The influence of general practitioners' knowledge about their patients on the clinical decision-making process.

Continuity of care is claimed to be an important and integral part of general practice. A main result of continuity is the doctor's accumulated knowledge about his or her patients. The objective of the present study was to evaluate the modifying effects of this knowledge on the decision-making process that takes place in consultations, as experienced by practitioners. A representative sample of 133 Norwegian general practitioners evaluated a total of 3,918 of their own consultations. The main independent variable was the doctor's own subjectively evaluated knowledge about the patient's medical history, while the major outcome measures included the perceived influence of accumulated knowledge on the consultation process in general, and on the diagnostic and management decisions in particular. In two-thirds of all consultations, or in three out of four in which the doctor had previous knowledge about the patient, this knowledge was considered to be clinically useful. In more than one-third of all consultations with previously unknown patients, this lack of information was felt to be a hindrance. Among patients with new medical problems and when the doctor had prior knowledge about the patient, this knowledge was felt to have significantly more therapeutic than diagnostic impact. Accumulated knowledge was generally felt to be of most help in consultations due to psycho-social problems, and was of special diagnostic value in patients presenting new, unspecific problems such as fatigue, fever, and generalized pain. This study indicates that accumulated knowledge about the patient is felt by the general practitioners to play an important and integral part in their clinical decision-making process.     

护理人员对插管患者口腔护理知识掌握状况的调查分析

目的:了解重症监护病房护士对经口气管插管口腔护理相关知识的掌握情况。方法:应用自设问卷,采用方便抽样方法向北京市6家三级甲等医院重症监护病房护士发放问卷105份。结果:口腔护理基本知识掌握较好,但对于新知识,如牙菌斑,机械通气性肺炎的发生机制等的了解较差;职称为护师的护理人员的知识掌握情况好于主管护师(P<0.05)。结论:应该针对不同层次护理人员开展口腔护理新知识的培训和宣传工作,并为拓宽护士的知识领域提供多元化的教育途径。     

Registered nurses' expectations and experiences of first year students' clinical skills and knowledge

BACKGROUND: Clinical education is a fundamental component of nurse education. In theory, this aspect involves integrated input from registered nurses, clinical educators and university lecturers. Registered nurses are important contributors to this process and play a major role in influencing and shaping undergraduate nursing students' early clinical experiences. Despite this important function, their voice has been somewhat neglected. Little is known about registered nurses' expectations and experiences of first year aduate nursing students undertaking their first clinical placement. AIM: The aim of this study was to explore registered nurses' expectations and experiences of first year undergraduate students' levels of knowledge and clinical skills. METHOD: Three consecutive focus groups were conducted with a purposive sample of 16 registered nurses. Interviews were audiotaped and transcribed and thematic analysis applied to the data to identfy themes imbedded in the data sets. FINDINGS: Three main themes emerged: (1) Clinical nursing skills (2) Knowledge requirements and (3) Experiences of reality shock. The findings highlight that registered nurses' expectations of first year students' clinical skills and knowledge were not consistently met. Registered nurses placed significant emphasis upon a range of basic skills, but acknowledged that some aspects of nursing knowledge can only be learned through experience. Furthermore, they demonstrated a considerable degree of empathy surrounding the reality shock that students might experience during early clinical placement. CONCLUSION: Findings from this study suggest that registered nurses and academics differ in their perceptions surrounding the level of clinical skills first year students should have during their first clinical placement. There appears to be a two way theory practice gap between registered nurses in clinical practice and academics in tertiary institutions. Improved communication between registered nurses and providers of nurse education may assist in addressing some of the issues raised by this study and reduce the theory practice gap, which remains 'alive and well'.     

