临床主管护师绩效考核的相关性研究

目的 通过对主管护师工作绩效考核结果 进行分析,发现存在的问题并建立有效地主管护师考核体系.方法 自设主管护师工作绩效量化考核表,采用自评、他评的方法 从10个方面对医院30名主管护师进行绩效考核,并对考核结果 进行分析及讨论.结果 不同的评估者,对主管护师的评价不同;自评的结果 高于护士长和医生的评价;护士和护师对主管护师的评价低于医生的评价;护士长、护士与护师对主管护师工作状况评价组间比较差异有统计学意义（P＜0.05）.结论 护理管理人员应根据主管护师绩效考核的结果,明确主管护师工作改进方向,采取针对性的措施,使主管护师工作与管理目标一致,以有效提高护理管理效率.     

护理工作环境评价量表的测评

[目的]对运用德尔菲法构建的护理工作环境评价指标体系进行信度和效度的验证. [方法]采用重测信度、内在一致性信度进行信度评价,结构效度进行效度考评.[结果]护理工作环境评价指标体系量表的重测信度为0.877,克朗巴赫α系数为0.915,分半系数为0.941.对条目进行因子分析,提取了特征值大于1的公因子7个,解释了总方差的55.92%,因子分析的结果与问卷结构基本吻合.[结论]初步验证了指标体系的合理性和可操作性,从整体看护理工作环境指标体系有较好的信度和效度.     

Pilot study to test effectiveness of video game on reaching performance in stroke

Robotic systems currently used in upper-limb rehabilitation following stroke rely on some form of visual feedback as part of the intervention program. We evaluated the effect of a video game environment (air hockey) on reaching in stroke with various levels of arm support. We used the Arm Coordination Training 3D system to provide variable arm support and to control the hockey stick. We instructed seven subjects to reach to one of three targets covering the workspace of the impaired arm during the reaching task and to reach as far as possible while playing the video game. The results from this study showed that across subjects, support levels, and targets, the reaching distances achieved with the reaching task were greater than those covered with the video game. This held even after further restricting the mapped workspace of the arm to the area most affected by the flexion synergy (effectively forcing subjects to fight the synergy to reach the hockey puck). The results from this study highlight the importance of designing video games that include specific reaching targets in the workspace compromised by the expression of the flexion synergy. Such video games would also adapt the target location online as a subject's success rate increases.     

The work of practical nursing educators. A case study report

In 1987 a study was carried out at two upper secondary schools. The aim was to study the working conditions of teachers in a changing environment by interviewing different professionals in the school as well as students. In the last five years, the average age of students was found to have fallen by two to four years. Another finding was that the entrance requirements had been lowered. In the same five-year period the drop-out rates at one of the two schools had risen from 5/60 to 18/81. At the other school 5/30 dropped out in 1987. Many of the teachers interviewed reported their students to be open-minded and spontaneous but at the same time too immature to work in the medicare sector, especially in the psychiatric field. A tendency appeared for teachers to take on a more curative and supportive role. The teachers maintained certain minimum standards and students who did not pass their examinations were required to withdraw.     

Nurse teacher's clinical work: a survey report

This paper reports on the results of a survey of nurse teachers in four colleges of nursing in England (n = 126) Data were collected using a questionnaire survey In this survey a five-point Likert scale was developed from an earlier study, to explore nurse teachers' perception of their clinical role The findings indicate that a number of factors may be influential in the way in which nurse teachers approach their clinical activity This includes personal factors such as age, educational grade and the length of time spent working in nurse education Organizational factors also appear to make a difference in the teacher who worked in an organizational model which ensured a smaller number of link ward areas were more likely to exhibit a positive orientation towards clinical work Factor analysis of the clinical scale resulted in loading of items relating to confidence in clinical role, preparation for the role, influence in clinical area and supervision of students in clinical areas The implications of these findings are discussed     

Relationship between a global rating of speech ability at the age of 3 yrs and a phonological screening 1 yr later: a prospective field study

Relationship between a global rating of speech ability at the age of 3 yrs and a phonological screening 1 yr later Objective: This study, which was carried out under routine conditions, evaluates the predictability of a global rating of children’s speaking manner made by Child Health Centre nurses. The global rating was added to a formalized screening of 3‐yr olds, which intended to identify severely language disabled children. This screening procedure is used in several Swedish counties and the participation rate is nearly 100%. The main questions of the study are: (i) can a global rating of speech ability in children, who have passed the 3‐yr screening, predict the outcome of a new population screening 1 yr later? and if so (ii) what is the most efficient cut‐off point? Methods: The global ratings of the 3‐yr olds were made using a 100 mm visual analogue scale (VAS). At the age of 4 yrs, 2065 globally rated children with no objections from the 3‐yr screening participated in a second, well‐established assessment. The purpose of this second screening was to identify not only severe but also moderate disability. Results: The mean VAS value of the global ratings was 62 mm. One‐third of the ratings fell on the lower half of the scale. With a cut‐off level set at ≤50 mm on the VAS two newly‐identified, severely disabled children and 74% of the moderately disabled 4‐yr olds were identified. Conclusion: The results suggest that the global rating in connection to the 3‐yr screening would serve as a useful tool for selective screening of 4‐yr olds, and thus, reduce the work load.     

