糖尿病足发病风险预测模型的系统评价

目的 系统地分析、评价糖尿病足发病风险预测模型,以期为护理实践提供参考依据。 方法 检索PubMed、Embase、Web of Science、Cochrane图书馆、中国生物医学文献数据库、中国知网和万方数据库中有关糖尿病足发病风险预测模型的研究,检索时限为建库至2020年3月1日。由2名研究者独立筛选文献和提取数据,并应用预测模型研究的偏倚风险评估工具分析纳入文献的偏倚风险和适用性。 结果 共纳入7项糖尿病足发病风险预测模型研究,包括6项开发研究和1项验证研究。7个模型的受试者工作特征曲线下面积为0.65~0.88。所有纳入模型中包含最多的预测因子是单丝试验不敏感。7项研究的适用性较好,但存在一定的偏倚,主要是因为未采取或未报告盲法、应变量事件数不足、忽略缺失数据、缺乏模型性能评估以及模型过度拟合。 结论 糖尿病足发病风险预测模型的研究还处于发展阶段,未来应开发性能优良、偏倚风险低的预测模型,并进行内部验证或外部验证。     

The content and effects of palliative care courses for nurses: a literature review

OBJECTIVES: The present literature review describes the literature (1990-2005) that concerns the effects of courses in palliative care at the pre- and postgraduate levels. DATA SOURCES: A search was made for literature from the period between 1990 and 2005 using CINAHL, Pubmed and Psychlit, supplemented with a search for relevant systematic reviews from the Cochrane Library. DESIGN: The research questions were directed on the areas of expertise and skills, the didactical methods, the effects of the courses and the standards to measure these effects. RESULTS: The studies were all focused on general palliative care. Out of 27 studies 21 reported positive effects for communication, attitude, empathy and pain. Six of these 21 positive trails were studies with good quality designs, whereas 15 had moderate designs. The six studies with a lack of effects was one study with good quality and five studies with moderate quality designs. The effects on patients were described in only a few cases. There was still frequent use of self-constructed rating scales, where data about validity and reliability were lacking or where these aspects were not studied. CONCLUSIONS: The most successful were integrated courses focused on several themes with a variety of didactical methods.     

Psychological distress and delusional memories after critical care: a literature review

KIEKKAS P., THEODORAKOPOULOU G., SPYRATOS F. & BALTOPOULOS G.I. (2010) Psychological distress and delusional memories after critical care: a literature review. International Nursing Review 57 , 288–296 Background: A considerable number of intensive care unit (ICU) survivors report delusional memories, which refer to dreams, nightmares, paranoid delusions and hallucinations experienced in the ICU. These memories often have a strong vividness, long duration and high emotional impact. Aim: The aim of this review was to investigate and synthesize published literature about psychological distress associated with delusional memories of adult ICU survivors. Methods: Using key terms, a search was conducted in major health care electronic databases [Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science and PsycInfo] focusing on articles published between 1990 and 2009 in English‐language journals. Findings: Ten articles met the inclusion criteria. Recall of delusional memories at various intervals after ICU discharge was associated with post‐traumatic stress disorder (PTSD)‐related symptoms in many studies, while associations with other aspects of psychological distress, mainly feelings of fear, anxiety and depression, were also reported. Recent studies did not seem to confirm the protective role of factual memories. Conclusions: The findings support the association between delusional memories and PTSD‐related symptoms, but further research is needed to confirm their association with other psychological disorders. Development of a safety sense in the ICU can protect patients against the emotional impact of both delusional and stressful factual ICU memories. Appropriate follow‐up of high‐risk patients could improve their long‐term psychological recovery.     

Evolution of the concept of self-care and implications for nurses: A literature review

Background

Worldwide, the increasing prevalence of chronic disease evokes concern on a number of levels, including quality of life, health care costs and workforce issues to meet increasing demands on services. One response has been a shift in governmental health policy to encourage greater involvement of the chronically ill individual in their health care through participation in self-management programmes. Embedded in self-management programmes is the underlying concept of self-care, a complex and multidimensional phenomenon.

