风险管理在普外科护理管理中的运用

目的探讨风险管理在普外科护理管理中的运用效果。方法选取2014年3月~2015年3月本院普外科的126例患者为研究对象,随机分为对照组和观察组,对照组63例接受常规管理;观察组63例接受风险管理。比较两组风险事故发生情况及满意度情况。结果观察组风险事故发生率(4.76%)低于对照组(17.46%),满意度(95.24%)高于对照组(84.13%),差异均有统计学意义(P0.05)。结论普外科的护理管理实施风险管理,效果佳,风险事故率低,值得推广运用。     

柔性管理在普外科护理中的应用分析

目的 探讨柔性管理在普外科护理中的应用效果.方法 以2007年1～10月普外科护理人员21人和患者836例作为研究对象,对其实施柔性管理.以实施柔性管理前2006年1～12月普外科护理人员21人和住院患者797例作为对照,比较柔性管理对护士、患者的影响及护理满意度变化.结果 实施柔性管理后,护士工作和学习热情大大提高,学历和职称层次较实施前明显提高;实施前患者平均住院28 d,人均住院费用12 131元,实施后患者平均住院日下降为20 d,人均住院费用为8764元,实施前后比较差异显著;实施前护理满意度为87.0%,实施后则为97.0%,实施后患者的满意度显著高于实施前.结论 柔性管理在普外科护理中的应用效果显著,适合在实践中更多应用.     

护理人员分层使用模式在普外科病区应用的效果

目的 探讨护理岗位分层管理模式在临床运行的方式与优越性.方法 对普外科实施护理人员分层使用,改进护理人员配备、排班、培训考核及绩效分配的方法,并把实施前、后住院病人对护理工作满意率进行比较分析.结果 护理岗位分层管理模式运行后,护士的责任心增加,病人对护理工作满意率达到了99%,护理质量优于运行前,差异有统计学意义（P＜0.05）.结论 护理人员分层使用模式更加合理地运用了护理人力资源,满足临床护理实际工作的需要,是可行的运行模式.     

品管圈护理管理对普外科手术质量及护理满意度的影响

目的：采用品管圈护理管理提高普外科手术质量,改善患者的护理满意度。方法以品管圈护理管理为分界点,将160例普外科患者分为两组,观察组100例实施品管圈管理,对照组100例实施常规护理管理,比较两组的手术护理质量以及护理满意度。结果观察组在护理文书、消毒隔离、行为规范、手术室护理配合等护理质量方面的评分均高于对照组,有统计学意义（P＜0.05）。观察组的护理满意度高于对照组,有统计学意义（P＜0.05）。观察组护士的团队凝聚力,解决问题的能力、协调沟通能力高于对照组,有统计学意义（ P＜0.05）。结论品管圈护理管理能够有效增强护士的护理能力,改善护理质量,提高患者的满意度。     

在腹部手术全麻患者中实施基于小组管理模式的预见性护理的效果

目的：分析在腹部手术全麻病人群体中实施预见性护理（基于小组管理模式）效果。方法：挑选2021年3月-2023年3月本院实施腹部相关手术的全麻病人共112例为此次试验的对象,随机将上述全部病人分成2组。对照组56实施常规的麻醉护理,研究组56予以预见性护理（基于小组管理模式）。比较两组静息期和苏醒期相关手术指标、苏醒期质量、苏醒期不良事件发生情况、术后恢复质量和护理满意度。结果：苏醒期心率、舒张压和收缩压均上升,且研究组心率和血压波动小于对照组（P＜0.05）;研究组意识情况、呼吸情况、循环情况、氧合情况以及活动情况得分均均高于对照组（P＜0.05）;研究组患者苏醒期不良事件发生率为5.36%明显低于对照组患者不良事件发生率17.86%（P＜0.05）;研究组心理支持、躯体舒适度、躯体独立性、疼痛情况和情绪状态得分均高于对照组（P＜0.05）;两组患者护理满意度比较无明显差异（P＞0.05）。结论：预见性护理（基于小组管理模式）应用于腹部手术全麻患者能有有效提高患者苏醒期质量和术后恢复质量,降低不良事件发生率,值得推广。     

能级对应在普通外科护理管理中的运用

目的提高普通外科护理工作效率，确保临床护理安全。方法通过护理人员的个人能力和资历安排承担相应的临床工作，观察护理质量各项指标，评价实施效果。结果提升了普通外科的护理质量，提高了病人满意度和护理人员工作成就感。结论合理、有效地运用能级对应原理，可以达到提高护理工作质量和护士工作满意度的目标。     

Evidence-based management: a literature review

This paper presents a review of evidence-based management (EBM), exploring whether management activities within healthcare have been, or can be, subject to the same scientific framework as clinical practice. The evidence-based approach was initially examined, noting the hierarchy of evidence ranging from randomized control trials to clinical anecdote. The literature varied in its degree of criticism of this approach; the most common concern referring to the assumed superiority of positivism. However, evidence-based practice was generally accepted as the best way forward. Stewart (1998) offered the only detailed exposition of EBM, outlining a necessary 'attitude of mind' both for EBM and for the creation of a research culture. However, the term 'clinical effectiveness' emerged as a possible replacement buzz-word for EBM (McClarey 1998). The term appears to encompass the sentiments of the evidence-based approach, but with a concomitant concern for economic factors. In this paper the author has examined the divide between those who viewed EBM as an activity for managers to make their own practice accountable and those who believed it to be a facilitative practice to help clinicians with evidence-based practice. Most papers acknowledged the limited research base for management activities within the health service and offered some explanation such as government policy constraints and lack of time. Nevertheless, the overall emphasis is that ideally there should be a management culture firmly based in evidence.     

