眼科高级实践护士发展现状

介绍了眼科高级实践护士(APN)产生的背景,分别从角色范围、工作方式、价值作用、培养方式及资格认证等方面阐述了国外眼科APN的培养及发展现状,并描述了国内眼科领域的相关探索,提出借助国外经验,构建我国眼科APN培养模式的必要性。     

眼科护士对手术患儿黑暗恐惧认知与干预意向调查分析

目的 了解眼科护士对手术患儿黑暗恐惧的认知和干预意向,为实施有效干预和规范管理提供依据。 方法 采用横断面调查,利用眼科学术会议的微信平台对24所医院的眼科注册护士发放知情同意书及调查问卷链接,对430份有效问卷进行统计分析。 结果 80.0%、70.2%、76.0%的眼科护士知晓黑暗恐惧的定义、产生原因、临床表现,仅57.2%的眼科护士知晓如何预防黑暗恐惧;不同学历护士认知差异无统计学意义(P>0.05);不同职称护士对黑暗恐惧的预防知晓度及对手术诱发黑暗恐惧认知存在统计学差异;眼科护士对黑暗恐惧具有干预意向和策略,89.1%的眼科护士认为有必要行黑暗恐惧干预;90.9%的眼科护士愿意完成黑暗恐惧干预训练;83.7%的眼科护士认为有利于提高患儿治疗护理依从性;94.4%的眼科护士认为有利于改善护理质量、80.9%的眼科护士认为有利于提升满意度;78.1%的眼科护士选择黑暗适应性训练;78.4%的眼科护士选择情景游戏方式;86.5%的眼科护士选择训练时机为术前1日;75.8%的眼科护士选择训练时长为5~10min;87.2%的眼科护士选择家属-护士-患儿共同完成训练。 结论 眼科护士对手术患儿的黑暗恐惧认知存在局限性,但具有可行性干预意向和策略,应完善系统培训,实施科学的干预、管理与质量控制,开展适宜的关怀服务,提高患儿围术期的安全感。     

护士基础护理认知现状调查

目的:了解护士对基础护理的认知状况及其影响因素,为提高基础护理质量、开展优质护理服务示范工程提供依据。方法:采用自设问卷,用方便抽样对陕西省宝鸡市第三人民医院152名临床护理人员的基础护理认知状况进行调查。结果:多数护士对实施基础护理的意义有比较正确的认识;90.67%的护士认为现行的基础护理收费标准与劳动价值不符;89.34%的护士赞同在护士指导或协助下由护嫂或家属完成生活护理;82.00%的护士认为护理人员不足,难以承担生活护理。结论:护士对基础护理的认知受多方面因素的影响,需要进行针对性引导及长期而艰苦的教育和培训,并适当调整生活护理收费标准,合理配置护士,才能保证基础护理的有效落实。     

护士对“互联网+护理服务”认知和意愿的调查分析

目的:了解护士对"互联网+护理服务"的认知和意愿,影响护士开展"互联网+护理服务"的因素,了解护士愿意从事的护理服务项目。旨在为上海实行开展此项目提供参考意见。方法:采用自行设计的问卷对上海市某三级甲等医院执业注册护士进行调查。结果:共回收有效问卷1630份,其中有679人表示听说过"互联网+护理服务",有701人听说过"网约护士",有143人听说过"滴滴护士",有473人没听说过。其中有869人愿意参加"互联网+护理服务",340人表示不愿意参加,421人表示无所谓。愿意参与的护士中有922人认为可以增加工作灵活度和自主性,有920人认为可以增加收入。不愿意参与的原因,有543人认为提供服务时出现纠纷难以处理,有507人认为如遇紧急突发事件,病人安全难以保证。结论:多数护士愿意参与"互联网+护理服务",但较多护士担心在执业过程中病人和自己的医疗安全,完善相关的医疗保障法律法规是开展"互联网+护理服务"的保障。     

心脏外科重症监护室护士离职意愿现状调查

[目的]探讨心脏外科重症监护室(CICU)护士离职意愿现状,为人力资源管理提供参考。[方法]采用便利抽样法选取某院147名CICU护士进行离职意愿现状调查,并分析影响因素。[结果]护士离开医院和放弃护理专业的意愿较强烈的人数分别为12人(8.16%)和6人(4.08%)。护士离职意愿主要原因排名前3位的依次是:报酬太低、工作条件不尽如人意、需要照顾家庭。护士出生地、婚姻状况、职位、职称、工龄均对护士离开单位意愿的程度有显著性的影响(均P<0.05)。在本单位工作年限对护士放弃护理事业的程度有明显性的影响(P<0.05)。[结论]护理管理者应重视改善护士的福利待遇,营造正向的工作环境,关注低年资护士成长,注重对护士的人文关怀,才能降低CICU护士离职意愿,稳定护士队伍。     

