无陪护模式病房不同能级护理人员承担工作项目调查

目的了解山东省三级综合性医院无陪护模式病房不同能级护理人员承担工作项目情况,为实现护理人力资源优化管理提供基础和依据。方法自行设计无陪护模式病房临床护理人员能级对应相关情况调查表,对山东省6所三级医院无陪护模式病房551名护理人员承担部分工作项目情况进行调查。结果不同能级护理人员承担各护理工作项目有所侧重(均P<0.01),但均承担所有工作项目;基础护理、执行治疗是主要的临床护理工作,分别占23.81%、22.00%;临床教学及科研所占的比重最少,分别占8.17%、2.51%;无陪护模式病房护理工作的主力是大专学历、初级职称及工龄不足3年的护士。结论护理人力资源配置的不合理及利用低效率并存,护理管理者应制定科学的护理人力资源配置标准,并根据不同岗位的专业技术要求配备相应能力的护士,从而优化护理人力资源管理。     

优质护理服务试点病房护士有效护理工时的调查

目的了解优质护理服务示范工程实施过程中护士的有效护理工时,为护理人力资源合理配置提供依据。方法采用分层抽样法分别从内、外、妇、儿、监护病房和综合病区等10个护理单元抽取139名护士,以护理项目操作时间调查表调查护士的有效护理工时。结果护士日人均有效护理工时为(489.51±169.08)min,直接护理工时为(298.20±170.03)min,间接护理工时为(191.30±130.38)min;不同护理单元、不同学历和职称护士的直接护理工时和间接护理工时比较,差异有统计学意义(P<0.05,P<0.01)。结论优质护理服务示范工程的实施增加了护士的护理工时,护理管理者需合理配置护理人力资源,以增加直接护理工时,提高优质护理服务质量。     

儿科护理工作的风险意识和护理纠纷的预防

目的:探讨儿科护理工作的风险意识状况和护理纠纷的预防。方法:采用实地调查的方法对本地区五所三甲医院的儿科护理人员和患者进行调查,从而了解护理纠纷的常见隐患,提出相关预防措施。结果:五所医院儿科护士的护理工时都比较长,均超过了正常工作时间,不同医院间护理工时对比无明显差异(P>0.05)。患儿家属在护理风险意识认知方面得分高于护理人员(P<0.05),而在护理风险意识技巧方面得分低于护理人员(P<0.05)。结论:儿科护理工作的护理纠纷的产生多与护理人员工作时间过长和双方认知差异所造成,为此需要我们从多方面加强防范与管理。     

Investigation on nurses′ effective working hours in the high-quality nursing service demonstration units

目的 了解优质护理服务示范工程实施过程中护士的有效护理工时,为护理人力资源合理配置提供依据.方法 采用分层抽样法分别从内、外、妇、儿、监护病房和综合病区等10个护理单元抽取139名护士,以护理项目操作时间调查表调查护士的有效护理工时.结果 护士日人均有效护理工时为(489.51士169.08)min,直接护理工时为(298.20±170.03)min,间接护理工时为(191.30±130.38)min;不同护理单元、不同学历和职称护士的直接护理工时和间接护理工时比较,差异有统计学意义(P＜0.05,P＜0.01).结论 优质护理服务示范工程的实施增加了护士的护理工时,护理管理者需合理配置护理人力资源,以增加直接护理工时,提高优质护理服务质量.     

加速康复外科护理人力资源配置研究

目的通过测定加速康复外科病区护理工作量,为加速康复外科病区护理人力资源的合理配置提供参考。方法采用文献分析、专家咨询、现场调查等方法,基于工时测定法对实施加速康复的肝胆外科病区护理人员测算其护理工作量;采用人力资源配置相关公式,计算该病区护理人力资源配置标准。结果确立护理项目62项,其中直接护理项目40项,间接护理项目22项。病房护士每日为每例患者提供的护理时间为139.16min。直接护理用时和间接护理用时分别占总护理用时的62.84%和37.16%。适宜床护比为0.64,实际床护比为0.50。结论基于工时测定法测算的护理工作量及护士配比结果显示,护理人力资源配置不足。可通过完善护理工作流程,合理安排护理工作内容、增加护理人员数量等方法进行改进。     

医护直接服务项目收费价格的差异研究

目的 对比分析医护直接收费项目价格差异,探讨护士实际劳动社会价值对医疗机构护理人力资源配置的影响,为改善护理z-2资源缺编提供参考.方法 以深圳市非营利性医疗机构眼科医疗服务收费价格标准为蓝本,统计某院眼科7个专业类别常见病种各10例出院患者的医护直接服务收费项目及价格.结果 医生直接服务工时价格为1 270.7元/h,护士直接服务工时价格为49.4元/h;医生直接服务价格占总费用的46.3%,护士为4.1%.结论 在市场经济条件下,目前的医疗收费价格不能正确反映护理人员的劳动价值,是直接影响护理人力资源配置的重要原因之一.     