Objective

This paper explores the development of the concept of self-care through health related literature and reviews the factors that have shaped the concept.

Design

A comprehensive search of the literature was undertaken drawing principally on key electronic databases of the health literature, augmented with reference list searching.

Data sources

English language publications indexed in CINAHL, EMBASE, AMED, MEDLINE and PsycInfo with no limit on date of publication.

Review methods

Abstracts were reviewed against the inclusion criteria and quality appraisal undertaken. Twenty-two studies were reviewed.

Results

Many definitions of self-care exist and a consensual definition has not been reached. The current concept of self-care has been shaped by many different social, economic and political factors and is embedded in diverse theoretical perspectives and paradigms.

Conclusion

An understanding of the underlying theoretical perspectives and paradigms embedded within acute and chronic disease management will facilitate nurses’ engagement in the debate, practice within appropriate ethical boundaries and support individuals, families and communities more effectively in managing chronic disease.     

概念图在护理专业学生评判性思维培养中的应用研究进展

随着医疗实践水平的不断发展,护士应该在全面考虑患者各种护理需求基础上,综合各学科相关知识,进行独立思考,为患者提供安全有效的护理。因此要求护士角色必须向评判思维者、问题解决者和有效决策者转变。目前,评判性思维能力的培养已成为近年护理教育领域的研究热点。国际护理认证委员会（the Commission on International Certification of Nursing）在护理课程设置中已把评判性思维作为一种必需的技能[1]。     

Nursing in disasters: A review of existing models

BackgroundSince nurses play an important role in responding to disasters, evaluating their knowledge on common patterns of disasters is a necessity. This study examined researches conducted using disaster nursing as well as the models adopted. It provides a critical analysis of the models available for disaster nursing.MethodsInternational electronic databases including Scopus, PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar were investigated with no limitation on type of articles, between 1st January 1980 and 31st January 2016. The search terms and strategy were as follows: (Disaster¹ OR Emergenc¹) AND (Model OR Theory OR Package OR Pattern) AND (Nursing OR Nurse¹). They were applied for titles, abstracts and key words. This resulted in the generation of disaster nursing models.ResultsOut of the 1983 publications initially identified, the final analysis was conducted on 8 full text articles. These studies presented seven models. These evinced a diverse set of models with regard to the domains and the target population.ConclusionsAlthough, disaster nursing models will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further investigation is needed to develop a domestic nursing model in the event of disasters.     

从文献回顾分析我国临床路径研究现状

目的通过回顾相关文献,分析临床路径在我国医学领域中的应用状况。方法以临床路径或CP为关键词,检索2001-2008年中国期刊网全文数据库收录的文献。结果共检索相关文献829篇,不符合要求的文献13篇,最后获有效统计文献816篇。结论临床路径在我国得到重视,并在临床中得到应用,临床路径提高了医疗护理服务质量。     

护理关怀教育的研究现状与实施策略

##正##自南丁格尔创立现代护理学以来,关爱生命、关怀患者就是护理工作最显著的标志之一。1998年美国护理学院协会(AACN)提出,关怀及其价值观、关怀态度、关怀行为是护理教育的主要组成部分[1]。随着医学模式的转变     

高等医学院校安宁疗护教育的发展现状

安宁疗护教育是提高医学生临终照护能力,巩固和促进安宁疗护学科发展的基石。该文对国内外安宁疗护教育中的课程设置、教学形式与方法、实践基地建设、师资力量及考核方式进行回顾,针对我国安宁疗护教育中存在的不足,通过借鉴国外经验为完善我国医学院校安宁疗护教育提出可行性建议。     

Interruptions experienced by cardiovascular intensive care unit nurses: An observational study

Purpose

Intensive care unit (ICU) nurses get interrupted frequently. Although interruptions take cognitive resources from a primary task and may hinder performance, they may also convey critical information. Effective management of interruptions in ICUs requires the understanding of interruption characteristics, the context in which interruption happens, and interruption content.

