急诊儿科输液室护士实行弹性排班的探讨

目的探讨儿科急诊输液室护士弹性排班制度,以提高单位时间内的工作效率,提高患儿、家属满意度及护理质量。方法对15名急诊儿科输液室护士实行弹性排班。结果实施弹性排班5个月后,门诊输液室的科室管理和护理工作满意度明显提高,与弹性排班前比较差异有统计学意义(P<0.05)。结论对急诊儿科输液室,护士实行弹性排班,可提高工作效率,减轻护士压力,提高护理质量,有效防止差错事故发生。     

应用全程护士在恶性实体瘤患儿围手术期的效果研究

目的 探讨全程护士的参与对儿童恶性实体瘤围手术期护理质量的影响。方法 2020年我院肿瘤外科设置3名全程护士,全程护士由病房系统护士遴选,完成手术室相关技术培训后同时担任病房责任护士与手术室器械护士。结果 全程护士参与恶性实体瘤患儿护理后,医护配合更加融洽,术后并发症发生率由18.6%降低到4.3%;平均住院天数由的12.97d降到11.52d。护理满意度由98.1%提高到99.4%。结论 全程护士岗位的设立使恶性实体瘤患儿围手术期护理方法更精准、个性化、整体化,为全面提升小儿肿瘤外科护理质量提供了新思路。     

东北及内蒙古地区儿科重症监护病房护士镇痛镇静护理行为现状调查及影响因素分析

目的通过横断面调查,了解东北及内蒙古地区儿科重症监护病房(pediatric intesive care unit,PICU)护士镇痛镇静护理行为现状并对其影响因素进行分析,为进一步构建规范化培训方案及研发标准化镇痛镇静护理流程提供参考依据。方法采用自行设计的PICU护士镇痛镇静护理知信行现状调查问卷对东北及内蒙古地区18家医院的435名PICU护士进行问卷调查。结果东北及内蒙古地区PICU护士镇痛镇静护理行为问卷平均得分为(70.54±13.63)分。不同年龄、护龄、PICU护龄、学历、职称,以及是否是重症专科护士、是否接受过镇痛镇静培训、有无护理镇痛镇静患儿经历,各组间护士的行为得分比较,差异均有统计学意义(均P<0.05)。护士是否接受过镇痛镇静相关培训、有无护理镇痛镇静患儿经历及对镇痛镇静的态度是影响PICU护士镇痛镇静行为的主要因素。结论东北及内蒙古地区PICU护士镇痛镇静护理行为尚有很大提升空间,PICU护士参加镇痛镇静相关培训次数越多、护理镇痛镇静患儿经历越丰富、镇痛镇静态度越积极,其临床护理实践能力越强。     

PDCA循环模式应用于新生儿重症监护病房感染管理的效果研究

目的 通过改变新生儿重症监护病房(NICU)感染管理模式,探索提高NICU医院感染管理质量的有效途径.方法 本院2010年开始将计划、实施、检查、处理(PDCA)循环模式引入NICU的感染管理工作,通过目标性监测,及时发现感染隐患,制定针对性的感染控制干预措施和标准操作规程,并对干预措施的落实加以巩固.观察2009年和2010年NICU医院感染率及相关质控指标的变化.结果 2009年NICU医院感染率16.9%,2010年NICU医院感染率9.6%,两年比较差异有统计学意义(χ2=7.936,P＜0.05);2010年NICU环境卫生学监测合格率及工作人员的手卫生依从性明显提高,与2009年比较差异均有统计学意义(P均<0.05).结论 NICU引进PDCA循环管理模式,能够提高感染管理质量,降低医院感染率.     

