医务人员脂肪肝相关因素调查分析及其在健康教育中的意义

目的　分析医务人员中脂肪肝的患病情况及其相关因素 ,有针对性地进行健康教育和预防指导。方法　对 890例医务人员血清生化检查和超声波等资料进行调查分析。结果　共发现脂肪肝 3 3 3例 ,总患病率为 3 7.4% ( 3 3 3 /890 ) ;脂肪肝组 (n =3 3 3 )血清谷丙转氨酶、三酰甘油和胆固醇的水平高于非脂肪肝组 (n =5 5 7) ,且差异显著 (P <0 .0 5 ) ;患高血压、高三酰甘油血症、高胆固醇血症和高血糖的比例均高于非脂肪肝组 ,差异显著 (P <0 .0 5 )。结论　医务人员中脂肪肝患者常伴有代谢指标的异常 ,提示在健康教育中应重视脂肪肝相关因素的认识和预防。     

Community/Public Health Nursing Practice Leaders' Views of the Doctorate of Nursing Practice

ABSTRACT Objectives: This paper presents thoughts of practice leaders in the community/public health nursing (C/PHN) specialty on advanced nursing practice (ANP) and the necessary educational preparation for such practice.
Design and Sample: Practice leaders were engaged in conversations specifically focused on the Doctor of Nursing Practice (DNP) as preparation for ANP in their specialties, and asked to consider the benefits of, and challenges to, this educational program.
Measures and Results: The resulting remarks were then assessed for themes by the interviewers and these are presented along with thoughts on the future of education for ANP.
Conclusion: Overall, there was much agreement among the practice leaders interviewed about the importance of a broad skill set for ANP in the specialty. However, the practice leaders interviewed here also identified the practical challenges involved in educating nurses at the DNP level in the C/PHN specialty, as well as some concerns about the definitions of ANP for the future.     

Improving Oral Health: Integrating Oral Health Content in Advanced Practice Registered Nurse Education

This article describes the development, implementation, and evaluation of a community-based, interprofessional education experience designed to improve oral health and collaborative practice knowledge, skills, and attitudes of advanced practice registered nurse students. As part of an online advanced physical assessment course, students completed Smiles for Life (Society of Teachers of Family Medicine Group on Oral Health, Leawood, KS) online modules and a 4-hour observational experience with a dental provider in their community. After completing the assignments, students had increased knowledge and skills and improved attitudes about oral health and collaborative practice. These learning strategies are suitable for on-campus and distance programs. Additionally, these resources are useful to practicing nurse practitioners for improving their oral health knowledge.     

内科住院患者疾病知识健康教育需求及其影响因素

目的了解内科住院患者对疾病知识健康教育的需求及其影响因素,以提高对患者健康教育的效果。方法采用方便抽样法,于2010年3月由专人分别对11个内科病区所有住院患者共330例进行问卷调查,调查前进行预调查,调查内容包括治疗方案、治疗效果、重点药物的治疗作用与不良反应、重点药物治疗的注意事项、自身疾病的病程和预后及费用、并发症的防治、疾病对自身生活与工作的影响、日常生活护理指导等。结果内科住院患者需求最强烈的是有关治疗方案、治疗效果及与疾病相关的内容（病程、预后、费用）,不良反应和并发症防治的需求次之,治疗注意事项和疾病影响的需求程度一般,日常生活护理指导需求度最低;但在性别、年龄、婚姻状况、文化程度、住院次数等方面,患者间存在不同差异（均P〈0.01）。结论护理人员必须加强专科知识的学习,对患者的健康教育应因人而异。     

护生临床实习健康教育效果评价表的设计和应用

为提高护生的健康教育能力,弥补临床护理人员不足导致的健康教育不到位,制定了护生临床实习健康教育效果评价表并将之应用到临床。通过一年多的实践证明,健康教育评价表的使用大大提高了护生的沟通能力、主动服务意识、自信心和责任感,同时也合理利用了人力资源,使健康教育覆盖率达100%,患者满意度大幅度提高。     

健康教育对高血压患者遵医行为的影响

目的：了解健康教育对高血压患者遵医行为的影响。方法：对高血压患者讲解高血压相关知识，强调控制血压的重要性，制定合理的膳食和运动计划，了解患者遵医行为。患者出院3个月回访。结果；通过对患者健康教育后，患者有关高血压危险因素的认识提高，对高血压的知晓率、自我观察的控制知识，与人院时比较有显著性差异（P〈0．05）。结论：健康教育能提高患者药物治疗的依从性及对疾病相关知识的认知程序。     

Health promotion as a systems science and practice

Rationale  Health promotion is where clinical practice and prevention science intersect to address complex or 'wicked' problems that have multiple sources and require a broad perspective to address. This means focusing on the social determinants of health and the complex individual, community and environmental interactions that influence health and wellbeing. Health promotion research and practice recognizes that social change is not linear and involves multiple communities of interest working together in a coordinated manner in order to address health problems. An approach that acknowledges this non-linear system of interaction in its data gathering, strategic planning, and program implementation is necessary to addressing this complexity in practice.
Methods  Concepts such as chaos theory, self-organization, social emergence can inform how health promotion is practiced at multiple levels. Evaluation approaches such as social network analysis, system dynamics modeling combined with social organizing strategies like communities of practice and unconferences provide opportunities to leverage social capital effectively to promote health in complex environments with diverse populations.
Conclusion  Health promotion's focus on the multi-layered, complex interactions that create or limit health and wellbeing require knowledge and action that match this complexity. Approaches to engagement and evaluation that are based on systems theories and methodologies provide the means of addressing this complexity, while framing health promotion as a systems science and practice.     

