新护士规范化培训中的多元化策略探讨

目的探讨新护士多元化培训策略的实践效果,为新护士规范化培训提供依据。方法将2007年入院的新护士43名设为对照组,采用传统跟班方法进行培训;将2008年入院的50名新护士设为观察组,采用多元化策略进行系统培训1年,包括脱产1周的专业岗前培训,双导师带教,进入科室第1～3月实行住院护士制,3个月后实行夜班准入制,上岗第7～12月组织进行非脱产技能强化训练等。结果两组操作考核成绩、理论考试成绩、德能勤绩学得分比较,差异有统计学意义(均P0.01);观察组对培训方法的评价显著优于对照组(均P0.01)。结论采用多元化策略对新护士进行规范化培训,有利于新护士尽快适应环境,提高解决问题的能力,迅速实现从学生到护士的角色转变。     

Criterion-based laparoscopic training reduces total training time

Introduction  

The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency.     

Surgical training with simulators in training centers

The development of new endoscopic procedures and minimally-invasive surgical interventions has led the methodology used to date to be questioned. Greater demand for safety by patients, the growth of the health budget and the reduced time available for training have led to the proliferation of centers with accredited personnel in which the knowledge and surgical skills necessary for the controlled incorporation of these techniques can be acquired. Simulators are available for the learning of both digestive endoscopy and laparoscopic techniques. These simulators are more or less dynamic, virtual, with viscera or mixed; even live animals can be used. Thus, the various techniques can be incorporated into clinical practice safely and effectively and at a reasonable cost. Simulators also allow evaluation and follow-up of the skills acquired.     

规范化培训护士叙事护理培训课程的构建

目的 构建规范化培训护士叙事护理培训课程,为护士叙事护理教育提供教材.方法 通过查阅文献、现状调查、半结构式访谈拟定规范化培训护士叙事护理培训课程初稿,采用德尔菲法,对21名相关领域专家进行两轮咨询.结果 第1、2轮专家咨询的积极系数分别为92.00％、91.30％;权威程度分别为0.85、0.84;专家协调程度分别为0.115、0.126(均P＜0.01).最终形成了包括培训目标、内容、方法、师资、效果评价5个一级指标、29个二级指标、65个三级指标的规范化培训护士叙事护理培训课程.结论 构建的规范化培训护士叙事护理培训课程内容全面,具有一定的科学性和可靠性,编写完成后可用于规范化培训护士叙事护理培训,推动人文教育.     

Influence of endovascular training on fellowship and general surgical training

PURPOSE: As endovascular procedures develop, there is a risk of diminished training of residents and fellows in traditional open surgery. We evaluated the effect of our endovascular program, initiated in 1999 coincident with the Federal Drug Administration's approval of endoluminal vascular aortic grafts, on the number of endovascular procedures and open abdominal aortic aneurysm (AAA) repairs performed in comparison to national trends. METHODS: The experience of vascular fellows and chief residents at completion of training (1996-2002) was reviewed and compared with the national mean case numbers before and after initiation of our endovascular program. RESULTS: The development of an endovascular program increased the total number of aneurysms repaired at the Robert Wood Johnson (RWJ) Medical School from 49 +/- 15 to 92 +/- 8 per year (P < 0.01). The number of vascular operations performed by the RWJ fellow increased from 320 +/- 48 to 553 +/- 155 per year (P < 0.05). The number of operations performed nationally by vascular fellows also increased during the same period, but did not reach statistical significance. There was no change in the number of open AAA repairs performed by the RWJ fellow or nationally. There was also no change in the average number of vascular operations completed by RWJ chief residents or nationally (160 +/- 17 versus 157 +/- 1 and 192 +/- 4 versus 189 +/- 4, respectively; P > 0.05). However, the average number of open AAA repairs performed nationally by general surgical chief residents decreased from 10 +/- 0.3 to 9 +/- 0.4 (P < 0.05). CONCLUSION: An endovascular program can increase the total number of AAA repairs performed without influencing the total number of vascular operations performed by general surgical chief residents. There was a decrease in open AAA repairs performed nationally by general surgical chief residents. The advancement of endovascular therapies may decrease the number of open procedures available for trainees in both general and vascular surgery. Perhaps those that will specialize in the field of vascular surgery should have the benefit of those open procedures.     

标准化方案在静脉输液专科培训中的应用

目的提高临床护士静脉输液水平和专业素质。方法抽取全院23个病区各2名共计46名临床护士,设计包括心态、理念及能力培训的标准化培训方案进行静脉输液专科培训2个月,分析培训效果和调查培训满意度。结果培训后理论、操作考核成绩得分85.20±4.13、95.18±6.22,显著高于培训前(均P0.01);撰写个案护理报告46份,优良率80.4%;模拟情境角色扮演优良率89.1%;培训方案及实施7项满意率76.09%~84.78%。结论标准化培训方案设计合理,用于临床护士静脉输液培训有助于提高其专业水平和素质,从而提高静脉输液水平和保障患者治疗安全。     

Residency training

R. C. is an orthopaedic resident in a teaching program. At the orthopaedic clinic, he examines an elderly, otherwise healthy patient who requires a total hip replacement. He presents the patient to his covering attending physician, who agrees to supervise the joint replacement surgery. The resident discusses the surgery with the patient. The procedure, risks, goals, benefits, and alternatives are presented. The patient agrees to proceed with the surgery. The resident performs the surgical procedure with the attending physician's assistance. The surgery lasts forty minutes longer than the attending physician's usual surgical time, and the blood loss is 300 milliliters greater. Postoperative radiographs demonstrate a well positioned press-fit acetabular component and a cemented femoral component in 6 degrees of varus.     

ALS training

Editor—Turley and colleagues¹ have highlighted a well-knownproblem. By completing a 2- or 3-day course on Advanced LifeSupport (ALS), one