呼吸科专业护士核心能力的界定及评价

目的：探讨核心能力培训在呼吸科专业护士在职培训中应用,提高呼吸科专业护士专科护理能力。方法：通过问卷调查的方法确定呼吸科专业护士的核心能力培训需求,制定呼吸科专业护士核心能力培训模块,分层培训,比较培训前后护士的理论、技能成绩及患者、医生等对护理工作的满意度。结果：在呼吸科实施护士核心能力培训2年后,护士的理论、技能考核成绩明显提高,新护士的临床适应周期缩短,患者、医生、护士的满意度均提高。结论：呼吸科护士核心能力培训,有利于提高专科护理水平,为患者提供优质浦意的护理服务。     

Public health skills in primary care in South West England--a survey of training needs, obstacles and solutions.

The UK government is moving primary care towards a more health needs led service. This will require a greater awareness of public health skills among primary care staff. We therefore sent a postal questionnaire to the chairmen of primary care groups (general practitioners), the chief officers of primary care groups, directors of public health, nurse advisors of health authorities, directors of community nursing and directors of midwifery in the South West region of England. Respondents were asked about skills in health needs assessment, health service planning and other public health skills among general practitioners, health visitors and midwives. The survey also covered perceived obstacles to the acquisition of such skills and possible solutions. The response rate was 67% (96/143). Eighty percent of primary care groups returned at least one reply. Sixty-four percent had either not considered the problem or considered it but not acted. Fifty percent of directors of public health felt that they could not provide more training to non-specialist staff. Most organisations provided little training in public health skills to non-specialist staff despite a perceived skill shortage particularly in health promotion, advocacy and the evaluation of the effectiveness and efficiency of services. We conclude that primary care groups and public health departments need to agree how to access public health advice. Primary care groups need to identify individuals with an interest in strategic working and service planning, identify their skill deficits and seek appropriate training.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

Improving health care communication for persons with mental retardation.

There has been little effort directed at training health care professionals in behaviors and attitudes that are effective in communicating with persons with mental retardation. Such training would be beneficial not only to assist those with congenital cognitive deficits but for those with acquired central nervous system conditions as well, for example, dementia. Persons with mental retardation are living in community settings in greater numbers and increasingly participating in vocational, residential, and health care programs. Yet, most health care professionals are not routinely offered an opportunity to gain experience interacting with people who have limited ability to express and understand health care information. An education program was focused on health care professionals' use of basic communication skills when providing health information to an adult who is mentally retarded. A self-study instructional text and a 20-minute companion video provided methods of communicating with a patient with mental retardation in medical and dental care settings. Resident physicians, medical students, nurses, and nursing assistants improved their communication skills, knew more about mental retardation, and were more proactive in health care interviews following training. Health care training needs to incorporate educational opportunities focusing on skills to assist special populations. Brief, structured, and interactive skill training in communication offered early in the health care professional's career has positive benefits for the recipient and the provider.     

绵阳市社区护理人员培养需求分析及对策研究

目的 了解绵阳市社区护理人员岗位培训需求,为卫生主管部门制定人才继续培养计划提供参考.方法 采用整群便利抽样,对参与培训的绵阳市38家社区卫生服务中心的295名社区护理人员培养需求进行问卷调查.结果 90.8％护理人员希望通过网络快速获取培训知识,68.5％建议三级医院免费提供进修名额.结论 建立区域化社区卫生护理人才培养组织,需要护理学会及卫生行政部门重视,畅通培训渠道,提供对口帮扶,并建立多元化社区护理人才培训体系.     

上海市老年护理院卫生人员现状与问题分析

该对上海市老年护理院卫生人员尤其是医护人员的数量、结构进行分析,以便了解卫生人力的现状及问题。更好地配置人力资源,提供更多、更好的服务,适应老龄化的发展。调查结果显示：22个护理院共有卫生人员1262人,医生310人。护士303人,另有护工393人。医生的学历构成中以中专和大专为主,分别占52．1％、31．4％;护士以中专为主。占83．8％。医、护人员的高、中、初职称之比分别为1：5：13．3、1：9：130。有部分医护人员接受了不同类型的培训。作建议：进一步提高医护人员的总体素质;加强适应现代医学模式及老年人特点的业务培训,提供全面服务;注意适当调整医护人员的职称构成;加强护工队伍的建设和发展;加强卫生人员的管理。     