新疆某三级甲等医院护士长工作时间调查分析

目的了解护士长有效护理工时,为有效提高护理管理工作提供依据。方法用分层抽样法分别从内、外、妇、儿、重症监护病房和综合病区抽出10名护士长,通过10名经统一培训的调查员现场观察5个工作日和护士长自我记录法测量护士长有效护理工时。结果不同科室护士长日人均有效护理工时不同,最多为593.80min,最小为280.00min,多以直接护理工时为主。日人均耗时最长的前3个直接护理工作项目是床边交接班49.24min、巡视病房35.01min、护理质控30.22min,分别占总有效护理工时的11.94%、8.49%、7.33%。结论护士长直接护理工时大多超出间接护理工时,且工作范围超出了护理范畴。应合理分布有效护理工时,提高护理管理效率。     

Investigation on head nurses' working hours in a top hospital in Xinjiang

目的 了解护士长有效护理工时,为有效提高护理管理工作提供依据.方法 用分层抽样法分别从内、外、妇、儿、重症监护病房和综合病区抽出10名护士长,通过10名经统一培训的调查员现场观察5个工作日和护士长自我记录法测量护士长有效护理工时.结果 不同科室护士长日人均有效护理工时不同,最多为593.80 min,最小为280.00 min,多以直接护理工时为主.日人均耗时最长的前3个直接护理工作项目是床边交接班49.24 min、巡视病房35.01 min、护理质控30.22 min,分别占总有效护理工时的11.94％、8.49％、7.33％.结论 护士长直接护理工时大多超出间接护理工时,且工作范围超出了护理范畴.应合理分布有效护理工时,提高护理管理效率.     

内外妇儿科护理工时及护士配置的测量与比较分析

目的了解病区不同专科的护理工作量及人员配置,为合理配置护理人力资源提供参考。方法选取内外妇儿科10个病区住院1周的患者,以实际操作测算患者例均护理工时及标准床护比。结果同一专科,一级护理患者护理工时显著多于二级护理患者（均P〈0.01）;不同专科,相同护理级别护理工时差异有统计学意义（均P〈0.01）。10个病区除妇科外,实际床护比均低于标准床护比。结论专科间护理工作量有差异,护理人员配置偏低,应根据专科工作量调配护理人员,同时应采取相应措施解决护理人员相对不足问题。     

门诊护理人力资源配置研究

目的 探讨医院门诊护理人力资源配置及护理人力需求状况,为医院管理人员科学合理配置护理人员提供实证参考.方法 采用文献法、专家咨询法、工时测定法和对比法对神经内科、心内科,妇产科、儿科,皮肤科、骨科6个具有代表性的门诊科室进行护理项目工时测定及护理人力资源配置分析.结果 直接护理时间占护理总时间的58.65%.每日例均直接护理时间皮肤科显著高于其他科室(均P＜0.05),心内科与神经内科、骨科比较.妇产科与骨科比较,差异无显性意义(均P＞0.05).间接护理时间各科室比较.差异无显著性意义(P＞0.05).T、P、R测量,维持就诊秩序,门诊患者登记,开诊前的准备,医疗操作的护理配合5项操作占22项护理操作时间的53.82%.按门诊患者与护士100:3的比例配比,6个科室缺编11人.结论 门诊护士人力资源欠缺.应根据不同科室情况增加护士配置,尤其皮肤科、妇产科及骨科等有较多治疗的科室,从而提高门诊护理工作的效率和质量.     

Total Joint Arthroplasty Surgery: Does Day of Surgery Matter?

Length of stay (LOS) after total joint arthroplasty (TJA) impacts the expense to the hospital. Our purpose was to evaluate the impact that day of surgery has on postoperative LOS. 547 patients who had a primary TJA at two tertiary care hospitals were identified retrospectively. TJA patients admitted on day of surgery and who had primary elective surgery were included in our sample. Patients were subdivided into one of four groups: those who had operations on Monday, Tuesday, Thursday, and Friday respectively. Patients who had surgery on Thursday and Friday had significantly longer LOS when compared to Monday and Tuesday. This variation in LOS between the groups may be due to inconsistencies in weekend functionality, less experienced part-time staffing, and inaccessibility of rehabilitation personnel.     

