老年科专科护士兼护理组长在护士分层级管理中的作用

目的:探讨老年科专科护士兼护理组长在护士分层级管理中的作用。方法:分析老年科专科护士兼护理组长在开展专科护理查房,制定专科护理指引及开展多元化健康教育,各层级护士的培训和临床护理核查,建设科室团队文化及实施专科护理文书书写等方面所开展的工作。结果:老年科专科护士兼护理组长在层级管理中提高了专科护理质量,提高了各层级护士的专业理论知识。结论:老年科专科护士兼护理组长在层级管理中能提供更专业的护理服务、规范化的培训,并推动科室团队文化的良性发展。     

Nursing care of patients with nasogastric feeding tubes

Nasogastric tubes are commonly used for patients as a short-term method of providing continuous, pre-packed liquid feed. In order to explore how evidence-based practice is being incorporated into care, we conducted a survey investigating the views and practices of nutrition specialist nurses in acute trusts across the UK. A postal questionnaire comprising 35 questions considered the role of the nutrition specialist nurse, care of patients with nasogastric tubes, and training and education of nurses in the care of these patients. Results of this small study indicate differences in the education and practice of nursing care for patients with nasogastric tubes. Therefore, it is vital that evidence and good practice is disseminated both locally and nationally by benchmarking practice and by sharing knowledge and experiences in both journals and conferences. Nurses also need support in practising their skills to ensure they feel confident in caring for patients with nasogastric tubes.     

District nurses' involvement and attitudes to mental health problems: a three-area cross-sectional study

Aims and objectives. The main aims of this study were to obtain information on the extent of staff contact and input with mental health problems and to determine their experience, training and attitudes to such problems. Background. Historical changes and policy shifts have resulted in primary care providers playing an increasing role in the care of mental health problems. Such problems are common within community settings and a major cause of suffering and disability. District nurses in particular are likely to encounter a high level of psychological co‐morbidity in their patients. Information is lacking on their involvement, attitudes and specific training for this area of their work. Design and methods. A cross‐sectional study was conducted of the staff of district nursing services in three areas, Jersey (Channel Islands), Lewisham and Hertfordshire, using a postal questionnaire. Results. Questionnaires were sent to 331 staff; 66% responded. Community and district nurses estimated a 16% prevalence of mental health problems among their patients, most commonly dementia, depression and anxiety disorders. Staff noted participation in a wide range of psychological care activities, but identified a lack of training for this aspect of their role (three‐quarter of nurses had received no such training during the past five years). They reported a willingness to develop their understanding and skills by means of educational programmes. Attitude measures revealed generally optimistic views concerning depression treatment, a rejection of deterministic attitudes about this condition and confidence in the role of district nursing staff in managing such problems. Conclusions. The need for primary care mental health training is widely noted and based upon consistent evidence of the limited detection and treatment of these problems. This study has employed quantitative methods to clarify the extent and nature of district nursing staff involvement in this area of practice and indicates that training needs are acknowledged by community nurses from geographically distinct settings. Relevance to clinical practice. Staff are interested in developing knowledge and skills pertinent to the psychological problems of their patients and their views reveal a consensus that the most important areas for learning are recognition of mental disorders, anxiety management, crisis intervention and pharmacological treatments for depression.     

以岗位需求为导向的专科护理发展模式的建立与实践

医院以岗位需求为导向,评估专科护理发展方向,建立专科护士选拔和认证机制,成立专科护士认证委员会对专科护士进行认证。认证的专科护士遵循护理部制订的专科实践标准,开展多种专科实践活动,并结合外出专科培训进行培养。该培养模式推动了临床专科护理质量持续提升,患者对专科护理工作给予认可,专科护士的专业价值得到了充分体现。     

重症监护室专科护士工作现状及专科水平能力的调查

目的探讨重症监护室（ICU）专科护士目前的工作现状及专科水平能力,以加强专科护士的管理,推动临床护理工作的发展。方法选取38名取得ICU专科护士资格证书1年以上的护士为研究对象,使用问卷调查法,对其一般情况、工作现状、待遇、专科水平能力自我测定方面进行调查。结果100％的ICU专科护士会对年轻护士进行培训、参与护理管理及科内的疑难问题讨论,36．8％的护士参加临床护理及夜班工作,5．3％从未参与过专科查房;能力水平自我测试情况临床工作实践、指导教学、为病人及家属提供信息咨询这3个方面达标率较高,均在90％以上。专科知识的全面掌握（86．8％）、理论授课方面（86．8％）、为护士提供专科知识（86．8％）还需继续提高。文献的查阅（65．8％）、论文撰写（57．9％）、科研设计开展（47．4％）达标率相对偏低。结论ICU专科护士在专科护理人才的培养和使用缺乏计划性、合理性;专科护士角色模糊;缺乏合理的人才梯队;待遇有待提高;科研能力需要加强;缺乏完善的准入、培训、使用、管理规范。     

Defining the unique role of the specialist district nurse practitioner

Due to the reorganization of primary care trusts across the country, certain trusts proposed a reduction in the specialist district nurse practitioner numbers in favour of less qualified community nurses and health care assistants. Such proposals in one PCT were blocked, partly in response to documentation compiled by practitioners at the sharp end of nursing practice. With the new agenda of practice based commissioning, it is imperative that commissioners and management alike are aware of the scope of specialist district nurse practitioners. This is the first of a series of articles looking at specific case histories where the role of the district nurse is highlighted. It is the intention to stress the importance of the clinical expertise and confidence required by the district nurse to care for patients with complex needs in the community.     

