家庭合作训练对慢性心力衰竭患者自我护理行为及生活质量的影响

目的建立慢性心力衰竭患者家庭合作训练模式,并探讨其效果。方法将235例心力衰竭患者采用随机数字表法分为对照组(120例)和干预组(115例)。对照组接受常规的护理和自我管理教育以及电话随访。干预组在常规护理基础上接受家庭合作训练。干预前后对患者的自我护理行为和生活质量进行比较分析。结果干预后干预组患者的自我护理行为得分明显高于对照组,差异具有统计学意义(P0.01),干预组患者生活质量改善明显优于对照组,差异具有统计学意义(P0.01)。结论家庭合作训练在慢性心力衰竭患者家庭中的运用是可行、有效的,能更好地改善患者的自我护理行为和生活质量。     

以行为转变理论为指导的干预模式对社区高血压病患者血压控制及服药依从性的影响

目的 探讨行为转变理论为指导的干预模式对社区高血压患者血压控制及服药依从性的影响.方法 选择社区高血压患者116例,以年龄、性别、病程为条件按照1∶1比例进行配对,分配至g干预组及对照组,干预组以行为转变理论为指导进行干预,对照组给予常规护理,比较干预6个月后两组患者血压及服药依从性情况.结果 干预组患者服药依从性得分为（15.20±1.48）分,对照组为（13.44±2.42）分,两组比较差异有统计学意义（Z=-4.023,P＜0.01）;干预后干预组患者收缩压为（131.64 ±9.85）mm Hg,对照组为（136.25±10.20） mm Hg,两组比较差异有统计学意义（t=-2.344,P＜0.05）.结论 以行为转变理论为指导干预模式可提高高血压患者的服药依从性,改善血压控制情况,建议在社区高血压护理中推广应用.     

人性化护理对老年高血压患者血压控制效果的影响

目的 观察人性化护理对老年高血压患者血压控制效果的影响.方法 选择我院138例老年高血压患者,随机分为干预组和对照组各69例,干预组接受抗高血压药物治疗,同时给予系统的护理干预,对照组接受单纯药物治疗,比较2组的血压控制效果.结果 干预组SCL-90因子干预前明显高于中国常模,干预后SCL-90因子明显低于干预前.干预组血压控制的总有效率为92.75%,明显高于对照组.结论 对老年高血压患者通过实施多种形式、多途径的人性化护理干预措施,有效地控制了患者的血压,提高了临床治疗效果,提高了护理满意度及护理质量,值得临床推广和应用.

Abstract：

Objective To observe the effect of humanistic care on blood pressure control of elderly patients with hypertension. Methods 138 elderly patients with hypertension patients in our hospital were randomly divided into the intervention group and the control group with 69 cases in each group, the intervention group received anti-hypertensive medication as well as the system of nursing intervention,and the control group only was given simple drug treatment. The blood pressure control results were compared. Results SCL-90 factor of the intervention group was significantly higher than the Chinese module before intervention, and SCL-90 factors after intervention was significantly lower than before intervention. In the intervention group, the total effective rate of blood pressure control was 92.75%, significantly higher than the control group. Conclusions Humanistic nursing interventions to elderly patients with hypertension with various forms and more ways can effectively control the blood pressure, improve the therapeutic effects, improve nursing satisfaction degree and quality of care and is worthy of promotion and application.     

Effectiveness of a medical education intervention to treat hypertension in primary care

Background and objectives In Mexico, hypertension is among the top five causes for visits to primary care clinics; its complications are among the main causes of emergency and hospital care. The present study reports the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. Methods A secondary data analysis was carried out using data of hypertensive patients treated by family doctors who participated in the CME intervention. The evaluation was designed as a pre‐/post‐intervention study with control group in six primary care clinics. The effect of the CME intervention was analysed using multiple logistic regression modelling in which the dependent variable was uncontrolled blood pressure in the post‐intervention patient measurement. Results After the CME intervention, the net reduction of uncontrolled blood pressure between stages in the intervention group was 10.3%. The model results were that being treated by a family doctor who participated in the CME intervention reduced by 53% the probability of lack of control of blood pressure; receiving dietary recommendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. Conclusions CME intervention improved the medical decision‐making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.     

