺癌;城市居民有16．7％知晓吸烟可引起糖尿病,而农村则无人知晓。城市居民通过大众传媒了解戒烟宣传人数达91．7％,明显高于农村。95．O％城乡居民否认社区有戒烟机构或途径。结论成都市城乡居民对限定吸烟环境认识不足,禁烟法律知识缺乏,烟草广告及戒烟宣传存在城乡差异,需继续加强宣传教育,控制烟草广告,主动提供戒烟途径。     

基于时机理论的戒烟干预对慢性阻塞性肺疾病患者的影响

目的 探讨以时机理论为框架的戒烟干预对COPD患者戒烟效果的影响。方法 便利选取2018年1月—10月某三级甲等医院呼吸与危重症医学科住院治疗的COPD患者104例,按照随机数字表法分为试验组和对照组,每组52例。试验组在对照组干预的基础上接受基于时机理论的戒烟干预,对照组接受呼吸科常规护理,并依据《中国临床戒烟指南（2015版）》对其进行简短戒烟干预及定期随访,两组均于患者出院后1个月、6个月评定戒烟率、尼古丁依赖程度及焦虑、抑郁情况。 结果 试验组出院后1个月戒烟率为72.34%,高于对照组的戒烟率40.82%,试验组出院后6个月戒烟率为85.11%,高于对照组的戒烟率48.98%,两组比较,差异有统计学意义（P<0.05）;试验组尼古丁依赖程度分值均低于对照组,两组比较,差异均有统计学意义（P<0.05）;两组焦虑、抑郁情况比较,差异无统计学意义（P>0.05）。 结论 基于时机理论的戒烟干预可有效提高COPD患者戒烟率,降低尼古丁依赖程度,尚未发现其对焦虑、抑郁情况的改善。     

社区护士控烟服务情况分析

目的：了解社区医院护士控烟知识知晓率及服务态度情况，为实施控烟行动提供依据。方法：分层整群随机抽取六省一市各级社区医院护士,对护士戒烟服务的知识、态度以及提供的服务情况进行调查。结果：共调查1531名护士，其中男性38人（2.03%），女性1493人（93.93%）；年龄在19至96岁，平均年龄34.09±9.85岁；参加过控烟相关培训1070人（69.89%），未参加过相关培训461人（30.11%）。其中愿意参加培训组在主动劝诫、干预和提供戒烟工作明显高于不愿意参加培训组（P<0.01）。其中影响护士提供戒烟服务态度的主要因素为劝诫效果不明显、门诊时间有限、专业技能不够（P<0.01）；影响护士提供戒烟服务信心的主要因素为没有足够的专业知识、专业技能以及不会使用Fagerstorm量表对吸烟者进行尼古丁依赖程度评估（P<0.01）。结论：本调查表明专业的培训较少，护士对于专业戒烟指导知识和技能掌握不够，以致影响提供戒烟服务的态度和信心。     

Preventing cancer by controlling youth tobacco use

OBJECTIVES: To review the epidemiology and prevention of teen smoking and the risks of smoking among survivors of childhood cancer. DATA SOURCES: Research articles, government reports, and surveys. CONCLUSION: Nicotine dependence often begins with the first few cigarettes smoked during adolescence. Teen tobacco use is fueled by the attractive social images that tobacco companies create for their products. Curtailing the sale of tobacco to minors and increasing their price decreases availability. Banning smoking in schools and public places reduces smoking opportunities. IMPLICATIONS FOR NURSING PRACTICE: Nurses have an important role to play in the battle against tobacco-induced malignancies through collaboration with community efforts or state initiatives.     

Tobacco control curricula content in baccalaureate nursing programs in four Asian nations

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation. Tobacco use is one of the leading causes of death worldwide, and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco. China is expected to lead the world in tobacco-related deaths by 2025. Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common. Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke. Training health care professional students about these issues can have a profound impact on public health. In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during "World No Tobacco Day" on May 31, 2005. The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.