健康教育与健康宣教在社区儿童保健中的应用效果

目的：探索健康教育与健康宣教在社区儿童保健中的作用。方法在深圳市某居民区随机抽取10个住宅小区200名儿童及其家长,随机分为对照组（n=200）和健康教育宣教组（n=200）。健康宣教组定期将家长组织起来开展专题讲座,在小区内发放健康教育的宣传手册,长期张贴内容丰富的养育海报,尽可能对家长进行一对一的指导培训,并提供联系方式以保证家长方便及时咨询。对照组仅发放养育宣传册。采用调查问卷的方式统计2组家长在接受健康教育后对儿童保健知识的掌握程度与儿童定期体检情况。结果在健康教育之前,2组家长对儿童保健知识有一定的了解,且差异无统计学意义（x^2=0.038,P〉0.05）;健康宣教组家长接受定期健康教育之后,儿童保健知识知晓率显著高于对照组（x^2=95.75,P〈0.001）。将调查儿童按年龄分为4个组后,发现健康宣教组儿童定期体检率均显著高于对照组儿童（P〈0.05）。结论通过对家长实施多种形式的健康教育,能够不断提高家长对儿童保健知识的掌握程度,提高儿童定期体检率,有助于社区儿童健康成长。     

Beyond the Medical Model: Thinking Differently about Medical Education and Medical Education Research

Abstract

Issue: In medical education, teaching is currently viewed as an intervention that causes learning. The task of medical education research is seen as establishing which educational interventions produce the desired learning outcomes. This ‘medical model’ of education does not do justice to the dynamics of education as an open, semiotic, recursive system rather than a closed, causal system. Evidence: Empirical ‘evidence’ of ‘what works’ – that is, what is supposed to affect ‘learning’ – has become the norm for medical educational improvements, where generalized summary outcomes of research are often presented as must-follow guidelines for myriad future educational situations. Such investigations of educational processes tend to lack an explicit engagement with the purposes of medical education, which we suggest to understand in terms of qualification (the acquisition of knowledge, skills, and understanding), socialization (becoming a member of the professional group) and subjectification (becoming a thoughtful, independent, responsible professional). In addition, investigations of educational processes tend to rely on causal assumptions that are inadequate for capturing the dynamics of educational communication and interaction. Although we see an increasing acknowledgement of the context-dependency of teaching practices toward educational aims, the currently prevailing view in medical education and educational research limits understanding of what is actually going on when educators teach and students participate in medical education – a situation which seriously hinders advancements in the field. Implications: In this paper, we hope to inform discussion about the practice of medical education by proposing to view medical education in terms of three domains of purpose (professional qualification, professional socialization, and professional subjectification) and with full acknowledgement of the dynamics of educational interaction and communication. Such a view implies that curriculum design, pedagogy, assessment, and evaluation should be reoriented to include and integrate all three purposes in educational practice. It also means that medical education research findings cannot be applied in just any teaching context without carefully considering the value of the suggested courses of actions toward the particular educational aims and teaching setting. In addition, medical educational research would need to investigate all three purposes and recognize the openness, semiotic nature, and recursivity of education in offering implications for teaching practice.     

Essential Public Health Competencies for Medical Students: Establishing a Consensus in Family Medicine

Phenomenon: The integration of public health (PH) competency training into medical education, and further integration of PH and primary care, has been urged by the U.S. Institute of Medicine. However, PH competencies are numerous, and no consensus exists over which competencies are most important for adoption by current trainees. Our objective was to conduct a group concept mapping exercise with stakeholders identifying the most important and feasible PH skills to incorporate in medical and residency curricula. Approach: We utilized a group concept mapping technique via the Concept System Global Max (http://www.conceptsystems.com), where family medicine educators and PH professionals completed the phrase, “A key Public Health competency for physicians-in-training to learn is …” with 1–10 statements. The statement list was edited for duplication and other issues; stakeholders then sorted the statements and rated them for importance and feasibility of integration. Multidimensional scaling and cluster analysis were used to create a two-dimensional point map of domains of PH training, allowing visual comparison of groupings of related ideas and relative importance of these ideas. Findings: There were 116 nonduplicative statements (225 total) suggested by 120 participants. Three metacategories of competencies emerged: Clinic, Community & Culture, Health System Understanding, and Population Health Science & Data. Insights: We identified and organized a set of topics that serve as a foundation for the integration of family medicine and PH education. Incorporating these topics into medical education is viewed as important and feasible by family medicine educators and PH professions.     