加强患者健康教育对控制血液透析患者高血压的影响

目的调查分析维持性血液透析患者高血压的危险因素,加强患者健康教育,提高血压达标率。方法对177例透析患者进行调查问卷。分析血压控制不达标的原因,有针对性进行健康教育和医疗干预。结果合并高血压维持性血液透析患者112例,其中68例血压未达标(>140/90mmHg)。血压未达标患者的透析间期体质量增长率较血压达标患者高,分别为(6.18±1.83)%和(5.19±1.60)%,差异有统计学意义(P<0.01)。加强患者健康教育,进行医疗护理干预2个月后,血压未达标者透析间期体质量增长量较干预前减少,收缩压和舒张压较干预前均有所下降。结论对透析患者进行相关知识的宣教有助于患者控制体质量增长,降低血压。     

The public health strategy for palliative care

The quality of life of at least 100 million people would have improved--if today's knowledge of palliative care was accessible to everyone. A Public Health Strategy (PHS) offers the best approach for translating new knowledge and skills into evidence-based, cost-effective interventions that can reach everyone in the population. For PHSs to be effective, they must be incorporated by governments into all levels of their health care systems and owned by the community. This strategy will be most effective if it involves the society through collective and social action. The World Health Organization (WHO) pioneered a PHS for integrating palliative care into a country's health care system. It included advice and guidelines to governments on priorities and how to implement both national palliative care programs and national cancer control programs where palliative care will be one of the four key pillars of comprehensive cancer control. The WHO PHS addresses 1) appropriate policies; 2) adequate drug availability; 3) education of policy makers, health care workers, and the public; and 4) implementation of palliative care services at all levels throughout the society. This approach has demonstrated that it provides an effective strategy for integrating/establishing palliative care into a country.     

人性化护理对老年高血压患者血压控制效果的影响

目的 观察人性化护理对老年高血压患者血压控制效果的影响.方法 选择我院138例老年高血压患者,随机分为干预组和对照组各69例,干预组接受抗高血压药物治疗,同时给予系统的护理干预,对照组接受单纯药物治疗,比较2组的血压控制效果.结果 干预组SCL-90因子干预前明显高于中国常模,干预后SCL-90因子明显低于干预前.干预组血压控制的总有效率为92.75%,明显高于对照组.结论 对老年高血压患者通过实施多种形式、多途径的人性化护理干预措施,有效地控制了患者的血压,提高了临床治疗效果,提高了护理满意度及护理质量,值得临床推广和应用.     

中国癌症疼痛现状调查中国医务人员对癌痛治疗态度、知识、实践情况的调查

采用“医务人员对癌症疼痛认知及临床治疗情况调查表”,对全国２９个省、区、市各级医疗卫生机构的医药卫生专业人员进行了调查。结果表明：在癌痛治疗基本知识、态度方面,２７３名参加过癌痛治疗培训的专业人员癌痛基本知识平均得分分值为９．２７±１．６７,显著高于未参加过培训人员６．８４±２．５４的平均分值（ｔ＝１４．２３,Ｐ＜０．０５）;在癌痛治疗现状上,分别有３５．６％、３７．０％和２６．８％的人认为目前癌痛患者中的７０％以上、约５０％和３０％以下得到了必要的止痛药治疗,而认为基本达到ＷＨＯ三级止痛治疗阶梯目标的仅占所有应答者的１７．１％;在有效癌痛治疗的障碍因素上,医务人员、患者的“恐瘾”心理和麻醉性镇痛药管理过严是主要障碍因素。     