Residual Nitrous Oxide in Operating Room Personnel

The concentrations of nitrous oxide in the blood and end-tidal air of 10 operating-room nurses were assayed by gas chromatography immediately and 1, 2, 5, and 21 h after 3 hours of exposure to an average of 380 ppm of nitrous oxide in operating-room air. In the second trial the nurses' end-tidal air concentrations of nitrous oxide were assayed on Monday, Wednesday, Friday and Sunday morning, and on Sunday afternoon and evening to reveal a possible accumulation of nitrous oxide during a routine week. After cessation of exposure there was a rapid decrease in the blood concentrations of nitrous oxide during the first hour (from 153 +/- 110 microgram/1 to 48 +/- 20 microgram/l at 1 h; means +/- s.d.), followed by a slower decrease. Small amounts (mean +/- s.d.: 18 +/- 6 microgram/l) of nitrous oxide were still measurable on the following morning 21 h after exposure. At 2 or 5 h after exposure there was an increase in blood and end-tidal air concentrations of nitrous oxide in seven and nine nurses, respectively. The end-tidal air concentrations of nitrous oxide were greater on Wednesday (22 +/- 7 microgram/l) than on Monday morning (8.4 +/- 1.5 microgram/l), but on Friday they were similar to those measured on Monday morning. The concentrations measured on Sunday, i.e. 2 days after exposure, were similar (average 15 microgram/l) to those measured during the week. It is concluded that, after cessation of exposure to nitrous oxide, there is a rapid decrease in the concentrations in blood and end-tidal air, but small amounts of nitrous oxide remain in the body for at least 3 days after cessation of exposure.     

Timing is everything—colectomy performed on Monday decreases length of stay

Background

Perioperative care of patients undergoing colon resection requires a multidisciplinary approach by the operating surgeon, residents, and nurses. Operations performed on Monday take full advantage of hospital resources throughout the week to meet expected discharge by Friday. In a current health care environment of diminishing means, improving the timing of surgery in relation to expected length of stay may play an important role in preserving health care resources.

Methods

A retrospective review of a prospectively collected colorectal surgical database identified all patients who underwent segmental colon resection at a single tertiary care referral center from 2004 to 2010. Length of stay for patients undergoing elective open and minimally invasive segmental colectomy was compared for Monday versus Tuesday through the weekend. Patient and surgeon demographics were recorded as well as postoperative outcomes and complications.

Results

A total of 868 segmental colectomies were performed during the study period. Length of stay was significantly decreased by .73 days (P < .01) for all segmental colectomies performed on Monday compared with those performed Tuesday through Sunday. There was also a significant decrease in length of stay looking independently at right (.96 days, P < .01) and left or sigmoid colectomies (.56 days, P < .01). There was no significant difference in patient or surgeon demographics to account for this difference.

Conclusions

Segmental colectomies have a significantly decreased length in stay when performed on Monday compared with the rest of the week. The decrease is independent of surgeon, comorbidities, and complications. This difference may be the result of patients' taking full advantage of hospital resources and ancillary support. Cost-effective measures may be evaluated and directed at adjustment of resources available throughout the week to reduce length of stay.     

Mortality after nonemergent major surgery performed on Friday versus Monday through Wednesday

OBJECTIVE: To determine whether nonemergent major surgery leads to higher mortality when performed on Friday versus early weekdays. SUMMARY BACKGROUND DATA: Adults admitted emergently to acute-care hospitals on weekends experience higher mortality than those admitted on weekdays. METHODS: Cohort study of 188,212 patients undergoing nonemergent major surgery at 124 Veterans Affairs hospitals from 2000 to 2004. Risk-adjusted 30-day mortality was compared for operations performed on Fridays versus Mondays through Wednesdays. Data were derived from the Veterans Affairs' National Surgical Quality Improvement Program database. Patients were divided into 3 groups: floor (admitted postoperatively to regular floor), ICU (admitted postoperatively to intensive care unit), and outpatient (not admitted postoperatively). A stepwise logistic regression analysis was used to test the effect of day of surgery (Friday vs. Monday-through-Wednesday) on 30-day mortality in the presence of characteristics that were significant in bivariate analysis. RESULTS: In the floor group (n = 89,786), operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays (2.94% vs. 2.18%; odds ratio, 1.36; 95% confidence interval, 1.24-1.49; P < 0.001). After adjusting for patient characteristics, odds ratio of 30-day mortality for operations on Fridays, when compared with Mondays through Wednesdays, was 1.17 (95% confidence interval, 1.05-1.26; P = 0.003). Within the ICU (n = 14,271) and outpatient (n = 84,155) groups, nonsignificant differences in 30-day mortality were observed for operations on Fridays versus Mondays through Wednesdays. CONCLUSIONS: For patients admitted to regular hospital floors after nonemergent major surgery, mortality is increased if surgery is performed on Friday versus Monday through Wednesday.     

