临床路径在临床护理带教工作中的应用

临床实习是护理教育的最后阶段，护生临床实习是理论联系实际，巩固和提高已学知识的有效途径，是一种锻炼服务思想，培养专业素质，提高技术水平，培养工作能力的综合性教学环节。临床路径（clinical pathways，CP）是美国20世纪80年代以后逐步发展起来的质量效益型的管理模式。它是一种包括了多专业的协调合作、预期结果的制定、服务的时限性、服务的连续性、持续的服务品质改进等特殊内涵的，设计精密的临床服务计划。     

水中分娩的临床护理路径研究

临床护理路径是制订的一种有效降低医疗费用、缩短住院日、提高服务品 质的管理式照顾新模式[1].临床路径起源于1950年国外的工业质量管理体系,经过近20年的实践与发展,临床路径的理论和实践在国外已形成了较完善的体系[2].     

早期接触临床的预实习模式在护理本科生中的应用

[目的]培养学生的沟通能力和临床思维能力,提高护理本科生的临床实习质量.[方法]在临床实习前1年,采用周末到门诊导诊、晨间到病房参与晨间护理的方法对174名护理本科生实施了早期接触临床的预实习模式.[结果]100%的学生认为该模式加深了对护理专业的认识,有利于理论与实践的结合,提高了沟通能力;92%的学生认为该模式能激发学习兴趣;80%的学生认为该模式提高各科知识的综合应用能力.75%的带教老师认为该模式有利于提高晨间护理和导诊质量.[结论]在护理本科生中实施早期接触临床的预实习模式切实可行,实现了理论教学、临床思维与学生沟通能力的培养于一体,缩短了临床实习的适应期,提高了临床实习的质量.     

临床护理路径在无抽搐电休克治疗患者中的应用

<正>无抽搐电休克治疗是在通电前给予麻醉剂和肌肉松弛剂,使得通电后不发生抽搐,更安全,也易被患者和家属接受[1]。临床护理路径是一个可以预先决定起点和终点的流程,将"早日康复"和"尽可能少的医疗费用"作为医疗护理服务的最终目标。是一种以患者为中心的成效管理模式[3]。我院将临床护理路径应用到无抽搐电休克治疗中,护士按照护理路径内容,观察、分析病情、实施相应的护理操作,规范了临床护理工作,提高了护理质量。1临床资料     

德尔菲法在标准临床护理教学路径设计中的应用

[目的]研制适合临床护理教学使用的标准临床护理教学路径,规范临床护理教学工作。[方法]根据护生进入各专业科室实习的时间安排,参考护理专业实习大纲,结合医院临床教学安排及专业带教实际情况,研究小组经过广泛查阅相关文献资料,形成初步的临床护理教学路径的框架和指标,选取15名护理专家,利用德尔菲法确立路径表的最终结构和各项评估指标。[结果]两轮专家函询的积极系数均为100.0%,专家权威系数分别为0.90和0.93,变异系数0.3。[结论]基于德尔菲法构建的标准临床护理教学路径明确了各专业的实习目标及内容,规范了全院护理教学行为。     

实习护生对临床带教反馈的调查分析与对策

临床实习是完成护理教学计划和培养目标的最后阶段 ,是整个专业教学计划的重要组成部分 ,是以临床实践为主对学生的基本理论、基本知识和基本技能进行综合训练的重要环节 ,是以培养学生的独立工作能力为主要目的的综合培养和全面实践训练 ,是一种将理论知识转化为实际工作能力的教学方法 ,是将专业理论知识应用于解决病人的临床实际问题 ,并在实践中进一步充实和提高的过程 ,是护理教育的重要环节[1] 。通过临床实习 ,可以为学生以后从事专业工作打下良好的基础 ,因此 ,临床教学质量的优劣直接关系到向社会输送护理人才的质量。为了提高临床…     

临床护理路径在经桡动脉穿刺冠状动脉介入治疗中的应用

临床护理路径(clinical pathway of nursing,CPN)是一种制订好的计划,它的功能是用图表的形式提供有效的照顾,使诊疗、护理有序,减少遗漏项目,缩短患者住院日,提高护理质量[1]。近年来,桡动脉穿刺冠状动脉介入治疗在临床上逐步应用[2~4]。为了探求一条合适的护理路径,尽可能提供全方位的护理服务,使患者尽早康复,减少医疗费用,提高患者满意度,我科2004年11月-2005年11月对84例经桡动脉穿刺行冠状动脉介入治疗的患者实施CPN,提高了工作效率,保证了护理质量,现报道如下。资料与方法1.一般资料。2004年11月-2005年11月,经桡动脉穿刺冠状动脉…     

护理教学质量控制小组在临床护生带教质量考核中的应用

临床实习是护理教育的最后阶段,也是培养护生成为实用型护理人才的重要阶段。护生临床实习是理论联系实际,巩固和提高已学知识的有效途径,是一种锻炼服务思想,培养专业素质,提高技术水平,培养工作能力的综合性教学环节。护理质量控制是护理工作的核心,而质控管理是护理管理的重点。基于护理教育将临床实习作为培养护士的重要环节,     

护理本科生在临床实习中实施"双导师制"的实践与效果

[目的]对本科护生应用"双导师制"临床带教模式,旨在提高护生临床实习质量与综合素质。[方法]对2005年—2007年来院实习的68名护理本科生实施双导师制临床带教模式,并在实习结束时对其进行了临床综合能力考核评价和问卷调查。[结果]"双导师制"带教模式的护生在护理综合知识、护理技能操作、程序应用、护理管理等方面的综合素质明显提高。[结论]"双导师制"临床带教方法对稳定护生的专业思想、实习质量、培养护生的综合素质起着十分重要的作用。     