发热门诊患者传染病相关知识调查研究

目的 了解发热门诊患者对传染病相关知识掌握情况，探讨对发热患者进行针对性健康教育的方法。方法 采用问卷方式对2004年11月-2005年1月在发热门诊就诊的495例患者就传染病防治法、常见传染病预防知识、合理卫生习惯、防病治病常识等方面内容进行调查分析。结果 患者对传染病法和传染病预防知识答对率最低；初中、高中学历、50岁以上的受调查者答题正确率较低，工人及一般城市居民答对率最低；电视广播是患者认可的传染病知识宣传方式。结论 应加强传染病法和传染病预防知识的宣传；重视对低学历、中老年人以及工人、城市居民群体的宣传教育；电视广播是目前健康教育的主要途径。     

发热门诊患者传染病相关知识调查研究

目的了解发热门诊患者对传染病相关知识掌握情况,探讨对发热患者进行针对性健康教育的方法。方法采用问卷方式对2004年11月-2005年1月在发热门诊就诊的495例患者就传染病防治法、常见传染病预防知识、合理卫生习惯、防病治病常识等方面内容进行调查分析。结果患者对传染病法和传染病预防知识答对率最低;初中、高中学历、50岁以上的受调查者答题正确率较低,工人及一般城市居民答对率最低;电视广播是患者认可的传染病知识宣传方式。结论应加强传染病法和传染病预防知识的宣传;重视对低学历、中老年人以及工人、城市居民群体的宣传教育;电视广播是目前健康教育的主要途径。     

发热门诊患者传染病相关知识调查研究

目的 了解发热门诊患者对传染病相关知识掌握情况,探讨对发热患者进行针对性健康教育的方法.方法 采用问卷方式对2004年11月-2005年1月在发热门诊就诊的495例患者就传染病防治法、常见传染病预防知识、合理卫生习惯、防病治病常识等方面内容进行调查分析.结果 患者对传染病法和传染病预防知识答对率最低;初中、高中学历、50岁以上的受调查者答题正确率较低,工人及一般城市居民答对率最低;电视广播是患者认可的传染病知识宣传方式.结论 应加强传染病法和传染病预防知识的宣传;重视对低学历、中老年人以及工人、城市居民群体的宣传教育;电视广播是目前健康教育的主要途径.     

The end-of-life care practices of emergency care nurses and the factors that influence these practices: An integrative review

IntroductionDue to philosophical tensions between end-of-life care and emergency care, nurses in the emergency department face challenges in the provision of end-of-life care. The purpose of this integrative review was to synthesise evidence of the end-of-life care practices of emergency care nurses and the factors that influence these practices.MethodsFor this integrative review, CINAHL, Embase, and MEDLINE databases were systematically searched in April 2020. In total, 30 studies written in English and published between 2010 and 2020 investigating the experiences of nurses caring for a patient that died in the emergency department were included. A constant comparative method was used to analyse and synthesise data.ResultsEnd-of-life care practices prominent in the literature included modifying the environment for privacy, the provision of information to families and the management of symptoms. The culture of emergency care, the nurse’s personal characteristics, the trajectory of death and available resources are factors that appear to determine whether ED nurses immerse themselves in end-of-life care or display distancing behaviours.ConclusionThere is limited evidence articulating the frequency to which specific practices are undertaken and the magnitude to which various factors influence end-oflife care provision. The generation of such knowledge may facilitate the development of initiatives that can optimise end-of-life care in the emergency department.     

The influence of high technology care on patients, their relatives and nurses.

This article focuses on the potentially dichotomous relationship of caring for critically ill patients in a high technology environment. Does technology enhance or hinder the quality of patient care delivered by nurses in such an environment? The discussion within this article is initially at a societal level before focusing at an interpersonal level within a specific care setting. The author argues for finding a balance between high technology and humanity within the intensive care environment by highlighting the psychological impact that this may have on patients, relatives and nurses. Guidance as to how a balance may be achieved is also provided. Technology is an explicit theme within the text, whilst the concept of power that technology holds is discussed in an implicit manner.     

造口知识掌握程度对结肠造口患者生活质量的影响

目的 调查结肠造口患者对造口知识掌握程度及生活质量状况,分析两者之间的关系,为提高结肠造口患者的生活质量提供依据.方法 对西安交通大学第一医院行结肠造口手术,现已出院的患者进行随机抽样,发放调查问卷,将所得资料进行统计学分析.结果 造口患者生活质量的总体评分为59.60,造口知识掌握程度的评分为19.13.结论 加强造口知识教育,提高结肠造口患者生活质量.     

