灾难护理的特性及建议

对灾难护理的发展沿革进行梳理和回顾,分析了灾难护理的特性,其特性包括工作量大且复杂、工作环境艰险、伦理困境的冲击、人员选拔与培养的困难.提出需加强灾难护理在职教育,合理调配救援人员,建构灾难护理的协作网络,重视灾难护理的实证研究,以提高灾难救护的效率和功能.     

从海啸救援谈国际突发灾难救援护理

近几年来,世界范围内各种灾害的发生逐渐呈大规模、长期化趋势.通过印尼海啸灾害救援护理的参与和实践,显现出护理学在救援医学中占有重要的地位.对救援护理队伍的人员素质、专业水平、应急能力以及和其他国际救援人员的配合进行探讨,为今后突发灾害应急救援护理模式的构建奠定基础.     

灾难救援护理人力资源库的构建及在批量伤员救护中的应用

目的构建灾难救援护理人力资源库并应用于批量伤员的救护,以提高批量伤员救治成功率。方法构建灾难救援护理人力资源库,通过自愿报名、科室推荐、护理部筛选的方式选拔护理人员,并进行灾害救护技能培训,将灾难救援护理人力资源库人员分组及明确各自的职责,遇灾难事件及批量伤员时由护理部根据任务需要统一调配,参与救援护理。结果灾难救援护理人力资源库成立后,批量伤员从来院到接受治疗、特殊检查、转手术室的时间显著缩短,病死率显著下降;灾难救援护理人力资源库建立后医生对护理工作满意率显著提高(P<0.05,P<0.01)。结论构建灾难护理人力资源库,能够提高批量伤员的救治成功率,提高医生对护理工作的满意度。     

腹腔镜胰腺手术护理团队的组建及培训

近年来随着腹腔镜技术的发展,腹腔镜胰腺手术得以广泛开展。手术护理配合是腹腔镜胰腺手术顺利开展的重要前提。重视腹腔镜胰腺手术护理团队建设、增强团队间配合、构建手术护理团队标准化培训模式有助于腹腔镜胰腺手术护理标准化实践的应用和推广。     

临床护士灾害救援知识培训效果的追踪调查

目的探讨临床护士灾害救援知识培训及效果的持续性,为进一步提高灾害救援知识培训效果提供参考。方法在武汉大学人民医院抽取56名临床护士,由2位灾害护理专家对其进行8学时的灾害救援知识培训,并用不同试题顺序的同一问卷在培训前、培训毕、培训3个月后对护士进行灾害救援知识调查。结果培训前护士灾害救援知识掌握薄弱,得分仅为44．52±1．71;培训不同阶段临床护士灾害救援知识得分比较,差异有统计学意义（均P〈0．01）;灾害救援知识得分按升序排列依次为培训前、培训3个月后、培训毕。不同学历临床护士在培训毕、培训3个月后灾害救援知识得分比较,差异有统计学意义（均P〈0．05）。结论通过灾害救援培训可以提高临床护士灾害救援知识水平,但需进行长期科学、系统的灾害救援培训,才能保持灾害救援培训的效果。     

影像科护理人员规范化护理培训模块的建立与实施

目的建立规范化护理分层次培训模块,以提升影像科护理人员的临床护理能力。方法根据影像科护理岗位特点,构建规范化护理培训模块,以分层次培训法对影像科护理人员30人进行培训。结果培训前后护理人员理论与操作考核成绩及5项护理质量指标质控结果比较,差异有统计学意义(P0.05,P0.01),教学与科研能力明显提升。结论影像科护理人员规范化护理培训模块的建立,具有针对性和可行性,提高了影像科护理人员规范化培训效果。     

首届全国急救与灾难高峰论坛暨第一届中国（广州）国际急救与灾难救援器材、设备展览会

会议时间：2009年11月22日-11月25日 会议地点：广州白云会议中心 本次会议面向临床专业人员，包括急诊、ICU、麻醉、全科医生、内外科等专业的医生以及各政府机关的采购部门、应急办公室、疾病控制中心、应急专业救援队、应急专业救援队、急救中心和消防武警系统等。     

护理人员美学培训与护理效果观察

目的:探讨护理人员美学培训与护理效果。方法:对我院2010年～2011年在护理岗位的大学专科和大学本科护理人员50名,进行护理美学知识培训及问卷跟踪调查,收集护理人员在临床实践中应用护理美学知识后与护理效果的观察。结果:护理人员美学培训8个方面与护理效果呈正相关系。结论:护理人员护理美学知识培训势在必行,为护理人员在临床工作中构建和谐的人际关系提供了依据。     

超早产儿空中救援转运的护理

总结1例24+5周超早产儿直升机航空医疗救援转运救治成功经验,包括把握转运时机和条件,科学组织与管理,制订个体化救援方案和应急预案,物品和仪器准备,空中转运途中体温管理、体位管理、静脉通路护理及密切监护和应急处理等.     