The weekend effect in status epilepticus: a national cohort study

Higher mortality following admission to hospital at the weekend has been reported for several conditions. It is unclear whether this variation is due to differences in patients or their care. Status epilepticus mandates hospital admission and usually critical care: its study might provide new insights into the nature of any weekend effect. We studied 20,922 adults admitted to UK critical care with status epilepticus from 2010 to 2015. We used multiple logistic regression to evaluate the association between weekend admission and in-hospital mortality, comparing university hospitals with other hospitals. There were 2462 in-hospital deaths (12%). There was no difference in mortality after weekend admission to university hospitals, adjusted odds ratio (95%CI) 0.99 (0.84–1.16), p = 0.89. Mortality was less after weekend admission than after admissions Monday to Friday in hospitals not associated with a university, adjusted odds ratio (95%CI) 0.74 (0.64–0.87), p = 0.0001. There is no evidence that adults admitted to UK critical care at the weekend in status epilepticus are more likely to die than similar patients admitted during the week.     

Monday to Friday-clinic (author's transl)

On a Monday to Friday ward with 21 beds in 1 1/2 years 1149 patients underwent the following operations: appendectomy 23%, hernioplasty (femoral and inguinal) 20,5%, phimoses 14,4%, cryptorchidism 9,7%, anal fistula and fissure 7,8%, hydrocelectomy 2,9%, saphenectomy 2,7%, haemorrhoidectomy 2,9%, excisions of Dupuytren's contracture 1,0%, varicocelectomy 0,4% pacemaker implantations 2,7%, other operations and patients for diagnostics 8,5%. The standardised diagnostic procedure is performed during the prehospital time. On Monday all patients were operated upon and dismissed on Friday. The operative results are good. The in-patient time is 4,5 days. - The advantage of this system is: increase of scheduled in-patient surgery, short stay, prophylaxis of noso - comial infections, more efficiency.     

上海市医院麻醉科护士人力资源管理现状调查

目的 调查并分析上海市医院麻醉科护士人力资源的配置、工作内容及管理情况,为上海市麻醉科护理人员的配置与管理提供参考依据.方法 采用自制调查表,应用整群抽样法,以电子邮件方式对上海市99家二级及以上医院进行调查分析.结果 回收问卷98份,调查的98家医院共有麻醉科护士401名,21.4%的医院未配备麻醉科护士;仅有22.1%的医院设置了专门的麻醉科护士长岗位;麻醉科护士目前主要以PACU患者护理、麻醉药品管理、麻醉前准备、镇痛泵配置与术后镇痛随访等为工作内容,围麻醉期护理尚未成为其工作重点.结论 目前,上海市医院麻醉科作为一级临床科室人力资源配置不合理;麻醉科普遍存在护士配备不足、麻醉护士数量和素质难以适应麻醉学科发展与围麻醉期护理实践需求等问题.     

白藜芦醇对大鼠前列腺增生的抑制作用初探

目的 探讨门藜芦醇对丙酸睾酮诱导未去势成年人鼠前列腺增牛的抑制作用.方法 将大鼠随机分组,模型组每日皮下注射内酸睾酮5mg/kg,同时给药组灌饲不同剂量的白藜芦醇(剂量分别为15mg/kg、5mg/kg、1mg/kg),连续14d,皮下注射己烯雌酚1mg/kg,每周3次(周一、三、五).于第15d杀剂,分离前列腺、精囊和睾丸,称重,计算各腺体指数[腺体湿重(mg)/体重(g)],光镜下观察前列腺组织形态变化.结果 白藜芦醇在5mg/kg和15mg/kg剂最时分别与模型对照组相比,其前列腺指数差异均具钉统计学意义(P＜0.05或0.01),睾丸指数、精囊指数、体重变化差异无显著性意义(P＞0.05).白藜芦醇对动物的前列腺组织病理表现改善明显.结论 白藜芦醇具有一定的抑制前列腺增生作用,且对睾丸、精囊及体重无明显影响.     

甘肃省护理人力资源配置现状及公平性分析

目的了解甘肃省护理人力资源现状,评价2010~2014年甘肃省护理人力资源配置的公平性。方法根据地理位置、自然和人文特点将甘肃省下辖的14个地级市(州)划分为5个片区,运用描述性统计分析方法和泰尔指数对甘肃省护理人力资源配置现状及公平性进行分析。结果甘肃省每千常住人口注册护士为1.74人,低于全国同期水平(2.20人);陇中片区、河西片区每千常住人口注册护士高于全国同期水平(分别为2.33人和2.21人),其他3个片区低于全国同期水平。片区之间泰尔指数由2010年的0.0546递减至2014年的0.0256,片区内部差异贡献率由2010年的55.38%增加至2014年的63.18%。结论甘肃省护理人力资源配置不足,配置公平性有待改善,片区内部差异是造成护理人力资源配置不公平的主要因素。应合理制定护理事业发展规划,加强护理队伍建设,优化护理人力资源内部结构,提升护理人力资源配置的公平性。