佩戴冰帽缓解乳腺癌化疗患者脱发的应用效果

目的探讨佩戴冰帽对缓解乳腺癌化疗患者脱发的效果。 方法2020年1月至12月纳入北京市某三级甲等医院行化疗的乳腺癌患者202例为研究对象,根据佩戴冰帽的意愿将患者分为干预组（127例）和对照组（75例）。干预组于化疗过程中佩戴冰帽,对照组化疗过程中不接受头皮护理。于患者首次化疗开始前、末次化疗开始前拍摄其头部前、后、两侧及头顶的发量照片,由不知晓患者分组情况的研究护士按世界卫生组织（WHO）的抗癌药物毒性分级标准判断脱发程度,评估患者末次化疗前的脱发状态。 结果末次化疗前,干预组未脱发患者86例（67.7%）,对照组未脱发患者12例（16.0%）,差异有统计学意义（P＜0.001）。佩戴冰帽对不同化疗方案所致脱发的预防有效率为60.9%~73.9%。 结论佩戴冰帽可有效缓解乳腺癌化疗导致的脱发,且佩戴方便,不适症状少,值得在临床推广。     

The shifting sands of health care delivery: curriculum revision and integration of community health nursing.

The health care delivery system in the United States is moving from an institutionally driven and controlled medical care model toward the Primary Health Care model described by the Alma-Alta Conference (World Health Organization [WHO], 1978) as community-driven comprehensive health care. However, nursing education still remains institutionally based, anchored in a medical model. Dynamic curricula must be developed that prepare nurses to practice in an ever-changing health care delivery system that is becoming more community based. The purpose of this article is twofold: to provide an overview of the revised curriculum of Brigham Young University's College of Nursing (BYU-CON) as one example of a faculty's attempt to develop a program that prepares graduates skilled in providing health care in the 21st century; and to examine closely the integration of community health nursing into the curriculum.     

早期护理干预在妊娠高血压综合征产妇中的应用及效果

目的:探讨早期护理干预妊娠高血压综合征(简称妊高征)产妇中的应用及临床效果。方法:将113例妊高征产妇随机分为干预组58例和对照组55例,对照组给予常规护理,干预组在此基础上进行定期产前检查、健康宣教及预见性护理。观察比较两组先兆子痫及子痫发生率、分娩方式、并发症情况、产后出血及围生儿结局。结果:干预组先兆子痫及子痫发生率、剖宫产率均低于对照组(P<0.05),产时并发症少于照组(P<0.01),围生儿结局优于对照组(P<0.01)。结论:对妊高征产妇进行早期护理干预,可降低先兆子痫、子痫及剖宫产发生率,减少并发症发生,提高母婴生存质量。     

Partnership caring: a theory of high blood pressure control in Iranian hypertensives

This study uses grounded theory methodology to generate a substantive theory that describes and explains the problem of high blood pressure control among Iranian patients. High blood pressure control is a major world health problem on which many studies have been carried out. Most of these studies have been done by quantitative research methods. The main purpose of this qualitative research was to determine the essential structure of high blood pressure control in an Iranian hypertensive population and to identify a theoretical explanation for this problem. Four interrelated concepts: 'non-compliance', 'lack of knowledge', 'lack of effective caring relationship', and 'necessity of partnership' were identified. Based on these processes, a partnership care theory was developed that provides an appropriate context for the active participation of patients, nurses and physicians in the control of hypertensive disease. This theory can be utilized in the control of hypertension as well as other chronic diseases.     