陕西省基层医疗卫生机构护理人员现状调查

目的了解陕西省基层医疗机构护理人员现状和护理人员执业能力。方法抽取陕西省1市10县医药卫生体制综合改革试点市县,通过座谈、问卷调查及实地走访等形式,在县乡医疗卫生机构开展调研。结果陕西省基层护理专业人员结构概况:农村地区平均每千人拥有注册护士1.62人;基层护理人员中女性占96%,男性占4%;学历以大专为主,其次为中专和本科;职称结构中以初级职称为主,占88%;从事护理专业5年及5年以下者占40.8%,6年-10年占23.8%。基层护理人员执业能力整体状况良好,健康教育及预防保健能力、科研能力、社区护理能力评价较低。结论基层卫生机构护理人力资源匮乏,护理队伍结构不合理;基层护理人员执业能力较强,能够胜任一般护理工作,基本能够满足用人单位的需求,但仍需进一步加强沟通能力、急危重症患者的监护处置能力,提高科研意识,强化社区护理意识和能力。     

Promoting safety: longer-term responses of three health professional groups to a safety improvement programme

PURPOSE: Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The programme involved two-day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team-working skills would advantage the respective groups when conducting RCAs. DESIGN/METHODOLOGY/APPROACH: Responses to a 2005 follow-up questionnaire survey of doctors (n = 53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs. FINDINGS: Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar. RESEARCH LIMITATIONS/IMPLICATIONS: Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting. PRACTICAL IMPLICATIONS: There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed. ORIGINALITY/VALUE: Few longer-term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood.     

上海市浦东新区远郊社区卫生服务中心综合病房医护人员配置情况分析

目的了解上海市浦东新区远郊社区卫生服务中心综合病房医护人员的数量和质量,为合理配置人力资源、提升医护人员专业能力提供决策依据。方法采用回顾性调查和现况调查相结合的方法,对2015—2017年浦东新区远郊社区卫生服务中心综合病房医护人员配置情况进行分析。结果社区综合病房床位使用率85%,医生数量有所增加,但床位/医生比始终低于1∶0.2的最低标准,护士数量已达标;医护人员专业技术职称结构不理想;人才培养有待加强。结论远郊社区卫生服务中心应积极吸引并稳定全科医生队伍,完善人才培养及激励机制,优化医护人员专业技术职称结构、提升专业能力,更好地发挥住院病房的健康服务功能。     

Development of a psychometrically valid training needs analysis instrument for use with primary health care teams.

The growing demand for professional updating and training within the health service has created a proliferation of post-registration courses, many of which fail to reach the appropriate personnel or the real training objectives of the participants and their managers. One reason behind this problem relates to the fact that many such courses are constructed and delivered in a haphazard way, without systematic reference to the direct and indirect consumers of the educational programmes. A more rational approach to post-experience provision of this sort might involve the methodical collection of information regarding the training needs of target health professional populations. Such a data base would afford a global overview of competencies and deficiencies, both within and between individuals. From this the content, level and focus of training could be customized to meet the reported needs, thereby streamlining the commissioning process to enhance efficiency and effectiveness. Previous attempts to rationalize provision through the prior use of training needs analysis instruments have been compromised by the shortcomings of the analysis tool. This study, then, was an attempt to redress this problem, using a training needs analysis instrument developed along traditional psychometric principles. The tool was intended to be used with primary health care teams because of the increasing role this sector of the health service will play in the future delivery of care, although this would not preclude its use with other health care professionals (following appropriate modification), since the principles behind its construction and format are transferable. The instrument has demonstrable construct, content and face validity and significant reliability. Moreover, preliminary investigations suggest that it also has criterion validity in the areas tested. These findings suggest that the instrument is unique of its kind. Early use of the tool has demonstrated its value in a variety of ways, such as in team building exercises and skill mix reviews as well as in precise and effective commissioning of training and education in a range of areas.     

The struggle to improve patient care in the face of professional boundaries

Professional boundaries make inter-professional communication, collaboration and teamwork more challenging and can jeopardise the provision of safe, high quality patient care. This in-depth interview study conducted in three UK acute hospital organisations in 2003-2004 explored how professional boundaries affected efforts to improve routine practice by acute pain services (small specialist teams set up to drive improvements in postoperative pain management through education, training, standard-setting and audit). The study found that many anaesthetists and to a lesser extent nursing staff saw postoperative pain management as a new and unjustified addition to their professional role. Professional identities and strong fears about the risks of treatments meant that health professionals resisted attempts by the acute pain services to standardise practice and to change medical and nursing roles in relation to postoperative pain management. Efforts by the acute pain services to improve practice were further hindered by inter-professional boundaries (between the medical and nursing professions) and by intra-professional boundaries (within the medical and nursing professions). The inter-professional boundaries led to the acute pain services devoting a substantial part of their time to performing a 'go-between' function between nurses and doctors. The intra-professional boundaries hindered collaborative working among doctors and limited the influence that the acute pain service nurses could have on improving the practice of other nurses. Further work is needed to address the underlying fears that can lead to resistance around role changes and to develop effective strategies to minimise the impact of professional boundaries on patient care.     