疼痛护理在骨科护士分层培训中的应用及效果研究

目的探讨疼痛护理在骨科护士分层培训中的应用及效果。方法选取我院144名护理人员参加骨科疼痛护理分层培训,考核合格的护士对我科288例患者进行疼痛教育及护理干预。培训前后均以问卷的形式对护士及患者进行调查,通过患者对疼痛程度的判断及满意度、护理人员疼痛知识和技能的改变来观察培训的效果。结果通过疼痛护理分层培训,各级护士在疼痛理论知识及疼痛护理技能方面都有明显提升,其中N0级、N1级、N2级护士培训后较培训前差异均有显著统计学意义(均P<0.01),N3级、N4级护士较培训前差异均有统计学意义(均P<0.05)。在"出现疼痛马上通知"这一条目的比较上,培训后患者的比例较培训前稍有增加,但差异无统计学意义(P>0.05)。而在其他方面,培训后患者对疼痛知识的认知情况明显好于培训前,差异均有显著统计学意义(均P<0.01)。培训前患者的疼痛分级指数(pain rating index,PRI)评定中感觉项与情感项的总分、疼痛视觉模拟量表(visual analogue scale,VAS)得分及疼痛现有强度(present pain intensity,PPI)评定基本属于中重度或难以忍受的疼痛,培训后的评分基本属于轻度或稍有不适的疼痛,培训后患者对疼痛的控制满意度较培训前明显提升,差异均有显著统计学意义(均P<0.01)。结论通过疼痛护理在骨科的分层培训拓宽了护士们的视野,提高了护士解决问题的能力,增长了经验,同时患者又能享受到优质的疼痛护理服务,能正确对待疼痛,提高了患者对疼痛的控制能力以及对医护人员的满意度,推动了骨科无痛病房模式的改进。     

基于信息化平台的新型冠状病毒肺炎护理应急队伍快速培训方案的实施

目的 通过信息化平台,构建新型冠状病毒肺炎（下称新冠肺炎）护理应急队伍快速培训方案。方法 依托“京颐512”信息化平台,通过“人员管理”“理论培训管理”“操作培训管理”及“我的学习”4大功能模块,构建新冠肺炎护理的应急队伍、理论培训内容及操作培训内容。其中应急队伍包括管理组（6名）、师资组（13名）、骨干组（529名）及心理健康服务组（8名）;理论培训内容包含诊疗方案、安全防护、感染控制、风险沟通和心理健康5个方面;操作培训为新冠肺炎个人防护用具的穿脱技能。结果 529名护理骨干成员3 d内完成了理论学习和测试,1周内完成了防护操作培训,参与率及合格率达100%。结论 基于信息化平台的新冠肺炎护理应急队伍培训方案具有一定的高效性和实用性,便于迅速培养新冠肺炎的护理应急队伍,为满足新冠肺炎的护理人力资源需求提供了保障。     

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

Background

The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage.

Methods

By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient’s condition on-scene and hospital course.

Results

Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p?<?0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of € 34,448, amounting to 2.2% of the total MMT costs during the study period.

Conclusion

In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.     

Bridging the communication gap in the operating room with medical team training

BACKGROUND: In the operating room (OR), poor communication among the surgeons, anesthesiologists, and nurses may lead to adverse events that can compromise patient safety. A survey performed at our institution showed low communication ratings from surgeons, anesthesiologists, and OR nursing staff. Our objective was to determine if communication in the operating room could be improved through medical team training (MTT). METHODS: A dedicated training session (didactic instruction, interactive participation, role-play, training films, and clinical vignettes) was offered to the entire surgical service using crew resource management principles. Attendees also were instructed in the principles of change management. A change team was formed to drive the implementation of the principles reviewed through a preoperative briefing conducted among the surgeon, anesthesiologist, and OR nurse. A validated Likert scale survey with questions specific to effective communication was administered to the nurses, anesthesiologists, and surgeons 2 months after the MTT to determine the impact on communication. Data are presented as mean +/- SEM. RESULTS: There was a significant increase in the anesthesiologist and surgeon communication composite score after medical team training (anesthesia pre-MTT = 2.0 +/- .3, anesthesia post-MTT = 4.5 +/- .6, P <.0008; surgeons pre-MTT = 5.2 +/- .2, surgeons post-MTT = 6.6+/-.3, P <.0004; nurses pre-MTT = 4.3 +/- .3, nurses post-MTT = 4.2 +/- .4, P = .7). CONCLUSIONS: Medical team training using crew resource management principles can improve communication in the OR, ensuring a safer environment that leads to decreased adverse events.     

规范化培训护士叙事护理培训课程的构建

目的 构建规范化培训护士叙事护理培训课程,为护士叙事护理教育提供教材.方法 通过查阅文献、现状调查、半结构式访谈拟定规范化培训护士叙事护理培训课程初稿,采用德尔菲法,对21名相关领域专家进行两轮咨询.结果 第1、2轮专家咨询的积极系数分别为92.00％、91.30％;权威程度分别为0.85、0.84;专家协调程度分别为...     

Anaesthesia in a disaster zone: a report on the experience of an Australian medical team in Banda Aceh following the 'Boxing Day Tsunami'

We report on the experience of a 23-member Australian medical team in Banda Aceh, Indonesia, following the 2004 Boxing Day tsunami. Arriving 13 days after the tsunami that devastated the city, killed 100,000 of its inhabitants and injured thousands more, we carried out 130 surgical procedures in austere conditions over a 12-day period. Most surgery was peripheral, principally for plastic surgical or orthopaedic procedures to lower limb injuries. Intravenous ketamine anaesthesia was the technique of choice, with good surgical conditions and few significant side-effects.