术前准备间在普外手术中的应用

目的探讨术前准备间在普外手术围手术期的作用。方法将398例普外择期手术患者随机分为手术间组(n=199)和术前准备间组(n=199),分别在手术间和术前准备间进行术前准备。记录两组患者的呼吸、脉搏、血压、术前等待时间和连台手术的周转时间。结果术前准备间组脉搏、呼吸、血压的变化均明显低于手术间组(P0.05),术前准备间组病人术前等待时间平均缩短12.62 min,每台连台手术平均缩短9.53 min(P0.05),进一步保障了病人的安全。结论应用术前准备间可有效平稳病人的生命体征,提高手术室服务质量和工作效率。     

烧伤患者生存质量现状与研究进展

在我国,每年有500～1000万人不同程度被烧伤[1].在15～43岁的烧伤患者中,20世纪50年代半数致死量(LD50)的烧伤面积为45%,随着救治水平的不断提高,40年后LD50达到70%以上,2006年又有了显著性提高[2].国外统计[3]表明,1984年,烧伤患者LD50的烧伤面积为65%,90年代初期,LD50的烧伤面积上升为81%.     

Wound management: a literature review

? This paper provides an overview of literature on wound management, including wound assessment and wound care and their relationship to the healing process. ? No attempt is made to describe individual tools or dressing materials as this literature can be found elsewhere. ? Patient and economic benefits of accurate wound assessment and choice of dressing material are highlighted. ? The case for an improved and updated nursing knowledge base regarding all aspects of wound care is made.     

Post-operative pain management: a literature review

• ? The appropriateness of any set of criteria generated to measure the quality of a particular intervention is dependent upon a thorough, up-to-date assessment of the current state-of-the-art. Few areas in nursing have received as much research attention as that of pain control, particularly post-operative pain control.
• ? The following review of the literature ^{* *}The literature review was undertaken as part of a 3–year Department of Health-funded study called the ODySSSy Project where a nursing quality-assurance system was being evaluated in relation to its effect on nursing actions and patient outcomes on the quality of post-operative pain management in 10 acute surgical wards.
  on this subject complements earlier reviews undertaken by Seers (1988) by organizing the information according to four distinct categories, namely environmental issues, nursing actions, patient outcomes and a review of a number of pain measures. This particular format was selected in order to help in the development of structure, process and outcome criteria on the topic of post-operative pain management.
• ? The section on measurement is to inform practitioners about pain-assessment charts and provide ideas about auditing this area.

     

护士对血生化报告及其临床意义认识的调查分析

随着我国法制的不断健全，人们自我保护意识的不断增强，对短时间死亡患者的情况会提出各种质疑，而患者短期内死亡后还关系到一系列善后处理问题。本文就2006年1—12月我院226份死亡病案中护理文书中存在的潜在的法律问题进行综合分析，并制订相应对策，旨在提高护理质量，现报道如下。     

Patient anxiety and modern elective surgery: a literature review

Medical advances have led to a considerable rise in the level of elective surgery undertaken as day-case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static. A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention. Thirty-four studies embracing data from 3754 patients undergoing both inpatient and day-case procedures were reviewed. Three main themes emerged - causes of anxiety, clinical concerns and measurement, and anxiety management. Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified.     

The effect of bariatric surgery on echocardiographic indices: a review of the literature

Obesity is the new epidemic and is associated with an increased risk of diastolic and systolic heart failure. Effective treatment options with drastic results such as bariatric surgery have raised interest in the possible reversal of some of the cardiovascular sequelae. Many studies have assessed individually the effect of weight loss on specific echocardiographic indices, mostly employing nonhomogeneous groups. The purpose of this narrative review is to summarise the effect of bariatric surgery on echocardiographic indices of biventricular function and to help in the understanding of the expected echocardiographic changes in bariatric patients after weight‐loss surgery     

Discharge education delivered to general surgical patients in their management of recovery post discharge: A systematic mixed studies review

