护理组织承诺与工作绩效的相关研究

[目的]探讨护理组织承诺与工作绩效的关系。[方法]用组织承诺量表和工作绩效量表对187名护士进行测查,然后进行相关和回归分析。[结果]护理组织承诺的总分及其各维度都与工作绩效总分存在显著相关;组织承诺各维度对工作绩效都具有一定的预测性,其中,感情承诺对工作奉献的预测性最大;规范承诺对人际促进和任务绩效的预测性最大。[结论]护理组织承诺对工作绩效具有一定的预测性,护理管理者应通过加强护理组织承诺方面的管理来提高其工作绩效。     

儿科护士心理韧性、组织承诺水平调查及相关性研究

[目的]对儿科护士心理韧性及组织承诺关系进行探讨,为针对性护士心理干预提供理论参考依据。[方法]采用心理韧性量表与中国职工组织承诺量表对江西省某三级甲等儿童专科医院的481名儿科护士进行问卷调查,以儿科护士组织承诺总分作为应变量,以护士一般情况资料及心理韧性3个维度及总分为自变量进行多元逐步回归分析。[结果]儿科护士心理韧性得分为(97.76±10.77)分,组织承诺得分为(90.27±11.94)分,两量表各维度得分之间呈正相关。其中婚姻状况及心理韧性总分是影响儿科护士组织承诺的相关因素,可解释护士组织承诺31.8%的变异(F=113.08,P=0.000)。[结论]儿科护士心理韧性及组织承诺水平处于中等偏上水平,护理管理者应结合护士自身心理韧性水平及相关影响因素,来对儿科护士进行科学管理,提升护士职业归属成就感。     

社区护士组织承诺与离职倾向的相关性研究

[目的]研究社区护士的组织承诺水平及与离职倾向的关系。[方法]用组织承诺量表和离职倾向量表对长春市160名社区护士进行问卷调查并进行分析。[结果]社区护士的总体组织承诺及其情感承诺、继续承诺、规范承诺维度都与离职倾向呈负相关（r值分别为：-0．588,-0．598,-0．201,-0．609）;年龄越轻,继续承诺和总体组织承诺越低;学历越高,离职倾向越高;职称越低,继续承诺越低。[结论]社区护士的组织承诺对离职倾向具有一定的预测性,管理者可以通过加强对护士组织承诺的管理来减少护士的流失率。     

社区护士组织承诺与离职倾向的相关性研究

[目的]研究社区护士的组织承诺水平及与离职倾向的关系.[方法]用组织承诺量表和离职倾向量表对长春市160名社区护士进行问卷调查并进行分析.[结果]社区护士的总体组织承诺及其情感承诺、继续承诺、规范承诺维度都与离职倾向呈负相关(r值分别为:-0.588,-0.598,-0.201,-0.609);年龄越轻,继续承诺和总体组织承诺越低;学历越高,离职倾向越高;职称越低,继续承诺越低.[结论]社区护士的组织承诺对离职倾向具有一定的预测性,管理者可以通过加强对护士组织承诺的管理来减少护士的流失率.     

护士职业高原与工作绩效的相关性研究

[目的]调查护士职业高原、工作绩效的现状及二者的相关性,为提高护士工作绩效提供有价值的参考。[方法]采用问卷调查法,应用职业高原问卷、工作绩效问卷对4所医院382名护士进行调查。[结果]护士职业高原总分为(2.92±0.63)分,处在潜高原状态;护士工作绩效总分为(3.36±0.62)分,略高于中等水平;护士职业高原与工作绩效呈负相关(P0.01);工龄、职称、层级高原、中心化高原是预测护士工作绩效的主要因素。[结论]护士职业高原对其工作绩效具有一定的预测性,护理管理者如采取有效措施减轻护士职业高原,将有助于提高护士的工作绩效,从而提高护理质量。     

护理团队气氛对工作绩效影响的研究

[目的]探讨护理团队气氛与工作绩效的关系,分析影响团队气氛的因素。[方法]采用护理团队气氛问卷和工作绩效问卷对哈尔滨市某三级甲等医院133名护理人员进行调查。[结果]护理团队气氛总分及各因子得分与工作绩效总分呈正相关;是否乐意在科室工作和工作时间影响团队气氛。[结论]团队气氛直接影响工作绩效。医院和科室领导应加强多方面的工作,改进团队气氛,从而达到提高工作绩效的目的。     

护士工作投入与组织沉默的关系研究

[目的]调查医院护士工作投入和组织沉默的现状,并研究二者之间的关系,为护理管理者改变人力资源规划和组织管理策略提供参考。[方法]采用一般资料问卷、工作投入量表和护士组织沉默测评问卷对485名护士进行问卷调查。[结果]护士工作投入、组织沉默总分分别为31.18分±10.48分、47.50分±15.04分,分别处于中等偏上、中等偏下水平。除亲社会性沉默外组织沉默其他各维度与工作投入总分及各维度呈负相关。[结论]护理管理者应该明确护士工作投入和组织沉默的影响因素,采取针对性的措施来挖掘护士工作投入潜能,打破组织沉默,从而促进护士自身及科室、医院的可持续发展。     

精神科护士职业价值观与工作绩效的相关性研究

[目的]了解精神科护士职业价值观和工作绩效的现状,分析两者的相关性。[方法]采用整群抽样的方法,选取深圳市某精神专科医院的223名护士,应用护士职业价值观量表和医院护士工作绩效评估量表对精神科护士进行调查。[结果]护士职业价值观量表总均分为3.74分±0.60分;医院护士工作绩效评估量表总均分为4.30分±0.31分;护士职业价值观量表总分与医院护士工作绩效评估量表总分呈正相关(r=0.339,P0.001)。[结论]积极健康的职业价值观有助于提高精神科护士的工作绩效。精神科护理管理者应有针对性地培养和发展护士职业价值观。     

感恩和快乐感对护士工作绩效的影响研究

目的 了解护士感恩、快乐感对护理工作绩效的影响及相关关系.方法 采取分层整群抽样方法,对311名临床护士进行问卷调查,包括护士感恩量表、快乐感测评量表和护士工作绩效自评量表.结果 护士感恩、快乐感和工作绩效的维度及总体得分均值处于中高等水平.护士感恩与工作绩效呈正性相关(P<0.05),护士快乐感与护理工作绩效各维度及总分呈不同程度的正性相关(P<0.05).结论 护士感恩、快乐感与护理工作绩效呈正相关关系.护理管理者应全面认识护士个体因素中的积极心理特质,进一步优化护理人力资源,提高护理质量及提升护理工作绩效.     

护理组织文化与护士核心能力相关性研究

[目的]探讨护理组织文化与护士核心能力之间的相关性,为提高医院护理组织文化水平和提升护士核心能力提供理论依据以及实施建议。[方法]采用中文版护理组织文化量表（NCAT）与护士核心能力量表（CIRN）对上海市中心城区3所三级甲等医院514名在职护士的护理组织文化、护士核心能力进行问卷调查。采用 Pearson 相关分析法研究两者之间的相关性。[结果]护理组织文化总分为（60.66±8.27）分,护士核心能力总分为（147.15±37.76）分;护理组织文化与护士核心能力水平呈正相关（P 〈0.01）。[结论]医院管理者在进行护理组织文化的建设过程中,应注重强化护士的专业承诺意识,培养角色与职责观念,加强团队的合作与沟通,提高护士工作满意度,从而提高护士核心能力,进而提升护理队伍的整体水平。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.