三甲公立医院护理团队绩效影响机制研究

目的 了解三甲公立医院护理团队绩效水平及影响机制,为提升护理团队绩效水平提供参考。方法 采用护士长服务型领导量表、护士建言行为量表、团队绩效量表、工作场所乐趣量表对5所三甲公立医院771名临床护士进行调查,利用结构方程模型验证护理团队绩效与服务型领导、护士建言行为、工作场所乐趣的关系。结果 三甲公立医院护理团队绩效总分为(4.33±0.59)分;服务型领导正向影响护理团队绩效;护士建言行为在服务型领导与护理团队绩效间起部分中介作用,中介效应占总效应的28.4%;工作场所乐趣在服务型领导与护士建言行为之间起正向调节作用,工作场所乐趣水平越高,服务型领导对护士建言行为的正向作用越强,护士建言行为的中介作用也越强。结论 三甲公立医院护理团队绩效水平较高,塑造护理管理者服务型领导品质,促进护士积极建言以及创建富有乐趣的工作环境可打造高绩效水平的护理团队。     

住院患者护理满意度调查方法的探讨

目的 探讨住院患者护理满意度调查的最佳方式,以获得准确信息,为护理管理决策的制定及改进护理工作提供可靠依据.方法 采用护理部设计的护理质量问卷调查表对住院患者进行护理满意度调查,分别由护理部组织护士长深入病房调查住院患者及由入院处护士调查出院患者,并对结果进行比较分析.结果 入院处护士每月收集的住院患者护理满意度显著低于护士长所收集的数据(均P＜0.01).结论 入院处护士对出院患者发放满意度调查结果真实、可靠,是一种较好的护理满意度调查方法.     

病房住院总护师岗位的设置与成效

目的 探讨设置住院总护师岗位的方法及效果,以降低护士长及夜班护士工作压力,提高护理质量.方法 参照《住院总医师实施管理办法》,在内科、外科、妇科、产科、儿科等15个病区设置住院总护师岗位,由经过系统规范化培训,并经考试考核合格的高年资护师担任.于设岗后半年,分别发放护士长、夜班护士工作压力程度调查表,同时进行护理质量检查评价与患者满意度调查.结果 设岗后,护士长及夜班护士的工作压力较设岗前显著降低(均P＜0.01);病房管理、特一级护理、护理技术水平、病历书写、患者满意度、护理投诉与纠纷显著优于设岗前(均P＜0.01).结论 住院总护师岗位的设置,能缓解护士长及夜班护士的工作压力,提高护理质量及患者满意度,且使一大批护理人员得到培养和锻炼,有利于护理人才的发掘和储备.     

护士长诚信领导行为与团队关系冲突对护士留职意愿的影响

目的探讨护士长诚信领导行为与团队关系冲突对护士留职意愿的影响。方法采用方便抽样法抽取哈尔滨市3所三级甲等综合性医院629名护士,应用诚信领导量表、团队关系冲突量表和护士留职意愿量表进行调查。结果护士感知护士长诚信领导行为得分40.64±9.85,团队关系冲突得分19.08±4.83,留职意愿得分19.32±4.25;团队关系冲突及护士长诚信领导行为的关系透明、内化道德观为护士留职意愿的主要影响因素(均P0.01)。结论护士留职意愿有待提高,可通过提高护士长的诚信领导行为,营造和谐的护理团队氛围,以提高护士的留职意愿。     

护士长变革型领导行为与领导有效性的实证研究

目的探讨护士长变革型领导行为与领导有效性的关系。方法采用变革型领导行为问卷、团体内合作量表、团体绩效量表、团体满意度量表、团体凝聚力量表、自我效能感量表及自行设计的下属对领导的信任问卷对重庆市万州区1094名护士进行问卷调查,对研究涉及的121名护士长进行专题分析。结果护士长变革型领导行为总均分为4.66±1.04,其德行垂范、领导魅力、愿景激励、个性化关怀维度评分分别为4.72±1.02、4.75±1.02、4.62±1.01、4.54±1.08。护士长变革型领导行为与领导有效性显著相关(均P0.01),可有效预测领导有效性;在下属对领导的信任方面,变革型领导行为的4个维度均是其预测变量(P0.05,P0.01)。结论护士长在德行垂范、领导魅力方面做得较好,但愿景激励、个性化关怀方面有待加强。对护士长进行变革型领导行为培养,将有助于提高团队层面和个体层面的领导有效性。     

