Public health nursing competencies 1953-1966: effective and efficient

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.     

Public health nursing: an autonomous career for World War II nurse veterans

The 1944 G.I. Bill increased accessibility of higher education to male veterans. Less is known about how its availability affected opportunities for female veterans. The purpose of this study was to examine nurse veterans' use of the G. I. Bill at one large public university. Primary sources included archival documents of one large public university as well as articles published in professional nursing and medical journals of the 1940s and 1950s. Secondary sources addressing nursing and nursing education history, and the history of the G. I. Bill provided further context. Historical research methodology was conducted. Findings demonstrate that nurse veterans desired more independence in practice following the war. Archival documents of one large public university show that nurse veterans used G. I. Bill funds to seek degrees in public health nursing. The specialty of public health provided increased independence and autonomy of practice not experienced in hospital based care. G.I. Bill educational funds provided these nurse veterans the means to attain degrees in public health nursing, providing them the opportunity for more autonomous practice.     

Professional standards and public accountability

In a rapidly evolving healthcare environment, nurse anesthetists will experience increased pressure to deliver value based anesthesia care. Activities of the professional association must be dedicated to advancing patient safety and excellence in anesthesia. To best serve the public and the profession, the nurse anesthetist profession must continue to be accountable for quality of care to patients, committed to continuing competency for professional practice, and promote sustained communication and dissemination of research-based standards development.     

Patient safety: a shared responsibility

Patient safety is an essential and vital component of quality nursing care. However, the nation's health care system is prone to errors, and can be detrimental to safe patient care, as a result of basic systems flaws. A variety of stakeholders (society in general; patients; individual nurses; nursing educators, administrators, and researchers; physicians; governments and legislative bodies; professional associations; and accrediting agencies) are responsible for ensuring that patient care is safely delivered and that no harm occurs to patients. The responsibility of these stakeholders in addressing patient safety in the context of a nursing shortage is discussed, along with specific actions they have taken, and can continue to take, to promote safe care.     

患者的安全共同的责任

患者安全是护理质量中基本和重要的部分。然而，国际卫生保健系统是易于出现过失的，并且对患者的安全性护理是有害的，是基本系统缺陷所造成的。大量的利益相关者（社会大众、患者、护士、护理教育者、管理者和研究者、医师、政府和立法机关、职业协会和委任机构）对促进患者安全出院及无伤害发生是负有责任的。本文讨论了护理缺陷中相关者对患者安全的职责与特殊功能及继续接受和促进安全护理。     

责任制整体护理在全程护理模式中的应用

目的探讨责任制整体护理模式在肝胆外科围手术期患者中的应用效果。方法在肝胆外科病区实施责任制整体护理,包括改进照护模式、落实分级护理、优化工作流程、科学人力配置及完善护理质量监督体系,比较实施前后患者对专科疾病知识的了解情况、患者满意度、对责任护士知晓率、院内护理质量评分结果、护士直接护理时间及护理文件书写时间。结果实施后患者对各专科疾病知识的了解情况均高于实施前,差异有统计学意义（P〈0．05）;实施后患者满意度及对责任护士知晓率分别为98．22％,93．96％,均高于实施前的96．22％,89．67％,差异均有统计学意义（x2分别为7．16,11．84;P〈0．05）;实施后危重患者护理、急救技术、基础护理及消毒隔离的护理质量评分分别为（98．00±1．22）,（96．56±1．22）,（99．10±0．22）,（99．30±0．22）分,均高于实施前的（91．58±1．22）,（90．70±1．22）,（91．84±1．22）,（83．72±1．22）分,差异均有统计学意义（F分别为4．74,5．01,4．34,6．24;P〈0．05）;实施后护士直接护理时间为（368±12）min,高于实施前的（329±21）min,而护理文件书写时间为（20±4）min,低于实施前的（49±11）min,差异均有统计学意义（F分别为3．35,3．02;P〈0．05）。结论责任制整体护理的实施,有利于为患者提供全面、全程、专业、无缝隙的护理,促进了住院患者围手术期的专令与舒活．提高了患者及家属的满意席。     

