护士职业生涯规划管理现状调查分析

护士职业生涯规划是指医院人力资源部和护理管理部门将护士个人发展与医院发展相结合,对界定护士职业生涯规划的主客观因素进行分析、总结与测定,确定护士的奋斗目标,选择实现这一目标的岗位,制定相应的工作、教育和培训计划,并对每一步骤的时序、方向作出科学合理的安排,为护士提供提高职业素质的人力资源管理方法[1]。注重坚持对护     

手术室护士岗位管理的实践与探索

目的:探索手术室护士岗位管理模式的方法及效果。方法:结合手术室工作特点,从岗位设置、岗位培训、绩效考核等方面探索手术室护理岗位管理模式。结果:实施岗位管理后,建立了护士分层进阶体系,改革绩效考核分配方式,阐明了护士岗位管理是推进优质护理服务长效机制建立的重要途径,提高了护士职业认同感及患者满意度,降低了护理人员离职率。结论:手术室实施护士岗位管理,有利于提升护理人员工作积极性,提高医生对手术护士配合的满意度,更有利于手术护理的发展。     

北京市5所医院护理岗位垂直管理实施中的问题与建议

目的了解护理岗位垂直管理实施过程中的问题及相应建议,为实行护理岗位管理改革提供参考依据。方法通过目的抽样的方法,选取北京市5所岗位管理试点医院的护理管理者、临床护士、科主任和绩效处处长等进行半结构访谈。采用Colaizzi现象学分析法进行分析。结果通过对访谈资料进行分析,总结护理岗位垂直管理实施过程中遇到的问题,包括4个主题:影响科室内部管理与合作、绩效分配方案的科学性和公开度不够、高年资护士绩效分配和岗位设置问题突出、临时调配护士存在胜任力和归属感问题;总结护理岗位垂直管理工作的建议,包括4个主题:提高科室对护士管理的参与度、公开绩效分配制度并征求多方意见、为高年资护士提供职业发展空间、设置规范化培训和储备护士库,避免随意调配。结论护理岗位垂直管理实施过程中仍存在很多问题,包括科室内部管理与合作、绩效分配方案的科学性和公开度不够、高年资护士绩效分配和岗位设置问题等。建议从提高科室对护士管理的参与度、公开分配制度并征求多方意见、为高年资护士提供职业发展空间等方面着手,促进护理岗位垂直管理的顺利实施。     

综合性医院护士个人绩效考核实施效果

目的 探讨科学、合理、公正的综合性医院护士个人绩效考核方案.方法 在我院岗位管理模式及护理质量可持续改进基础上设计绩效考核管理标准,综合比较实施1年前后护士个人奖金及护理质量改进情况.结果 实施1年后护士个人奖金明显提高,护士对护理工作满意度由83.5%上升到97.2%,对薪酬待遇满意度由82.6%上升至96.2%;护理质量指标较前有明显提高.护士积极性及参与管理意识性明显增强.结论 我院实施的护士个人绩效管理方案,提升了护士个人职业认同感,调动了护士工作积极性,强化了护士的责任感和竞争意识,护理质量得到可持续改进;同时,建立了有效的激励机制,增强了科研教学意识,激发了护士潜能,有利于护理体系人力资源的调配,稳定了护理队伍;综合提高了护士工作满意度,提高了护理工作质量.     

院内骨科专科护士培训的实施及效果

目的:探讨院内骨科专科护士培训的实施方法及效果分析。方法:从骨科中心择优选取6名护士,按计划实施院内骨科专科护士培训。包括建立院内专科护士培训组织管理体系;准备培训教材;培训实践过程。对结业后的专科护士工作现状进行调查并对效果进行初步评价。结果:专科护士个人职业发展良好(40%进入临床教育岗位,60%进入临床管理岗位);专科护士培训开展后专科护理质量较开展前明显提高(P0.01);专科整体素质明显提升;患者满意度及同行满意度均有明显上升。结论:骨科专科护士培训促进了骨科护理专业建设,提升了专科护理质量。     

