夜间门诊的护理管理

全科夜间门诊在大型综合医院的开展，对护理管理工作提出更高的要求。夜间门诊中健全的管理体制、科学的管理方法、有效的质量监督是搞好夜间门诊的关键。问卷调查的结果提示我们要不断改进工作．深化优质服务，使夜间门诊这项方便患者的工作做的更好更完善。     

夜间门诊的护理管理

全科夜间门诊在大型综合医院的开展,对护理管理工作提出更高的要求.夜间门诊中健全的管理体制、科学的管理方法、有效的质量监督是搞好夜间门诊的关键.问卷调查的结果提示我们要不断改进工作,深化优质服务,使夜间门诊这项方便患者的工作做的更好更完善.     

A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals

Background: Goal Attainment Scaling (GAS) is an individualized goal-setting and measurement approach that is useful for patients with multiple, individualized health problems, such as those served by geriatric day hospitals (GDHs) and other specialized geriatric programmes. Purpose: To assess the feasibility and utility of GAS in a multi-site study of six GDH affiliated with the Regional Geriatric Programmes of Ontario. Method: Individualized GAS guides were developed for 15 consecutively admitted patients at each site [total n = 90; mean age: 76.2 SD 8.3; 58.9% female; mean attendances: 24.0 SD 10.3]. Staff members (n = 39) were surveyed on their experience with GAS. Results: Mean goals/patient ranged across sites from 2.1 to 4.3. Mean GAS discharge score was 52.3 SD 8.7, close to the theoretically expected values of 50 SD 10. Common goals included mobility, community reintegration, basic and instrumental activities of daily living, medical issues, cognition/communication, and home safety. Estimated mean time to develop a GAS guide ranged across sites from 15.3 to 43.8 min. Conclusion: Clients were often involved in goal setting; family involvement was less frequent. The staff survey identified challenges and benefits regarding the use of GAS. Study results are being used to inform a more consistent approach to the clinical and research use of GAS in GDH.

Implications for Rehabilitation

• The geriatric day hospital (GDH) has had a long history as one element of a comprehensive system of specialized geriatric services with potential advantages including ongoing treatment and rehabilitation from an interdisciplinary team. Despite this history, the evidence for the effectiveness of GDHs in rehabilitation of older persons has been equivocal.

• We found that Goal Attainment Scaling (GAS) was able to detect clinically relevant change in this setting which can aid in demonstrating evidence for the utility and impact of GDHs.

• GAS was feasible in this setting and clinicians felt that GAS may have an effect on speeding up discharge, as a result of having a clearer focus on outcomes that are desired for each patient.

• Clinicians felt the involvement of clients and families in goals settings resulted in more meaningful outcomes for clients and GAS aided in identifying highly individual outcomes such as quality of life and community integration that are routinely difficult to measure with standardized tools.

     

Aloud real- time reading of intensive care unit diaries: A feasibility study

ObjectivesMemories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories.Research methodologyProspective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay.SettingVarious intensive care units in a single academic center.Main outcome measuresFeasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not.ResultsOverall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort.ConclusionWe encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted.Implications for Clinical PracticeThere is no recommendation to change current practice as benefits of the intervention are unproven.     

PBL在《急救护理学》教学中的应用研究

[目的 ]探讨以问题为基础的教学 (PBL)在《急救护理学》大课教学中的应用效果。 [方法 ]实验组在《急救护理学》大部分理论课中采用了PBL ;对照组均采用传统课堂讲授法。 [结果 ]实验组对PBL法的各项教学效果评价均较好 ;期末考试成绩与对照组相比较 ,总分、选择题、问答题及综合分析题得分有统计学意义 (P <0 .0 5 )。 [结论 ] :PBL可提高《急救护理学》大课教学的教学效果。     

Science and Tradition in the Nursing Discipline

The purpose of the article is to argue for a conception of nursing knowledge that stresses theoretical and practical knowledge as equally important, and to analyze the roles of nursing science and nursing tradition in the discipline of nursing. Nursing knowledge is characterized as involving values, sets of beliefs, and procedural knowledge. Practical nursing knowledge is viewed as an integration of values, beliefs and procedural knowledge into action, whereas theoretical knowledge is viewed as a conception of nursing. Nursing tradition is described as the main organizer of practical nursing knowledge at the collective level, and nursing science as the main organizer of collective theoretical knowledge.