精细化视角下儿童专科医院日间手术管理的探索与实践

日间手术是一种先进的手术管理模式,能一定程度上缓解群众"住院难"和"手术难"的问题。湖南省儿童医院于2009年开始探索实施日间手术,采用分散与集中管理并行制模式,建立起较为完善的一站式日间手术流程和职责,对过程的安全与质量进行把控。截止2017年5月底,共计实施日间手术11 256例,涉及小儿普外、泌尿外科和骨科三个专科共计15个病种,在缩短平均住院时间、提高医院服务效率、减少医疗费用和提高患者满意度方面取得了较明显的效果。     

PICC在新生儿先天性肠闭锁围手术期的应用

目的探讨在新生儿先天性肠闭锁围手术期,使用经外周中心静脉置管(PICC)进行静脉输液和全肠外营养支持的应用效果。方法对2009年1月至2014年3月在本院小儿外科接受手术治疗的89例先天性肠闭锁新生儿进行回顾性分析。按照是否实施PICC,分为PICC治疗组56例,对照组33例,比较两组患儿体重增长情况、静脉输液费用、并发症发生率、患儿家属的满意度等方面的差异。结果与对照组比较,PICC治疗组患儿体重增加明显(P0.05);导管费用偏低、导管留置时间明显延长,药液外渗、导管脱落、静脉炎等并发症的发生率明显降低(P0.01);患儿家属对护理工作满意度及护士工作满意度均明显提高(P0.05)。结论新生儿肠闭锁围手术期应用PICC治疗,为患儿长期静脉输液提供了有效的静脉通道,能保证患儿药物及营养的供给,明显减轻患儿的痛苦及家属的心理、经济负担,提高家属对护理工作的满意度,是新生儿先天性肠闭锁围手术期维持长期静脉输液的一种有效方法。     

新生儿重症监护病房早产儿的家庭参与式综合管理北大核心CSCD

医疗技术的进步使早产儿救治成功率明显提高。在目前的生物-医学-人文模式理念指导下,在医疗硬件投入增加、医疗技术水平提高的同时,医护人员开始关注新生儿重症监护病房(NICU)护理模式的科学性、人性化改变。家庭参与式护理(FICare或FIC)是一种先对护士进行有效培训,然后再对家长进行足够指导,在此基础上允许家长进入NICU参与新生儿住院期间非医学性常规生活护理的综合管理模式。现就FICare的背景、方法及其对早产儿母乳喂养率及预后、医疗负担的影响等内容进行阐述。     

小儿颞部静脉穿刺的体会

头皮静脉穿刺技术是临床3岁以下小儿应用最广泛，最基本的护理技术操作之一，也是临床治疗抢救危重患儿的重要给药途径，同时也是对护士基本功的衡量和对护理工作质量的检验。笔者从事小儿头皮静脉穿刺8年，针对如何提高小儿颞部静脉穿刺的成功率，现总结经验如下。     

儿科护理工作标准流程图表

<正>讲服务,就得有标准,求效率,就得讲流程。《儿科护理工作标准流程图表》——儿科护士快速成长的摇篮。该书由国内资深儿科护理专家执笔,是中华护理学会指定儿科专科护士培训用书。内容集儿科临床护理实践、病房管理、护理教学与科研于一体,观点新,可操作性强,有较好的学术权威性。     

PDCA循环在新生儿重症监护病房医院感染管理中的应用

目的探讨应用计划、实施、检查、处理(PDCA)循环法在新生儿重症监护病房(NICU)医院感染管理中的效果。方法收集本院在医院感染管理上应用PDCA前后NICU的医院感染率、环境卫生学和消毒灭菌合格率资料,2007年6月至2008年5月为对照组,2009年6月至2010年5月为观察组。结果对照期间共收治患儿783例,发生医院感染37例,医院感染率4.7%;观察期间共收治患儿2164例,发生医院感染42例,医院感染率1.9%,差异有统计学意义(P<0.05)。实施PDCA后医务人员手、物体表面、空气、恒温箱水、使用中消毒液合格率均高于实施PDCA前,差异有统计学意义(P<0.05)。结论 PDCA循环法在医院感染管理实践中应用的效果显著。     

个体化干预模式在儿童肝移植受者术后随访中的应用

目的探讨个体化护理干预对提高儿童肝移植受者社会生活能力的效果。方法将2013年12月至2015年6月在本院随访的64例儿童肝移植受者,随机分为个体化护理干预组(实验组)和常规药物指导组(对照组)。对照组按原有随访模式仅进行常规药物及对症健康指导,实验组在随访过程中采用个体化随访干预模式,干预时间12个月,比较两组干预前后的社会生活能力评分。结果干预组社会生活能力各方面有较大提高,在自我管理能力、运动能力、集体活动能力方面均逐步恢复正常,学习生活能力达到优秀。两组干预前后,社会生活能力各项指标差异有统计学意义(P0.05)。结论有针对性地对儿童肝移植受者在生长发育各阶段中存在的影响社会生活能力的问题,进行个体化干预,能够有效提高其远期生活质量。     

