北京市属医院护士规范化培训模式介绍

护士规范化培训是护理人才培养的"摇篮工程",对加强我国护理人才队伍建设、提高护理服务质量有着重要的作用。北京市医院管理局适时启动了护士规范化培训试点工作,逐步完善护士毕业后教育模式,探索建立以岗位需求为导向、岗位胜任力为核心的护士规范化培训制度。本文介绍了以培养临床思维方式、提高护理实践能力为主导的护士规范化培训模式,为建立符合临床需求的护士规范化培训制度,形成护士岗位培训的长效机制奠定基础。     

视频教学在中医医院低年资护士规范化培训中的应用

目的 探讨视频教学在中医医院低年资护士规范化培训中的作用,为中医医院建立中医护士规范化培训模式提供参考依据.方法 采用视频教学替代传统的课堂讲授、操作示教,结合小组讨论、临床查房、情景模拟、个案护理等培训方法,对本院低年资护士进行规范化培训.结果 运用视频教学进行规范化培训,低年资护士的中西医基本理论知识、常见临床护理操作技术与中医护理操作技术、专业理论与实践能力均有了很大提高,三年共91名低年资护士均通过规范化培训结业.结论 应用视频教学对中医医院低年资护士进行规范化培训,培训效果显著提升,提升护士专业技术水平和护理服务能力,有利于中医医院中医护理人才的培养,是一种适合临床的中医护士规范化培训方法.     

提高规范化培训护士人文素质的方法与效果

目的 探讨人文素质教育在护士规范化培训中的应用及效果.方法 对规范化培训的护士采取多种形式、多种渠道进行人文素质教育,通过护理都、科护士长、临床科室三级培训体系,在注重知识、技能传授的同时,更注重人文素质培训,建立完善人文素质评价机制,从而提高规范化培训护士人文素质的整体水平.结果 经过1年多的培训探索,规范化培训护士的护理不良事件上报率增加,建立了良好的职业认同感,构建了良好的护患关系,提高了患者的满意度,与培训前相比,差异均有显著意义(P＜0.05).结论 护士规范化培训中不能忽视人文素质的培养,人文素质教育是综合素质培养的重要基础.     

设置障碍法在新护士规范化培训中的应用

护士规范化培训是指在完成医学院校基础教育后,接受规范的护理专业培训。它是护理学科发展的关键环节,也是护理人才梯队培养的重要任务之一。本院于2008年起正式开展了护士规范化培训。通过规范化培训能提高护士的业务水平和实践能力,对促进人才的成长及提高本院护理服务水平起到了积极的推动作用。     

新护士规范化培训的需求调查与对策

护士培训是护理人力资源管理的重要组成部份,而新毕业护士培训是整个培训的基础,对于护理队伍的建设和护理人才的培养起举足轻重的作用,通过有计划、有目标、有针对性的对第1年新护士进行规范化岗前和岗位培训,可以帮助他们尽快适应新环境,实现从学生到专业护理人员的角色转变,从而胜任临床护理工作.     

毕业后第一年新护士规范化培训实践

目的探讨毕业后第一年新护士规范化培训方法,夯实其护理基础理论和基本技能,提高综合素质,提高护理质量。方法通过建立规章制度和新护士规范化培训总则,完善新护士培养手册及评价标准,规范培训流程,强化培训频次,进一步明确毕业后第一年新护士不同阶段的培训及考核要求,从而实施规范化培训。结果新护士的基础护理知识、基础技术操作明显提高,实现了毕业后第一年新护士培训程序化及规范化的科学管理。结论规范化培训模式,加快了毕业后第一年新护士的培养,促进了护理“三基”水平和护理质量的提高,为今后新护士的培养提供了经验。     

我国新毕业护士规范化培训体系的现状及发展

<正>护士规范化培训是指在护理专业院校完成基础教育后接受的护理专业化培训,促使他们很快熟悉医院环境、胜任临床护理工作。李继平等报道,新护士规范化培训能完善我国护士培训制度和毕业后护士继续教育体系,培养临床实践人才,提升临床护理工作质量。《卫生部关于实施医院护士岗位管理的指导意见》中强调要加强新护士培训,实行岗前培训和岗位规范化培训制度。虽然全国大多数医院均开展新护士     

护士规范化培训中存在问题与管理对策

护士规范化培训是指护理专业院校的毕业生在完成基础教育后,接受规范的护理专业化培训,是护理人力资源管理的重要组成部分,是护理人才梯队培养的重要任务之一[1].对于低年资护士,在从事专业的早期进行系统、规范的培训,是非常必要的[2].它是培养能够学以致用的合格护理人才的重要途径,也是提高医院护理质量的有效办法,是实施优质护理的前提,更是保证优质护理的有力措施.但在护士规范化培训的具体实施过程中,也发现了许多存在问题,需要尽快予以解决.     

护士规范化培训与专业化发展一体化模式构建设想

分析和讨论我国护士规范培训现状,分别从我国护理人力资源编制、护士规范化培训的现状、护理人员职业生涯规划以及护士专业化发展体系等方面阐述了对我国护士规范化培训长效机制建立的思考。认为我国目前护理人才的间断式培养模式不利于护理人员的专业化发展,逐步建立和完善护士规范化培训与护士专业化发展综合教育培训体系是我国在职护理人才培养和队伍建设的关键。     

护士规范化培训与专业化发展一体化模式构建设想

分析和讨论我国护士规范培训现状,分别从我国护理人力资源编制、护士规范化培训的现状、护理人员职业生涯规划以及护士专业化发展体系等方面阐述了对我国护士规范化培训长效机制建立的思考.认为我国目前护理人才的间断式培养模式不利于护理人员的专业化发展,逐步建立和完善护士规范化培训与护士专业化发展综合教育培训体系是我国在职护理人才培养和队伍建设的关键.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.