Registered nurses' everyday activities in municipal health care: A study of diaries

This study described the work content of registered nurses (RNs) employed in municipal health care. Diary notes of three working days from 34 RNs were analysed using content analysis, and a total of 3185 activities were identified. Of these, 2807 were analysed further and grouped by comparing similarities and differences. The content of the RNs' nursing activities consisted of assessing health, giving treatments and conducting check‐ups, handling pharmaceuticals and teaching. In the administration category, the content comprised planning and reporting, followed by documentation. The RNs' role in municipal health care is consultative, which reinforces their need for competence in advanced nursing, as well as in leadership and pedagogy. RNs mostly work without colleagues and they are responsible for many seriously ill patients. In order to be confident in providing qualified nursing, specialist nursing education in elderly care is needed.     

Reinstating district nursing: A UK perspective

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively.     

Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey

Aim. To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing. Background. Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter‐professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions. Methods. A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self‐completed a written questionnaire. Results. Five hundred and twenty (89·7%) nurses were based in primary care and worked in general practice. Four hundred and thirty‐six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88·3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing. Conclusions. Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice. Relevance to clinical practice. Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.     

Impact of the Powys Macmillan GP clinical facilitator project: views of health-care professionals

The UK charity, Macmillan Cancer Relief, commissioned a 3-year pilot project employing 12 GP clinical facilitators (GPCFs). The aim was to raise the standard of generalist palliative care, provide extended clinical palliative care and provide a coordinated framework for commissioning specialist palliative and cancer care in Powys, rural Wales. As part of the comprehensive evaluation, surveys of GPCFs, GPs, district nurses and community hospital nurses were undertaken in order to record changes in palliative care activity, specialist palliative care services and training needs. Services providing 24-hour nursing and social services were perceived as in need of development. Referrals to Macmillan nurses increased by 40% and GPs reported that time spent on palliative care increased, on average, from a quarter of a day to half a day per week, although district nurses reported a reduction in palliative care activity. The majority of nurses thought that the GPCF's contribution was important. The use of local palliative care guidelines increased significantly among district nurses by the end of the project.     

Prescribing by specialist nurses in cancer and palliative care: results of a national survey

BACKGROUND: This study investigates Macmillan nurses' views on nurse prescribing in cancer and palliative care and explores perceived motivators and barriers to training for and the implementation of this extended nursing role. METHOD: National postal survey of 2252 Macmillan nurses in the UK. RESULTS: A response rate of 70% (1575) was achieved. Eleven percent (168 of 1575) of Macmillan nurses surveyed were trained as extended formulary independent nurse prescribers. Half (88 of 168) of the Macmillan nurses who could prescribe from the extended formulary were prescribing, representing just 6% (88 of 1575) of the sample. Training deficits highlighted included poor organization and insufficient length, depth and specificity of courses (to meet the needs of nurses working in palliative care) and a lack of medical mentorship. Among Macmillan nurses who had not undergone extended formulary independent nurse prescribing training, 25% (335) perceived that prescribing was not part of their specialist nursing role. A further 40% (538) expressed reluctance to undergo training. CONCLUSIONS: A clear lack of enthusiasm amongst specialist nurses in cancer and palliative care to undertake prescribing training was identified. It is noteworthy that half of the Macmillan nurses trained as extended formulary independent nurse prescribers were not prescribing. Since government targets for nurse prescribing are not yet being met, these findings raise important questions concerning whether extended nurse prescribing is likely to be a successful initiative in cancer and palliative care.     

专科护士管理实践

为了更好地发挥专科护士在专科护理领域的作用,推动专科护理的发展,护理部为专科护士从事专科护理工作提供平台,如每周半天或每月1～2天提供给专科护士,通过定期召开专科护士座谈会,开展专科学术活动,年终评选优秀专科护士等措施,有效地调动了专科护士的工作积极性。该院25位专科护士在各自的岗位上认真开展专科护理工作:成立联络护士小组、开展专科查房、专科会诊、护理门诊、专科培训等,取得了较好的成效,有效地推动了医院专科护理的发展;专科护士还积极参与省内各专科护理的学术活动,使其影响力在省内逐步扩大。     

重庆市重症医学专科护士培训学习体会的质性研究

目的了解重庆市重症医学科专科护士在专科护士培训项目中的学习体会,为进一步构建和完善重庆市重症医学科专科护士培训体系提供依据。方法以质性研究的现象学研究方法为依据,对参加重庆市重症医学科专科护士培训的9名护士进行深入访谈,并提炼主题。结果共得到5个主题:培训的需求大,但培训时间不充足;专科护理要点和临床操作技能是学员的主要收获;希望培训中增加护理管理和护理科研知识;要求培训人员临床经验丰富;期待更科学更灵活的考核方式。结论护理管理人员应该认识到专科护理培训的重要性,根据学员要求结合实践情况不断改进培训内容和方法,以进一步构建和完善重症医学科专科护士培训体系。     

The role of the specialist in community nursing: perceptions of specialist and district nurses.

