护士工作倦怠感与工作压力源、自我效能感的相关性分析

目的:了解目前护士工作压力、自我效能感及工作倦怠的现状,探讨三者之间的关系。方法:采用护士工作压力源量表、一般自我效能感量表(GSES)、工作倦怠感量表(MBI)调查2所医院的310名护理人员的相关情况,并分析其相关性。结果:本组护士工作压力源量表中工作量及时间分配方面的问题得分最高为(3.22±0.96)分;自我效能感得分为(2.45±0.58)分,处于中等以上水平;MBI中情绪衰竭得分为(29.84±13.99)分、个人成就感得分为(27.58±11.18)分,都属于高度倦怠感,去人格化得分为(8.19±5.82)分、为中度倦怠感;工作压力源、自我效能感与工作倦怠呈显著相关性(P<0.05);分层回归结果表明,工作压力和自我效能感显著影响工作倦怠各因子(P<0.05),自我效能感在工作压力与工作倦怠之间存在一定的调节作用。结论:管理者应采取一定护理措施减少和消除护士压力源,提高护士自我效能感水平,降低护士工作倦怠的水平,提高护理质量。     

基于行动研究法的护士结构性授权的干预效果评价

目的探索结构性授权与工作倦怠之间的关系，探讨护士结构性授权的干预措施。方法采用工作效能条件问卷、工作倦怠感量表对某三级甲等医院的380名护士进行调查，针对干预前的调查结果制订干预对策并实施，对干预后的结果进行调查，了解结构性授权干预措施的实施效果。结果结构性授权各因子与工作倦怠中情感衰竭和去人格化呈显著负相关性，但信息权利在本研究中未发现与去人格化显著相关，与个人成就感这一因子呈显著正相关性；干预4个月后，被干预护士群体的结构性授权中支持、信息和机会权利显著改善，资源权利未发现显著改善；工作倦怠中情感衰竭和去人格化水平显著降低，个人成就感没有显著改善；干预后工作倦怠的程度较干预前降低。结论管理者应该灵活利用提高结构性授权水平的干预措施，达到降低护士工作倦怠感的目的。     

综合医院护士心理健康的分析研究

目的 了解护士抑郁、焦虑、职业压力及工作倦怠情况,探讨护士的抑郁、焦虑与职业压力及工作倦怠之间的相互关系.方法 对入选的各临床科室护士进行抑郁自评量表、焦虑自评量表、工作压力源量表和工作倦怠量表问卷调查.结果 抑郁平均分（51±8）分,焦虑平均分（41±7）分,压力平均分（82±18）分,工作倦怠平均分（59±13）分;护士抑郁、焦虑得分与年龄成反比,而职业压力和工作倦怠得分与年龄成正比.结论 护士年龄越小抑郁、焦虑情绪越大,年龄越大工作倦怠感越强烈.建议从管理角度采取相应措施减少或消除护士的抑郁、焦虑情绪和职业压力源,并对不同年龄段的护士进行有针对性的减压方面的训练,必要时可行心理干预治疗.     

手术室护士工作压力源与自我效能、心理弹性以及工作倦怠感的相关性研究

目的 分析手术室护士工作压力源与自我效能、心理弹性以及工作倦怠感的相关性。方法 采用便利抽样法,于2022年10月-12月选取本地区4所二级甲等医院108名手术室护士为研究对象,采用中国护士工作压力源量表、心理弹性简化量表、一般自我效能感量表以及职业倦怠量表进行调查,分析工作压力源与自我效能、心理弹性以及工作倦怠感的相关性。结果 共发放调查问卷110份,回收有效问卷108份(98.18%)。108名手术室护士工作压力源总分为(2.01±0.52)分,处于中度压力水平;自我效能、心理弹性以及工作倦怠感得分分别为(2.18±0.69)分、(2.52±0.43)分和(68.96±13.08)分;Pearson相关分析结果显示,手术室护士工作压力与自我效能、心理弹性呈显著负相关(r=-0.531、-0.489,P<0.05),与工作倦怠感呈显著正相关性(r=0.672,P<0.05)。结论 手术室护士工作压力处于中等水平,且工作压力水平与自我效能、心理弹性以及工作倦怠感密切相关,医院管理部门应结合手术室护士实际情况,制定针对性管理措施,缓解其工作压力,改善自我效能、心理弹性,降低工...     

工作压力在护士职业倦怠与工作特征的中介作用

目的了解护士职业倦怠、工作特征与工作压力的现状并评估三者的关系。方法采用一般情况调查表、中文版护士职业倦怠量表(maslach burnout inventory,MBI)、护士压力源量表、工作特征量表(job characteristics inventory)对423名护士进行调查。采用Pearson相关分析探讨护士工作特征、工作压力与职业倦怠三者的关系,根据Pearson相关分析,建立路径关系模型,对护士职业倦怠、工作特征与工作压力三者之间的关系进行路径分析。结果职业倦怠量表中护士情感耗竭维度的得分(26.04±11.64)分、工作冷漠感维度(7.39±2.14)分、个人无成就感维度(33.87±8.64)分,三者高度倦怠感分别占50.83%、39.01%、49.41%;护士工作特征总分(104.52±15.51)分;工作压力总分(109.32±18.93)分。工作压力在工作特征与职业倦怠之间有部分中介作用,中介效应占总效应的54.40%。结论护士职业倦怠较严重。护理管理者应采取有效的措施降低护士的工作压力感,从多个维度改善护士的工作特征,从而降低护士职业倦怠水平。     

