APN责任制排班在骨科护理服务中的应用

为了为患者提供优质护理服务,提升护理水平,我科采用APN模式对传统护理排班制度进行改革,在患者和医务人员中引起了较大的反应,提高了护理服务质量,改善了护士工作方式,现将应用情况介绍如下.     

对护士APN排班方式满意度的调查

目的了解护士对APN排班方式的满意度,初步探讨APN排班方式对护士工作及其个人和家庭的影响。方法采用自行设计的护士排班满意度调查问卷以不记名自填式问卷调查法,调查2个科室共51名执业护士对APN排班方式的满意度。经测定,问卷的Cronbach’S＆系数为0．724。结果已婚、本科学历的护士对APN排班方式满意度分别为69．57％、88．89％,高于未婚、专科学历的39．29％和47．62％,差异有统计学意义（x2=4．647,5．098;P均〈0．05）。护士认为APN排班方式使护士之间合作性增加,护患交流机会增多,业余可利用时间增加,夜班心理压力减轻。结论护士对APN排班的满意度较高,较之传统的排班方式,APN排班考虑了轮班工作对护士自身健康、家庭生活及业余学习的影响,更加人件化、科举化。     

氟伐他汀对冠心病患者白细胞介素-6、基质金属蛋白酶-1和脂联素水平的影响

目的 探讨氟伐他汀对冠心病患者白细胞介素-6(IL-6)、基质金属蛋白酶-1(MMP-1)和脂联素(APN)水平的影响.方法 选择冠心病患者60例,随机平均分为氟伐他汀40 mg治疗组和80 mg治疗组;另外选择健康对照者20例.测定治疗前后IL-6、MMP-1和APN浓度.结果 冠心病患者治疗前IL-6和MMP-1高于对照组(t=4.896、4.231,均P＜0.05),APN低于对照组(t=4.352,P＜0.05);两组治疗后IL-6和MMP-1均有明显下降,APN明显升高(t=4.156、4.121、4.553,均P＜0.05),但80 mg组更显著(t=3.786、3.690、4.110,均P＜0.05).结论 在冠心病患者中,血清IL-6、MMP-1水平明显升高,APN水平明显降低,可能与炎性反应有关;氟伐他汀可能通过降低IL-6、MMP-1的水平,升高APN水平而发挥抗炎作用,并与药物浓度相关.     

2型糖尿病大血管病变患者CRP、TNF-α、APN水平的检测及临床意义

目的:探讨2型糖尿病大血管病变患者C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、脂联素(APN)的水平及临床意义。方法:125例2型糖尿病患者分为两组,有大血管病变患者65例为A组,无大血管病变患者60例为B组,同时选取50例健康者作为对照组。检测并比较3组血清超敏C反应蛋白(hs-CRP)、TNF-α、APN水平及颈动脉内膜-中膜厚度(IMT)。结果:A组、B组及对照组血清hs-CRP、TNF-α水平及IMT依次降低,APN水平依次升高,组间比较差异均有统计学意义(F值分别为7.218、8.924、7.721、6.356,P均<0.05);Pearson相关分析显示:A组hs-CRP、TNF-α、APN水平与IMT显著相关(r值分别为0.357、0.287、-0.639,P均<0.05)。结论:hs-CRP、TNF-α及APN参与动脉粥样硬化的发生机制,与2型糖尿病大血管病变密切相关。     

神内ICU两种护理排班方法比较

目的 寻求神经内科重症监护室病人及护士满意度高的排班方法.方法 通过连续排班法(APN排班法)、弹性排班法在神经内科监护室分别实行3个月后,对监护室34名护士及105名住院病人进行问卷调查.结果 APN排班法、弹性排班法住院病人满意率分别为93％和97％;两种方法在工作强度和医患沟通方面的护士满意度差异无统计学意义(P＞0.05),在每周工作时间(2.59±0.75,3.59±0.66)、对生活影响(2.53±0.79,3.50士0.79)、总体评价(2.41±0.70,3.59±0.70)方面的护士满意度差异有统计学意义(P＜0.05).结论 弹性排班法在神内监护室的临床工作中更受护士及病人欢迎.     

Advanced practice nursing for enduring health needs management: a global perspective

Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.     

The U.S. Preventive Services Task Force: An evidence-based prevention resource for nurse practitioners

Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services.
Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.
Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.
Implications for Practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.     

脂联素及血脂变化对于子痫前期患者的临床意义

目的 探讨脂联素及血脂在子痫前期患者血清中的变化,并评价其临床意义.方法 对2009年10月～2011年10月在本院妇产科进行治疗的52例子痫前期患者（轻度28例,重度24例）,同时以同期在本院进行体检的50名健康妊娠期孕妇为正常对照组,采用放射免疫吸附法检测子痫前期患者及正常对照者血清中的脂联素（APN）含量,应用全自动生化仪检测两组受试者血清中的总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）含量,并比较两组间的差异.结果 子痫前期患者血清中的APN、LDL及HDL的水平明显低于健康对照组,而TG的水平明显高于健康对照组,两组间差异具有统计学意义（P 〈 0.05）;重度子痫前期患者的APN及HDL的水平明显低于轻度子痫组患者,两组间差异具有统计学意义（P 〈 0.05）;子痫患者血清中APN含量与产妇的孕周及TG的水平呈现负相关（r分别为-0.51和-0.89,P 〈 0.05）.结论 子痫前期患者血清中APN含量降低,TG含量升高等可能与子痫前期发生有关,APN含量可以反映子痫患者的疾病严重程度.