A survey on nurses' job burnout in the high-quality nursing care project

目的 了解优质护理服务活动中护士职业倦怠现状,为针对性干预提供参考.方法 采用MBI量表中文版对荆州市第一人民医院的62名护士进行调查.结果 优质护理服务过程中,护士情绪衰竭(EE)、去个性化(DP)和个人成就感丧失(PA)3个维度得分分别为25.79±10.65、8.73±6.38和14.35±8.45;EE和DP倦怠水平显著高于一般护理模式下的护士常模(均P＜0.05);PA倦怠水平显著低于常模(P＜0.01);EE中度倦怠和高度倦怠检出率分别为20.97％和53.22％,DP分别为24.19％和48.39％,PA分别为24.19％和0.护士EE、DP严重倦怠显著高于常模(均P＜0.01),而PA严重倦怠显著低于常模(P＜0.05);工龄≥3年护士PA的倦怠程度显著高于年资＜3年的护士(P＜0.01);本科护士在职业倦怠3个维度上的严重程度均显著高于中专、大专护士(P＜0.05,P＜0.01).结论 无陪护理模式下的护士职业倦怠水平显著高于一般护理模式下的护士职业倦怠水平,年资和学历越高,护士职业倦怠水平越高;护理管理者应引起重视.     

护士工作满意度与心理健康的相关性分析

目的 研究医院护士工作满意度与心理健康的相关性,帮助医院护士提高心理健康水平及应对能力.方法 采用工作满意度调查表与症状自评量表(SCL-90),对532名护士进行调查.结果 SCL-90中除人际敏感因子外,其余8个因子评分显著高于女性常模(均P＜0.01).护士工作满意度与心理健康水平呈正相关,其中相关性最大的是工作压力(均P＜0.01).结论 护士的心理健康水平较低,其工作满意度与心理健康水平呈正相关,管理者要在帮助护士掌握应对技能的同时也要营造一个有利于护士成长的环境,以维护护士的心理健康水平,提高其工作质量与护理质量.     

中医医院护士传染病突发事件应对能力现状及影响因素

目的 了解广东省三级甲等中医医院护士对传染病突发事件应对能力及影响因素,为医院开展针对性的应急救护培训提供依据.方法 采用传染病突发事件应对能力问卷对广东省26所三级甲等中医医院的7 314名护士进行调查.结果 中医医院护士传染病突发事件应对能力得分为(3.86±0.67)分.不同工作年限、科室、应急事件理论培训及应急演练次数、救援经历的护士传染病突发事件应对能力得分比较,差异有统计学意义;科室、救援经历、应急事件理论培训及应急演练次数是影响护士传染病突发事件应对能力的主要因素(均P＜0.01).结论 广东省三级甲等中医医院护士传染病突发事件应对能力处于中等水平,护士传染病应急事件应对知识和技能水平有待提高.需加强对中医医院护士开展传染病相关知识培训,以提高护士应对传染病突发事件的能力.     

护士工作倦怠与坚韧性人格的相关研究

目的 了解护士工作倦怠状况及其与坚韧性人格的相关性,为有效干预护士的工作倦怠提供依据.方法 采用摩斯腊克工作疲倦量表(MBI)和健康相关坚韧性量表(HRHS)对703名护士进行调查.结果 护士的坚韧性水平较为理想;护士的工作倦怠主要表现在个人成就感维度上,65.86%护士在该维度上呈现高度倦怠;工作冷漠、个人成就感维度的得分显著低于常模(均P＜0.01),情绪疲倦维度得分显著高于常模(P＜0.01);护士在工作倦怠的情绪疲倦、工作冷漠维度与坚韧性人格呈负相关(P＜0.05,P＜0.01),个人成就感维度与坚韧性人格呈正相关(均P＜0.01).结论 护士工作倦怠问题不容乐观,其坚韧性人格与工作倦怠密切相关,护理管理部门应引起重视,提高护士的坚韧性水平,减轻其工作倦怠.     

Career plateau among nurses working at a top-notch hospital in Yunnan province and the related factors

目的 了解云南省护士的职业高原现状,为针对性干预提供实证依据.方法 采用护士职业倦怠量表(简化版)和自拟的8个相关条目对某三级甲等医院118名护士进行问卷调查.结果 护士职业倦怠量表5个维度得分为(27.2士8.8)～(47.6士11.4)分;不同护龄护士压力源、职业倦怠、应对方式得分比较,差异有统计学意义(P＜0.05,P＜0.01);不同编制护士压力源、人格特征、应对方式得分比较,差异有统计学意义(P＜0.05,P＜0.01);8个相关条目得分为(2.0士0.6)～(3.2士0.8)分,其中人员不足、工作处于超负荷状态,护士没有外出学习机会及晋升高级职称机会少排前三位.结论 护士职业高原呈现中等水平;人员不够,学习晋升机会少等是主要影响因素.护理管理者应引起高度重视,并采取针对性干预措施,以降低护理队伍的职业高原水平.     