上海市闵行区各级公立医疗机构护理门诊管理与护理实践现况调查

目的 了解闵行区各级公立医疗机构护理门诊管理与护理实践开展情况。方法 2018年10-11月,采用自设调查问卷,对闵行区公立二三级医院、社区卫生服务中心的护理门诊主诊护士、医院主管部门管理者进行问卷调研,主要了解护理门诊开诊情况、管理方式、主诊护士基本情况、主诊护士对自身专业价值的认识等。结果 各级医院护理门诊均以门诊专科专职护士为主。在学历、职称、护龄方面差异均无统计学意义,但在有无相关任职专业资质证书方面存在差异(P<0.05)；各级医院绩效考核机制与质量考核机制存在差异(P<0.05)。结论 闵行区公立医疗机构护理门诊开设呈现专科化、专病化,需尽快建立专科护士在护理门诊的准入制度,开展护理门诊主诊护士规范化培训；建立规范护理门诊绩效考核制度和质量安全考核制度,并希望早日形成护士处方权的设置与管理办法,以进一步推动和规范护理门诊的管理与发展。     

Recreating nursing practice for a new century. Recommendations and implications of the Pew Health Professions Commission's final report

The erratic path of evolution of health care in the United States creates daunting threats as well as new opportunities for institutions, professionals, and the public. Perhaps no stakeholder has more to risk or gain than professional nursing. As the largest of all the health professions, nursing serves as the backbone for much of the care delivery system. Historically, nurses have been employed primarily in hospital settings. Toward the latter part of the 20th century, however, nurses assumed such expanded roles as independent practitioners, managers of care in large health plans, and providers of alternative and complementary health care services. These new roles point to how nursing may rapidly evolve as the health care system addresses continuing issues of cost, performance, access, and consumer satisfaction. While today's opportunities are great, threats remain to the traditional role of the nurse in the hospital setting, through regulatory constraints on nursing practice and the lack of clear purpose and direction within the broad professional nursing community. Following a decade of leadership and advocacy for health professions education, the Pew Health Professions Commission issued its fourth and final report in December 1998. In this report, the Commission assessed the challenges facing professionals in the 21st century and made general and profession-specific recommendations for action.     

Stability in shifting sands: contemporary leadership roles in critical care

Background Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. Key issues In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer‐term outcomes from intensive care. Evaluation New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice. Conclusions The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors. Implications for nursing management There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders.     

Safe practice of population-focused nursing care: Development of a public health nursing concept

Patient safety, a cornerstone of quality nursing care in most healthcare organizations, has not received attention in the specialty of public health nursing, owing to the conceptual challenges of applying this individual level concept to populations. Public health nurses (PHNs), by definition, provide population-focused care. Safe practice of population-focused nursing care involves preventing errors that would affect the health of entire populations and communities. The purpose of this article is to conceptually develop the public health nursing concept of safe practice of population-focused care and calls for related research. Key literature on patient safety is reviewed. Concepts applying to population-focused care are organized based on Donabedian's Framework. Structural, operational and system failures and process errors of omission and commission can occur at the population level of practice and potentially influence outcomes for population-patients. Practice, research and policy implications are discussed. Safe PHN population-focused practice deserves attention.     

Adaptation of a Best Practice Guideline to Strengthen Client‐Centered Care in Public Health

Best practice guidelines (BPGs) were developed by the Registered Nurses Association of Ontario (RNAO) to support evidence‐based nursing practice. One Ontario public health unit chose to implement the BPG on client‐centered care (CCC). A critical review of this BPG revealed issues that would hinder successful implementation within a public health setting. These included a focus on the client as an individual, the predominance of acute care exemplars and training resources that were not representative of public health nursing practice, and the need to reconcile the enforcement roles of public health with the BPG principles. The purpose of this article is to describe the process of adapting the CCC BPG to more accurately reflect the broad scope of public health nursing practice. A model for CCC in public health nursing context is presented and processes for implementing, evaluating, and sustaining CCC are described.     

