老人院护工护理氧疗病人健康教育路径的构建与应用

[目的]探讨老人院氧疗病人健康教育路径的构建与应用效果。[方法]运用循证护理和临床路径相结合的先进管理理念制定氧疗健康教育路径表,采用集中或一对一的方式对1所老人院22名护工进行氧疗相关知识的健康教育;1所老人院20名护工实行常规健康教育。比较两组护工健康教育后的知识认知水平和对氧疗病人的护理效果(氧疗依从性、舒适度、症状改善)。[结果]实施健康教育路径培训的护工,氧疗知识、协助氧疗护理操作考核成绩优于常规健康教育培训的护工(P<0.01);对氧疗病人的护理效果优于常规健康教育的护工对氧疗病人的护理效果(P<0.05)。[结论]实施健康教育路径,提高了老人院护工氧疗知识认知水平和护理操作能力,提高了氧疗病人的护理效果。     

重症监护病房铜绿假单胞菌疑似感染暴发调查分析与护理干预

目的:探讨重症监护病房铜绿假单胞菌下呼吸道感染暴发的危险因素及护理干预措施.方法:通过对重症监护病房2009年6月发生的一起铜绿假单胞菌疑似感染暴发进行流行病学调查及环境微生物学检测,明确诊断并进行危险因素分析.结果:ICU仪器污染、工作人员医疗护理操作行为不规范引起的患者间交叉感染,患者自身内源性因素是造成此次感染暴发的主要原因.结论:规范医护人员操作行为,提高手卫生依从性,加强对病房环境、呼吸机、护工、患者及探视者管理等护理干预措施,切断内源性和外源性感染传播途径,能有效预防和控制铜绿假单胞菌引起的医院感染暴发.     

循证健康教育培训在社区老人院护工用药知识认知中的应用

目的:探讨循证健康教育培训在社区老人院护工用药认知中的应用效果。方法:采用自行设计的调查问卷了解社区老人院老人的用药及依从性情况,采用测评法对其老人院的22名护工用药知识认知调查,根据老人存在的用药依从问题和对护工进行考核后发现的问题,广泛收集科学依据,有针对性的对护工进行常见疾病的用药知识循证培训,观察护工培训前后对老人用药依从性的影响。结果:培训后护工的用药知识掌握情况与培训前比较差异有统计学意义(P<0.01),培训后老人用药依从性高于培训前(P<0.05,P<0.01)。结论:循证健康教育培训可提高护工的照护能力,提高老人的用药依从性。     

护工手卫生对预防和控制医院感染的影响

院内感染也称医院感染是指住院患者在医院内获得的感染,我社区卫生服务中心收治的患者以脑卒中康复患者为主,绝大多数是老年人、长期卧床、生活不能自理.为了缓解护理人员资源紧缺的社会问题,护工便应运而生.但由于护工的文化程度普遍低,有的甚至是文盲,未受过专业培训且管理上欠规范,因此消毒隔离意识淡薄.同时护理几个患者却不能做到规范的手消毒,无形中便成为医院交叉感染的媒介.针对这一情况,我院开展了护工手卫生的调查研究.现报道如下.     

我院规范化护工管理模式探讨

目的:规范护工管理,提升医院服务品质,更好地为病人和社会服务。方法:对护工的工作进行一系列改革,包括制度的完善,管理的统一,规范的培训,素质的提升,适时的奖惩等。结果:提升护工群体形象,降低护患纠纷,减少医院感染等。结论:规范护工的管理有助于提升医院形象,提高护理服务质量。     

