新冠肺炎疫情期间江西省援鄂护士同情心疲乏的调查

目的了解新型冠状病毒肺炎（新冠肺炎）疫情期间江西省援鄂一线护士同情心疲乏现状并分析其相关影响因素,为改善他们的专业生活品质提供理论依据。方法采用便利抽样法,选取江西省不同医院的402名援鄂一线护士,均填写一般资料调查表和中文版护士专业生活品质量表（ProQOL）,采用描述性分析、单因素分析、多元回归分析其同情心疲乏的特点及影响因素。结果 402名援鄂一线护士同情心满足得分（40.14±6.32）分,工作倦怠得分（19.67±5.62）分,二次创伤得分（22.40±5.69）分。多元回归分析显示影响护士同情心满足的主要因素有职务（t=2.279,P=0.023）、生育情况（t=2.405,P=0.017）、睡眠状况（t=-2.824,P=0.005）,影响工作倦怠和二次创伤的因素有上夜班的频次（t=2.562,P=0.011）,每周上班的天数（t=2.514,P=0.012）,睡眠状况（t=5.255,P<0.001;t=6.270,P<0.001）。结论在疫情期间,江西省援鄂护士同情心疲乏总体处于中等水平,建议科学排班,关注护士的心理和睡眠状况,同时,建立健全突发公共卫生事件应对机制,提高医护人员的灾害应对能力,以降低医护人员工作倦怠和二次创伤的程度。     

精神科护士同情心疲乏及其影响因素研究

目的 探讨精神科护士同情心疲乏水平及其影响因素.方法 采用一般情况调查表、医护人员同情心疲乏量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活事件量表(LES)、特质应对方式问卷等对成都市2所三级甲等医院190名精神科护士进行调查分析.结果 190名精神科护士同情心疲乏总分为(101.95±7.14)分,条目均分为(2.83±0.22)分.其中,感情淡漠得分最高,行为消极得分最低.多元回归分析显示,性别、护龄、负性生活事件、消极应对方式是同情心疲乏的主要影响因素(P＜0.05).结论 精神科护士同情心疲乏处于中等水平并受多种因素影响,应给予重视并采取相应应对措施.     

护士职业应激影响因素的研究

目的 探讨护士工作年限、婚姻状态、职称、年龄、地区、文化程度、工作性质以及工作科室与护士职业应激的关系.方法 应用中国护士应激源量表(CNSS)对中国东部、中部及西部的3091名护士进行调查.结果 3091名护士全部女性,年龄18～55.06岁,平均年龄(30.13±1.98)岁;工作年限最长38.00年,平均(10.23±8.05)年.不同工作年限(F=9.472,P=0.000)、不同婚姻状态(F=4.598,P=0.010)、不同职称(F=3.667,P=0.012)、不同年龄(F=7.600,P=0.000)、不同地区(F=46.971,P=0.000)、不同工作性质(F=14.888,P=0.000)以及不同工作科室(F=3.876,P=0.000)的护士职业应激水平差异有显著性,不同文化程度(F=2.052,P=0.129)的护士职业应激差异无显著性;影响护士工作应激的主要变量依次为:工作年限、工作科室、职称、工作性质、婚姻、地域.结论 我国护士的职业应激受多方面因素的影响,正确评估护士职业应激的特点,不仅对广大护士的工作,而且对护理管理者有重要意义.     

三级甲等医院护士职业倦怠现状调查

目的：分析新疆某三甲医院护士职业倦怠现状及其影响因素,以期为采取合理的干预措施提供科学依据。方法采用整群抽样的方法,抽取新疆某三甲医院内科、外科、门诊和其他科室工作1 a以上（含1 a）的女性护士688名,应用基本情况调查量表和职业倦怠问卷（CMBI）调查护士的一般情况、工作倦怠情况,比较不同工龄、不同学历、不同夜班频率护士职业倦怠水平的差异,并对影响职业倦怠的因素进行Logistic分析。结果688名护士中以汉族为主（64．1％）,工龄以＜5 a和5∽15 a为主。不同工龄护士个人成就感降低、人格解体、情绪耗竭和工作倦怠总分差异有统计学意义（P ＜0.05）。不同学历水平护士人格解体、情绪耗竭、工作倦怠得分差异有统计学意义。不同夜班频率护士个人成就感降低、人格解体、情绪耗竭和工作倦怠得分差异具有统计学意义（P ＜0.05）。工龄和夜班频率是职业倦怠的影响因素。护理人员职业倦怠水平与国外M aslach常模比较差异有统计学意义（P ＜0.05）。结论职业倦怠受个体特征因素影响;多夜班工作是发生工作倦怠的危险因素,应当在个人层面加强自身应对和组织管理层面采取干预措施,降低工作倦怠的风险,提高护士职业健康水平。     

