设置手术室神经外科专科护士的实践与效果

目的评价手术室设置神经外科专科护士对于提高护理质量的作用。方法选拔手术室神经外科专科护士,设置固定护理人员,制定制度,明确职责,系统学习,专业培训,定期考核。结果手术室设置神经外科专科护士后,手术医生和患者对手术室护理质量的满意度明显提高,手术配合的准确度达100．00％,急诊手术患者的抢救时间明显缩短（P〈0．01）。结论手术室设置神经外科专科护士是提高手术室神经外科专科护理质量的有效手段     

手术室护士对设置手术室专科护士的态度

目的 了解手术室护士对设置手术室专科护士的态度.方法 采用问卷调查法对7家医院的149名手术室护士进行调查.结果 90.7%的护士认为有必要发展和培养手术室专科护士;67.1%护士认为应成立专门负责手术室专科护士培训的培训管理中心和组织较为合适.77.9%的护士能接受集体授课与实践学习相结合的学习方法.40.3%的护士认为应由政府卫生部门颁发手术室专科护士资格证书,33.6%的护士认为应由临床培训基地颁发.44.3%的护士认为手术室专科护士应具备大专学历,31.5%的护士认为应有本科学历.结论 我国发展手术室专科护士已是必然趋势,但手术室专科护士的培养、认证、临床基地资质的认证等一系列工作还有待于探索和完善.     

北京市8所三级甲等医院ICU护理人力资源的调查分析

目的调查三级甲等医院ICU护理人力资源现状,为ICU护士队伍建设、ICU专科护士的培养提供依据。方法采用自制问卷调查北京市8所三级甲等医院13个ICU护理人力资源状况。结果ICU护士以大专及以上学历为主,占90．54％,职称结构不尽合理,护师及以下职称的护士占90．54％,年轻护士比例大,年龄≤30岁的占72．97％,具有ICU专科护士资质的占29．05％。结论应加强ICU护士的分层次培训和专科护士培训,充实ICU护士数量,以保障ICU护理工作质鼍。     

突出护理专业特性 合理使用专科护士——访北京大学第三医院护理部主任张洪君

北京大学第三医院ICU和CCU中的护士将近20%持有北京市卫生局、北京市护理学会颁发的北京市ICU专科护士证书。北京大学第三医院在专科护士的使用上进行了积极的探索。本刊记者采访了护理部主任张洪君,张主任介绍了在专科护士的选拔、培养、使用中的经验。张主任说,专科护士的培养与使用是一个连续的过程。护理部要对新上岗的ICU、CCU护士进行40多学时的院内培训,包括基本理论、常用仪器设备两方面的培训。完成院内培训的护士才有资格在ICU或CCU从事护士工作。从这些护士中选择责任心强、爱岗敬业,具有大专以上学历的护士参加3～4个…     

新疆地区ICU专科护士培训基地临床带教师资情况调查

目的调查新疆地区ICU培训基地临床带教师资情况,为加强ICU专科师资培训提供依据。方法查阅新疆地区3所ICU专科护士培训基地承担带教临床带教工作的194名护士的资料（学历、职称、专业年限、带教年限、专科护士资格证及科研情况）,进行统计学分析。结果新疆地区ICU师资以大专学历、初级职称、专业工作年限5年以上及带教年限3年以上为主,有141人获得自治区级专科护士证,19人持教师资格证。本研究调查的3个培训基地师资状况存在差异,其中3个基地带教老师学历比较差异具有统计学意义（x2=19．275,P〈0．05）。结论新疆地区ICU专科护士培训基地整体师资力量充足,能满足专人带教需求,但不同基地师资状况存在差异,师资的学历、职称等构成欠合理。     