Making guidelines,research and scientific papers as simple as possible

Background: Most patients with cancer want to die at home and will spend most of the final year of life there. Primary care staff will, therefore, provide the bulk of palliative care at home. Yet, palliative care training for staff is fragmented and ad hoc. Some feel inadequately trained for the tasks they are expected to perform.

Aim: The aim of this study was to carry out an educational needs assessment in palliative care of general practitioners and community nurses in Northern Ireland.

Method: A semi-structured postal questionnaire was sent to 1018 GPs and 750 community nurses with a reminder approximately one month later.

Results: 611 GPs and 497 nurses replied giving a response rate of 60% for the doctors and 66% for nurses. 52% of doctors and 94% of nurses expressed a special interest in palliative care. Though the majority of both groups felt confident in their palliative care skills, 83% of doctors and 95% of nurses said they would be likely to undertake further training in palliative care. Preferences for the topics and type of further training were similar for the two groups. The most popular topics for further training for both groups were pain and symptom control, bereavement care and research and audit methods. Preferred methods of further training included specialist lectures, discussion with specialists, hands-on experience in a hospice and multidisciplinary team meetings. Perceived barriers to further training were lack of time, lack of locally available courses, expense of providing locums or of self-funding courses and lack of recognition from management.

Conclusion: Primary care staff have expressed a keenness to provide community palliative care and provide it well. It now rests with managers and educationalists in the field to recognise and support staff in their needs.     

我院护理人员对中医护理的知信度和培训需求调查

目的：了解我院护理人员对中医护理的知信度和培训需求。方法采用自行设计的问卷,对我院的150名护理人员进行问卷调查,并运用统计学方法进行分析。结果本院150名护理人员对中医护理的知信度较差,平均总得分为49．3,其中不同年龄、不同工作年限及不同职称的护理人员对中医护理的知信度得分差别无统计学意义（ P＞0.05）,而不同教育程度之间的护理人员对中医护理的知信度得分的差别有统计学意义（P＜0．05）。关于培训需求方面,护理人员倾向采取外出培训（55．3％）,在职、半脱产的形式进行（82．0％）,培训时间以1～3个月为宜（40．7％）,培训内容以中医护理技能培训需求最高（92．0％）。结论医院管理者应重视对护理人员的中医护理培训,建立有效的继续教育培训机制,以培养中医护理骨干队伍,促进中医护理发展。     

社区卫生服务机构医务人员从业培训状况调查及分析

目的通过对社区卫生服务机构医务人员的调查,探讨社区医疗全科医学教育的合理方案和模式。方法采用调查问卷方式,对广州市越秀区部分社区医疗医务人员进行调查,包括基本信息、工作状况、培训教育状况等。结果社区卫生服务机构医务人员构成以大学本科、大专学历为主,职称构成以初级为主。对工作满意程度一般的占44.4%,认为工作压力很大的占44.1%。进行全科医生规范培训前有61.9%的人员没有获得过进修机会。大部分人愿意参加全科医生规范培训,并认为业务水平有一定程度提高。结论全科医生规范培训是提高社区卫生服务机构医务人员业务和服务水平有效途径。对于存在一些问题,需要加强政府管理,加以改善。     

Training needs of staff in Romanian institutions for young children

Summary In order to make adequate provision for staffing and staff training in leagane (long-term residential care institutions for preschool age children in Romania) a postal survey was conducted in the autumn of 1991 to ascertain the demographic characteristics, job titles and educational attainment of directors and staff, staffing needs and the kinds of positions currently filled, the numbers of directors and staff exposed to continuing education programmes within the last 2 years, and the opinions of directors and staff regarding their most important continuing educational needs.
The bulk of the direct care workforce was less than 50 years old. Thirty-four per cent of the direct care staff had less than a high-school education. Sixty-seven per cent of the staff were health professionals or health care workers. There were few psychologists, physical therapists, teachers or social workers.
In the last 2 years, directors and other physicians had been mostly exposed to courses in the areas of psycho-social care/management and paediatric medical care. Nurses had attended professional development courses. Infirmiera (nursing assistants) had also attended professional development courses such as those offered by foreign non-governmental organizations on the care of institutionalized children. Educators (teaching assistants) had attended courses in child development and rehabilitation. Directors and staff expressed clear opinions regarding their needs and preferences for additional training     