护士心理授权状况与工作倦怠的相关性分析

目的：了解护士的心理授权现状和工作倦怠情况,分析两者间的相关性,探索预防和降低护士工作倦怠的新对策。方法整群抽取广州5家三甲医院的临床护士203人,采用心理授权量表及工作倦怠量表进行调查。结果护士的心理授权感知得分（4．75±0．67）分,为中等水平;其中自我效能得分最高为（5．34±0．73）分,工作影响得分最低为（3．64±0．11）分;护士有较严重的工作倦怠,其中个人成就感丧失维度（3．83±0．62）分,情绪枯竭维度（2．96±0．81）分,去人格化倾向维度（1．89±0．84）分;护士心理授权感知与工作倦怠关系密切,与情绪枯竭、去人格化倾向、个人成就感各维度呈负相关（r值分别为－0．436,－0．366,0．514;P＜0．01）。结论临床护士的心理授权处于中等水平,临床护理管理者应加强护士对心理授权的感知,以降低工作倦怠感的产生。     

随州市护士工作倦怠状况及其与工作压力源和控制感的相关性研究

目的 探讨护士的工作倦怠状况及其与工作压力源、控制感的关系.方法 运用护士工作倦怠量表(MBI)、护士工作压力源量表(NJSI)、工作心理控制感问卷(WLCS)对随州市3所医院356名护士进行调查,采用Person相关法分析工作倦怠与工作压力源、控制感的相关性.结果 356名护士工作倦怠量表测评中,高度情绪枯竭者占45.5%,高度去人格化倾向者占31.4%,低度个人成就感者为38.6%.在个人成就感纬度上,中专组护士的得分显著低于大专组护士(P＜0.05);在去人格化倾向纬度上,手术室组得分显著低于其他科室组(P之0.05或P＜0.01).相关分析表明,护士情绪枯竭和去人格化维度得分与工作压力源5个方面因子、控制感均存在显著正相关(P＜0.01或P＜0.001),个人成就感仅与管理及人际关系方面因子、控制感存在显著负相关俨＜0.05或氏0.001).结论 临床护士普遍存在工作倦怠问题,低学历护士工作倦怠情况较严重,手术科室护士相对其他i临床科室护士工作倦怠情况较轻.医院应通过降低护士工作压力源、培养护士内控的性格,以缓解其工作倦怠的情况.     

新形势下护士工作倦怠与自我效能水平的调查研究

目的:了解优质护理服务实施过程中护士的工作倦怠水平及自我效能水平。方法:采用工作倦怠感量表及自我效能量表对临床护士进行问卷调查。结果:工作倦怠中情绪疲倦感得分为(17.36±10.22)分,工作冷漠感得分为(4.17±4.13)分,均为低度倦怠;个人成就感得分为(12.19±7.70)分,属于高个人成就感。自我效能感得分为(25.08±4.49)分,自信心处于较高水平。自我效能与个人成就感呈显著正相关(r=0.40,P<0.01),而与情绪倦怠、工作冷漠感之间无显著相关性(r=-0.25,r=-0.14,P>0.01)。结论:护士的工作倦怠感低,自我效能水平较高,自我效能与情绪疲倦、工作冷漠之间无明显相关性,与个人成就感显著相关。     

护士工作压力、职业承诺与工作倦怠的研究

【】目的：探讨护士工作压力、职业承诺对其工作倦怠的影响。方法：采用中国护士压力源量表、职业承诺问卷、国内修订版工作倦怠普适量表(MBI-GS)对160名护士进行问卷调查。结果：①护士工作压力的总均分为3.06&amp;#177;0.68分;职业承诺的总均分为3.02&amp;#177;0.67分;工作倦怠中情绪枯竭得分为20.47&amp;#177;7.20分,工作态度(玩世不恭)得分为13.26&amp;#177;5.82分,低成就感得分为25.76&amp;#177;8.33分。②工作压力和职业承诺均对工作倦怠有显著影响;且工作压力能够通过职业承诺的中介作用,负向预测护士工作倦怠的情绪枯竭和工作态度两个维度。结论：护士工作压力、职业承诺和工作倦怠三者密切相关;职业承诺对工作压力和工作倦怠有部分中介作用。     

儿科夜班护士工作倦怠感及其自我效能的相关性分析

目的:探讨儿科夜班护士工作倦怠感及其自我效能的相关性.方法:采用问卷调查法对80名儿科夜班护士进行工作倦怠感及其自我效能的相关性调查.结果:儿科夜班护士工作倦怠感中情绪倦怠感得分为(25.45±10.17)分, 工作冷漠感得分为(6.52±5.58)分, 均为中度倦怠; 个人成就感得分为(29.32±8.27)分, 属于高度倦怠.自我效能感得分为(2.58±0.53)分.自我效能感得分与情绪倦怠感得分呈显著负相关( r=-0.225, P<0.01) , 自我效能感得分与个人成就感得分呈显著正相关( r=0.419, P<0.01).结论:应重视提高儿科夜班护士的自我效能感,以便更有效地降低护士的工作倦怠感.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.