Problem solving strategies integrated into nursing process to promote clinical problem solving abilities of RN-BSN students

A set of problem solving strategies integrated into nursing process in nursing core courses (PSNP) was developed for students enrolled in a post-RN baccalaureate nursing program (RN-BSN) in a university in Taiwan. The purpose of this study, therefore, was to evaluate the effectiveness of PSNP on students' clinical problem solving abilities. The one-group post-test design with repeated measures was used. In total 114 nursing students with 47 full-time students and 67 part-time students participated in this study. The nursing core courses were undertaken separately in three semesters. After each semester's learning, students would start their clinical practice, and were asked to submit three written nursing process recordings during each clinic. Assignments from the three practices were named post-test I, II, and III sequentially, and provided the data for this study. The overall score of problem solving indicated that score on the post-test III was significantly better than that on post-test I and II, meaning both full-time and part-time students' clinical problem solving abilities improved at the last semester. In conclusion, problem-solving strategies integrated into nursing process designed for future RN-BSN students are recommendable.     

综合医院住院患者饮酒问题的筛查和早期干预

目的本研究尝试由护士对住院患者开展简短的饮酒问题早期干预,观察干预对于患者饮酒状况改善的情况。方法对北京某三级甲等医院的1019例住院内外科患者使用酒精依赖性疾患识别测验(AUDIT)进行饮酒状况的筛查,筛查出问题饮酒者,即危险饮酒者和有害饮酒者后,随机将其分为实验组(即早期干预组)和对照组,实验组患者接受护士有关饮酒问题的20min简短干预,1年后使用AUDIT随访实验组和对照组患者。结果实验组和对照组干预前后饮酒状况都有明显的改善(P<0.01),但实验组AUDIT总分下降的幅度显著高于对照组(P<0.05)。结论综合医院住院患者中有相当比例的患者属于危险饮酒或有害饮酒。护士开展的简短干预对于患者改善饮酒状况有一定的效果。但是如何修订更符合文化背景的干预内容,寻找改善饮酒问题的有效成分还需要进一步的研究。     

护理业务查房模式的探讨

目的 探讨护理业务查房的模式，提高临床护理质量及护理人员业务素质。方法 针对性地组织护理人员开展护理问题查房、英语护理查房、护理教学查房等多种形式的护理查房，并在护理业务查房过程中引入“以问题为基础”的教学方法。结果 多种形式的护理业务查房激发了护理人员的学习兴趣，提高护理人员的判断、解决问题的能力、专业英语水平及业务能力等综合素质。结论 多种形式的护理业务查房是提高了临床护理质量及护理人员综合素质的有效方法。     

临床科研一体化化电子病历使用中的问题及对策

通过对中医失眠症临床科研一体化电子病历使用的临床实践,发现中医临床科研一体化电子病历使用过程中的一些问题,并提出对策。     

基层医院人才建设存在的问题与建议

基层医院的人才队伍建设是我国基层医院建设的核心。本文着重考察了十堰市基层医院人才队伍建设现状,归纳梳理十堰市基层医院人才建设存在的主要问题,并结合＂新医改＂取向提出相应对策与建议。     

中国的生物信息库和伦理问题

1998年,科技部在上海成立了国家南方和北方人类基因研究中心,两个研究中心建立了与疾病有关的信息库;2007年,泰州市开展了人群健康追踪研究项目;温州市于2008年建立了温州医学院中心生物信息库;中国法医DNA数据库自1998年开始建设,并发挥了具体作用;中国慢性病kadoorle研究与肿瘤基因组学研究项目也得以开展;香港建成了几个遗传信息库,台湾生物数据的研究也已开展。但有一些生物数据库在具体的实践中,也遇到了许多伦理难题,应随着生物信息库的建立和使用尽快解决。     

首次病程记录书写的探讨

首次病程记录是指患者入院后由经治医师或值班医师书写的第一次病程记录,内容包括病例特点、初步诊断、诊断依据、鉴别诊断和诊疗计划,不是入院录的简单重复。首次病程记录书写有3个基本要求,如书写者、书写时间和记录时间的限定。首次病程记录标题、书写者限定、书写者签名位置和记录时间的书写是书写过程中存在争议的地方;诊断与诊断依据、鉴别诊断与鉴别依据和诊疗计划是书写时问题存在最多的部分。对争议和问题进行了深入探讨,并提出了合理的对策,为规范书写首次病程记录提供参考。     

Ways of problem solving as predictors of relapse in alcohol dependent male inpatients

Aim

The purpose of this study was to identify how remitters and relapsers view their everyday problem solving strategies.

Method

A total of 128 male alcohol dependent male inpatients who were hospitalized at the Ankara University Psychiatry Clinic, Alcohol and Substance Abuse Treatment Unit were recruited for the study. Subjects demographic status and alcohol use histories were assessed by a self-report questionnaire. Also, patients were evaluated with The Coopersmith Self-esteem Inventory (CSI), The Spielberger State-Trait Anxiety Scale (STAI-I-II), and The Problem Solving Inventory (PSI). Patients were followed for six months with monthly intervals after hospital discharge. Drinking status was assessed in terms of abstinence and relapse. Data were assessed with Student t-test, and univariate and multivariate analyses. In the logistic regression analysis, age, marital status, employment status and PSI subscores were taken as the independent variables and drinking state at the end of six months as the dependent variable.

Results

There were significant differences in reflective and avoidant styles, and monitoring style of problem solving between abstainers and relapses. It was found that subjects who perceived their problem solving style as less avoidant and less reflective were at greater risk to relapse.

Conclusions

The findings demonstrated that active engagement in problem solving like utilizing avoidant and reflective styles of problem solving enhances abstinence. In treatment, expanding the behavior repertoire and increasing the variety of ways of problem solving ways that can be utilized in daily life should be one of the major goals of the treatment program.     

信息产品对以病例为基础的临床教学模式的推动作用

分析PBL教学模式和标准化病人存在的问题和局限性,阐述DxR-Clinician系统的发展过程与特点,指出该系统能为基于病例的教学模式改革带来新的契机。     

医院执行力面临的问题及改进策略

执行力是医院竞争力的核心,是把医院战略转化成为效益的关键。执行力不足是医院管理中普遍存在的问题,因此积极探索医院执行力的建设具有十分重要的现实意义。本文通过整合医院管理执行力不足的现象及其成因,从执行力的概念、核心及要素等角度分析并提出相应的解决策略。