Nurses and public health: evolution of missions and trainings

Reflection upon the role of nurses in public health is not something new; however, over the past few years, a questioning and similar reports have sprung up pointing to the difficulty perceived by nurses in reconciling their professional practice and public health. Currently, in light of the evolution of public health, where does the practice of nursing fit into public health practice? What are the potential movements and trends in terms of training? The goal of this paper is to present a number of possible avenues for thought on the subject, namely concerning the training and the allocation of competencies. It would be undoubtedly a pity to conceive of public health training today being intended only for nurses. It is rather preferable that post-graduate public health training is aimed at a variety of professional categories, regardless of their initial training or degree course. The development of schools of public health to which nurses could have access in the same way that other health professionals or from the social and educational fields do is critical. Above and beyond what is at stake for specialisation, and even independent of the implication of nurses in public health work, the current trend to re-balance the work and tasks of both nurses and doctors constitutes a significant challenge for public health.     

Mental health services in Perth nursing homes

Directors of nursing (DONs) in 42 nursing homes in Perth were asked for information concerning mental health services provided for their residents. A questionnaire similar to those used by other researchers in Sydney and in Ontario was utilised to enable meaningful comparisons among the three studies. According to the DONs' perceptions, the mean proportion of residents in Perth nursing homes with psychiatric and/or behavioural problems was between 50% and 75%. The mental health services provided to nursing homes were significantly less than that desired by the DONs. Other variables assessed in this study included the number of transfers per year because of psychiatric problems; the number of staff with psychiatric qualifications; the provision of psychiatric training for staff; the most frequently occurring psychiatric problems in residents and the most valued mental health services provided to nursing homes. Results were comparable to those of the Sydney and Ontario studies. This study suggests that there is a significant psychiatric population in Perth nursing homes that, like those in Sydney and Ontario are seriously neglected regarding appropriate professional psychiatric care. Existing psychogeriatric community assessment teams could provide more of these services if adequately staffed and resourced.     

高专层次社区护理专业分化方向培养模式的实践和研究

随着社区卫生服务的开展，社会对社区护理人员的需求越来越大，社区护理教育将成为高职高专护理教育发展方向。某校自2004年下半年起对04级护理专业学生实行了专业方向（模块化）的教学改革试点，对学生从基础理论、操作技能、心理素质、人际沟通和循证护理能力方面进行培养。培养出既能适用于大中型医院的护理工作。又能适用于社区护理工作的新型社区护理人才。据此提出适时调整护理人才的培养模式。     

Sexual health and the practice nurse: a survey of reported practice and attitudes

BACKGROUND: Practice nurses have an important role in the provision of sexual health services in general practice. AIM: This study set out to determine practice nurses' reported practice and training in sexual health, attitudes towards sexual health, barriers to discussing sexual health with patients, and training needs. METHOD: A confidential self-administered postal questionnaire survey was sent to all 298 practice nurses in one English health district (Leicestershire). RESULTS: Completed questionnaires were returned by 234 practice nurses (response rate 79%). Most nurses routinely offered well-person checks (90%), cervical smears (89%), travel clinics (83%), saw women with genito-urinary symptoms (77%) and offered family planning advice (54%). Only a minority of nurses (13%) offered specific teenage health clinics. Sexual health issues were always discussed in a majority of consultations when giving family planning advice (65%) and in women with genito-urinary symptoms (58%). Most practice nurses (62%) had undertaken at least one course dealing with sexual health issues in the last 5 years. Uptake of training was, however, significantly lower in certain groups of nurses. An analysis of the attitude statements suggested that nurses were more comfortable discussing sexual health issues with female patients and teenagers than with male patients and those of different sexual orientations. Nurses who had received training reported more positive attitudes towards discussing sexual health issues with patients. CONCLUSION: Practice nurses offer a wide range of services in which the need to be able to take a sexual history and offer appropriate advice is important. There is scope to improve the provision of sexual health services by nurses in general practice, particularly in relation to services for teenagers.