澳大利亚护理见闻:走向科学化、现代化的社区服务

应澳大利亚护理学会邀请，我同卫生局一行５人自１９９８年２月１５日～２５日参加了在澳大利亚堪培拉举行的第３次国际护理学术会议。来自１５个国家和地区的护理、医疗专家、学者近２００人参加了会议。大会主题是：护理协作，护士作为评论的思想家，在学术研究和临床实践中信息系统的文化冲击——抛弃糟粕，吸取精华。来自美国、日本、澳大利亚等不同国家的医学和护理专家交流经验，作了许多高水平的讲座。如：“护士教育——面对２１世纪的挑战”、“超现代世界的护士思维方式”、“分享未来的梦想——护士实践主义者的合作”、“护士对…     

论中国哲学与护理伦理学的融合:以慎独为切入点

随着医学模式的再次更新,护理学科的范围进一步拓宽,除维持健康和疾病护理外,环境、生理和文化的遗传、社会、心理等等护理相关问题,无不与一个民族个性化的文化根基息息相关,要开发原创护理理论和护理文化,唯有从本土哲学中吸取养分.本文以慎独为切入点,分析了儒家心性论对培养护士性情的优势,以及中国传统文化与护理学融合的方向.     

构建护理文化的探索与实践

本文为探讨医院文化作为一种新型的管理理念,在构建“以人为本”的护理文化中的作用及意义,介绍了我院护理部应用医院文化理论,在护理管理工作中构建护理文化的实践:①全员动员,转变观念;②启动礼仪服务试点病房;③导入了“医院形象识别系统(CIS)”策略;④开展多种形式的护理文化活动;⑤组织编写了《护士行为规范及礼仪服务手册》。护理文化正在全体护士群体中形成一种约束力、凝聚力和向心力,有助于促进护理工作的可持续发展。护理管理者应在管理工作中,自觉实践医院文化理论,构建良好的护理文化氛围。     

从两起错用药的严重差错中应吸取的教训

从两起错用药的严重差错中应吸取的教训牟晓红（淄博市建筑医院，２５５０００）护理工作中的各项规章制度都是前人通过多年的护理实践，科学的总结而成。我们在平时的护理工作中，必须认真遵守。下面介绍２例，护理人员在病房工作中由于未认真进行“三查七对”，造成了给...     

护理服务与护理文化

中华文化渊远流长、博大精深、以“仁爱为核心的儒家思想积淀了深厚的智慧和思辨”。中华医学是中华文化的重要组成部分,而现代医院的护理服务理念和护理文化正是“以人为本”思想的合理延伸。 1 护理服务与护理文化的构成及相互关系 医院这一特殊的社会群体,在其不断发展的过程中,在为人类提供医疗保健服务的实践中,创造了护理服务的基本模式,形成了具有鲜明特色的护理文化。作为护理服务和护理文化赖以     

基于“仁心护理”文化的内涵建设与实践

目的:探讨“仁心护理”文化在推进护理内涵建设的实践与成效。方法:实行以病人安全需求为导向和以提高职业幸福感为目标的“仁心护理”文化,构建护理内涵建设模型,以随机抽样的方法对实行“仁心护理”举措前后病人的满意度和护士的满意度进行比较。结果:实行“仁心护理”文化后病人和护士满意度均得到提高。结论:实行“仁心护理”文化,有助于提升护理质量和专业内涵,有助于增强品牌效应和护理核心竞争力。     

浅谈急诊病人“文化休克”的护理

随着我国现代护理事业的发展和整体护理观在急救护理学中的不断深入，以“人的健康为中心”的整体护理模式也在急诊病人的护理过程中得到了体现。综合考虑病人的生理、心理、社会、精神和文化等方面的因素，了解不同文化背景的病人的需要，运用“文化关怀”缓解和消除“文化休克”给急诊病人带来的不良情绪，帮助患者尽快适应医院环     

护理实践场域下SECI隐性人文管理模式的显性化探究

人文管理是知识经济时代对人本管理理论的超越,人文管理将“人”视为管理核心,强调以“文化”开发人力资源,把“人”视为生产及管理中心、企事业及管理主人,重视“人”的人力、体力、人才、智力、灵魂与精神,同时特别重视管理中的和谐氛围、文化及灵活的领导方式。护理人文管理同样离不开社会化的初构,护士离不开社会和工作“实践场”域,离不开护理文化内涵指引。本文将库尔特·勒温“场论”与SECI(socitization, externalization, combization, internalition)模型相融合,从影响护理人文管理的内外因素出发探究护理“实践场域”下SECI隐性人文管理模式的显性化过程,尝试从一个新的角度全方位、多视角透视护理人文管理,以期更好地为护理管理者在实践场中践行人文管理提供参考依据。     

试论护理管理中的“文化关怀”

目的 为了适应以“人的健康为中心”的护理模式的需要，更好地将“文化关怀”运用到护理实践中去，强化“以人为本”的管理方式。方法 文章通过对两组资料的比较和对在职人员“文化关怀”缺陷的分析，提出建立“文化关怀”的护理策略。结果 说明了“文化关怀”在护理管理中的重要性。结论 提出了“文化关怀”既是当前行之有效的护理管理方式之一，也是实现以“人的健康为中心”最为有效的护理方式之一。     

护理学基础

971田2护理病历书写中常见错误和原因分析/蒋红…//实用护理杂志一1996,12(6)一242 护理病历中存在的错误,大致可分基础文化知识应用不当和护理知识缺乏。表现在1.错别字、方言在护理病历中出现。2.标点符号使用不正确;语法和修辞问题。3.护理问题书写中出现“多”、“类”、“少”现象:“多”指在护理过程中某一天将该病人整个护理过程中可能存在的或潜在的所有护理问题提出。“类”指执行者常将患同一疾病的病人护理问题类同起来。“少”即为心理问题少。4.护理措施不结合病人实际,常见相同疾病的病人具有相同的护理措施。5.护理的写与做…     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.