按三级学科方向培养手术室专科护士可行性的调查

目的：了解不同等级医院对手术室专科护士的需求,探索能满足不同等级医院手术室护理工作实际需求的专科护士培训方案。方法自行设计调查表,选择在江苏省手术室专科护士培训基地学习的80名手术室护士进行调查。调查内容包括一般资料、所在医院三级学科和亚专业学科细化情况、参加专科护士培训后工作状况、手术室专科护士的培养模式和按照三级学科培养手术室专科护士的实施方案4个方面。结果80名护士均认为有必要开展手术室专科护士培训,80．00％的人认为目前模式属手术室全科护士的培训;72．22％的二级医院的护士认为参加培训学习的理论知识、参加的临床实践技能能满足工作需要,可继续采取目前培养模式;74．19％的三级医院的护士认为培训知识尚能满足工作需要,但针对自己的三级学科方向还不够强、不够细,应该按照三级学科培养手术室专科护士。结论根据不同等级医院手术室护理工作的实际需求,建立统一招生、同步培训、分层培养的统分结合培养模式,能培养适应不同等级医院手术室需求的专科护士。     

重症监护室专科护士工作现状及专科水平能力的调查

目的探讨重症监护室（ICU）专科护士目前的工作现状及专科水平能力,以加强专科护士的管理,推动临床护理工作的发展。方法选取38名取得ICU专科护士资格证书1年以上的护士为研究对象,使用问卷调查法,对其一般情况、工作现状、待遇、专科水平能力自我测定方面进行调查。结果100％的ICU专科护士会对年轻护士进行培训、参与护理管理及科内的疑难问题讨论,36．8％的护士参加临床护理及夜班工作,5．3％从未参与过专科查房;能力水平自我测试情况临床工作实践、指导教学、为病人及家属提供信息咨询这3个方面达标率较高,均在90％以上。专科知识的全面掌握（86．8％）、理论授课方面（86．8％）、为护士提供专科知识（86．8％）还需继续提高。文献的查阅（65．8％）、论文撰写（57．9％）、科研设计开展（47．4％）达标率相对偏低。结论ICU专科护士在专科护理人才的培养和使用缺乏计划性、合理性;专科护士角色模糊;缺乏合理的人才梯队;待遇有待提高;科研能力需要加强;缺乏完善的准入、培训、使用、管理规范。     

手术室设置骨科专科护士的实践及效果评价

目的 评价手术室设置骨科专科护士对提高手术室护理质量的作用.方法 手术室设置骨科专科护士,固定护理人员,系统学习,专业培训,定期考核.结果 手术室设置骨科专科护士,手术医生、麻醉医生和患者对手术室护理质量满意度明显提高,手术配合准确度也明显提高.结论 手术室设置骨科专科护士有利于提高手术室骨科专科护理质量.     

CCU护士心理压力及其影响因素调查

目的了解CCU护士心理压力水平,并探讨其相关因素,为护理人力资源管理提供信息和依据。方法采用自行设计问卷,调查上海市12家三级综合性医院220名CCU护士的心理压力情况。该问卷共30个条目,分4部分,包括调查对象的基本资料,调查对象所在医院监护室情况,调查对象每周上班工作时间、夜班、公休假及福利待遇情况,调查对象自觉工作量、精神压力等。整个问卷经65名CCU护士预测得内部一致性系数Cronbaeh’sα值为0．78。结果收回问卷219份,回收率99．5％。其中无效问卷3份,有效问卷为216份,有效回收率98．2％。2名（占0．9％）护士认为心理压力较小,32名（占14．8％）认为适中,97名（占44．9％）认为较大,85名（占39．4％）认为非常大。不同文化程度、不同周上班时间和不同自觉工作量情况下护士心理压力差异有统计学意义（分别为）（x^2=10．588,P=0．032;x^2=17．697,P=0．001;X^2=178．676,P〈0．001）。Spearman分析显示自觉工作量水平与心理压力情况呈正相关（r=0．763,P=0．000）;Logistic回归分析显示大专护士压力水平大的概率与非常大的概率之比较本科及以上的护士的这一比值小0．11倍,此外自觉护理工作量较大的护士压力水平大的概率与非常大的概率之比较自觉工作量超负荷的护士的这一比值大119．889倍。结论CCU护士心理压力大,应关注大专及中专和低收入家庭护士心理压力,合理配置人力资源,减轻护士压力。     