临床护士遭遇工作场所欺负状况调查

目的 了解临床护士遭遇工作场所欺负的现状,为防范管理与教育提供参考.方法 采用中文版负性行为问卷(NAQ-R)对山东省6所医院242名护士进行调查.结果 242名护士NAQ-R得分为31.98±9.48,85人(35.12%)在过去6个月中遭遇工作场所欺负,其中9人遭遇严重欺负.不同年龄、婚姻状况、职称、护龄、用工性质、学历的护士NAQ-R得分比较,差异有统计学意义(P＜0.05,P＜0.01).结论 工作场所欺负在临床护士中普遍存在,低年资、已婚、合同、高学历及低职称护士遭遇工作场所欺负程度较高.护理管理者、教育者应高度重视,实施有效防范措施和针对性教育,提高护士防范意识与技巧,以降低护士工作场所遭遇欺负的发生.     

基层医院手术室与病房护士工作压力源调查比较

采用护士职业压力源量表对手术室和病房各45名护士进行调查比较.结果压力源均值、时间分配及工作量、工作环境及资源、病人护理、管理及人际关系评分,手术室护士显著高于病房护士(P＜0.01,P＜0.05);护理专业及工作评分两组比较,差异无显著性意义(P＞0.05),但均偏高.提示护士压力程度较高,手术室护士更甚.医院及护理管理者应引起高度重视,采取切实措施减轻护士压力.     

合同制护士工作满意度与工作压力源的相关性分析

目的 了解合同制护士工作满意度的现状及其与工作压力源的关系.方法 采用明尼苏达满意度问卷、护士工作压力源量表对130名合同制护士进行问卷调查.结果 合同制护士的工作满意度总分62.92±10.21,内在满意度得分39.75±6.42,外在满意度得分23.18±4.71.内在满意度、外在满意度均与工作压力源的5个方面以及工龄呈负相关(P＜0.05,P＜0.01),内在满意度与科室呈正相关(P＜0.05).多元线性回归分析显示,管理与人际关系方面的问题及患者护理方面的问题对合同制护士的内在满意度有显著作用(均P＜0.01),而管理与人际关系方面的问题、时间分配及工作量方面的问题、学历对其外在满意度有显著作用(P＜0.05,P＜0.01).结论 护理工作自身的特点是影响合同制护士工作满意度的主要因素,管理者应注重合同制护士压力应对能力的培养,关注其职业生涯的规划,提高合同制护士整体的工作满意度.     

特需护士多元文化护理认知状况调查

目的了解浦东新区特需护士多元文化护理的认知水平及相关因素,为多元文化护理培训课程的设置提供依据及管理建议.方法自行设计特需护士多元文化护理认知状况调查问卷,对浦东新区具有特需医疗服务的6家综合性医院从事特需服务的87名护士在同一时间内进行调查.结果特需护士多元文化护理认知总体得分为(137.10±20.21)分,其中知识理论维度认知得分最低为(28.55±6.18)分;中专及大专护士的总体认知水平及其知识理论维度显著低于本科护士(P＜0.01,P＜0.05),护士的文化程度、每日学习时间与总体认知水平之间呈正相关(P＜0.01,P＜0.05).结论浦东新区特需护士多元文化护理知识的认知水平亟待提高,必须采取果断措施加强培训与管理.     

护理人员知识隐藏行为与创新能力的相关性分析

目的 了解护理人员知识隐藏行为及创新能力的影响因素及其相关性,为改善护理人员知识隐藏行为、提高创新能力提供参考.方法 方便抽样211名护士,采用一般资料调查表、知识隐藏行为量表及创新行为量表进行调查.结果 护士知识隐藏行为总分(21.88±9.29)分,知识隐藏行为各维度得分由高到低依次为合理化、聋哑式、逃避式;创新行为条目均分为(3.61±0.55)分,创新能力各维度得分由高到低分别为创新过程、创新环境和压力、创新主体、创新产品;护士知识隐藏行为得分在学历、婚姻状况、科室职务、护理团队角色、参与创新学习5个方面差异有统计学意义(P＜0.05,P＜0.01),而护士创新能力在性别、护龄、婚姻状况、科室职务、护理团队角色、参与创新学习、是否为专科护士7个方面差异有统计学意义(P＜0.05,P＜0.01);护士知识隐藏行为与创新能力得分呈负相关(P＜0.05).结论 护士的知识隐藏行为和创新能力总体状况一般,两者呈负相关.护理管理者可通过创建良好的氛围、增加学习机会等措施降低护士的知识隐藏行为,激发护士创新行为.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.