Evaluation of the built environment at a children's convalescent hospital: development of the Pediatric Quality of Life Inventory parent and staff satisfaction measures for pediatric health care facilities

In preparation for the design, construction, and postoccupancy evaluation of a new Children's Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of the existing pediatric health care facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility. The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric health care facility, (2) parent satisfaction with the health care services provided to their child, and (3) staff satisfaction with their coworker relationships. The newly developed Pediatric Quality of Life Inventory scales demonstrated internal consistency reliability (average alpha = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with health care services (r =.54, p <.01; r =.59, p <.01, respectively). Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction (r =.53; p <.001; r =.51; p <.01, respectively). The implications of the findings for the architectural design and evaluation of pediatric health care facilities are discussed.     

临床路径在儿童轮状病毒肠炎患儿中的应用及临床评价

目的：临床路径是一种多学科的、综合性的整体管理方式。本研究旨在评价临床路径在轮状病毒肠炎患儿中应用的效果。方法：将71例轮状病毒肠炎住院患儿作为观察组,按临床路径接受个体化治疗、护理。 同时选取同期75例轮状病毒肠炎住院患儿为对照组,给予传统的治疗、护理方式。结果：与对照组比较,观察组患儿住院日明显缩短,住院费用明显降低,患儿家长满意度明显增加,差异均有统计学意义（P<0.05）。结论：应用临床路径可减少轮状病毒肠炎患儿平均住院日和住院费用,提高护理质量,增加患儿家长的满意度。     

改良儿科营养风险筛查工具的临床应用

目的 探讨改良儿科营养风险筛查工具及营养评估在临床中的应用,为建立儿科规范化营养管理流程提供理论依据.方法 回顾性分析16249例住院患儿的入院营养风险筛查和营养评估资料,将患儿按营养风险程度分为高营养风险组(588例)、中营养风险组(4330例)、无营养风险组(11331例),对比各营养风险组患儿的营养评估情况,分析...     

儿童早发性脊柱侧弯的系统治疗

早发性脊柱侧弯是儿童脊柱外科乃至儿童骨科治疗的难点,需要在术前进行详细检查,若存在其他畸形则需要联合相应学科进行评估。早发性脊柱侧弯的治疗方法包括非手术治疗和手术治疗,其中手术治疗分为融合手术与非融合手术,需要根据病情和儿童发育特点采用合适的治疗方法,并不断调整,以达到系统化治疗的目的。其治疗目标不应是仅仅矫正脊柱畸形,维持正常脊柱和胸廓发育、减少并发症和促进整体健康也必须纳入考虑的范畴。     

A simple approach to improving patient satisfaction

Improved communication with families may significantly increase their satisfaction with the care of their hospitalized child. The families of children admitted to a general pediatric service were randomly assigned to receive a daily visit from a communicator/facilitator whose purpose was to respond to any questions the family might have and, if necessary, to explain results of laboratory tests. Control families received routine care. At the time of discharge (study 1) or following discharge (study 2), the families were asked to complete a brief questionnaire regarding the quality of nursing care and physician care (both attending and resident physician). Responses were received from 76/83 (91.6%) in the study group and 75/83 (90.4%) in the control group. There was a highly significant improvement in parent satisfaction with all of the care delivered-nursing, attending physician, and resident care (p相似文献   

Advances in pediatric heart failure and treatments

Heart failure remains a significant contributor to morbidity and mortality in pediatric patients with congenital and acquired heart diseases. However, there are several new promising therapies for acute and chronic heart failures including the development of new pediatric specific ventricular assist devices. There remains a need for collaborative research including the creation of a large-scale registry of pediatric heart failure, increased utilization of genetic testing, and an improved understanding of the optimal model of disease management that maximizes quality care.     