综合护理干预对老人院老年人睡眠质量的影响

目的:探究将综合性护理应用于老人院老年人睡眠的护理的效果。方法:选择我院从2015年9月至2017年6月间收治的老人院老年人64例作为研究对象,按照老年人的入院顺序,将所有老年人随机分为对照组和实验组,每组中均包含32例老年人;护理过程中,对照组老年人采用常规护理方案,而实验组老年人则在此基础上加用综合性护理干预,对比2组老年人的睡眠质量,评价2组老年人的生活质量评分。结果:实验结果显示,实验组老年人的睡眠质量较对照组明显更好;并且实验组老年人的生活质量评分较对照组明显更高,各数据组间差异有统计学意义(P0.05)。结论:将综合性护理干预应用于老人院老年人睡眠老年人的护理工作中,能够辅助护理工作的开展,有效提高老年人的睡眠质量,并在一定程度上改善老年人的生活质量,是一种十分积极的护理方案,值得推广使用。     

一起肺炎支原体感染暴发的流行病学分析与应急处理

【目的】了解肺炎支原体感染暴发的流行病学特征,为制定应急处理措施提供科学依据。【方法】采取现场流行病学方法,对某游泳中心学员肺炎支原体感染暴发的传播因素进行调查与分析并进行应急处理。【结果】该游泳中心382名游泳学员支原体肺炎罹患率18．06％．集中乘坐空调车者罹患率为77．78％．自行解决交通工具者罹患率为8、23％,对照组罹患率为5、45％。【结论】肺炎支原体感染暴发主要是在密闭的空气环境中,经空气传播,与人员的密集程度有关,与游泳水质无关联。应急处理措施及时是可以预防控制二代病例发生的。     

护工自行管理在住院肿瘤患者中的应用价值研究

目的：探讨护工管理模式在肿瘤患者中的应用价值。方法我院2013年以肿瘤科为试点,签订工作合同护工42人。执行规范的招聘条件,由医院后勤保障部、护理部、医院感染管理科自行管理培训,明确各项规章制度,建立完善的护工考核和奖励机制。观察执行护工自我管理后1年护工的流失率、病房患者陪人率、护工雇请率、患者及家属满意度、护工与患者纠纷发生情况。结果实行护工自行管理后,护工人员流失率较执行该项政策前3年均明显降低（均P＜0.05）,患者及家属、其他医务人员对护工的满意度均明显提高（均P＜0.05）,护工的雇请率较之前明显增加（P＜0.05）,病房陪人率、护工与患者纠纷发生数均明显下降（均P＜0.05）。结论护工管理模式能够降低护工人员流失率、病房陪人率、护工与患者纠纷,提高患者及家属对医院的满意度。     

护理本科生老年护理学教学方法及效果

目的探讨学习老年护理学对提高护理本科生照顾老年人意愿的效果。方法对3年级116名护理本科生开展老年护理学教学,学习内容包括老年护理学理论学习、老年护理技术训练、角色扮演进行老化游戏、观看老年题材的影片、老人院实地探访等,学习时间4个月。结果护理本科生对老年人态度、老化知识得分均高于学习前(P0.01或P0.05),学习后照顾老年人意愿由61.21%提高到74.14%(P0.05)。结论学习老年护理学可改善护理本科生对老年人的态度、增加老化知识、提高照顾老年人意愿,应重视老年护理教学内容和方法的改进。     

循证健康教育提高老人院护工防骨质疏松患者跌倒认知水平的效果

目的探讨循证健康教育提高老人院护工防骨质疏松(osteoporosis,OP)患者跌倒认知水平的效果。方法2011年9月,采用循证健康教育模式对佛山市仁爱"老人院"的22名护工进行了OP知识以及跌倒危险因素认知的系统培训,并督导护工遵照所学内容在工作中实施防跌倒的干预措施。结果结果显示,护工接受培训后,理论和操作考核成绩均优于培训前(P<0.01);OP患者跌倒的危险因素减少(P<0.01),跌倒率由36.7%降到16.1%(χ2=6.274,P<0.05)。结论护工接受循证教育模式的培训可以提高其防OP患者跌倒认知水平,从而更有效地实施防跌倒干预措施,提高老人的生活质量。     

COVID outbreak after the 1st dose of COVID vaccine among the nursing home residents: What happened?

