护士针刺伤后心理状态的调查分析

目的 了解护士针刺伤后的心理状态.方法 采用问卷法调查256名护士针刺伤后的心理状态,并对结果进行分析.结果 256名护士中有220名护士经历过针刺伤,79%的护士认识到针刺伤后最严重的结果是各种血源传播性疾病;91%的受伤者对被体液污染的针头刺伤感到害怕,70%的受伤者对针刺伤持有"难以避免"的消极态度;有10%和11%的护士产生回避和离职的念头.结论 多数护士刺伤后心理状态为非常害怕且消极无奈,但认为针刺伤不可避免以及对针刺伤不够重视;少数护士对针刺伤认识不足.     

强化教育对实习护生针刺伤发生状况的效果研究

目的探讨强化教育对实习护生针刺伤发生状况的影响。方法选取2012年7月至2014年5月405名实习护生为对照组,2014年7月至2015年5月221名实习护生为干预组,根据对照组实习护生针刺伤及针刺伤后上报情况制订强化教育措施,干预组实习护生实习过程中进行理论授课、技能训练、情景模拟及案例分析等一系列强化教育,分别在实习结束时采用相同的问卷调查,比较两组实习护生针刺伤发生率及针刺伤后上报率。结果对照组针刺伤发生率为70.37%,干预组发生率为16.74%;对照组上报率为34.39%,干预组上报率为75.68%,差异有统计学意义(P0.01)。干预组实习护生针刺伤相关知识、态度及行为得分高于对照组(P0.01)。结论强化教育可降低实习护生刺伤发生率,提高上报率。     

血液透析室医疗垃圾处理过程中预防针刺伤的流程管理

目的探讨规范操作及工作流程对于血液透析室医疗垃圾处理过程中针刺伤预防的影响。方法通过对血液透析室2014年6105例次血液透析进行统计分析,制定医疗垃圾处理的规范操作及工作流程,并将此规范流程在2015年9471例次血液透析中予以实施,观察其对预防医疗垃圾处理过程中医务人员发生针刺伤的效果分析。结果2014年医疗垃圾处理过程中,护士、护理员、工人的针刺伤发生率分别为0.3‰、0.5‰、0.5‰,护士、护理员、工人的针刺伤发生环节分别是医疗垃圾的转运、处理和运输。以此结果制定医疗垃圾处理的规范操作及工作流程,应用此规范流程,2015年医疗垃圾处理过程中护士、护理员、工人的针刺伤发生率均为0。结论通过规范操作及工作流程可以有效地减少针刺伤发生率。     

Improving clinical experiences for nursing students in nursing homes: An integrative literature review

Well-organized clinical placements in older adult care settings will prepare nursing students to provide care for this growing population and may influence career choices. The purpose of this integrative review is to identify strategies that can be used to provide student nurses with effective clinical education experiences in residential aged care facilities offering skilled nursing (RACF-SNs). Twenty-three studies evaluating teaching and learning models and experiences were reviewed. Four themes were identified related to effective strategies for providing gerontological clinical education to students in residential aged care environments, principally nursing homes. These were: developing a partnership, comprehensive orientation, effective supervision for students, and supporting staff. Eight different models were described for enhancing clinical learning experiences in these environments. These models reflect the themes highlighted in the review. Relevance of the findings to a conceptual framework for evaluating gerontological clinical placements, the Senses Framework, is considered. Strong partnerships between schools of nursing and residential aged care environments can provide well-organized clinical education to undergraduate nursing students. To be sustainable, these partnerships must be developed in ways that do not require significant additional resources. A guideline for this process based on findings of the review has been developed.     

