广州市精神科床位及其人员配置的现况调查

目的了解广州市精神科床位及其人员配置的现状。方法采用自编调查表对广州市15家有精神科床位的医疗卫生机构进行调查。结果截至2009年末,广州市精神科定编床位3440张,床位密度为3.33张/万人,实际使用床位5767张,实际使用床位密度为5.58张/万人。增城市、从化市、花都区、海珠区均未设置精神科病床。共有精神科医师421人,精神科护士1050人,每10万人口医师数为4.07名,每10万人口护士数为10.16名。结论广州市精神科床位及医护人员的数量不足,分布不平衡。精神卫生专业机构目前超负荷运作,需要加大投入,增加床位及医护人员。     

杭州市精神卫生服务机构资源调查

目的了解杭州市精神卫生服务机构资源现状,为政府相关部门合理配置精神卫生服务资源提供依据。方法杭州市精神卫生工作领导小组办公室(精卫办)组织实施,编制并下发《杭州市精神卫生服务基础情况调查表》,由各县(市、区)精卫办填报;对2015年杭州市精神卫生服务机构的分布、床位、门诊/住院人次、从业人员配置等资料进行分析。结果杭州市共有29家精神卫生医疗机构,其中24家位于城区;康复中心11家,全部位于城区;精神卫生服务工疗站128家,覆盖各县(市、区)。杭州市精神科编制床位3 079张,3.54张/万人;城区为3.86张/万人,县(市)为2.24张/万人。床位使用率均在80%以上。全市精神卫生医疗机构年门诊857 512人次、年住院25 041人次。全市精神科执业医师467人,5.37人/10万人,平均每名精神科医师年负担1 836人次,年负担住院53人次;精神科护士833人,9.57人/10万人。杭州市精神服务机构床位与卫生技术人员比例为1∶0.42。结论杭州市精神卫生服务资源在各县(市、区)之间分布不均衡;床位、从业人员密度虽高于全国平均水平,但仍不能满足社会需求。     

四川省成都天府新区卫生资源配置现状及分析

目的 对成都天府新区卫生资源现状进行分析,为加强科学规划提供依据.方法 采用文献法查阅四川省卫生统计年报表数据、《四川卫生统计年鉴》等相关资料,对天府新区2011年底的卫生资源情况进行描述性分析.结果 天府新区有各类医疗卫生机构722家,其中医院37家仅占5.12％;基层医疗卫生机构671家占92.94％;专业公共卫生机构8家占1.11％.天府新区的37家医院中,仅有三级医院2家、二级医院5家,其余为非二三级医院.天府新区共有床位7111张,医院床位占72％;基层医疗卫床位占26.72％;专业公共卫生机构床位占1.28％.天府新区卫生人力分布为50％以上的卫生人员、卫技人员、执业(助理)医师、注册护士集中在医院,其次在基层医疗卫生机构.天府新区的每千人床位数、执业(助理)医师数和注册护士数都低于全省平均水平.结论 天府新区现有大型优质医疗资源和公共卫生资源偏少;卫生资源的拥有量均低于全省平均水平.在今后发展中卫生行政部门应重视新区卫生资源规划的顶层设计,调整和利用好现有卫生资源;要加强天府新区的优质医疗资源建设;根据天府新区建设的产业特点来谋划公共卫生和专科医院的布局;加强天府新区的卫生人力资源建设.     

建立护士间接服务支助系统的研究

我院内科于1997年初建立护士间接服务支助系统(以下简称支助系统)。运行两年来,通过试点、运行、总结、评估,并不断地进行摸索和改进,取得了明显的成效。 1 实施步骤与方法 1.1 前期调研 通过调查各病区护土所承担的非护理性工作项目并评估其工作量,确定支助系统所需人数,同时确立研究和工作思路。我科设病床220张,其中普通病床207张,按床位护士1∶0.4,应编护士81人;ICU病床13张,按床位护士1∶2,应编护士26人。而全科实有护士80人,经调查,大     