The partnership care delivery model: an examination of the core concept and the need for a new model of care

Aim  This article describes the foundation of an emerging care delivery model based on partnership. It also reflects on and synthesizes the findings of earlier concept analyses of its core concept.
Background  Changes in the delivery of health care services in the United States have been driven significantly by cost containment over the last 20 years. This has resulted in an unprecedented pace of work, fragmentation of care, and medical errors. Fundamental changes are needed to meet the needs of today's health care environment.
Methods  A literature search was done in electronic data bases. Concept analysis papers were reviewed and synthesized.
Results  The antecedents, attributes and consequences of partnership are described and linked to the supporting literature and theoretical models.
Conclusions  Engaging and empowering the patient through partnership seem to be crucial to developing a cohesive and effective model of care delivery. Partnerships among patients, their families, physicians, nurses and other clinicians positively impact on safety, quality of care, satisfaction, outcomes and job fulfillment.
Implications for nursing management  Managers need to foster an environment that allows for stronger reciprocal relationships. They need to facilitate changes in practice that support the development of partnerships among patients, their families and all care providers.     

多学科护理照顾模式对青少年癫痫患者术后应激及生活质量的影响

目的 探讨多学科护理照顾模式的应用对青少年癫痫患者术后应激、遵医行为、自我护理能力及生活质量的影响.方法 将90例手术治疗青少年癫痫患者按随机数字表法分为两组,每组45例.对照组采取常规护理干预,研究组采取多学科护理照顾模式开展护理干预,观察住院全程.比较干预前后两组患者应激指标、遵医行为、自我护理能力及生活质量.结果...     

护理干预对提高维持性血液透析高血压患者用药依从性的影响

目的 探讨护理干预对提高维持性血液透析（MHD）高血压患者用药依从性及血压控制的影响.方法 选择MHD高血压患者60例,随机分成干预组30例和对照组30例.对照组采用常规护理和一般指导方法,干预组在此基础上根据对患者的评估情况增加护理干预措施.在每次透析时及透析间期分别对每个患者进行有针对性的为期6个月的护理干预.观察实施干预后两组患者用药依从性和血压异常发生率、并发症发生率及住院率的变化情况.结果 6个月后干预组血压异常发生率、并发症发生率、住院率显著低于对照组,差异均有统计学意义（P＜0.01） 用药依从程度明显高于对照组,差异均有统计学意义（P＜0.01）.结论 护理干预是提高MHD高血压患者用药依从性、控制血压达标的有效方法.     

护理干预对社区高血压患者遵医行为和生活质量的影响

目的：探讨护理干预对社区高血压患者遵医行为和生活质量的影响。方法选取2010年~2011年本社区278例高血压患者作为研究对象,按照随机分组法随机分为对照组和干预组各139例,对照组给予常规的治疗和护理,干预组给予社区综合护理干预。6个月后比较2组患者的血压变化、遵医行为以及生活质量。结果干预组患者遵医行为和生活质量较对照组明显改善（P＆lt;0.05）。结论社区护理干预可明显改善高血压患者血压水平,提高患者的遵医行为以及生活质量。     

The Pan American Health Organization: its structure and role in the development of a palliative care program for Latin America and the Caribbean

In recent years palliative care has emerged as a major public health care issue, both in developed and developing countries. The rising number of cancer deaths as a result of increased tobacco consumption, control of other diseases, lack of preventive programs, and the difficulties of accessing curative treatments in many countries have made palliative care and pain relief the appropriate, and in many cases, the only option for patients with advanced disease. The World Health Organization (WHO) and its Regional Office for the Americas, the Pan American Health Organization (PAHO), have promoted palliative care as a component of their cancer control program. Some health care workers and policy makers are not adequately informed about the role that intergovernmental agencies such as WHO and PAHO play in the health care field. This has led to confusion and, in some cases, misjudgment of the organization. This paper summarizes the structure and role of PAHO and, specifically, its participation in the development of a palliative care program for Latin America and the Caribbean. Many health care professionals, administrators, and policy makers are unaware of the organization's objectives in this area and the tools available to assist in the implementation and development of national programs to care for patients with advanced cancer. The information in this paper is based on data found in the PAHO and WHO web sites, as well as other technical publications from different sources, including individuals not formally associated with WHO or PAHO.     