大中专护生职业防护认知的调查与对策

目的了解大中专护生岗前职业防护认知情况,针对问题提出对策。方法自行设计调查问卷,内容包括何谓标准预防、职业伤害的应急处理、常规自身防护、接触化学药物防护、接触感染性疾病的防护;对96名不同学历护生进行职业防护认知调查。结果护生防护知识严重缺乏,防护意识淡薄,大专护生与中专护生对标准预防、职业伤害应急处理的认知存在差异。结论针对不同学历层次的护生,有所侧重地加强职业防护教育非常重要。     

The learning experiences of international doctoral students with particular reference to nursing students: A literature review

One of the key challenges for the advancement of nursing globally is the development of doctorally prepared educators and leaders in a context where there is a shortage of provision of doctoral nursing programmes. For the short term future, many nurses wishing to undertake a doctorate will need to complete this education in the USA, the UK or Australia. Very little is known however about the nature of their learning experiences in these countries. This paper presents a literature review on the international doctoral student experience, with specific reference to nursing. A thorough review of the literature from 1990 to 2009 was undertaken which yielded only three empirical studies related to nursing. The review was then expanded to include subjects other than nursing which yielded 16 studies in total. This paper presents key themes that appear to be generic to international doctoral students, and draws out specific implications for nursing.The review found that international doctoral students’ learning experiences were strongly influenced by the extent to which they could engage with three key elements of doctoral programmes:

1.

pedagogical paradigms (specifically, self-directed learning and an emphasis upon criticality),

2.

pedagogical practices (specifically, understanding supervision styles and relationships and learning in a second language),

3.

academic environments (including the availability and accessibility of peer support and professional development opportunities).

The first months represented a critical time of transition and most international students seemed to want and expect considerable support and structured in-put during this period. Most studies concluded that there was a need for greater institutional support and supervisor training. The three nursing-specific papers were entirely consistent with these themes.The existing evidence is extremely heterogeneous and of variable methodological quality. In order to ensure that doctoral nursing students are getting a high quality and appropriate PhD experience, there is a need for more research specifically with this group. There is also a need to investigate the different stages of the doctoral process in nursing, including, for example, writing up and examination processes and post-doctoral career outcomes.     

医院非呼吸机相关性肺炎护理预防措施的研究进展

非呼吸机相关性肺炎是最常见的医院感染类型,也是导致医院感染死亡的首要原因。了解其护理预防措施对指导护理人员开展相关工作,降低发生率与病死率具有重要意义。该文就非呼吸机相关性肺炎的概念及发展、形成原因与危害、护理预防措施、问题及应对策略进行综述。旨在为国内开展非呼吸机相关性肺炎护理预防措施的研究、制订预防管理相关策略提供参考。     

胜任力本位教育在护理本科生中的应用进展

护理本科生是未来护理领域的核心力量,需要有扎实的理论基础和实际工作能力,目前传统的知识本位教育思想在本科护理教育中仍占主体,即将书本中已成体系的学科知识作为教育的主要目的,强调对理论知识的理解和记忆,存在"重理论、轻实践"的弊端,导致护理本科生虽理论知识丰富,但缺乏足够的临床应用能力,毕业后不能很好地胜任临床工作.胜任力本位教育(competency-based education)是一种以职业需求为导向的新型教育模式,强调将传授知识、培养能力、提高素质三者融为一体的整体教育理念,有助于综合培养学生实际工作能力[1].本文旨在介绍胜任力本位教育在护理教育中的概念、实施方法、效果评价及应用进展,让护理教育者对该模式的理论基础及应用方法有一个更深入、直观的认识,从而更好地在护理本科生中进行应用,为培养理论及实践操作能力均全面发展的综合性护理人才奠定基础.     