护士对员工援助计划的应用需求现状

目的 探讨员工援助计划在护士中的应用需求,为护理管理引入员工援助计划提供参考。方法 检索国内外数据库,就医疗组织、护理管理者、护士三方对员工援助计划的需求及员工援助计划在护士中的应用总结。结果 从国家战略目标和医院自身人文建设2个角度,介绍了医疗组织对员工援助计划的需求。从降低护士离职率,提高护理服务质量;提高护士工作满意度,增强职业认同感介绍了护理管理者对员工援助计划的需求。从工作、生活、健康3方面介绍了护士对员工援助计划的需求。从应用模式、服务内容和效果评价3个角度介绍了员工援助计划在护士中的应用。结论 将员工援助计划引入护理管理具有必要性和有效性。员工援助计划在我国护理管理中尚处于萌芽期,需进一步了解员工援助计划服务对象的需求,完善员工援助计划在护理管理中的服务体系。     

注册护士职业稳定性与职业发展的思考之一

<正>在我国政府十三五规划、医疗改革及医养结合等国策方针中,给予护士职业者高度的重视,发布了一系列相关政策,护士可以多点执业及开办护理院等。面临利好政策,各级护理管理者应以国际化视野与胸怀,重新思考护理管理模式,激发护士职业热情,稳定护士队伍,提高护士执业能力。广大注册护士应以医养融合为契机,思考、设计、积累个人专业才能,     

临床护士对岗位动态管理工作感受的质性研究

目的：了解护士在岗位动态管理中的工作感受,为护理管理者构建护理岗位动态管理模式提供参考依据。方法采用质性研究中现象学的研究方法对16名护士进行深度访谈,将获得的资料按Colaizzi步骤进行分析。结果通过分析得出五个主题：个人价值的实现、专业知识和业务能力提高、职业发展和定位、缺乏组织归属感、福利待遇感受。结论岗位动态管理是个新的岗位管理模式,护理管理者应重视护士在新的管理模式中的工作感受,为临床护士提供良好的工作支持和氛围,提升护理质量。     

N1岗位护士职业态度影响因素调查分析

目的:了解N1岗位护士的职业态度的现状,分析其职业态度的影响因素,为进一步培训N1岗位护士工作能力提供管理依据。方法:采用姜安丽护士职业态度量表,对5所三甲医院N1岗位护士问答,发放问卷1 200份,回收1 140份。结果:多元回归分析中,学历、是否担任行政职务、劳动关系、个人成长与发展、性别和工作时间与低年资护士职业态度有相关性(P0.05)。结论:N1岗位护士的职业态度收多因素影响,护理管理者可根据其影响因素,调整培训计划,实施具体的管理方案,提升N1岗位护士的职业态度,从而提高患者满意度。     

西北地区2704名本科学历护士个人职业规划现状及影响因素分析

目的调查西北地区全日制本科学历护士个人职业规划现状,并分析其影响因素。方法采用便利抽样的方法,选取西北地区(陕西、甘肃、宁夏、青海、新疆)五省14所三级甲等/乙等医院2 704名本科学历护士作为研究对象。采用一般资料问卷、职业规划量表、职业管理量表对其进行调查。采用分层回归分析个人职业规划的影响因素。结果本科护士职业规划总分为(37.96±8.71)分;分层回归分析显示,一般资料中的职称、工作岗位与意愿、专科护士证书对个人职业规划有影响。在控制一般资料后,单位职业管理中的晋升公平、促进职业发展影响本科学历护士个人职业规划,独立解释其个人职业规划36.2%的变异。结论西北地区全日制本科学历护士职业规划处于中等水平,尤其应关注职称低、工作岗位与意愿相符程度不高及无专科护士证书的护士。护理管理者需要加强晋升公平,鼓励护士主动展示,了解护士的兴趣、能力,让护士兴趣、能力与岗位及发展空间匹配,充分挖掘专科护士的职业潜能,促进个体实现自我价值。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.