Methods

An observational study was conducted in a cardiovascular ICU at a Canadian teaching hospital. Four observers (1 PhD and 3 undergraduate students) trained in human factors research observed 40 nurses, approximately 1 hour each, over a 3-week period. Data were recorded by the observers in real time, using touchscreen tablet PCs and special software designed for this purpose.

Results

Although approximately half of the interruptions (~ 51%) happened during high-severity tasks, more than half of these interruptions, which happened during high-severity tasks, conveyed either work- or patient-related information. Furthermore, the rate of interruptions with personal content was significantly higher during low-severity tasks compared with medium- and high-severity tasks.

Conclusions

Mitigation strategies other than blocking should also be explored. In addition, interrupters might have evaluated primary task severity before interrupting. Therefore, making task severity more transparent may help others modulate when and how they interrupt a nurse.     

新毕业护士角色转变的研究进展

新毕业护士(以下简称新护士)是指毕业后工作1年以内的护士.新护士从学生走向工作岗位,面临环境的改变和自身角色的转变,如何尽快适应工作环境和顺利进入工作角色,是所有新护士面临的严峻问题.有文献[1]报道,国外新护士1年的流动(离职及换岗)率为35％～60％,而新护士的离职会给医院带来一定的经济损失[2].为了缓解全球护士短缺和避免新护士离职带来的损失,各国都致力于帮助新护士顺利完成角色的转变.现综述新护士角色转变的研究进展.     

Expertise among critical care nurses: A grounded theory study

ObjectivesExplore critical care nurses’ personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice.DesignFollowing constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process.SettingA multi-site urban area in the southeastern United States.Participants10 certified critical care nurses, three males and seven females, with 10–30+ years of critical care experience.FindingsExperience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses’ aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care.ConclusionKey findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse’s trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.     

Work motivation of nurses: a literature review

Objectives

The aim of this review is to describe nurses’ work motivation from the perspective of staff nurses. This information would be useful for the development of motivation strategies and further research into nurses’ work motivation.

Design

A thorough review of the research literature.

Data sources

The literature search was performed using four databases: CINAHL, PubMed, PsychINFO, and SocINDEX. Only studies that met the following criteria were selected for review: (1) were published between 1990 and 2009, (2) were written in English, (3) dealt with work motivation, (4) concerned working staff nurses, (5) involved empirical research, (6) clearly and explicitly provided the research results about the factors affecting nurses’ work motivation. Altogether 24 studies met these criteria and were included in this review.

Review methods

Inductive content analysis was carried out to analyse and categorise the data.

Results

Nursing research has neither clear understanding nor consensus about the concept of work motivation; nor has a universal definition been adopted. Despite limited empirical evidence it may be concluded that staff nurses appear to be motivated. Five categories of factors affecting their work motivation were identified: (1) work-place characteristics, (2) working conditions, (3) personal characteristics, (4) individual priorities, and (5) internal psychological states.

Conclusions

Further research is needed to gain a more comprehensive insight into nurses’ work motivation and the factors affecting it. This can be achieved by defining the concept of work motivation as precisely as possible, working out a pertinent research methodology, and subsequently developing and testing a theoretical model of nurses’ work motivation.     

A review of free radicals and antioxidants for critical care nurses.

In the critical care setting, nurses frequently care for patients with acute and chronic diseases that affect multiple body systems. Many of these medical conditions have been associated with an imbalance between oxidizing chemicals called free radicals and antioxidants. Free radical damage is now assumed to be a contributing factor in all major diseases. In order to provide the most current and comprehensive care, critical care nurses need to be well informed about how free radicals cause damage and the antioxidant compounds that neutralize their destructive effects. This article provides an overview of oxygen free radicals and antioxidants and how they impact different clinical illnesses familiar to critical care nurses.