北京市产科床位资源现状分析

目的了解北京市助产机构产科床位资源现状,为政府出台应对生育高峰的决策提供依据。方法通过统一问卷对北京市所有助产机构进行现况调查,同时收集2013年10月、11月及2014年10月、11月所有机构产科住院病历相关数据。结果北京市活产数呈逐年上升趋势,2014年全年达248 814人,各级助产机构床位数也呈增加趋势,但床位增加比例不能满足活产增加比例。相比2013年,除外一级机构病床周转次数略有降低外,各级助产机构无论产科病床周转次数还是病床周转率均有所增加,二三级助产机构产科病床周转次数分别达61.28、86.67,病床周转率分别达到88.85%、108.83%;相比2013年,病床效率指数除一级机构无变化外,各级助产机构均有增加,二三级助产机构分别为2.72、5.55。2015年每千活产拥有产科床位数相比2013年,除一级机构外均有不同程度降低,目前三级机构数值最低,为15.23张;除一级机构外,各级助产机构每床活产数均较2013年有所增加,三级机构增加最多,每床活产数增加5人,现为66人/张;三级、二级、一级、营利性机构产科床位供需比值分别为:0.80、1.03、7.51、2.56。结论北京市产科床位配置不足,二三级助产机构产科床位处于高效运行阶段,一级及营利性助产机构产科床位还有使用空间。     

福建省精神卫生资源及财政拨补调查

目的了解福建省精神卫生资源及经济补偿状况。方法用调查问卷对全省53家精神专科医院进行调查分析。结果全省共有53家精神专科医院,其中隶属卫生系统的专科医院28所、民政17所、民营4所,设精神科的综合性医院4所;共开放床位8 799张,床位密度2.35张/万人,其中专科医院占52.5%,民政医院占39.3%,民营医院占5.3%,综合性医院精神科占2.8%。全省共有精神卫生技术人员3 502人,精神科医师配比1.42/10万,护士配比4.44/10万;医师中10.5%尚未注册,注册医师中精神卫生专业占81.6%,高级职称占26.2%;全省尚有1/3的县市精神卫生资源空白;2012年各级财政补助仅占机构总支出的40.0%。结论福建省精神卫生专业机构及技术人员数有明显增长,护士配备高于全国平均水平,但机构分布不均,总体投入不足。     

大连市县区级精神卫生专科医院服务能力现状调查

目的：了解大连市县区级精神卫生专科医疗机构服务能力。 对象和方法：本调查采用整群抽样的调查方法，随机选取大连四家县区级精神卫生专科医院（金州四院，瓦房店四院，庄河三院，普兰店六院），具体调查对象包括物资资源（建筑面积、床位），人力资源（医生和护士数量、职称、学历、专业背景），医疗环境（建筑机构、科室设备）和服务对象（患者总数、年龄、病种、诊断），对收集数据进行统计分析。 结果：四所专科服务机构总建筑面积为31842 m2，定编床位为610张，实际开放床位为2130张；每万人口有床位6.75张，平均每床面积为11.91 m2；建筑机构年限大多在30年以上，科室设置为精神科、心理科，无较新治疗设备；精神科职业医师共78人，医师/10万人口比值为2.6，医师/床位比值为0.04；精神科护士共有269人，护士/10万人口比值为6.53，护士/床位比值为0.15,医/护比值是1：3.45；医师中，副高级职称约占整个专科医师总数的14.33%，中级职称和初级职称占医师总数分别为39.25%及46.42%；护士中，中级职称、初级职称占护士总数分别分别为24.91%和75.09%；在医护人员学历情况中，大专及以下学历分别占总人数的55.29%和74.88%。有专业背景的精神科医师占医师总人数的8.97%。在服务对象特点方面以慢性精神分裂症为主（78.7%）。 结论：大连县区级精神专科医院建筑机构及设备老化，床位密度高，床均建筑面积低，专科服务人员数量缺乏，业务素质较低，服务对象以精神分裂症占多数，科室设置以临床为主。     