低年资护士同情心疲乏现状及影响因素分析

目的 了解低年资护士同情心疲乏现状,分析其影响因素。 方法 采用方便抽样的方法,于2020年3—4月抽取温州市4所三级甲等医院348名低年资护士为研究对象。应用汉化版生命意义感量表、心理韧性量表和同情心疲乏量表进行调查。 结果 低年资护士生命意义感评分为(45.77±6.82)分,心理韧性评分为(78.74±16.84)分,同情心疲乏评分为(109.74±14.59)分;单因素分析显示,不同年龄、学历、职称、护龄、值夜班情况、对薪酬满意程度的低年资护士同情心疲乏评分比较,差异均有统计学意义(均P<0.05);Pearson相关分析显示,低年资护士的生命意义感、心理韧性总分及各维度评分均与同情心疲乏评分呈负相关(均P<0.01);多元线性回归分析显示,低年资护士职称、生命意义感、心理韧性、值夜班情况是同情心疲乏的主要影响因素(均P<0.05)。 结论 低年资护士的同情心疲乏程度较高,低年资护士的职称、生命意义感、心理韧性、值夜班情况均会影响同情心疲乏水平。护理管理者应当制定公平公正的职称晋级评定规则,规范轮班轮岗制度,采取针对性措施提升低年资护士的生命意义感和心理韧性力水平,缓解低年资护士的同情心疲乏,提高临床护理服务质量。      

成都市某社区卫生服务中心护士职业倦怠现状调查研究

目的 了解成都市某社区卫生服务中心(以下简称中心)护士职业倦怠现状,并提出改进措施.方法 采用自制量表和Maslach工作倦怠量表调查中心66名护士职业倦怠状况,并对调查结果进行统计分析.结果 中心护士情感耗竭、去人格化、个人成就感3个维度得分分别为(24.89±8.76)、(8.86±5.72)、(29.79±9.18)分.中心护士与武汉市社区护士常模比较,情感耗竭、去人格化、个人成就感维度得分较高,差异有统计学意义(P＜0.05);与美国M氏医务人员常模比较,情感耗竭、去人格化维度得分较高,差异有统计学意义(P＜0.05).学历、从事专业年限、年龄是影响中心护士职业倦怠的重要因素.结论 中心护理管理者应重视护士职业倦怠情况,并根据调查结果,制定有效措施以降低护士职业倦怠.     

儿科护士专业生活品质对疼痛共情能力影响的研究

  目的  探讨儿科护士专业生活品质及疼痛共情能力的现状,并分析专业生活品质与疼痛共情能力的相关性及影响程度。  方法  于2020年7—10月,采取便利抽样的方法,采用儿科护士一般情况调查表、中文版护士专业生活品质量表、疼痛共情量表对浙江省温州市2所三级甲等医院工作的132名儿科护士进行问卷调查,使用SPSS 21.0统计学软件进行数据分析。  结果  儿科护士疼痛共情量表条目均分为(2.63±0.73)分,处于中等水平,在专业生活品质量表维度得分上,处于低度共情满足水平的儿科护士占18.94%,处于高度倦怠水平的儿科护士占21.21%,处于二次创伤应激水平的儿科护士占25.75%。共情满足与疼痛共情总分及各维度呈正相关(r=0.174~0.308,均P＜0.01);倦怠、二次创伤应激与疼痛共情总分及各维度呈负相关(r=-0.295~-0.151,均P＜0.05)。儿科工作年限、是否生育、是否参加疼痛共情相关培训及是否遭受工作场所暴力在儿科护士疼痛共情量表得分上差异有统计学意义(均P＜0.05),分层回归分析显示,倦怠、共情满足、二次创伤应激能够对儿科护士疼痛共情产生影响,共解释总变异的18.2%(均P＜0.01)。  结论  儿科护士疼痛共情处于中等水平,可通过提高专业生活品质水平从而提升疼痛共情能力。      

