基于JCI标准的护理人员员工档案的建立及应用效果复旦大学附属华山医院

目的：基于JCI评审标准,明确护理人员的岗位职责和工作权限,做好相应的专业培训及教育,旨在确保其专业知识、技能履行医院宗旨及持续地满足病人的需求。方法：我院自2007年接受JCI基线调查以来,积极以该标准建立护理人员员工档案,其内容包括员基本信息表、岗位所需执照、有效期注册证书复印件、岗位职责、工作评价表、教育与培训证书等,并进行有效管理。结果：2010年1月30日我院通过JCI评审,护理人员员工档案符合JCI标准下的人力资源管理。结论：建立全员标准化的员工个人档案记录了护士完整的培训过程,使护士的职业规划更具体、并有效促进病人的安全保障,是护理管理工作的重要组成部分。     

信息沟通本在护理安全管理中的应用

仪征市人民医院从2007年起针对护理工作繁琐的特点,利用信息沟通本,使护理人员在繁忙的工作中引起有意注意,来规避护理风险,取得良好效果。1信息沟通本应用的方法1.1护士长记录由护士长书写,记录的内容包括:①医院和护理部的要求及需要传达的会议精神。②近期护理工作中存在的问题及改进措施及要求。③护理管理的新要求新方法。④护理工作中需要提醒的细节。⑤节假日的一些人性化的问候等。使用方法:每天上班前阅读信息沟通本的内容,在护理排班表上注明,提醒大家阅读,达到人人知晓的目的。使用这些方法的好处是避免发生倒班或轮转过来的护士因对有些护理工作的要求和具体细节不知晓而发生的护理缺陷,避免发生护士长口头传达不全面、不统一,同时对一些不太常用的工作细节进行查询、提醒。1.2护士记录护理工作繁杂琐碎,患者病情变化及随机性问题时有发生,存在着有些工作当班护士无法完成,须由下一班的值班护士或隔一班的值班护士完成的情况。若此时信息沟通本和口头交班并用,可弥补口头交班时遗漏或者接班者注意力不集中、未记清或理解错误而造成的护理缺陷,当班护士还可以及时记录护理部质量检查及护士长夜查房中存在的问题,使护士长及护士们在第一时间了解质控情况,便于持...     

流程化上岗护士接班报告制度实施效果的研究

[目的]探讨实施流程化上岗护士接班报告制度与提高护理人员素质和改进病区护理质量之间的关系,为临床一线护理管理者提供全面提升和持续改进护理工作的有效管理措施。[方法]查阅2010年2月-2013年7月本科室的护士晨会记录,以2011年7月实施上岗护士接班报告制度为分界线,对开展责任制整体护理前后两个时期的护士晨会和绩效考核记录进行分析研究,从护士交接班的绩效考核内容、不良事件发生率及口服药安全管理3个方面进行上岗护士接班报告制度实施效果的比较。[结果]流程化上岗护士接班报告制度发挥了护士长基层管理者的职能,提高了病区护理服务水平,完善了护理人员综合素质培养工作,使护理质量管理水平得到了提高。[结论]流程化上岗护士接班报告制度是进行护理质量管理的一项有效措施,是保证护理质量管理规范化、科学化运行的重要前提。     

流程化上岗护士接班报告制度实施效果的研究

[目的]探讨实施流程化上岗护士接班报告制度与提高护理人员素质和改进病区护理质量之间的关系,为临床一线护理管理者提供全面提升和持续改进护理工作的有效管理措施。[方法]查阅2010年2月—2013年7月本科室的护士晨会记录,以2011年7月实施上岗护士接班报告制度为分界线,对开展责任制整体护理前后两个时期的护士晨会和绩效考核记录进行分析研究,从护士交接班的绩效考核内容、不良事件发生率及口服药安全管理3个方面进行上岗护士接班报告制度实施效果的比较。[结果]流程化上岗护士接班报告制度发挥了护士长基层管理者的职能,提高了病区护理服务水平,完善了护理人员综合素质培养工作,使护理质量管理水平得到了提高。[结论]流程化上岗护士接班报告制度是进行护理质量管理的一项有效措施,是保证护理质量管理规范化、科学化运行的重要前提。     