上海市产科服务现状调查

目的:了解全市产科服务现状,为政府出台应对生育高峰的决策提供依据。方法:2012年6月通过统一问卷对全市所有助产机构进行现况调查,结合专题现场调研。结果:全市2012年1～5月分娩90 239人,同比增加14.33%;其中3家三级专科医院分娩20 333人,7家二级专科医院分娩20 429人。全市2012年1～5月产科初诊建卡孕妇94 227人,同比增加26.81%;其中3家三级专科医院建卡18 141人,7家二级专科医院建卡25 908人。全市产科医师1 164人,产科护士2 032人,助产士963人,产科B超医生221人;其中三级专科医院的产科医生186人,产科护士415人,助产士116人,产科B超医生44人。全市产科开放床位3 889张,其中3家三级专科医院的开放产科床位755张,7家二级妇幼保健院的产科床位850张;3家三级专科医院的床位使用率106.09%,四家危重孕产妇救治中心使用率都超过100%。床位与人员比为1∶1.07。结论:产科人员不足,产科服务的供需矛盾集中凸显"结构性"问题,服务对象集中于专科医院和三级医院呈现"重心上移",而使服务资源出现"超负荷"与闲置并存现象,急需以"缓解短期矛盾和解决深层次问题"双管齐下为原则,从供需两方考虑解决对策。     

“十二五”儿童医院建设重点

目前,我国每千人口医院床位为3.81张,到2015年力争达到4张,其中儿科病床数仅占医院床位数的5.54％,但0～18岁儿童人口的数量占总人口数的2293％,可见,我国儿童医疗资源总量不足,尤其是优质医疗资源严重短缺. 截至2011年底,全国共有儿童医院79家,其中为儿童服务且有床位的儿童医院仅59家.包括综合医院在内,全国儿科病床总数为20.51万张. 截止到2011年底,广西、西藏、甘肃和宁夏4个西部省份和全国大部分地市没有专门的儿童医院;现有儿童医疗资源多集中在城市,其中近80％的优质医疗资源又集中在地市级以上政府办儿童医院;农村与城市、中西部地区与东部地区以及不同人群之间的儿童医疗服务质量、水平和可及性差距加大.可见,儿童医疗资源区域配置不均衡、城乡发展不协调、体系结构不合理.另外,人才使用和管理长效机制不健全,人才流失严重.     

广州市儿科医疗资源配置公平性分析

目的:分析广州市儿科资源配置现状及公平性,为广州儿科医疗资源的合理配置提供科学依据。方法:2011年1月对广州市12区(县)所有儿科医疗机构进行普查,调查问卷采用自行设计的《儿科机构现状调查表》,并运用洛伦茨曲线和基尼系数(Gini),分析儿科资源配置现状及公平性。结果:2010年广州市开设有儿科的医疗机构共102所,从事与儿科相关业务的医生1 549名,儿科护士2 120名,开放床位3 584张。儿科机构、儿科医生、儿科护士数、床位数按人口分布的Gini系数分别为0.15,0.49,0.53,0.38,按面积分布的Gini系数分别为0.77,0.85,0.86,0.78。结论:广州市优质儿科专科服务能力不足,机构区域分布不平衡,医护比例不平衡,儿科医疗资源的配置不合理。需要推进儿科医疗机构的布局调整,调整部分中心城区优质儿科资源向郊区疏散,增加资源薄弱地区的儿童医疗资源。     

三级甲等医院分级护理巡视时间调查分析

调查临床实践中分级护理巡视时间的执行现况,找出存在的问题,分析原因并提出建议。采用分层抽样的方法．抽取广州市某三级甲等医院内外科各4个病区为调查对象,采用观察法调查每个病区白班护士08：00-18：00对病人的巡视情况,并记录各病区各级护理病人数量,每个病区调查1周。调查结果显示,共调查病人436例,一、二级护理者分别为35．6％、63．8％。三级护理病人仅占0．60％,各级护理病人在各病区所占比例各不相同：各病区护士白天对病人（不分护理级别）的巡视平均时间最短为35．7min巡视1次,最长为57．7min巡视1次,二者相差较大,但各病区巡视时间都在1个小时之内。分级护理的巡视要求在临床实践中难以做到,输液巡视作为分级护理巡视的一种特殊形式,有利有弊。应进一步完善分级护理巡视要求,使其适于临床实践。     