Antecedents and consequences of emotional work in midwifery: A prospective field study

BackgroundGiven the effort made in today's birthing rooms to increase women's childbirth satisfaction, special attention is directed to midwives’ expressions of authenticity (namely to display emotions that he/she actually experience) in birth encounters.ObjectivesTo explore antecedents and consequences of emotional work strategies expressed in a specific birth encounter, to (1) understand the specific factors in a midwife–birthing woman encounter, namely parity (whether or not it is a first birth), use of epidural analgesia, induction of labor, and instrumental birth that stimulate the use of deep or surface acting; (2) test the link between emotional work strategies and birthing experience, and (3) assess whether associations between the midwife's choice of strategy (deep acting or surface acting), and the woman's childbirth experience is moderated by the birthing woman's perception of the midwife's emotional work strategies.DesignA prospective-correlational field study.Participants104 births, selected by a convenience sampling method—including 24 midwives and 104 birthing women, in one birthing room in Israel.MethodsData were collected by validated questionnaires at two time points: immediately after labor and 48 h after labor.ResultsLinear mixed model analyses revealed that of the antecedents to emotional work strategies, epidural analgesia was negatively associated with surface acting (β = −.301, p < .05); primigravida was significantly associated with deep acting (β = 611, p < .01) and negatively associated with surface acting (β = −.433, p < .01); induction of birth was not associated with deep or surface acting (p > .05), and instrumental birth was significantly associated with deep acting (β = −.590, p < .05) and positively associated with surface acting (β = .444, p < .05). Regarding consequences of emotional work strategies, the midwife's engagement with surface acting was negatively related to the woman's birthing experience (β = −.155, p < .05), whereas the relationship between midwife's engagement in deep acting and the woman's satisfaction also depended on the latter's perception that the midwife had engaged in deep acting (β = −.096, p < .05).ConclusionsThe midwife–birthing woman encounter is becoming globally significant for improving childbirth outcomes. Therefore, these findings offer empirical support for the importance of the midwife's expression of authenticity toward the birthing woman in improving her childbirth experience, especially when the woman perceives the midwife's emotional work strategy accurately. Also noteworthy are the aforementioned conditions that shape the midwife's engagement in deep acting or surface acting, with important recommendations to improve women's childbirth experiences.     

Pilot study of a neurophysiological dysphagia therapy for neurological patients

OBJECTIVE: To investigate the success of a neurophysiological dysphagia therapy in patients with neurological disorders. DESIGN: A pre- and post-intervention group study. SETTING: Acute rehabilitation unit. SUBJECTS: Ten patients (swallowing rate <1/5 minutes, Frühreha-Barthel Index <-150, tracheostomy as a result of a swallowing disorder) with dysphagia as a result of a head injury or cerebral haemorrhage. INTERVENTIONS: Therapy was given based on facio-oral tract therapy for three weeks (15 sessions of 1 hour each). MEASURES: The general scales used were the Frühreha-Barthel Index and Coma Remission Scale. Measures of swallowing rate, alertness and swallowing ability were undertaken before, during and after the treatment sessions and at intervals of 30 minutes for 2 hours after the treatment sessions. RESULTS: On the treatment days, the therapy did not lead to an increase in swallowing rate, but did lead to a significant increase in alertness. After completion of a single treatment session, there was a statistically significant decrease in alertness and swallowing rate for 90 minutes. An increase in alertness (Frühreha-Barthel Index and Coma Remission Scale), swallowing ability (measured using an endoscopic examination) and protection of the respiratory tract was observed over the entire therapy period. CONCLUSION: Facio-oral tract therapy led to a statistically significant increase in alertness during the treatment session and, over the entire therapy period, to an increase in swallowing rate, alertness and swallowing ability. The decrease in alertness following therapy sessions must be taken into account in planning rehabilitative measures. Further studies on larger populations as well as studies currently in progress should further elucidate the strategies employed to rehabilitate dysphagic patients.     

Pilot study of a paediatric emergency department oral rehydration protocol

Objective: To ascertain if the use of a paediatric oral rehydration protocol in the emergency department changed rates of admission, total time spent in hospital, total time spent in the emergency department, or number of unscheduled returns to the emergency department.

Methods: A two month time period was analysed before and then after the adoption of an oral rehydration protocol for children presenting to the emergency department with symptoms suggestive of gastroenteritis. The rates of admission, total time spent in hospital, total time spent in the emergency department, and the rate of unscheduled returns were analysed using Fisher's exact and Wilcoxon testing for non-parametric data.

Results: The adoption of a paediatric rehydration protocol was associated with a significant reduction in admission rates (before = 22.5%, after 5.1%; p = 0.048) and mean total hospital time (before = 7 hours 54 minutes, after = 2 hours 17 minutes; p = 0.017). There was no significant difference in time spent in the emergency department (before = 1 hour 25 minutes, after 1 hour 35 minutes, p = 0.3). The number of unscheduled returns did not change significantly (p = 0.3).

Conclusion: Adoption of a paediatric rehydration protocol significantly reduces admission rates and total time spent in hospital for children presenting to the emergency department with symptoms of gastroenteritis. The mean time spent in the actual emergency department does not significantly increase. The rate of unscheduled returns does not change.

     

The work of a lipid clinic: an audit of performance

An audit of the work of a lipid clinic revealed the need to promote awareness of the problem of hypercholesterolaemia, particularly among the ethnic minority groups. Significant reductions in serum lipid levels and blood pressure were achieved, though target levels were reached in only 40 per cent of patients. Efforts to encourage weight reduction among the obese and to discourage smoking had limited success. The establishment of a lipid clinic ensures ready access to paramedical advice and permits effective treatment of hyperlipidaemia and other coronary risk factors. Such a service costs approximately 500 pounds per patients per year.