妇科应用信息本和个人考核本的体会

目的设立信息本和个人考核本,对身边发生的每件事、护理人员存在的问题和优点进行随时记录,通过有意识导向与控制,提高护理质量。方法对身边发生的每一件事情、护理人员存在的问题和优点进行随时记录。结果设立信息本为护理人员提供信息,使她们能够随时阅读,加强了护士长与护士间信息交流的互动,采用个人考核本能够对护理人员存在的问题和优点进行详细记录,通过有意识导向与控制,提高护理质量。结论设立信息本使护士长与护士间的沟通变得更加快捷、直接和有效,个人考核本的设立,能够对护士的问题和优点进行详细记录,使她们及时发现自己的长处和短处,并在此基础上取长补短,从而更加出色地完成本职工作,提高了护理质量。     

护士层级管理在儿童骨科病房中的应用

从目前护理人员分层使用的情况来看,一些高级技术职务人员主要在管理岗位上任职,中级职务人员除担任护士长和临床带教外,多数工作内容与初级护理人员相同,初级职务中除整体护理病房的责任护士由护师担任外,其他护师和护士的工作基本相同.由于不能按职称拉开档次,科学地使用护理人才,不仅影响了护理质量,制约了护理队伍的发展,还影响了护理人员学习和工作的积极主动性[1].影响护士分层次使用的因素有很多,如医院支持系统不健全,护理人员严重缺编,护士超负荷劳动,护理教育有待于改革、提高等.现将护士分层次管理在儿童骨科病房中的应用报告如下.     

妇科应用信息本和个人考核本的体会

目的 设立信息本和个人考核本,对身边发生的每件事、护理人员存在的问题和优点进行随时记录,通过有意识导向与控制,提高护理质量.方法 对身边发生的每一件事情、护理人员存在的问题和优点进行随时记录.结果 设立信息本为护理人员提供信息,使她们能够随时阅读,加强了护士长与护士间信息交流的互动,采用个人考核本能够对护理人员存在的问题和优点进行详细记录,通过有意识导向与控制,提高护理质量.结论 设立信息本使护士长与护士间的沟通变得更加快捷、直接和有效,个人考核本的设立,能够对护士的问题和优点进行详细记录,使她们及时发现自己的长处和短处,并在此基础上取长补短,从而更加出色地完成本职工作,提高了护理质量.     

浅谈护士长管理技巧

护士长对病房护理工作的管理涉及许多方面,从完善和落实各项工作制度入手,实施科学的管理方法,严把质量控制关,注重护士业务技术水平的整体提高,做好示范工作,及时完成各种记录,科学合理调配人员,人性化公正和公开地处事,科室管理才会步入良性循环,取得满意效果。本文对护士长管理技巧进行探讨,总结出病房护理管理的方式方法,达到提高护理质量的目的。     

绩效考核在护理管理中的应用与效果

目的：调动护理人员工作的积极性和主动性，提高护理质量和护理管理水平。方法：制定护士长和护士绩效量化管理方案，将绩效管理与量化管理相结合，对护理人员的技术职称、工作质量、岗位职责、劳动纪律、服务质量统一考评计分作为绩效工资。结果：调动了护士和护士长工作积极性和主动性，增加护理人员的责任心；提高了护理工作质量；稳定护理队伍，体现了多劳多得的原则。结论：实行绩效考核有利于护理部和护士长的管理。     

阿拉伯数字在排班表中的应用

为了体现护士长的管理技巧,体现护士长对护士的关怀以及保证临床护理工作得以顺利开展,护士长合理安排护士的排班很重要。我科于2003年2月开始,将阿拉伯数字用于护理工作排班表上,用于记录护理人员节假日休息的天数,以及护生实习周数,通过4年来的实践应用,受到了护士的赞同。认     

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.