腹腔镜胆囊切除病人健康教育的临床路径效果观察

[目的]探讨临床护理路径在腹腔镜胆囊切除术病人健康中教育的应用效果。[方法]将住院行腹腔镜胆囊切除术病人204例随机分组,对照组和实验组各102例,对照组采用传统健康教育方法,实验组采用临床路径标准模式进行健康教育。[结果]实验组健康教育知识掌握率、对护理服务满意率明显高于对照组(P<0.01)。[结论]运用临床护理路径进行健康教育,提高了教育效果及病人对护理的满意度,因而提高了医疗护理质量,是一种有效的健康教育方法。     

Rofecoxib: clinical pharmacology and clinical experience

BACKGROUND: Rofecoxib is a member of a subgroup of nonsteroidal anti-inflammatory drugs (NSAIDs) known as cyclooxygenase-2 (COX-2)-selective inhibitors. It has been studied in adult and elderly patients in a number of painful conditions (primary dysmenorrhea, acute pain after dental and orthopedic surgery, osteoarthritis [OA], and rheumatoid arthritis). OBJECTIVE: This review discusses the clinical pharmacology of and clinical experience with rofecoxib, and the role of COX-2-selective inhibitors in clinical practice. METHODS: Pertinent studies were identified through searches of MEDLINE and EMBASE, as well as the Web sites and proceedings of relevant scientific meetings. RESULTS: Although the published literature is limited, the data indicate that rofecoxib is an effective analgesic agent for the painful conditions in which it has been studied. As a COX-2-selective inhibitor, rofecoxib offers safety advantages over traditional NSAIDs. In clinical trials, gastrointestinal (GI) toxicity, including mucosal damage, perforation, ulcers, and bleeding, occurred significantly less often in healthy volunteers and patients treated with rofecoxib than in those who received NSAIDs such as ibuprofen, naproxen, or diclofenac (all comparisons, P < 0.001). In terms of renal toxicity, rofecoxib does not appear to offer a safety advantage over traditional NSAIDs. Rofecoxib has not been shown to affect platelets (bleeding time and platelet aggregation), unlike traditional NSAIDs. CONCLUSIONS: Rofecoxib is an appropriate choice for patients who do not obtain adequate analgesia with acetaminophen and those who have not obtained adequate analgesia from, cannot tolerate, or are at risk for GI toxicity with traditional NSAIDs. Patients who require chronic analgesic medication (ie, those with OA), including those who take other medications daily for comorbid conditions, may also benefit from the once-daily dosing regimen of rofecoxib.     

Enhancing clinical effectiveness among clinical nurse specialists

This article describes the findings of an exploratory study which aimed to discover how clinically effective nursing care is fostered among clinical nurse specialists (CNSs) and nurse practitioners (NPs) in an NHS trust in East London. The study was funded by the Central and East London Education Consortium in January 1999. Qualitative approaches included non-participant observation of practice, interviews during observaton and focus group meetings, Findings from the research identify areas that both foster and hinder the ability of the CNSs and NPs to engage in and provide clinically effective nursing care.     

Laboratory clinical effectiveness: pathologists improving clinical outcomes

This article calls on pathologists to take a larger role in improving the performance of the American health care system. To improve outcomes for populations and individuals require that pathologists increase their activities outside of the traditional laboratory in interdisciplinary collaborations, outcomes research, health care systems development, and clinical care.     

Adherence in clinical trials and in clinical practice

The degree of patient adherence is increasingly recognized to be a key factor in the success of highly active antiretroviral therapy (HAART). HAART regimens are also among the most complex ever prescribed and low adherence is directly related to treatment complexity. Physicians prescribing HAART need to make adherence a priority both in clinical practice and in the design and interpretation of clinical trials if HAART really is to succeed in the long term.     

The clinical imperative in clinical nursing research.

Conducting preliminary clinical fieldwork to update clinical knowledge in preparation to plan and perform relevant, meaningful, credible and feasible clinical research is imperative. Clinical nurse investigators cannot generate relevant questions to study a current phenomenon with which they are not experienced. The nurse researcher's early involvement in the clinical world of health care as a prerequisite of proposal development not only contributes to the design of a study that has rigor and significance, but it also augments his or her competence and commitment to the improvement of patient outcomes.     

Antiplatelet therapy from clinical trials to clinical practice

A platelet-rich clot at the site of severe coronary stenosis, plaque erosion, or a recent plaque rupture is the common etiology of acute ischemic syndromes. Thus, antiplatelet therapy is the cornerstone in the management of these conditions. Aspirin in a dose ranging from 160 to 325 mg once daily should be administered to virtually all patients. In patients with severe disease, particularly those who have no acute angiography, clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi Pharmaceuticals) in a dose of 75 mg once daily should add to the benefit of aspirin for up to a year after the event. Clopidogrel also is an alternative to aspirin where a true aspirin allergy exists. Intravenous platelet glycoprotein IIb/IIIa receptor inhibitors demonstrated a robust benefit when used in conjunction with coronary intervention and thus far have no role in medical therapy alone. Oral platelet glycoprotein IIb/IIIa receptor inhibitors are of no clinical value.