冠心病患者的健康行为及其影响因素

目的探讨影响冠心病患者健康行为水平的因素。方法采用健康促进生活方式量表、慢性病自我效能量表、冠心病健康信念问卷和冠心病知识问卷对随机抽取的广州市3家三甲医院的103名冠心病患者进行调查，以105名正常人作为对照，并对结果进行分析。结果冠心病患者的健康行为总分低于正常对照人群（p〈0．05）；不同婚姻状况或不同既往住院次数的冠心病患者在健康行为总分上的差异具有统计学意义（P〈0．05）；冠心病患者的自我效能、婚姻状况、冠心病知识知晓率进入了健康行为的回归方程，其联合决定系数为0．291；健康信念中维护健康动机因素分别进入了健康行为中健康责任、营养2个维度的回归方程，其决定系数分别为0．098和0．052。结论冠心病患者的健康行为水平低于正常对照人群，良好的自我效能、健康信念、冠心病知识知晓率可促进冠心病患者建立健康行为。     

社区中青年2型糖尿病患者遵医行为与健康信念、社会支持的相关性分析

目的了解社区中青年2型糖尿病患者遵医行为的现状,分析影响患者遵医行为的影响因素。方法采取整群抽样的方法,用社会人口学资料问卷、遵医行为量表、社会支持量表、健康信念量表对288例社区中青年2型糖尿病患者进行调查。结果本组患者遵医行为得分为（56．8±10．9）,得分率67．62％;患者在药物治疗、饮食治疗方面的执行最好,在自我监测及足部护理方面的遵医行为最差,运动治疗、定期复查、低血糖处理居中。社会支持总分得分（42．6±7．6）,得分率为72．2％;健康信念总分得分（156．0±16．4）,得分率为73．58％。影响因素社会支持按作用强度依次为主观支持、客观支持、支持利用度;健康信念按作用强度依次为感知到行动的障碍、感知到疾病的严重性、感知到遵从医嘱的益处、行动线索、感知到疾病的易感性。遵医行为与社会支持呈正相关（r=0．20,P〈0．01）,与健康信念呈正相关（r=0．33,P〈0．01）,与社会支持利用度无相关性（r=0．005,P〉0．05）。本组患者除低血糖反应处理外,健康信念中障碍性认知与遵医行为及其各部分均呈负相关,其余各维度与遵医行为及其各部分均呈正相关（P〈0．05）。结论社区中青年2型糖尿病患者的遵医行为较低,健康信念及主观社会支持、客观支持是遵医行为的影响因素。     

健康信念模式在护理人员血源性职业暴露防护中的应用研究

目的通过健康信念模式教育对血源性职业暴露的干预,减少护理人员职业暴露率以及感染血源性传播疾病的风险。方法以健康信念模式为理论指导,成立血源性职业暴露防护管理小组,采取感知教育、行为益处教育、提升自我效能、减少制约因素以及行为督导等系列干预措施。结果健康信念模式干预后,护理人员血源性职业暴露除防护认知的安全注射条目和防护行为中的暴露后处理条目外,其他防护认知及防护行为得分均提高（P〈0．01或P〈0．05）;职业暴露发生率降低（P〈0．01）。结论应用健康信念模式可以增强护理人员对血源性职业暴露防护的健康信念,促进健康行为的养成,从而降低血源性职业暴露率。     

健康信念模式在评价大学生艾滋病健康教育中的应用

[目的]采取健康信念模式对艾滋病健康教育效果进行评价和分析。[方法]采取多种途径对大学生进行健康教育,对比培训前后大学生对艾滋病易感性、严重性、健康行为益处以及健康行为障碍的感知变化。[结果]与训练前比较,培训后大学生知觉到AIDS易感性及严重性（P〈0.01）;提高了大学生对AIDS预防行为效益、行为障碍认知（P〈0.01）。[结论]健康教育可以提高大学生对艾滋病认知,促进大学生采取健康行为,防止感染艾滋病。     