优质护理服务病房提高患者护理满意度的对策及效果

目的:探讨提高优质护理服务示范病房提高患者护理满意度的措施及效果.方法:在六个病房开展优质护理服务,实施提高患者护理满意度的各项措施前后每月各病房随机抽取10名住院患者填写满意度调查表.结果:开展优质护理服务,采取各项措施提高满意度前2009年90.7±8.38分,开展优质护理服务后2010年满意度95.86±8.87分.结论:通过开展优质护理服务各项措施,有效提高了住院患者的满意度(P＜0.05).     

临床护士长绩效考评与分配方法的研究

目的 通过改革护士长绩效考评体系,充分发挥护士长的工作能动性,强化管理意识,提高管理水平.方法 医院确定不同级别护士长的奖金系数,护理部制定的护士长工作绩效考评标准.每季度由护理质控小组按护士长工作绩效考评标准对护士长进行考评,考评分数×奖金系数即为其奖金系数.结果 实施前后病区护理质量、医护人员对护士长的满意度、患者满意度比较,差异有统计学意义（均P＜0.01）.结论 新的考评方法不仅充分调动了护士长的工作积极性,激励了护士长的工作热情,而且改变了被动管理意识,从而推动优质护理服务持续开展,提升了管理水平,提高了患者对护理服务工作满意度.     

护士对老年住院患者的安全护理知识、态度及行为调查

目的 了解护士对老年患者安全防范的知识、态度和行为,为规范老年患者的安全护理措施提供依据.方法 采取自行设计的护士对老年住院患者安全护理知识、态度及行为调查表在广西6所三级甲等医院中随机抽取244名护士进行调查.结果 护士对老年患者的安全知识、态度及行为总分为76.2±16.0.老年科护士安全知识、态度及行为评分显著高于非老年科护士(P＜0.01).不同学历、职称护士安全护理知识、态度及行为评分比较,差异有显著性意义(均P＜0.05).结论 护士应关注老年患者这一特殊群体,并加强相应的安全护理知识培训,确保老年患者住院期间的安全.     

眼科住院患者对护理服务满意度影响因素研究

目的探讨影响眼科住院患者对护理服务满意度的因素,为提高护理服务质量提供参考。方法采用方便抽样法选取武汉市某三级甲等医院眼科住院患者220例,进行护理服务满意度问卷调查。结果患者对护理服务满意度总分90.31±8.44;不同人口学资料患者总体满意度得分比较,差异无统计学意义(均P0.05);多元线性回归分析显示,注射抽血技术、介绍相关知识、病房宽敞程度、病房干净程度、病房安静程度和环境总体印象对患者总体满意度有影响,总变异的解释率为81.3%。结论眼科住院患者对护理服务满意度影响因素较多,护理管理者应充分重视暴露出来的问题,及时制定相应改进措施,最大程度地满足患者的需求,进而提高患者的满意度。     

《护理学杂志》继续医学教育(2006年外科版第3季度)试题

一、单选题1.医院PM量表从团队关系和工作绩效2个方面测评护士长的()A.工作能力B.发展潜力C.领导行为D.管理方式2.工作绩效职能属于()的形式,即通过制定规章制度和外部监督来实现组织目标A.外部管理B.人本管理C.全面管理D.以上都不对3.以往关于住院患者满意度的研究,对()因素关注较多A.医院管理B.患者自身C.社会环境D.医护人员4.独立处方人具体包括()A.负责计划生育的护士B.器官组织成活护士C.器官组织成活护士、足部医师D.负责计划生育的护士、足部医师和专业理疗师E.负责计划生育的护士、器官组织成活护士、足部医师和专业理疗师5…     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.