The Take Control of Your Blood pressure (TCYB) study: study design and methodology

BACKGROUND: Among the 65 million Americans with hypertension, only approximately 31% have their blood pressure under control (<140/90 mm/Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for blood pressure, interventions to improve blood pressure control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a two by two design is being conducted to improve blood pressure control. This five-year trial evaluates two patient-directed interventions designed to improve blood pressure control among patients diagnosed with hypertension in a community-based primary care setting. METHODS: Patients are randomized to one of four groups: usual care, home blood pressure monitoring, tailored behavioral self-management intervention that is administered via telephone by a nurse, or a combination of the home blood pressure monitoring and tailored behavioral intervention. Patients receiving the home blood pressure monitoring are trained in the use of an electronic blood pressure measurement device, are asked to measure their blood pressure 3 times/week, and send in two-month blood pressure recordings throughout the 24-month study duration. The behavioral intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. A nurse delivers all behavioral self-management modules over the telephone bi-monthly for 24 months. The primary outcome is the proportion of patients who achieve control of their blood pressure based on evidence-based guidelines (for patients without diabetes <140/90 mm/Hg, for patients with diabetes <130/80 mm/Hg) evaluated at six-month intervals over 24 months (five measurements) using a random-zero sphygmomanometer. CONCLUSION: Despite the known risk of poor blood pressure control, and the wide availability of effective treatment strategies, a majority of adults still do not have their blood pressure controlled. This study will be an important step in defining two explicit interventions to improve blood pressure control. To our knowledge, this study is the first to combine both a tailored behavioral self-management intervention and self-monitoring home blood pressure intervention to improve blood pressure control among patients in a primary care setting.     

Treatment of mild to moderate dehydration in children with oral rehydration therapy

Purpose: To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children.
Data sources: Recommendations from American Academy of Pediatrics (AAP), World Health Organization (WHO), selected research articles (2000–2006), and Internet sources.
Conclusions: Dehydration is a common diagnosis in pediatric primary care. The literature indicates that dehydration is more often treated with intravenous (IV) therapy when ORT would be equally effective. ORT is an effective treatment for children with mild to moderate dehydration. ORT could be used more frequently rather than IV rehydration therapy. The use of ORT versus traditional methods of IV hydration matches the nursing philosophy of holistic care by enhancing client comfort and autonomy.
Implications for practice: Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.     

Synergy towards health: a nursing intervention model for women living with fibromyalgia, and their spouses

AIM: The purpose of this study was to develop a consensus-based nursing intervention model for women living with fibromyalgia, their spouses and nurses working in a community health centre in Québec, Canada. BACKGROUND: Fibromyalgia syndrome, a rheumatic disorder associated with severe chronic pain and fatigue, has a major impact on the lives of individuals and their family. To date, research results on effective interventions are somewhat limited and inconclusive. Few studies take into account the perspective of those who live with this health problem on a day-to-day basis. METHODS: Data were collected mainly in 1999, through in-depth interviews and through group meetings using a qualitative research design, along the lines of the constructivist paradigm. The analysis plan aims for movement between the global and the specific: synthesis and thematic analysis. Analysed data were submitted to all participants throughout the data-collection process, thus allowing for shared constructions. FINDINGS: Results present the general consensus stemming from shared construction in all three groups. The nature of the intervention involves two major elements, support and teaching along with the fundamental importance of believing in the person. The timing of the intervention and the health and social context in which the intervention occurs also emerge as integral parts of the model. Synergy towards health in fibromyalgia emerges as the constitutive pattern composed of the following three elements: personal growth, spousal and professional support. The discussion addresses the model's components and uses an ecological perspective, in order to consider all the contexts that greatly influence the intervention. Empowerment is embedded in this intervention model. CONCLUSIONS: This study shows that research based on partnership allows the integration of perspectives and skills of various actors so as to develop meaningful interventions for both those seeking care and health professionals.