The nursing critical thinking in clinical practice questionnaire for nursing students: A psychometric evaluation study

AimTo adapt and validate the N-CT-4 Practice for use with Spanish nursing students.BackgroundPromoting critical thinking is one of the primary objectives of nursing education programs all over the world. Using reliable and valid instruments to measure critical thinking is essential. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) is used internationally to assess critical thinking in nursing practice. However, little is known about the possible applications of this instrument in the context of nursing education.MethodsTwo-phase study: Phase I, adaptation of the N-CT-4 Practice for use with nursing students and verification of its content validity; phase 2, cross-sectional study to validate its psychometric properties in a sample of 331 nursing students from three university nursing schools. A subsample of 34 students completed the questionnaire on two occasions, with a time interval of two weeks. The construct validity and reliability of the instrument were tested using confirmatory factor analysis, convergent validity, internal consistency reliability and test-retest reliability. The STROBE guidelines and the COSMIN checklist were followed.ResultsAll items obtained optimal content validity values. The model fit indices obtained from the confirmatory factor analysis supported the hypothesis of the four-dimensional structure on which the original questionnaire was based. Cronbach's alpha of 0.96 indicated high reliability. The correlations between the total score and the scores for the dimensions were statistically significant, positive and high, with values above r = 0.78 (p < 0.05). Lin's concordance correlation coefficient was 0.6 (p < 0.001).ConclusionsThe adapted version of the N-CT-4 Practice is suitable for measuring critical thinking skills in the educational context of the degree course in nursing in Spain. Its psychometric validation yielded satisfactory results.     

Challenges and strategies in developing nursing research capacity: a review of the literature

OBJECTIVES: This paper reports the findings of a critical overview of the development of nursing research capacity in academic departments. It examines the major barriers to developing research capacity, the capacity building strategies adopted (or proposed) within the literature, and considers the wider context within which such endeavours take place. DESIGN: The literature review forms part of a longitudinal project utilising case study methodology. A key word search was used to locate relevant journal articles for the period 1999-2004, derived from the project's research question and an earlier literature review. A number of manual 'shelf searches' were conducted. DATA SOURCES: Bibliographic data were retrieved from The Cumulative Index of Nursing and Allied Health literature, The Social Science Citation Index, and Medline. REVIEW METHODS: Approximately 150 articles were retrieved, of which 47 were included in the study. Given the paucity of work in this area papers were not excluded on the grounds of methodological weakness. Major themes were identified in each paper and an analytical framework was developed. RESULTS: Two main challenges affecting research capacity development were identified-material constraints and organisational contexts, and the changing roles and expectations of nurse educators. The importance of developing an overall strategic approach, clearly communicated, and accompanied by effective leadership was a point of common agreement. Debate existed on how research support should be managed, particularly the merits of inclusivity and the reconcilement of individual and organisational needs. Specific capacity strategies identified in the literature were the creation of infrastructures, the fostering of research cultures and environments, and the facilitation of training and collaboration. CONCLUSIONS: The literature offers many examples of capacity building strategies. However, more empirical studies are needed to understand the situated process of implementing and evaluating capacity building in individual academic departments, and how this process differs between geographical settings.     

Intervention studies for prevention of pressure ulcers in Turkey: a literature review

AIM: To examine critically the literature published in the Turkish language (1955-2004) related to risk assessment tool(s), their application to nursing care and prevention of pressure ulcers (PrUs). Specific objectives were to identify the advantages of risk assessment and prevention of PrUs in hospital; to establish the most valid and reliable methods available to evaluate the effectiveness of PrU prevention programmes; to determine methodological problems encountered by researchers and explore how these were overcome; and to present the findings so they could be used to develop a valid and reliable audit tool based upon the empirical evidence. METHODS: All journals and convention booklets published in Turkey related to nursing between the years 1955-2004 were examined. Because many journals in Turkey are not yet available by electronic means, the published Turkish articles were all examined by hand. A total of 3031 articles in 17 nursing journals and 36 congress books (convention booklets) were examined. Five articles were found to meet the study criteria and were taken into the study and evaluated. CONCLUSION: There is a need to determine valid and reliable assessment methods, and the results need to be recorded on standard forms. In addition, it is important to increase the motivation of nursing personnel who give direct patient care to use the tools available in order to prevent the development of PrUs. From the review findings it is apparent that in Turkey, there is a dearth of research evidence upon which to base practice in the sphere of PrU prevention, and further research is urgently required.     