The purpose of this study was to assess the effectiveness of Pfizer-BioNTech COVID19 vaccine among nursing home residents by exploring the outcomes of a major COVID-19 outbreak following COVID-19 vaccination in a nursing home located at a metropolitan area of South-Central Texas. 91 residents resided in this nursing home during the outbreak, and 86 residents received the 1st dose of COVID-19 vaccine on January 4th, 2021. A retrospective chart review explored outcomes of this outbreak by accessing the electronic medical records from January 4th, 2021 thru February 28th, 2021. Residents partially vaccinated with COVID-19 vaccine were found less likely to be symptomatic during this outbreak. The risk of SARS-CoV-2 infection was significantly lower among residents who received both doses of the COVID-19 vaccine. Completion of both doses of COVID vaccination for all nursing home residents is essential and can prevent future COVID-19 outbreaks in nursing homes.     

Influenza in the nursing home.

Although influenza affects persons of all ages, the Centers for Disease Control and Prevention has identified several groups who are at increased risk for complications. One such group is residents of nursing homes or other long-term care facilities. During influenza epidemics, mortality rates among nursing home residents often exceed 5 percent. To lessen the impact of this infection, the influenza vaccine is recommended as the primary way of preventing the illness and its complications. Many studies have shown that vaccination of nursing home residents and staff can significantly decrease rates of hospitalization, pneumonia, and related mortality. When an influenza outbreak occurs in a nursing home, several measures can be implemented by the treating physician. Treatment and prophylaxis can be accomplished using antiviral medications such as amantadine, rimantadine, and oseltamivir. The antiviral medication zanamivir can be used in the treatment of influenza, but not for prophylaxis. Once an outbreak has been established, control measures, including vaccination of unvaccinated residents and employees, and limitations on resident movement and visits, can be implemented.     

Current status of long‐term indwelling urinary catheter management by visiting nurses

Patients with indwelling catheters at home are more likely to receive home‐visit nursing care. However, the condition of patients with indwelling catheters among those receiving home‐visit nursing care, as well as the actual status of catheter management practised by visiting nurses, has not been studied. The aim of this study was to study the condition of long‐term indwelling urinary catheter users receiving home‐visit nursing care and the status of catheter management by visiting nurses. Thirty visiting nurses with experience in home‐visit nursing care for patients with long‐term indwelling catheters participated in this study. The questionnaire covered (1) attributes of visiting nurses, (2) the condition of indwelling catheter users, and (3) the state of implementation of catheter management by visiting nurses and difficulties experienced. It was found that patients receiving home‐visit nursing care had used indwelling catheters for a prolonged period for both disease management and other reasons, and they developed various abnormal symptoms and complications such as urinary tract infection. A high percentage of visiting nurses implemented all the items of observation, practice, guidance and cooperation in catheter management. Items of catheter management that caused difficulty for visiting nurses included detection of urinary tract infection or other complications, catheter insertion, obtaining catheter replacement supplies, encouraging ingestion of water and cooperation with physicians. This study concludes by throwing light on the condition of long‐term indwelling urinary catheter users receiving home‐visit nursing care, and the status of catheter management by visiting nurses.     

Are nursing homes adequately staffed? The silent epidemic of malnutrition and dehydration in nursing home residents. Until mandatory staffing standards are created and enforced, residents are at risk

Providing care to produce positive resident outcomes is an ethical duty of nursing home staff. Research has shown that inadequate staffing levels present an increased health risk to nursing home residents. Nursing home residents may experience dehydration and malnutrition caused by inadequate staffing. Continued research in the area of nutrition and dehydration in nursing home residents may positively influence changes in staffing levels at nursing homes. Currently, residents living in understaffed nursing homes and not receiving proper care are the victims. It is time for nurses to forcefully lobby for national mandatory nurse staffing standards.     