临床护士离职意愿的调查

目的探讨临床护士离职意愿现状。方法采用方便抽样的方法对广州市7家医院944名注册护士进行离职意愿问卷调查。结果944名临床护士离职意愿总分为（14．71±3．487）分,指标值为0．612。离职意愿较高和很高人数共占73．3％。结论广州市临床护士离职意愿整体上处于较高的水平,主要体现在寻找外部工作的可能性大。     

河北省三甲医院护士对多点执业的认知及从业意愿分析

目的 了解河北省三甲医院护士对多点执业的认知及从业意愿,为护士多点执业的进一步发展提供参考.方法 采用分层抽样的方法 对河北省4所三甲医院的915名护士进行问卷调查.结果 62.19％的护士有多点执业的意愿;对多点执业的了解渠道、认为外界对多点执业的评价、护士多点执业的前景认知不同,差异均具有统计学意义(P<0.05)...     

正在起步的中国开业护士

开业护士（Nurse Practitioner）是高级临床护理注册护士(advanced practice registered nurse,APRN)中的一个角色,美国护士协会关于APRN的定义是这样描述的：APRN是获得高等教育并分别具有儿科、麻醉科、老年科、新生儿或精神科等领域专长的注册护士。它包括开业护士、临床护理专家、持证护理助产士、持证注册护士麻醉师。开业护士是承担高级临床护理角色的执业护士,并根据法律规定在一定范围内具有诊断、处方、转治建议的权限。主要在初级卫生保健场所或急症医院。结合我国现有的医疗护理现状,笔者认为开业护士的培养能从根本上缓解公民看病难、候诊时间长等热点问题,因此本文旨在介绍国外开业护士的发展,以此探讨开业护士在中国的开展提供依据。     

英国开业护士概况及启示

在英国,开业护士参与了社区诊所、急诊、儿科等领域的卫生服务。开业护士拥有处方权,提高了服务效率,改善了医疗服务效果,节约了社会成本。该文对英国开业护士的历史、现状、培养及能力要求、管理、优势评价方面进行介绍,建议我国应探索开业护士参与卫生服务模式,建立完善培养体系,制订明确的管理体制,扩充开业护士人力资源。     

美国开业护士的执业现状与管理体系

美国是最早开展开业护士(nurse practitioner,NP)培养的国家,经验表明,NP的培养和执业可提高卫生服务的可及性,也是实现护理人员分层次管理的有效途径之一。该文通过综述美国NP的执业现状,显示NP能够以比医生更低的总成本提供优质的医疗保健服务。通过总结以NP教育、项目认证、资格证书和执照管理为核心的美国NP管理体系,为建立健全我国NP的培养认证体系和执业规范提供借鉴。     

Characteristics of nurse practitioner curricula in the United States related to antimicrobial prescribing and resistance

PURPOSE: The purpose of this study was to examine current nurse practitioner (NP) curricula in the United States with regard to antibiotics and antimicrobial resistance and assess the need for a web-based module for instruction on antimicrobial resistance and appropriate prescribing of antibiotics. DATA SOURCES: A 22-item, anonymous, self-administered, web-based survey was sent to 312 NP programs; 149 (48%) responded. Survey items included questions related to NP specialties offered, program accreditation, format of pharmacology course(s), lecture hours related to antimicrobial therapy, and whether the participant would use a Web-based module to teach NP students about antimicrobial resistance, if one were available. CONCLUSIONS: Most NP programs (99.3%) required a pharmacology course, and 95% had lectures dedicated to antimicrobial therapy. Half of the programs (53.5%) devoted >or=4 lecture hours to antimicrobial therapy in the pharmacology course, and most (84.8%) reported covering antimicrobial therapy in nonpharmacology courses as well. Approximately half of the programs (45.3%) reported <4 h of lecture on antimicrobial therapy in nonpharmacology courses. Many programs (51.9%) did not offer a microbiology course; 39.2% required microbiology as a prerequisite. Most respondents (86.7%) were familiar with the Centers for Disease Control and Prevention antimicrobial resistance program, and 92.6% reported that they would use an electronic module regarding resistance. IMPLICATIONS FOR PRACTICE: NP curricula generally include <10 h of content on antimicrobial therapy. An electronic module regarding antimicrobial resistance is likely to be a useful and relevant adjunct to current curricula.     