The Role of the Nurse Practitioner in Congenital Heart Surgery

Pediatric nurse practitioners are often members of the interdisciplinary team caring for children with congenital heart disease. The collaborative practice model, in which a physician-led team of physicians, nurse practitioners, and other clinicians work together to provide comprehensive, quality patient care, has had positive benefits for patients and their families, physicians, and nurses. The acute care pediatric nurse practitioner combines advanced training in assessment, diagnosis, and management of common pediatric health problems with advanced nursing expertise in patient education, counseling, and health promotion to meet the specialized needs of children with complex acute and chronic illnesses. This article focuses on the development and current practice of pediatric nurse practitioners in acute care settings and concludes with a discussion of the role of nurse practitioners on the postoperative cardiac surgery service at Children's Hospital, Boston.     

Effect of a pediatric hospitalist system on housestaff education and experience

OBJECTIVE: To determine the effect of a pediatric hospitalist system on housestaff education and experience. SETTING: Free-standing academic children's hospital. Hospitalists were introduced in June 24, 1998, to supervise teaching and care on the general pediatric wards. METHODS: On 2 surveys, housestaff rated their skills, knowledge, and experiences on the wards (experiences survey), and the quality of teaching and supervision by attending physicians (attending survey). Responses before and after the introduction of the hospitalist system were compared using Wilcoxon nonparametric tests. RESULTS: Seventy-six (70%) of the 109 interns and 54 (62%) of the 87 senior residents responded to the experiences survey. Following introduction of the hospitalist system, the interns' mean overall rating of the general pediatrics wards rose from 4.1 to 4.7 on a 5-point Likert scale (P =.01). Their ratings of comparison rotations did not change significantly. Interns' satisfaction with the educational experience (3.2 to 3.5 of a 4-point Likert scale, P<.05), supervision, and quality of life on the pediatrics wards also improved significantly, as did their self-assessments of skills and knowledge related to general pediatrics training. Senior residents' ratings were generally unchanged. Three hundred seventy-one (63%) of the 593 attending physicians' surveys were completed. Compared with nonhospitalist attendings, hospitalists were rated more effective role models (4.7 vs 4.5 points, P<.05) and teachers (4.7 vs 4.4 points, P<.01). They were rated more knowledgeable (4.8 vs 4.5 of 5, P<.001) and accessible (4.7 vs 4.5 points, P<.05), involved housestaff more in the learning process (4.7 vs 4.4 points, P<.05), and gave better feedback (4.5 vs 4.2 points, P<.01). Hospitalists' bedside teaching, however, was rated lower (3.7 vs 4.2 points, P<.001). CONCLUSIONS: Overall, hospitalists were rated significantly higher as educators than were traditional attending physicians. Introduction of a hospitalist system was associated with improved intern experience and quality of life on general pediatrics wards, and with improved self-reported skills and knowledge in general pediatrics.     

Extension of academic pediatric radiology to the community setting: experience in two sites

Background. Children are better served by radiologists and technical personnel trained in the care of pediatric patients. However, a variety of obstacles may limit the access of children to dedicated pediatric imaging facilities.¶Objective. We designed and implemented two models for providing community-based imaging by academic pediatric radiologists.¶Materials and methods. The first site was an outpatient clinic staffed by physicians from the university-affiliated children's hospital. Imaging services included radiography, fluoroscopy, and ultrasound. The second site was a full-service community hospital radiology department staffed by a group practice, with pediatric imaging covered by the children's hospital radiologists. Facility, equipment, and protocol modifications were required to maintain quality standards. Success of these models was determined by volume statistics, referring physician/patient satisfaction surveys, and quality-assurance (QA) programs.¶Results. The outpatient satellite had a 48 % increase in total examinations from the first year to the second year and 87 % the third year. Pediatric examinations in the community hospital increased over 1000 % the first 7 months. Referring physicians reported increased diagnostic information and patient satisfaction compared to previous service. QA efforts revealed improved image quality when pediatric radiologists were present, but some continuing difficulties off-hours.¶Conclusion. We successfully implemented pediatric imaging programs in previously underserved communities. This resulted in increased pediatric radiologist supervision and interpretation of examinations performed on children and improved referring physician and patient satisfaction.