老年高血压病患者疾病相关健康行为调查研究

目的了解老年高血压病患者疾病相关的健康行为现状，探讨预防对策。方法采用自编一般资料调查表、Mofisky—Green服药依从性测评表和健康行为量表对120例老年高血压病患者进行问卷调查。结果本组102例患者服药治疗高血压，其中依从性高23例，依从性中45例，依从性差34例。老年高血压病患者在参与活动、心理应激、生活习惯方面均存在不健康行为；老年高血压病患者在心理应激，生活习惯维度健康行为得分明显高于普通老年人群，差异有统计学意义（P〈0．05）；老年高血压病患者与普通老年人群在参与活动维度健康行为的差异无统计学意义（P〉0．05）。结论老年高血压病患者存在疾病相关的不健康行为，促进患者采取健康行为的预防控制策略和措施亟待加强：     

脑卒中患者健康信念与健康行为的调查研究

目的描述脑卒中患者健康信念与健康行为水平,并探讨二者关系。方法采用健康信念模型量表、健康促进生活方式量表Ⅱ对100例脑卒中患者进行问卷调查。结果脑卒中患者健康信念总平均分为(3.11±0.36)分,其中健康动力、自我效能的水平较高,感知到的严重性和障碍的信念水平较低;患者的健康行为总平均分为(2.52±0.36)分,其中营养维度水平较高,运动和自我实现维度水平较低;脑卒中患者的健康信念和健康行为呈正相关。结论脑卒中患者健康信念水平越高,其健康行为越好。医护人员应重点关注患者"感知到的严重性和障碍"的健康信念;并在运动和自我实现维度的健康行为上给予更多指导和帮助。     

健康信念模式在冠心病患者健康宣教中的应用

目的探讨健康信念模式在冠心病患者健康宣教中的应用效果。方法选取100例冠心病住院患者作为研究对象,按入院时间顺序分为试验组和对照组各50例。试验组接受健康信念模式为理论基础的健康教育,对照组接受传统健康教育。干预前后,采用健康促进生活方式量表对患者进行调查,并检测患者血脂。结果干预后,试验组健康促进生活方式总分及健康责任、运动、营养、自我实现、人际关系维度得分高于对照组(P0.05),高于干预前(P0.05);试验组血脂指标(总胆固醇、三酰甘油、低密度脂蛋白)低于对照组(P0.05),低于干预前(P0.05)。对照组健康促进生活方式得分、血脂指标干预前后差异没有统计学意义(P0.05)。结论健康信念模式为理论基础的健康教育可以促进冠心病患者建立良好健康行为,有助于降低血脂。     

中青年2型糖尿病患者遵医行为影响因素分析

目的：探讨中青年2型糖尿病患者遵医行为现状,分析影响患者遵医行为的影响因素。方法：采取整群抽样的方法,用社会人口学资料问卷、遵医行为量表、社会支持量表、健康信念量表对300例社区中青年2型糖尿病患者进行调查。结果：患者遵医行为得分（56．8±10．9）分,得分率67．62％;遵医行为与社会支持、健康信念的复相关系数分别为r=0．20、r=0．33（P〈0．01）;不同性别患者在饮食治疗方面差异有统计学意义（P〈0．05）;不同居住情况患者在饮食治疗、运动治疗、总分方面差异有统计学意义（P〈0．05）;年龄与运动分数（r=-0．17,P〈0．01）、定期复查分数（r=-0．13,P〈0．05）呈负相关。结论：患者的性别、年龄、居住状况、主客观支持及其健康信念是糖尿病患者遵医行为的影响因素。     

护士标准预防的健康信念与行为依从性的相关性研究

目的了解护士标准预防的健康信念和行为依从性现状，探讨护士标准预防的健康信念与行为依从性的关系。方法采用分层随机按比例抽样方法，运用标准预防健康信念问卷、标准预防行为依从性问卷对500名注册护士进行调查。结果健康信念与行为依从性呈正相关，r=-0．202，p〈0．001；其中感知到疾病的易感性与严重性和行为依从性呈负相关，r分别为-0．126、-0、152，p〈0．01；感知到愈少的行动障碍和更多的行动线索与行为依从性呈正相关，r分别为0．420、0．269，p〈0．001。结论护士健康信念与行为依从性呈正相关，可以从提高护士健康信念着手，来提高护士标准预防行为的依从性。     