失效模式与效应分析在急诊科工作人员锐器伤防范中的应用

目的探讨失效模式与效应分析在急诊科工作人员锐器伤防护中的应用与效果。方法对2009年1月至12月发生的锐器伤事件中可能出现的失效模式进行评估、分析,从加强操作培训、加强环境和制度管理、提高工作人员的安全防护意识方面制订整改措施,并监控实施情况和效果。结果急诊科工作人员锐器伤发生率降低(P<0.05)。结论应用失效模式与效应分析能有效减少急诊科工作人员的职业风险。     

神经外科护理危机成因分析与防范策略

目的分析神经外科护理危机事件的成因,提出防范策略,规避护理风险,保证护理安全。方法对主动上报的38例神经外科危机事件进行分析,寻找构成原因。结果因疾病及护理人员因素造成的危机事件各占事件总数的31．59％,患者因素占事件总数的23．68％,环境及药物因素分别占事件总数的5．26％和7．89％。结论神经外科护理危机事件是由多重原因造成的,需要通过预警评估、提高可视度、动态人力调配、维护环境安全、注重培训、物品规范化管理等一系列护理防范措施,达到控制神经外科护理危机事件发生的目的。     

手术室实习护生职业损伤防护现状调查分析与对策

目的:调查手术室实习护生职业损伤防护现状,探讨有效防护对策。方法:对2010年7月～2011年7月我院158名手术室实习护生进行问卷调查,以了解实习护生发生职业损伤的危险因素。结果:实习护生发生职业损伤的危险因素,包括对环境的陌生感,对手术器械、用物的不了解,对无菌操作的不规范,对手术的紧张感,对应急事件的惊恐,实际操作机会少等。结论:实习护生在临床实习中发生职业损伤的状况较为普遍,预防损伤的措施和发生损伤后的处理仍有待改善,须加强护生的职业安全教育及自我保护意识,提高实习护生对风险的认知和处理能力,降低职业损伤的发生率。     

Encrustations of the urinary catheter and prevention strategies: a literature review

Patients with an indwelling urinary catheter are at risk of developing urinary tract infection: for each day of the catheter remaining in situ, there is an increasing risk from 3% to 7% for infection to appear. One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. Aim of this study is to describe the problem of indwelling urinary catheter encrustation and prevention strategies. A narrative review of the literature was conducted. Indwelling urinary catheter encrustations originate more easily when urine contains high concentrations of poorly soluble constituents and when the state of the urinary tract enables their precipitation as an alkaline urinary pH, often associated with the presence of bacteria urease‐producers, for instance Proteus mirabilis. Urease can generate crystals and this process keeps going until the accumulation of crystalline deposits block the urine flow within the catheter lumen. The literature suggests that there are manifold pharmacological and non‐pharmacological strategies to prevent encrustations. The literature analysis suggests that the permanence of the catheter could potentially be one of the most relevant causes of encrustation. The catheterization duration is the most important risk factor for bacteriuria, essential for the process of encrustation to start off. There are many prevention strategies, among which promotion of nucleation pH (pHn) supplementation in the daily diet with liquids containing citrate; this is the most simple and suitable for all patients being inexpensive and effective.     

实习护生与患者进行有效沟通的技巧探讨

目的了解护生与患者进行有效沟通及运用技巧的过程,探索提高护生与患者进行有效沟通的技巧。方法对2005~2006年在华中科技大学附属同济、协和两所医院实习的某高校90名实习护生(同济医院实习护生43人,协和医院实习护生47人)在实习过程中安排适当的沟通技巧的理论和临床教学,开展以“护生与患者进行有效沟通的技巧”为主题的访谈会,通过问卷调查的方式了解护生与患者进行有效沟通情况,总结运用技巧存在的问题并提出对策。结果护生普遍沟通意识较强,但不能很好地应用沟通技巧进行沟通实践,且存在一定的沟通问题。结论加强护生沟通能力的训练和临床实践,有助于护生熟练掌握沟通技巧。