Barriers to managing pain in the nursing home: findings from a statewide survey

OBJECTIVES: The objective of this study was to identify pain management demographics, perceived resources, and perceived barriers to adequately manage pain in the nursing home setting. DESIGN: Mailed survey. SETTING: All licensed Connecticut nursing homes. PARTICIPANTS: Directors of Nursing (DONs). MEASUREMENTS: Survey eliciting pain management demographics, perceived resources, and perceived barriers to adequately manage pain in respondents' nursing home. RESULTS: A total of 113 of 260 DONs (43%) responded to the survey. Respondents believed pain was suboptimally managed, particularly for residents with malignant and nonmalignant chronic pain. Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians' personal attitudes toward treating pain (eg, fear of addiction or overdose), lack of diagnostic precision in treating pain, and difficulty in choosing the right analgesic. Other barriers are also discussed, including low hospice enrollment of nursing home residents. CONCLUSION: Improving pain management in nursing homes requires improving provider knowledge and attitudes, enhancing diagnostic precision, standardizing pain treatment, and achieving an institutional commitment. Although responding DONs seemed aware of the need for improved pain management outcomes at their facilities, the required institutional commitment to accomplish this was not evidenced by these findings.     

妇幼保健机构二级评审中实现护理指标的探讨

妇幼保健机构等级评审细则对护理管理有明确的管理目标和量化指标。广州市妇幼保健院在二级妇幼保健机构等级评审工作中,护理管理确立以质量管理为核心,使护理管理工作制度化、质量管理标准化、质量控制数据化、技术操作规范化、病区设置规格化和日常工作程序化。按评审细则要求评价护理部在实施目标管理中对护理管理、院内感染管理和爱婴医院工作的管理能力和业务水平,注重考察护理人员的整体素质和操作技能,使护理工作趋向标准化、规范化和科学化管理。     

Hospice Characteristics and the Disenrollment of Patients with Cancer

Objective. To characterize the types of hospices with higher rates of patient disenrollment from the Medicare Hospice Benefit and the markets in which these hospices operate. Data Source. Secondary analyses of Surveillance, Epidemiology and End Results‐Medicare data. Analyses included patients who died of cancer from 1998 to 2002 and who used hospice (n=90,826). Study Design. We used generalized estimating equations to estimate the association of patient disenrollment with hospice size, years since Medicare certification, ownership, staff mix, competition, urban/rural status, region, and fiscal intermediary. Other covariates included patient demographic and clinical characteristics. Principal Findings. Patients were more likely to disenroll from hospice if they were served by newer hospices (OR=1.14; 95 percent CI 1.03, 1.26), by smaller hospices (OR=1.11; 95 percent CI 1.02, 1.20), or by hospices in more competitive markets (OR=1.17; 95 percent CI 1.03, 1.35). There was an independent effect of the hospice's fiscal intermediary on disenrollment, particularly disenrollment after 6 months with hospice (Wald χ²=21.2, p=.007). Conclusions. The reasons for higher disenrollment rates for newer hospices, for smaller hospices, and for hospices in highly competitive markets are likely complex; however, results suggest that there are organizational‐level barriers to keeping patients with cancer enrolled with hospice. Variation across fiscal intermediaries may indicate that regulatory oversight, particularly of long‐stay patients, influences hospice disenrollment.     

Bereaved Hospice Caregivers' Views of the Transition to Hospice

This study was conducted to explore the communication process between patients, caregivers, and health care professionals, including social workers, through which the decision to choose hospice occurred. Ten bereaved hospice caregivers of patients over age 60 receiving home hospice services participated in this qualitative (phenomenological) study. They represented a range of patient and caregiver characteristics such as age, ethnicity, diagnoses, length of hospice service use, and caregiver relationship to patient. A semi-structured interview guide was used to capture key components in the end-of-life communication process, including discussions caregivers had with health care professionals regarding patients' diagnoses, prognoses, end-of-life care treatment options, and eventual referral to hospice. Themes that emerged included: involvement of health care professionals, relationship with physicians, involvement of patients in decisions, content of discussion, understanding of hospice, and suggestions for improvement. Physicians and social workers were noted to be most involved in the communication, decision making, and transition to hospice; however, a need exists for a more coordinated approach to discussing end-of-life care options with seriously ill patients and their families.     