手术室骨科护理专家和专科护士的设置及培训

目的探讨手术室骨科护理专家和专科护士的设置及培训方法。方法在手术室设立专科组,按专科化模式培养手术室骨科护理专家和专科护士,建立培训考核体系。结果提高了工作质量,手术医生和病人对手术室的满意度得到提高。结论手术室专科护士和临床护理专家的设置培养,能适应外科手术日益专科化发展的需求,提高工作质量和工作效率,值得推广应用。     

医院对男护士需求的调查分析

目的 了解医院对男护士的认知、接受及需求情况，为培养和使用男护士提供依据。方法采用分层抽样的方法．对广州市5所医院的医护人员、患者及患者家属进行调查。结果在682名调查对象中,男护士的知晓率为61．6％；认为可以接受男护士的护理人员575人,占843％；认为最需要男护士的科室分别是精神科(85.0%)、急诊科(67．4％)、外科(64．2％)、手术室(58．1％)；男护士的职业影响因素主要是传统观念(84．5％)、性别偏见(56．9％)、亲朋好友的嘲笑(43．7％)、家庭成员的反对(38．996)。结论 医院对男护士有一定的需求，建议吸引更多的男性从事护士职业．充分发挥男护士的优点．有利于促进护理事业的发展.     

Emergency department nursing management of patients with orthopedic fractures resulting from motor vehicle accidents

Nursing management of patients with orthopedic fractures resulting from motor vehicle accidents is a frequent challenge for nurses in an emergency department setting. The nurse must have knowledge of the mechanics of injury, the classification of the resulting fracture types, and the usual medical interventions. In addition, emergency department nurses should follow plans of care that are based on nursing diagnoses so that appropriate nursing interventions can be determined and consistently provided. Initiation of these care plans must not be delayed until the patient is admitted to an inpatient nursing unit, but should be begun in the emergency unit setting. This article presents information that the emergency room nurse needs in order to make plans for nursing care, and discusses seven nursing diagnoses that are almost always appropriate for patients seen in the emergency department who are experiencing orthopedic fractures resulting from motor vehicle accidents.     

江西省护理人力资源配置现状及对策研究

目的了解及分析江西省护理人力资源状况,为合理配置和开发护理人力资源提供实证依据。方法采用问卷调查及我省卫生厅信息科提供的数据,对全省各级各类医疗卫生机构进行资料收集。结果江西省2007年每千人口有注册护士0．97人,医护比为1：0．82,床护比为1：0．45。学历情况：中专及中专以下学历占39．98％～66．58％,大专以上学历占33．42％～60．02％;基层医院以中专为主体,占66．58％,等级越高的医院本科学历人员越多。职称情况：三级甲等医院高、中、初级职称之比为1：4．6：5．4,三级乙等医院则为1：15．8：21．3,二级甲等医院则为1：42．9：50．4。年龄情况：25～45岁为主体,占55．58％～66．99％。结论江西省千人口护理人员数低于全国平均水平,医护比例结构有待改善,高学历高学位人才紧缺,聘用制护士的准入管理有待规范。     

Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors

AIM: This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. BACKGROUND: The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. METHODS: A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. FINDINGS: An overall response rate of 74.8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. CONCLUSION: There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries.     

护理专科小组的建立与实施效果

目的探讨护理专科小组的工作模式及其对提高护理人员综合素质和护理质量的作用。方法以经过培训和资格认证的手术室、急诊、ICU、静脉置管专科护士和糖尿病健康教育护理师为主体建立了静脉置管护理、护理安全管理和糖尿病健康教育3个护理专科小组,应用于医院护理人员培训、护理会诊和护理门诊中。效果培训后护理人员理论知识和操作技能评分明显提高;静脉置管平均留置时间延长;糖尿病患者健康教育满意度提高;促进了护理科研论文撰写和发表。结论护理专科小组在全院护理工作中发挥了重要作用,有效提升了护理服务质量和服务内涵,推动了护理专业化进程。     

基层医院急诊科护士层级管理与绩效考核的方法与效果

目的探讨护士层级管理与绩效考核的方法及效果。方法将急诊科护士分为车班组和门诊输液组,根据各组护士的工作年限、学历、职称、能力等状况设置岗位层级、岗位系数;绩效考核将绩效工资分为岗位工资和效益工资两部分,岗位工资占50.00%,主要体现岗位和层级;效益工资占50.00%,主要以工作量为基础,考核护理质量、病人满意度、护士综合素质等指标。结果护理质量、病人满意度和护士对绩效分配制度的满意度均提高(P<0.01或P<0.05)。结论基层医院急诊科对护理人员实施层级管理与绩效考核可提高护理质量、病人满意度和护士职业成就感。     

Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model

As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.     