Effectiveness of Community Health Worker/Nursing Student Teams as a Strategy for Public Health Nursing Education

ABSTRACT A unique program that partners community health workers with nursing students was developed in response to community‐based participatory research data and integrated into a public health practicum at a baccalaureate nursing program in West Michigan. The goal of the program is to promote the health of 3 underserved urban neighborhoods while educating nursing students in population health and public health nursing. The purpose of this paper is to describe program conception and implementation and discuss evaluation of educational outcomes as a public health learning experience.     

糖尿病患者健康教育干预的效果分析

目的提高社区糖尿病患者的遵医率，帮助患者实现治疗的最佳目标。方法150名糖尿病患者随机分为干预组(实施特殊健康教育)和对照组(实施常规健康教育)，6个月后，监测患者的遵医率及血糖、糖化血红蛋白。结果干预组的遵医率明显高于对照组，血糖、糖化血红蛋白值明显低于对照组。结论实施特殊教育在帮助患者提高遵医率、稳定和控制血糖方面对糖尿病患者有重要作用。     

2型糖尿病患者医学营养治疗健康教育需求调查

目的 探讨构建2型糖尿病医学营养治疗个体化应用的最佳健康教育模式.方法 自行设计调查问卷,与患者面谈、说明调查目的 后发放问卷调查100例2型糖尿病患者对营养治疗的健康教育内容和方式的需求.结果 健康教育内容需求以食物选择方法排在首位,其次是营养素分配与餐次、按"份"食物交换方法和食物血糖生成指数的概念;对糖尿病相关医学名词、诊断标准和转归需求排名末位.教育方式以面对面进行个体化指导排在首位,电话咨询为其次,再次为推荐图书和手册、观看宣传壁报、录像、举办专题沙龙、医护家访指导患者及家属.结论 从患者对医学营养治疗的健康教育内容需求可知,患者欠缺较深层次的糖尿病知识,对自我护理认知不够,知行未合一.应为患者提供科学、便捷、经济、有效的饮食治疗和健康促进模式,引导患者参与治疗过程,提高糖尿病患者的生存质量.     

基于循证实践指南的膝关节骨关节炎患者健康教育指导模块的构建

目的 构建膝关节骨关节炎（knee osteoarthritis, KOA）患者健康教育指导模块,为医护人员进行健康宣教提供索引与参考,从而促进患者的自我管理。方法 通过自我管理理论与健康教育策略分析,形成健康教育指导层级;通过检索全球膝关节骨关节炎相关循证实践指南,以AGREE II（Appraisal of Guidelines for Research and Evaluation II）评价工具进行严格评价进行指南的筛选;以指南的推荐意见形成遴选条目池和健康教育指导概念图;通过小组会议最终形成健康教育指导模块。结果 本研究共纳入循证实践指南6部,形成23条健康教育条目;通过专家与患者小组会议,最终纳入推荐意见14条,形成了以疾病管理（病因与危险因素、药物治疗或疼痛管理、保守治疗、侵入性治疗）,角色管理和情绪管理为框架的健康教育指导模块。结论 本研究重点强调了疼痛管理、运动策略和体质量控制的核心价值。健康教育工作者应采用个性化的教育和管理途径,促进患者的自我管理,提高患者生活质量,延缓KOA疾病的进程。     

以模拟为基础的医学教育（SBME）及其情境化设计观

以模拟为基础的医学教育已在当前的医学教育中起着核心作用。在分析以模拟为基础的医学教育（SBME）内涵的基础上,透视了SBME的发展现状、困境及其关键原因所在;通过描述情境认知理论作为SBME的理论基础及其设计观所显现的潜在力量,阐明了SBME设计的情境认知转向的重要性和可能性。作为探讨重点,为理论与实践境脉中的SBME提炼了系列情境化设计原理和实用原则。最后,勾画了SBME教师对待理论与实践的态度。     

健康教育质量控制的实施与体会

目的：探讨健康教育质量控制在整体护理工作中的作用。方法：结合医院健康教育质量控制的实际，总结归纳了健康教育质量控制的具体做法：三级质控、常规检查和抽检、满意度调查及质量反馈有机结合。结果：护理工作的满意度调查从1999年的77．6％提高到了2002年的96．3％，融洽了护患关系，提高了护理质量。结论：健康教育的质量控制是整体护理质量控制的重要内容，上述质控方法对护理部实施护理质量控制具有参考价值。     

康复医师以健康教育者参与社区康复的作用

目的：以社区老年学校中开展健康教育的实践,探讨医院康复医师参与社区康复的形式和作用。方法：康复医师到医院所在街道的老年学校开设社区康复教育课程,用问卷调查的方法评估课程的需求和效果。评估学员和听课前后对康复训练掌握的情况。结果：548人参加听课,对其中固定学员68人的问卷调查 表明：社区康复教育课程非常适合老年人的需要,为患者解决了许多以往得不到解决的康复问题。并使学员对康复知识的了解程度有了显著的提高（P＜0．01）。结论康复训练在社区老年人中有很大的需求,康复医师应该担负起教育者的职能,通过健康教育和咨询的手段,补充目前社区卫生服务中缺乏的康复技术服务,让更多有需求的患者能够及时得到康复指导与治疗。