Medical decision-making in the nursing home: a comparison of physician and nurse perspectives

The purpose of this study is to clarify the perspectives of physicians and nurses in the medical decision-making process at the time of status change events in nursing home residents. The decision-making processes studied involved 28 cognitively impaired nursing home residents in a large suburban nursing home. In interviews, the authors ascertained the personal opinions of physicians and the nurses related to the status change event and the decision-making process using the Medical Decision-Making During a Status Change Event Questionnaire. Nurses reported a greater degree of familiarity with the family's and resident's wishes than did physicians. Physicians reported considering more treatment options and choosing more treatments for residents than nurses. Both physicians and nurses reported that the physicians had a major role in decision-making and that nurses did not, yet the gap in reported roles was greater based on physicians' reports in comparison to nurse reports. In a third of the reported cases, physicians and nurses disagreed about whether advance directives had been followed. These findings reflect a division of roles and perspectives of nurses versus physicians in the medical decision-making process. This study demonstrates the ability of the questionnaire to reveal several key differences in perceptions of care. This information could be useful in developing forums for communication among the professionals to enhance mutual understanding.     

厦门市社区卫生服务机构护士职能特点的调查分析

目的调查厦门市不同年龄段人群就诊社区服务机构的现状及社区卫生服务机构护士护理职能执行情况,探讨社区医疗护理在不同人群中的侧重情况。方法随机抽取全市17个社区卫生服务机构的服务对象(n=510)进行问卷调查。随机抽取20个社区卫生服务机构的护士(n=216)进行护理职能开展情况问卷调查。结果青年组291例每年平均就诊次数为(4.09±2.06)次,中年组96例为(4.60±1.86)次,老年组123例为(5.24±1.45)次,三组比较差异有统计学意义(P<0.05)。216名社区护士中,53.70%进行过家庭访视,26.85%进行过居家护理,93.06%开展健康保健护理服务,42.59%进行过康复护理。结论厦门市社区护士已经认识到健康教育的重要性,但家庭访视、居家护理、康复护理服务开展较少。应重视社区护士老年护理相关知识的继续教育,以适应当前的健康需求。     

Antidepressant Treatment of Depression in Rural Nursing Home Residents

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.     

Antidepressant treatment of depression in rural nursing home residents

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.     

Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway

Aim. To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. Methods. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65–102 years with at least six months’ residence and a representative population sample of 1137 Norwegian citizens aged 65–102 years. All nursing home residents had a Clinical Dementia Rating Scale score ≥0·5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. Results. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23·2 and mean general population 62·9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. Conclusions. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. Relevance to clinical practice. This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.     

Feeling at home in nursing homes

AIM: The purpose of this study was to examine determinants of feeling at home and in particular the privacy in nursing homes in The Netherlands. The first question was to what extent nursing homes differed in the degree residents feel at home and experience privacy. The second question was whether feeling at home is related to privacy in the nursing homes. BACKGROUND: Feeling at home is of particular importance to residents of nursing homes because the average length of stay in The Netherlands is about 16 months. A growing number of people are of the opinion that the privacy of the residents has to be improved. Privacy in nursing homes, therefore, has been high on the political agenda over the last few years. Four aspects of privacy were distinguished: privacy related to the characteristics of the building, privacy as a consequence of the attitude of nurses towards residents, privacy in terms of choice and control over time schedules and activities, and privacy related to the amount of disturbance caused by other residents. DESIGN: The data were collected from individual interviews with 686 residents and family-members in 36 nursing homes in The Netherlands. RESULTS: Following quantitative data analysis, it was found that nursing homes differed in the proportion of residents feeling at home as well as in three aspects of privacy. Differences in feeling at home were found to be related to privacy, especially to the perceived attitudes of nurses and perceived disturbance caused by other residents. A weak relationship was found between residents and their perceived privacy of the building. CONCLUSIONS: A significant amount of variation in privacy was found at the nursing home level. This implies that feeling at home is not only individually determined but can be influenced by the nursing home's management policy.