院前急救护士创伤后应激障碍现状及其相关因素分析

目的 探讨院前急救护士创伤后应激障碍现状及其影响因素.方法 选取6所综合性医院的全部院前急救护士及其同等数量内科护士作为研究对象,采用自编创伤性事件调查表、PCLC、SCSQ及PSSS量表进行调查.结果 院前急救护士创伤性事件总分以及工作应激3个维度、PCL-C总分及重新体验、回避/麻木2个维度的得分均高于内科护士(P＜0.05);院前急救护士PCL-C总得分与工作应激呈正相关,与社会支持呈负相关(P＜0.01).结论 应采取措施降低院前急救护士PTSD症状水平.     

护士职业承诺对职业倦怠与工作要求关系的调节作用研究

目的:探讨护士职业承诺对职业倦怠与工作要求关系的调节作用.方法:选取695名护士作为研究对象,通过Maslach职业倦怠问卷(MBI-GS)、工作要求-资源问卷(JCQ)、护士职业承诺问卷(NCCS)分析护士职业承诺、职业倦怠与工作要求的相关性、职业承诺对职业倦怠及工作要求的调节作用.结果:护士职业倦怠3个维度得分与职业承诺均呈负相关(r=-0.24、-0.35、-0.37,P＜0.05);情绪衰竭及去个性化维度得分与JCQ总分呈正相关(r=0.35、0.13,P＜0.05);职业效能维度得分与JCQ总分呈负相关(r=-0.40,P＜0.05).职业承诺对情绪衰竭与工作要求3个维度之间有负向调节作用(β=-0.014、-0.010、-0.015,P＜0.05);职业承诺对去个性化与工作复杂性和工作强度有负向调节作用(β=-0.007、-0.006,P＜0.01);职业承诺对职业效能与工作要求3个维度有正向调节作用(β=0.012、0.019、0.013,P＜0.05).结论:高职业承诺可使护士积极满足工作高要求,其职业倦怠感更低;低职业承诺会使护士消极应对工作高要求,其职业倦怠感更高.     

护患感知关怀行为差异现状及影响因素

目的 探讨护士和患者对护理关怀行为的感知差异现状及与护理人员相关的影响因素.方法 应用关怀行为量表-24条目(CBI)对120对患者及其责任护士进行调查研究.结果 (1)量表的总平均得分(P＜0.05)及感知人性存在(P＜0.01)、尊重他人(P＜0.05)两个维度方面差异有统计学意义,而在知识和技能(P＞0.05)、正性沟通(P＞0.05)两个维度方面差异无统计学意义.(2) Logistic回归分析显示护士对护理工作的满意度(P＜0.01,OR=0.201)、工龄(P＜0.01,OR=5.261)与差异产生呈负相关,对医生的满意度(P＜0.01,OR=7.801)、护士学历(P＜0.01,OR=5.261)与差异产生呈正相关.结论 护士和患者对护理关怀行为感知存在差异,且护士的工龄,学历,对工作、医生的满意度是差异产生的影响因素.     

What should we say?

Abstract ethics mostly focuses on what we do. One form of action is a speech act. What we say can have profound effects. We can and should choose our words and how we speak wisely. When someone close to us suffers an injury or serious illness, a duty of beneficence requires that we support that person through beneficial words or actions. Though our intentions are most often benign, by what we say we often make the unfortunate person feel worse. Beginning with two personal accounts, this article explains what can go wrong in the compassionate speech of wellwishers, and uncovers some of the reasons why people say things that are hurtful or harmful. Despite a large body of clinical evidence, there is no perfect strategy for comforting a friend or relative who is ill, and sometimes even the best thing to say can still be perceived as insensitive and hurtful. In some cases, we may have good reason to knowingly say a hurtful or insensitive thing. Saying these ''wrong'' things can sometimes be the best way to help a person in the long term. To complicate matters, there can be moral reasons for overriding what is good for the patient. What kind of admonishments should we make to a badly behaved patient? What is the value of authenticity in our communication with the people we love? These questions demand an ethical defence of those speech acts which are painful to hear but which need to be said, and of those which go wrong despite the best efforts of the wellwisher. We offer an ethical account, identifying permissible and impermissible justifications for the things we say to a person with a serious injury or illness.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.