医生、护士和患者对优质护理观点的比较分析

目的探讨医生、护士和患者如何看待优质护理。方法通过开放式问卷调查及对项目的筛选,得出“优质护理评价问卷”。用此问卷对4所三级甲等医院的医生、护士和患者进行测试并分析。结果优质护理观点涉及7个主题41个项目。医生、护士和患者在41个项目的显著性检验中7项有差异,占17.07%。医生、护士和患者组均有差异的项目有4项(P<0.05)。医生和患者,护士和患者有差异的项目有3项(P<0.05)。结论医生、护士和患者优质护理观点在41项中34项是一致的,占82.93%;但个别观点有其独到的见解。医生和护士对优质护理的观点具有职业特性,患者对优质护理要求全面,护理管理者可将结果与护理质量控制指标及患者满意度调查问卷进行对照,制定符合患者和合作者期望的标准,以指导临床实践。     

The interplay of knowledge and decision making between nurses and doctors in critical care

This paper explores the complex interrelationships between knowledge and decision making as nurses and doctors interacted with each other in a critical care unit, which comprised a combined general intensive care and cardiothoracic surgical unit. The critical ethnographic study upon which this paper is based, involved a research group of six nurses who worked in the unit. Nurses differentially valued their knowledge, depending on the situation, experience and level of medical input. They were also involved in decision making based on their differential visibility in the process. Nurses' specialised knowledge of the critical care unit played a major role in influencing how they interacted during decision making.     

首次行冠脉造影患者的冠心病相关知识掌握及需求的现况调查

目的 描述并分析首次进行冠脉造影治疗患者对疾病相关知识的掌握及需求程度。方法 采用自编的冠心病患者知识及需求问卷对182名首次进行冠脉造影治疗的患者进行调查。结果 182例患者的年龄33~83岁,冠心病知识知晓得分为(3.08±1.45)分,回答正确率58.1%,冠心病知识需求得分为(109.59±5.68)分,回答“非常需要”或“需要”的比例为87.67%,其中对介入认知(91.22%)和康复认知(94.46%)需求最高。结论 首次行冠脉造影治疗患者对冠心病知识的掌握程度普遍偏低,但患者对疾病知识需求程度较高。医护人员应了解患者最想接受的健康教育方式,采取多种方式以提供个体化针对性的健康教育指导。     

Effect of basic life support training on the knowledge and skills of first aid of first year medical students

Objective: To determine the timing of first aid training in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine.Method: The study was conducted prospectively with 168 first year medical students at Faculty of Medicine, Maltepe University in October 2019. An 8-hour course plan consisting of theoretical and practical applications was prepared. Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques, basic life support scenarios, Heimlich's Maneuver and the coma position. Students were sent a link consisting of 17 questions created with Google forms at the beginning and the end of the course. Learned knowledge was measured with the posttest, and pre-and post-training results were compared. Results: A significant increase was found in the rate of correct answers compared to the pre-training period. Even the rate of correct post-test answers increased significantly in all questions; the increase in the questions related to the subjects supported by practical applications was more remarkable. It was found that more incorrect answers were given to questions about environmental injuries. Conclusions: It is possible to improve the public recognition of first aid, even with one day of theoretical and practical training. Thus, adding first aid practical courses to the first-year medical school curriculum and raising awareness at an earlier age will play an essential role in medical education.     

心理护理对先兆流产患者临床转归的影响

目的探讨心理护理对先兆流产患者临床转归的影响。方法采用单盲法随机将2005年1月-2006年12月期间于我院住院治疗的先兆流产孕妇分为实验组及对照组并施以不同护理措施,观察组间治愈率及平均住院天数的差异。结果接受我们心理护理的实验组的治愈率及平均住院天数均优于对照组。结论为明显改善先兆流产孕妇的临床转归对此病患者施行适当的心理护理是必要的。     

心理护理对先兆流产患者临床转归的影响

目的 探讨心理护理对先兆流产患者临床转归的影响.方法 采用单盲法随机将2005年1月-2006年12月期间于我院住院治疗的先兆流产孕妇分为实验组及对照组并施以不同护理措施,观察组间治愈率及平均住院天数的差异.结果 接受我们心理护理的实验组的治愈率及平均住院天数均优于对照组.结论 为明显改善先兆流产孕妇的临床转归对此病患者施行适当的心理护理是必要的.