BackgroundDischarge education is essential for postoperative general surgery patients for their self-management of care at home post discharge. The first 30 days’ post-surgery is pivotal to the post-operative recovery process as this is when most post-operative complications occur. Insufficient discharge education can compromise patients’ recovery process causing postoperative complications and unplanned hospital readmissions.ObjectivesTo identify the discharge education provided to general surgery patients.DesignSystematic mixed studies review.Data sourcesLiterature data sources were searched from December 2017 to January 2018 using the four databases: EBSCO CINAHL Plus, EBSCO MEDLINE, Ovid EMBASE and COCHRANE Library. Searches were supplemented with hand searching of reference lists.Review methodsThe relevance of the articles was reviewed using the inclusion and exclusion criteria; included data were extracted and presented in a summary table. Two reviewers appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool. Discussions were held to examine emergent themes, quality scores of the studies, and agreement reached by consensus. Themes were derived through inductive analysis.ResultsA total of 468 records were screened for titles and abstracts and 7 studies met the inclusion criteria. There was a mix of qualitative and quantitative studies. The majority of the included sample were patients with one quantitative study including patients’ family and nurses. Discharge education was delivered at various timing and at different doses during the surgical process. Education delivered was mostly standardised and some of the discharge interventions were tailored and included a checklist for stoma care and a discharge warning tool. Four themes were identified: quality of discharge education influences its uptake, health care professionals’ perceptions of their role in the delivery of discharge education to patients, patients’ preferences for education delivery and patients’ participation in their self-care.ConclusionsThe quality of discharge education has an influence on patient participation in their management of care post discharge. Assessing patients’ preparedness for discharge is an essential component of discharge planning process. The presentation, timing and frequency of discharge education was important in the delivery of information. Tailored education reflecting the learning needs of patients using multiple media delivered in varying doses enhanced patients’ overall knowledge for successful management of recovery post discharge. The scarcity of recent literature in discharge education indicates that the quantity of evidence regarding discharge education intervention in general surgery patients is low and further work in this area needs to be undertaken.     

浅谈台湾医院检验科之品质管理

通过与台湾4家医院检验科和1家能力验证组织的交流,了解台湾实验室品质管理的方法,对实验室质量管理的改进和实验室认可的推动提供指导。台湾实验室品质管理可归纳为3种模式:第一种是基于信息化的无缝式管理模式,即通过信息化功能将品质管理的要求嵌入实验室每一工作环节,可操作性极强,极大提高了管理效率;第二种是基于关键岗位责任制的管理模式,采用应聘上岗方式,变被动为主动工作,通过层层管控,传帮带教,提高品质管理的参与率;第三种是基于绩效考核的管理模式,是建立在到位的政府管控加上有序的市场化运作基础上,运用以人为本的激励机制,推动实验室的良性发展。台湾医院检验科以科学化、人性化的方法改进品质管理,使得实验室人员积极主动地参与到建立质量管理体系中,不断提升检验品质,满足临床需求。     

A retrospective explanatory case study of the implementation of a bleeding management quality initiative,in an Australian cardiac surgery unit

Background

Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; “How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?”

循证护理模式在改善普外科患者术前恐惧情绪及围手术期生存质量中应用的效果评价

目的 观察采用循证护理模式改善普外科患者术前恐惧情绪及围手术期生存质量的效果.方法 选择2009年9月至2010年9月普外科手术患者160例作为研究对象,将160例患者随机分为对照组及观察组各80例,予以对照组患者普外科手术围手术期常规护理,予以观察组患者围手术期循证护理模式护理,比较2组患者术前恐惧评分(FAVS)、围手术期的生存质量(QOL)评分及治疗依从性.结果 2组患者术前恐惧情绪评分比较,观察组明显低于对照组患者,术前及术后生存质量评分比较,观察组患者明显高于对照组患者.观察组的治疗依从性显著优于对照组.结论 循证护理模式可有效改善普外科患者术前恐惧情绪及围手术期生存质量,提高患者治疗过程中的依从性,促进手术成功及疾病恢复,值得临床推广应用.     

Private duty nurses in Greek hospitals: a literature review

PAPAGEORGIOU D., FOUKA G., PLAKAS S., KELESI M., FASOI G. & VARDAKI Z. (2012) Private duty nurses in Greek hospitals: a literature review. International Nursing Review Aim: The study aims to provide an overview of the practice of private duty nurses in Greek hospitals. Background: For several decades, it has been a necessity for some hospital patients to hire private duty nurses (PDNs) to counterbalance the inadequacies of hospital infrastructures. In the current economic crisis in Greece, the majority of patients will not be able to afford to pay for private nursing care. Methods: Databases such as PubMed, CINAHL, ScienceDirect, Wiley Online Library, Google Scholar and national sources were searched for relevant literature through a range of keywords. Information gathered was evaluated for relevance and grouped on a thematic basis. Findings: Five articles met the inclusion criteria. Nearly 90% of PDNs have secondary levels of education or below. Approximately 15% of patients use PDNs at night due to nurse shortages and inability of their families to stay with them. Fifty per cent of the relatives reported being very unsatisfied with PDN services, while the cost for the use of a PDN is rather high. Conclusion: The existence of private duty nursing has been largely responsible for protecting healthcare authorities from the need to develop effective care infrastructures. In the current economic climate, nursing and healthcare authorities must staff wards appropriately for safe, free and efficient care for all patients. Effective utilization of the national nursing and healthcare workforce – including PDNs with appropriate qualifications – and matching demand with the necessary skills is essential.