Nurse specialists in adult congenital heart disease: the current status in Europe.

AIM: Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the care for adults with congenital cardiac anomalies in Europe. METHODS: The Euro Heart Survey on Adult Congenital Heart Disease has previously showed that 20 out of 48 specialist centres (42%) have nurse specialists affiliated with their programme. Fifteen of these 20 centres (75%) validly completed a web-based survey tool. RESULTS: Specialist centres had a median number of 2 nurse specialists on staff, corresponding with 1 full-time equivalent. In most centres, the nurse specialists were also affiliated with other cardiac care programmes, in addition to congenital heart disease. The involvement of nurse specialists was not related to the caseload of inpatients and outpatient visits. Physical examination was the most prevalent activity undertaken by nurse specialists (93.3%), followed by telephone accessibility (86.7%), patient education (86.7%), co-ordination of care (73.3%), and follow-up after discharge (73.3%). Patient education covered mainly prevention and prophylaxis of endocarditis (100%), cardiovascular risk factors (92.3%), sport activities (92.3%), the type and characteristics of the heart defect (92.3%), the definition and aetiology of endocarditis (84.6%), cardiac risk in case of pregnancy (84.6%), and heredity (84.6%). Two third of the nurse specialists were involved in research. CONCLUSION: This survey revealed gaps in the provision of care for these patients in Europe and demonstrated that there is room for improvement in order to provide adequate chronic disease management. The results of this study can be used by individual hospitals for benchmarking.     

不同护士群体工作倦怠特征的调查

目的 了解不同护士群体间工作倦怠的情况。方法 对北京市和广州市25家医院的在岗临床执业护士进行问卷调查,问卷包含一般情况和MBI—SS问卷两部分。结果 不同年龄段的护士群体,去人格化分值的差异较为显著,其中以21～25岁年龄段护士的分值为最高;已生育的护士去人格化程度低于未生育的护士;不同科室的护士群体间,工作倦怠3个维度的分值均有差异,其中急诊科、ICU和内科的护士工作倦怠程度较高;不同文化程度和婚姻状况的护士群体间工作倦怠无差异;不同职称的护士群体间,副主任护师的个人成就感最高,护师的个人成就感最低。结论 21—25岁年龄段的护士,急诊科、ICU、内科的护士,以及护师是工作倦怠程度较高的群体,应是管理者干预的重点对象。     

Development of an alcohol withdrawal protocol: CNS collaborative exemplar

PURPOSE: The purpose of this process improvement project was to develop an Alcohol Withdrawal Syndrome (AWS) management protocol for acute care. SIGNIFICANCE: The prevalence of alcohol abuse in our society presents challenges for health professionals, and few nurses have received formal education on the identification and treatment of AWS, which has frequently resulted in ineffective, nonstandardized care. However, nurses practicing in medical-surgical, emergency, trauma, and critical care settings must be astute in the assessment and management of AWS. DESIGN/BACKGROUND/RATIONALE: Following an analysis of existing management protocols, a behavioral health clinical nurse specialist was asked to lead a work team composed of physicians, pharmacists, and nurses to develop a new evidence-based alcohol withdrawal protocol for acute care. METHODS/DESCRIPTION: By implementing a standardized assessment tool and treatment protocol, clinical nurse specialists empowered nursing staff with strategies to prevent the serious medical complications associated with AWS. FINDINGS/OUTCOMES: The development and integration of a safe and effective treatment protocol to manage AWS was facilitated by collaborative, evidence-based decision making. CONCLUSION: Clinical experience and specialty expertise were integrated by clinical nurse specialists skilled in group dynamics, problem-solving, and the implementation of change. Improving care of patients in AWS is an exemplar for clinical nurse specialist roles as change agent and patient advocate.