护士对便秘知识的认知程度调查与分析

目的了解护士对便秘的认知程度，为医生的诊断和治疗提供第一手资料。方法选择本院128名临床护士进行问卷调查，采用百分率殛矿检验进行统计学处理。结果临床护士对便秘的认知程度与所在科室无关，与学历、职称、护龄有密切关系。结论重视低学历、低职称临床护士的培养，充分发挥中级职称护士的指导作用，不断提高理论水平，能有效地指导护理工作。     

Using cost-analysis techniques to measure the value of nurse practitioner care

Nurse practitioners are in a unique position to deliver high-quality care to a variety of populations and are being utilized in many countries worldwide. Although certain aspects of the nurse practitioner role may differ from country to country, limited financial support and competition for access to patients make it incumbent on nurse practitioners to document the cost-effectiveness of their care. Cost analysis, a business tool that can be used by any practitioner in any health care system, was used to examine business practices of an academic-based nurse-managed centre. In order for this tool to be effective, nurse practitioners must become comfortable with using cost-analysis techniques in their practices. Linking outcome data with cost data was found to be one method for explicating the value of nurse practitioner practice. Nurse practitioners must also recognize that they are competing with primary-care physician practices and other primary health-care practices. It is vital for nurse practitioners to document both the quality and the costs of their care in order to compete with physicians and other health care providers, in order to influence policy and other health-care decision makers.     

对护士家属关于护士从事临床基础护理认知的调查

目的了解护士家属对护士从事临床基础护理的认知情况,分析其影响因素并探讨干预对策。方法选取462名临床一线护士家属为研究对象,采用自设问卷调查家属对护士从事基础护理的认知情况,分析其影响因素。结果在对基础护理重要性认知各条目中,462名家属的最高了解率不足20％,仅有13．85％的家属了解基础护理是护士的重要职责,97．83％的家属不了解《住院患者基础护理服务项目》内容;93．07％的家属不赞同自己的亲人从事基础护理工作;95％以上的家属希望护士从事静脉输液、氧气吸入等治疗性护理操作,而100％的家属不希望护士做协助排泄与处理大小便的工作;男性家属对护士从事基础护理的认知程度得分（45．60±7．32）分高于女性家属（39．85±5．10）分,差异具有统计学意义（t=9．80,P〈0．01）;与护士不同关系的家属对护士从事基础护理的认知程度,差异具有统计学意义（F=7．82,P〈0．01）。结论护士家属对护士从事临床基础护理认知偏颇,态度消极。应加大宣传教育力度与广度,重视家庭对护士的教育与影响作用,关心护士家属的教育与修养,提高护士待遇,促使家属以积极的态度从正面去影响护士的职业态度,激发护士对从事基础护理的热情。     

The discovery of unique nurse practitioner theory in the literature: seeking evidence using an integrative review approach

PURPOSE: To determine if theory unique to nurse practitioners (NPs) exists and to describe the attributes of such theory. DATA SOURCES: An integrative review of the literature was used. CINAHL and MEDLINE were searched using key terms such as nurse practitioners, theory, or research. Forty-five articles contributed to the final analysis. CONCLUSIONS: The NP role evolved from nursing yet is heavily influenced by medicine. This integration may affect both the use of theory in NP literature and the types of theories that are used to guide NP literature generation and research. Evidence was found of emerging theory unique to NPs with theoretical origins grounded in nursing, medicine, and social science. IMPLICATIONS FOR PRACTICE: NPs are beginning to develop theories of "nurse practitionering." This development is imperative for NP education, practice, and research to further the knowledge of the discipline and to help articulate the unique body of knowledge possessed by NPs.     

150名护士无痛结肠镜检查认知状况分析与对策

目的:了解护士对无痛肠镜检查的认知程度,对存在问题进行改进,保证肠道检查的安全性。方法:自制问卷了解我院150名护士对无痛肠镜检查知识的认知。结果:护士对无痛肠镜检查知识的知晓率为34.67%~98.67%。结论:护士对无痛肠镜检查的相关知识没有充分认识,应加大对全院护士进行系统培训,提高护士无痛肠镜检查认知的水平;在内镜中心候诊室的显眼处设立图文并茂、通俗易懂的宣传栏;落实检查前宣教工作和遵医行为,规范检查护理。     

Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review

BackgroundAdvanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness.ObjectiveTo examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles.MethodsOur methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel.ResultsThe narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles.ConclusionCurrent guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles.     

英国社区及其护士处方权现状

综述英国社区在国家医疗体系中的位置、英国社区护士发展现状及其先进的护士处方权管理办法,为我国社区护理健康快速的发展提供参考。