临床一线护士与医生自测健康及幸福感的比较分析

[目的]比较临床一线护士与医生的自测健康状况及幸福感。[方法]采用自测健康评定量表（SRHMS）和总体幸福感量表（GWB）对桐乡市3家医院的临床一线护士和医生作抽样调查，并做对照性分析。[结果]护士组与医生组的SRHMS总分、自测心理健康子量表得分无明显差异（P〉0．05）；自测生理健康得分护士组高于医生组（P〈0．05）；护士组在自测社会健康及相关的多个维度得分上均低于医生组（P〈0．05，P〈0．01）；GWB总分护士组明显低于医生组（P〈0．01）。[结论]临床护士自测社会健康及幸福感比医生差，需注意加强社会支持、提高其总体幸福感。     

School Health

School Health provides a forum to discuss policy, practice, research, issues and trends, and pearls of wisdom to enhance the day-to-day care of children in the school setting, from daycare to high school.     

The Impact of Health Information Exchange on Health Outcomes

Background and Objective

Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes.

Methods

A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data.

Results

Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used.

Conclusions

Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care.     

Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont

Mental health care shortages in the United States are most pronounced in rural areas. This practice-change project aimed to increase access to quality mental health care in rural areas for the treatment of depression and anxiety via telemental health delivery of care. The project yielded improvements across project aims, including an increased percent of enrolled patients from Healthcare Provider Shortage Areas; a decrease in quality measures for depression, anxiety, and disability; and increased patient satisfaction with care. The project can serve as a template for other practices wishing to increase access to mental health care in rural areas.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

Workplace Health Promotion Activities of Finnish Occupational Health Nurses

ABSTRACT Objective: This study describes workplace centered activities performed by occupational health professionals, as well as difficulties linked to workplace centered activities, cooperation with client workplaces, and participation both in risk assessment and in the development of working environment.
Design: The design is a cross-sectional prevalence study.
Sample: The questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms and of whom 99% were nurses.
Measurements: Their activities, difficulties, cooperation, and participation in risk assessment and development of safe and healthy working conditions.
Analytic strategy: The data were analyzed by using frequencies, means, 1-way ANOVA, and the Kruskal-Wallis test.
Results: Workplace focused activity hours were mainly spent on risk assessment and counseling. One workplace visit took approximately 4 hr. The greatest difficulties were encountered with participation in development projects and in monitoring the effectiveness of improvement activities, especially in health care centers. Occupational health nurses cooperated with client enterprises and participated in risk assessment more often than the other occupational health professionals. Also workplace representatives participated actively in risk assessment. The most difficult modules were considered to be the risk assessment of chemicals, biological factors, and perceived stress, this being especially so in health care centers.
Conclusions: It is essential that occupational health professionals visit more often in their client enterprises and improve their skills in preventing harms caused by chemical and biological factors, and perceived stress.     

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

ABSTRACT Objectives: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. Design and Sample: A cross‐sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). Measures: A 39‐item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. Results: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. Conclusion: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.     

Population Health Surveillance Practice of Public Health Nurses

ABSTRACT Objective: To report the population health surveillance functions of public health nurses and to describe factors that impede these functions.
Design and Sample: An interpretive qualitative study was conducted in Public Health Service areas in Eastern Canada. Participants were public health nurses ( n =55) with an average of 14.5 years of pertinent work experience.
Measures: Semistructured face-to-face, telephone interviews, and focus groups were conducted, transcribed, coded, and analyzed.
Results: The nurses in this study used ecosocial population health surveillance functions that included multilevel societal influences on health. Extensive interprofessional and intersectoral networks were foundational to their surveillance work, allowing them to monitor what was occurring in the community and transfer this knowledge into various systems to contribute toward improved health outcomes. However, the nurses did not acknowledge the significance of their population health surveillance work, and documentation structures did not support these surveillance functions.
Conclusion: New surveillance methods and documentation structures that reflect an ecosocial surveillance approach are needed that are more consistent with public health nurses' population-focused practice.