护理学生学业复原力与自我控制的相关性研究

目的 了解护理专业学生学业复原力及自我控制的现状,探讨两者之间的相关性,为解决护理专业学生心理和行为问题提供了理论依据,以提高护理学生的学业复原力与自制力水平。 方法 采用学业复原力量表和自我控制量表通过网络调查和现场派发形式对广州市4所高校的286名护理专业本科学生进行调查。 结果 护理专业学生学业复原力得分为(47.65±8.45)分,自我控制总分为(58.33±9.68)分,两者呈正相关,工作或学习表现及抵制诱惑是学业复原力的影响因素(F=40.735,R2=0.224)。 结论 护理专业学生的学业复原力和自我控制水平均处于中等水平,应针对具体因素提高学业复原力和自我控制水平,改善护生的心理健康状态。     

Psychiatric nursing production in Brazil, 1932-1993

The present research aims at studying the psychiatric nursing bibliographical production in Brazil, from 1932 to 1993. Therefore, the authors searched national journals, annals of the Brazilian Nursing Congresses, Annals of the National Seminars on Nursing Research and Catalogues of the Brazilian Nursing Association--Center of Nursing Studies and Research. In addition, the authors selected publications of the following events: III Meeting of Researchs on Mental Health, II Meeting of Specialists on Psychiatric Nursing, Nursing Undergraduation Golden Jubilee and National Meeting of University Hospitals. After the conclusion of this study, discussions were based on the central themes of the texts as well as on historical development of Psychiatric Nursing in Brazil.     

我国姑息护理的发展现状与分析

综述了始息护理的内涵与模式，明白指出其在我国目前的发展现状，提出了我国始息护理的不足与发展的若干建议和目标。     

Student nurse opinions about the importance of health promotion practices

Senior nursing students (N=505) attending 13 schools in the NY metropolitan area were administered a questionnaire to assess their beliefs about the importance of health promotion behaviors to the average person. Respondents rated 23 health promotion practices on a Likert scale. The five most important items concerned: knowledge of drug contents and their side effects; the elimination of cigarette and cigar smoking; eating a balanced diet; and using a seat belt. The least important item concerned having an annual exercise test. These results were similar to those found for other health care providers, including physicians, dieticians, and pharmacists. Further, the results were similar to those found in an earlier survey of student nurses. Nurses' attitudes and beliefs seem supportive of health promotion and disease prevention. These attitudes also seem associated with the nurse's role as health promoter. Positive nurse attitudes/beliefs toward health promotion are posited as precursors to the alteration of patient behaviors, although further exploration in this area is needed.Sherri Sheinfeld Gorin, Ph.D. is Associate Professor, School of Social Work, Adelphi University, Garden City, New York.This research was supported by National Cancer Institute Grant No. CA41621 and No. CA16713. The author thanks all participating Nursing Schools: Adelphi Marion A. Buckley School of Nursing; The City College-The City University of New York College of Nursing; Columbia University College of Nursing; State University of New York College of Technology at Farmingdale; Hunter College Bellevue School of Nursing; County College of Morris Nursing Department; College of New Rochelle School of Nursing; New York Technical College Nursing Department; The State University of New Jersey-Rutgers College of Nursing; Wagner College Department of Nursing; Westchester Community College Nursing Department; Mt. Vernon Hospital School of Nursing; and St. Vincent's School of Nursing.The author wishes to thank the following who contributed to the study: Drs. Jacqueline Royce and Mario Orlandi of the American Health Foundation, New York, N.Y.     

Nursing research into quality of life

This report describes the scope of nursing research in the area of quality of life. The strategy used to identify research reports relied heavily on nursing publications included in the Cumulative Index for Nursing and Allied Health Literature (CINAHL) from 1983 (when the database first included the subject, quality of life) to December, 1991. During this period, over 1,000 references concerning quality of life can be identified through a key-word search of the data set. Nursing investigators defined quality of life in terms of psychological, physical, social/interpersonal, and financial/material well-being. Nursing instruments have been developed to measure one or more of these dimensions of the concept. Nursing journals like Advances in Nursing Science (1985), Seminars in Oncology Nursing (1990), and Progress in Cardiovascular Nursing (1992) dedicated whole issues to the topic. Major nursing associations have supported conferences/talks (American Heart Association Council on Cardiovascular Nursing, Santa Fe, NM, 1991; Oncology Nursing Society, Fall Institute, Annual Quality of Life Lectureship) and provided awards on the subject (Oncology Nursing Society Annual Quality of Life Research Award). The National Center for Nursing Research is launching an intramural programme to address quality of life questions.