COVID-19 pandemic,as experienced in the surgical service of a district hospital in Spain

The coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2, was first identified in December 2019 in Wuhan, China, and has since spread rapidly, evolving into a full-blown pandemic. We would like to report our experience after 1 year of this pandemic in the surgical service of a district hospital in Spain. There have been many changes (including new protocols) that our service and the hospital have undergone, to adapt to the new situation. We believe that this experience can be useful for other professionals who have lived and are living a similar situation.     

新冠肺炎“动态清零”常态化下应急梯队护士体验的质性研究

目的 研究新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验。提出针对性改善护士的心理状况的方法和建议。方法 于2021年10月选取上海市静安区闸北中心医院应急梯队的护士11名为研究对象，对其进行半结构式面对面谈话，并采用Colaizzi七步分析法进行资料分析。结果 进入应急梯队的护士普遍存在着紧张焦虑，情绪低落，身心疲惫等心理问题。而执行完应急任务后的成就感，社会的认同，多方的理解支持，有利缓解心理压力。结论 通过对新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验的了解，护士普遍存在各种心理问题，需要给予针对性的干预措施，提高应急梯队成员的心理素质和应急能力。     

Learning to live with a hand nerve disorder: A constructed grounded theory

Study DesignGrounded theory.IntroductionThe broader perspective of health offered by the World Health Organization's International Classification of Functioning, Disability and Health has had a significant bearing on how we view the measurement of health outcomes after surgical or therapy interventions for peripheral nerve disorders affecting the hand. The value of the patient's perspective is now recognized and outcomes which reflect this are being advocated in the clinical management and support of this population.Purpose of the StudyThis qualitative study sought to explore the lived experience of a hand nerve disorder and in particular the impact on body structure/function, activities, and participation.MethodsIn depth, one-to-one interviews with 14 people with a range of hand nerve disorders were conducted. Constructivist grounded theory methods were used to collect and analyze the data. Patients were also given the option of taking photographs to visually represent what it is like to live with a nerve disorder, to bring with them for discussion during the interview.ResultsThe impact of hand nerve disorders forms part of a wider narrative on adaptation. A process of “struggling” and then “overcoming” was experienced. This was followed by an interior aspect of adaptation described as “accepting.” This gave rise to participants “transforming,” being changed as a result of the journey that they had been on.ConclusionsThis study provides an explanatory theory on the adaptive process following a hand nerve disorder which may inform future patient-therapist interactions.     

Learning social determinants of health through a home visiting course in the clinical years

ObjectiveThe purpose of this study was to assess the impact of a new experience-based educational program aiming to teach social determinants of health (SDH) and health disparities, through a post-discharge home-visit conducted with patients recruited in hospital.Methods105 clinical-year students visited 177 patients living in disadvantaged circumstances. Their home-visit reports were analyzed employing mixed methodology. Content analysis was conducted for classifying issues raised by students, and quantitative analysis to compare reports by level of elaboration, gender and class.ResultsFifteen taxonomy items were identified. Social support and patients' medical conditions were most prevalent, followed by personal-related and community-related issues. Analysis demonstrated students' understanding of the relationship between SDH and patient health, and challenges patients face following discharge. Women and mixed couples provided more elaborate reports, which contained significantly greater critique of medical care.ConclusionsMeeting patients both in hospital and at home enhanced awareness of SDH. Students learned to view the patient comprehensively, and to understand the diverse factors affecting their health. Students, who had essentially sole responsibility for the home-visit, successfully integrated their skills to take action when needed.Practice implicationsThe ETGAR experience provided a means for effective learning about how social determinants impact on health.     