We investigated the management of specialist nurses and how district and specialist nurses perceived themselves and each other, in terms of responsibility, autonomy, skills and training, communication, role conflicts and job satisfaction. All locality and neighbourhood nurse managers, all specialist nurses, and all district and community staff nurses in one Health Authority were interviewed and surveyed. There was little disagreement about the role of the specialist nurse. District nurses were largely positive about specialist nurses, but the area of "hands-on" care was difficult for both groups of nurses. Communication between district and specialist nurses needed to be improved. Both specialist nurses and their managers believed that specialists were inappropriately managed.     

军队临床护理示范基地专科护士培训现况的调查分析

目的 了解全军临床护理示范基地专科护士培训现况,并对当前所面临问题进行分析讨论.方法 采用自行设计的基地专科护士培训情况调查问卷,对全军临床护理示范基地2016-2018年专科护士培训情况进行调查.结果 共调查26个临床护理示范基地.近三年培训学员总数2906名,其中学历为本科(70.75％)、职称为护师(68.51％...     

利益相关群体对护理硕士专业学位与专科护士并轨培养的认知调查研究

目的了解护理专业型硕士、专科护士、护理专家对护理硕士专业学位与专科护士并轨培养的认知及态度。方法在文献研究的基础上编制问卷,采用便利抽样,从全国东北、东、中、西部部分省市调查护理硕士专业学位研究生250名、专科护士250名和护理专家50名。结果专科护士和护理专家对护理硕士专业学位的了解程度不同,差异有统计学意义(P0.01)。护理专硕和护理专家对专科护士的了解程度相对较高。三组人群普遍对并轨相关政策不太了解。三组人群普遍认为护理硕士专业学位教育与专科护士培训并轨是可行的,且支持护理硕士专业学位教育与国家级专科护士培训并轨。从临床实践环节实施并轨是三组人群认可度最高的并轨方式。结论我国护理硕士专业学位与专科护士并轨培养是可行的,但护理专业型硕士与专科护士之间的了解不足。护理硕士专业学位教育可尝试与国家级专科护士培训并轨,从临床实践环节实现接轨。     

Specialist or generic community nursing care for HIV/AIDS patients?

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings Most community-based health care in the United Kingdom is provided by primary health care teams general practitioners and community nurses, with support from social workers However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA) Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms Three models of care have developed in NETRHA specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity     

临床护士糖尿病专科培训的研究现状

阐述糖尿病流行现状以及护士在糖尿病病人护理、管理及教育中的作用,综述国内外护士糖尿病培训现状,阐明对非内分泌科护士进行糖尿病培训的重要意义及临床护士糖尿病专科培训对促进护理重点专科建设的积极意义。     

Children's nurses and nurse prescribing: a case study identifying issues for developing training programmes in the UK

Aims and objectives. (1) To develop an insight into the opportunities and barriers to nurse prescribing for a case study of children's nurses. (2) To consider the implications of independent nurse prescribing for children's nurses and the potential for nurse prescribing to be developed in acute children's care settings. (3) To use research data to develop a training strategy. Background. Nurse prescribing in the UK is evolving and current initiatives aim to extend the range and scope of prescribing. Children's nursing presents interesting challenges because of off‐license drugs. Successful nurse prescribing lies in practice area preparation, local policy and practice development and identifying precourse training needs. Design. Case study. Research questions. (1) What opportunities do children's nurses identify as being appropriate for nurse prescribing? (2) Can children's nurses identify the benefits of patient group directives and the different levels of nurse prescribing? (3) What preparation do children's nurses need for nurse prescribing? Methods. Focus group of health visitors/district nurses to inform a survey of 500 nurses working in acute and specialist care settings in a large Children's Hospital. Results. Focus group main themes – training, supervision and the development of confidence, record keeping, benefits of nurse prescribing, autonomous practice, the formulary and its use in practice. Response rate was 27%. Senior nurses and specialists identified potential benefits for their practice. Course content needed to focus on children, i.e. children's physiology and pharmokinetics. Children's nurses frequently advise junior medical colleagues on prescribing issues. Patient group directives are a useful alternative to prescribing. Conclusions. The results provide an insight into the training needs of children's nurses and specialist nurses which may be used to develop nurse prescribing training and practice. Training may need to be targeted at senior nurses/specialist nurses initially to develop a critical mass to change organizational culture. Relevance to clinical practice. Pertinent for senior nurses responsible for developing children's nursing practice and services for children in acute settings.