养老机构护理员护理安全风险认知现状与干预对策

目的对养老机构护理员进行护理安全风险认知水平的调查与干预,以提高护理员服务能力。方法2018年2—7月采用自行设计调查问卷调查东莞市9家公办养老机构的95名护理员对老年护理安全风险的认知现状,比较专业技术培训前后护理员护理安全风险认知水平。结果培训前护理员老年护理安全风险知识总分(121.06±9.50)分,得分率65.44%,各维度得分率由高及低依次是皮肤护理安全(得分率74.65%),跌倒安全(得分率73.35%),进食安全(得分率70.23%),认知障碍风险(得分率65.01%),服药安全(得分率48.90%)。培训后护理员对护理安全风险的认知总分及各维度得分均高于培训前(P<0.01)。结论东莞市养老机构护理员对老年护理安全风险的认知水平较低,针对性的专业培训可提高其护理安全认知水平,降低护理安全风险,从而提高其对老年人的照护水平。     

“责任制整体护理模式”的临床实践与体会

目的:探讨责任制整体护理模式在临床护理工作中的意义。方法:明确各岗位护士的职责,护理服务内涵、服务目标和工作标准,服务项目包括为患者实施的病情观察,治疗和护理措施,生活护理,康复健康指导等内容。结果:患者的基础护理、安全管理能很好落实,病房环境可达到安静、整洁、安全、有序,提高了护理质量、服务满意度。结论:责任制整体护理模式可持续提高护理质量,推进护理学科向专业方向发展。     

New nurses, new spaces: a preview of the AACN History Study.

This article previews selected findings of the American Association of Critical-Care Nurses History Project that is being conducted under the auspices of the Center for the Study of the History of Nursing at the University of Pennsylvania. Using methods of social history research, we reviewed pertinent literature, studied documents of institutions and organizations, and interviewed a broad array of participants. Analysis of this evidence resulted in a history of the evolution of nursing and hospital care for patients with life-threatening illnesses during the 40-year period since 1950. We explored the effects of changing public and professional ideas about the nature of critical illness, the effects of technology, and the historical dimensions of critical care nursing. Special attention was given to the events and circumstances that led to the development of AACN and the reciprocal relationships between AACN and the care of critically ill people.     

How professional nurses in a general hospital setting perceive mentally ill patients

In recognition of the enormous challenges in South Africa confronting the nursing of the mentally ill, this project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perceptions of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff. Data was collected using a survey questionnaire. The study looked at two different types of perceptions that were guided by categories of conceptual framework proposed by Mavundla in 2000, namely perception of self and perception of patients. This particular study found that the majority of professional nurses had a predominantly positive perception of self in caring for or nursing the mentally ill in a general hospital setting, although a significant number of them had a negative and stereotyped perception of the patients. Lack of knowledge, skill and experience in psychiatry among the nursing staff was identified as affecting the nursing care process of the mentally ill.     

深化整体护理模式在临床实践的理性思考

为适应21世纪卫生保健服务的需要和国际护理学科发展相接轨的现代护理模式,探索适合我国护理工作特点的整体护理模式,如何完善和深化整体护理最佳模式势在必行。提出深化整体护理应在遵循整体护理模式原则的基础上,以循证护理思想为指导,护理模式应与人性化护理模式、个体化护理模式、整体化医疗护理模式、多元文化护理模式、"按职称上岗,三位一体"护理模式相结合,以促进护理学科发展和整体护理的深化。     

呼吸道护理小组的建立与实践

目的探讨医院内建立呼吸道护理小组的方法与效果。方法成立了呼吸道护理小组,修订和完善呼吸道管理的实践标准,进行呼吸道护理理论及技能培训,建立质量监督体系和呼吸道护理会诊制度。结果提高了呼吸道护理小组成员的理论知识及专科技能水平,降低了呼吸道护理意外的发生,提高了医生及病人对护理工作的满意度。结论呼吸道护理小组可以使住院病人的呼吸道管理更趋安全性,促进了医院专科护理的发展。