周亚滨教授运用六经辨证治疗心病证治经验

周亚滨教授从“伤寒最多心病”立意,通过总结《伤寒论》一书对于心病的脉证及遣方用药,指出六经辨证体系对于心病证治具有指导意义。六经辨证是涵盖了八纲以及脏腑经络辨证的学说,能够指导着脏腑经络生理、病理变化的辨证论治。文章整理周亚滨教授在基于六经病证分论的基础上,临证上运用六经辨证思维论治心病的辨证经验,用药上可概括以和、温、补、清、下法为多。     

Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study

BackgroundThe fulfilment of birth expectations is important to women and strongly related to birth satisfaction.ObjectiveThe aim of this study was to investigate women’s expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled.MethodsA longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences.ResultsThe majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women’s expectations and experiences. Most likely to be fulfilled were women’s expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled.ConclusionsPregnant women’s expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.     

占永立教授从咽论治IgA肾病的理论与实践探析

本文从理论与临床实践2方面总结了占永立教授从咽论治IgA肾病的经验。占教授将Ig A肾病分为3型进行辨证论治:1)肺气不足,热毒扰咽证; 2)脾气虚弱,热邪客咽证; 3)肾阴亏虚,余热留咽证。治疗上以清热解毒利咽为主,兼以扶正,根据病情灵活选方用药,取得较好的临床疗效。     

Teaching,Learning and Bion's Model of Digestion

In this paper the author is using Bion's model of the digestive process, among other models, in order to think about how teaching of theory can be approached as a task and undertaken in practice. Beginning with the ideas of Plato, she discusses how new ideas may be best conveyed, and how psychoanalytic theory teachers (using the teaching of Melanie Klein's ideas here to make her points) may make what they teach acceptable and ‘digestible’ to students. She uses some material from a theory group as well as a baby observation group, and concludes that in group teaching the responsibility for the taking on and elaboration of ideas – a process of digestion – is shared by the teacher and by the group. As psychoanalytic workers need to be able to ‘manage uncertainty’ in daily practice, this state of mind can usefully also be held by the theory teacher. The process of digestion will vary according to the composition of any group, drawing out different facets of understanding in both ‘teachers’ and ‘learners’, and may well draw on other vertices beyond that of psychoanalysis. These links will aid the process of digesting ideas, and will also be evident in the author style, structure and content of this paper.     

‘A longing for a sense of security’ – Women’s experiences of continuity of midwifery care in rural Sweden: A qualitative study

BackgroundThere is evidence that continuity models of midwifery care benefit women and babies in terms of less birth interventions and higher maternal satisfaction. Studies about continuity models in a Swedish context are lacking.ObjectiveThe aim of this study was to describe how women experience continuity of midwifery care in a Swedish rural area, and thereby provide a deeper understanding of what this care entails for women.MethodsA qualitative interview study using thematic analysis was carried out. Telephone interviews were conducted with 33 women who participated in a continuity of midwifery care project in a rural area of Sweden.ResultsThe overarching theme ‘a longing for a sense of security’, pervaded the three main themes: ‘The importance of professional midwifery care’, ‘Continuity of midwifery – fulfilled expectations or full of disappointments’ and ‘New prerequisites – acceptable to some, but not a substitute for everyone’, which explains different aspects affecting the feeling of security. The endeavour to feel secure during pregnancy, birth and postpartum was a continually recurring subject that cannot be overstated.ConclusionContinuity of midwifery care strengthened women’s feelings of security during pregnancy, birth and postpartum. The deepened relationship developed over time was a central part of the positive aspects of the experience of continuity in midwifery care. Expectations and prerequisite circumstances are important to consider when developing and introducing new care models. Service providers and decision makers should pay attention to and prioritise this relational aspect when planning care for women during the childbearing period.     

Nurses’ knowledge,experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey

ObjectiveTo explore Australian intensive care nurses’ knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events.DesignA quantitative cross-sectional online survey was used.SettingThe study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses’ professional association (Australian College of Critical Care Nurses).Main outcome measuresParticipants’ knowledge and self-reported adherence to evidence-based guidelines.ResultsThe median knowledge score was 6/10 (IQR: 5–7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants’ years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6–8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants’ knowledge and adherence to evidence-based guidelines (p = 0.144).ConclusionParticipants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.