临床护理路径在经肛门行巨结肠根治术患儿中的应用

目的建立完善的经肛门巨结肠根治术的临床护理路径。方法随机将需经肛门行巨结肠根治术的40例先天性巨结肠患儿分成实验组和对照组各20例。对照组采用传统的常规护理，实验组患儿实施临床护理路径。结果实验组患儿的平均住院天数、平均住院费用、并发症的发生率均较对照组显著减少，满意度及对疾病相关知识的掌握情况均明显提高。结论临床护理路径应用于经肛门行巨结肠根治术的患儿中，可缩短住院天数，降低医疗费用，降低并发症的发生率，提高工作效率和患儿及家属的满意度．从而促进护理质量的提高。     

临床护理路径在经肛门行巨结肠根治术患儿中的应用

目的建立完善的经肛门巨结肠根治术的临床护理路径。方法随机将需经肛门行巨结肠根治术的40例先天性巨结肠患儿分成实验组和对照组各20例。对照组采用传统的常规护理,实验组患儿实施临床护理路径。结果实验组患儿的平均住院天数、平均住院费用、并发症的发生率均较对照组显著减少,满意度及对疾病相关知识的掌握情况均明显提高。结论临床护理路径应用于经肛门行巨结肠根治术的患儿中,可缩短住院天数,降低医疗费用,降低并发症的发生率,提高工作效率和患儿及家属的满意度,从而促进护理质量的提高。     

延续性护理在先天性巨结肠患儿术后的应用价值

目的探讨延续性护理在先天性巨结肠(HD)患儿术后的应用价值及对通便的影响。方法选择2013年6月至2017年6月我院收治的先天性巨结肠患儿70例,随机等分为对照组和观察组。对照组患儿采用常规护理,观察组在对照组基础上给予为期6个月的延续性护理,比较两组患儿及家属的遵医依从性,患儿并发症发生率,心理状况及排便情况。结果观察组患儿及家属在家庭护理过程中排便功能锻炼、坚持扩肛、科学饮食、儿童行为控制等遵医依从率显著高于对照组(P0.05);观察组患儿出院后6个月内感染、吻合口出血、粘连性肠梗阻及小肠结肠炎等并发症发生率显著低于对照组(P0.05);观察组患儿出院后焦虑指数评分与对照组患儿比较无显著性差异(P0.05),学习问题、品行问题、多动指数和心理障碍等评分显著低于对照组患儿(P0.05);观察组患儿发热、恶心呕吐等不良症状发生率显著低于对照组,排便通畅、大便颜色正常情况显著高于对照组(P0.05)。结论延续性护理有助于提高HD患儿及家属的遵医依从性,降低患儿的并发症发生率,改善其心理状况及排便情况,效果显著,值得推广应用。     

精细化护理干预在先天性巨结肠经肛门行巨结肠根治术患儿中的应用

目的:探讨精细化护理干预在先天性巨结肠经肛门行巨结肠根治术患儿中的应用。方法:将2015年1月~2017年12月收治的120例先天性巨结肠患儿随机分为观察组和对照组各60例,对照组采用常规护理干预,观察组采用精细化护理干预,比较两组术后恢复情况、住院费用、治愈率、并发症发生率及患儿家属满意度。结果:观察组患儿经口进食时间、肠鸣音恢复时间及肛门排气时间均早于对照组(P0.05),住院时间短于对照组(P0.05),住院费用少于对照组(P0.05),治愈率高于对照组(P0.05),并发症发生率低于对照组(P0.05),患儿家属护理满意度高于对照组(P0.05)。结论:在先天性巨结肠经肛门行巨结肠根治术患儿围术期应用精细化护理干预,可促进患儿术后恢复,缩短住院时间,提高治愈率及患儿家属护理满意度,降低住院费用和并发症风险。     

QCC护理模式在小儿先天性巨结肠围术期的应用价值

目的：探讨QCC护理模式在小儿先天性巨结肠围术期的应用价值。方法选取在我院进行择期小儿先天性巨结肠根治术的患儿160例,随机分为对照组和观察组,每组80例。对照组按小儿先天性巨结肠根治术的临床护理路径进行护理;观察组患儿围手术期实施QCC护理模式,围绕小儿先天性巨结肠围手术期护理问题实行品管圈活动。比较两组患儿及家属对手术的满意度及治疗效果。结果观察组患儿及家属就医的满意率显著高于对照组（P＜0.05）,患儿术后引流管放置时间、住院时间均显著少于对照组（均P＜0.05）,并发症发生率显著低于对照组（P＜0.05）,治愈率略高于对照组。结论在小儿先天性巨结肠围术期实施QCC护理模式能有效提高患儿及家属的满意率,有助于缓解医患矛盾、提高手术治疗效果。     

延续性护理对出院后继续抗凝治疗患者出血性并发症的影响

目的探讨延续性护理对出院后继续抗凝治疗患者的出血性并发症的影响及应用价值。方法将54例脑出血出院患者随机分为实验组和对照组各27例,实验组由专科护理人员采取网络信息回访、电话交流以及预约上门护理服务等多方式进行出院后延续性护理,为患者以及家属提供基础护理、专科陪护、后期康复训练以及康复期心理疏导,而对照组仅进行常规的定期回访。对比两组的出血性并发症发生情况、出院时和出院一年后的日常生活能力评分量表(ADL)评分以及出院后回访护理满意度。结果实验组出院后无出血性并发症以及意外的发生,而对照组中3例失去联系,5例患者伴有不同程度的出血性意外;一年后实验组ADL评分以及回访护理满意度均显著高于对照组,差异均具有统计学意义(P0.05)。结论对于出院后继续抗凝治疗的患者采取专业延续性护理可促进患者进一步康复,有助于患者提升生活质量,早日回归社会,减轻家庭负担。     

延续性护理在肢体偏瘫患儿中的应用效果评价

目的：对延续性护理在肢体偏瘫患儿中的应用效果进行分析与评价。方法：选取2011年8月-2012年8月收治的肢体偏瘫患儿74例为研究对象,随机分为实验组和对照组,每组38例。实验组采用出院后为期半年的延续性护理方案,对照组采用传统方法护理。在出院日和出院后半年对患者进行 ADL 评分,调查患者或家属对护理质量的满意度。结果：两组患者出院时 ADL 评分无明显差异（P〉0.05）,半年后两组患者的 ADL 评分均有显著提高,但实验组的 ADL 评分明显优于对照组（P 〈0.05）。而且实验组患者家属对护理质量的满意度明显优于对照组。结论：延续性护理在肢体偏瘫患儿的护理中具有很好的应用效果,能显著提高患儿的活动能力及患儿家属对护理工作的满意度。     

小儿先天性巨结肠患儿行腹腔镜辅助改良Soave术治疗时配合围术期细节护理的临床效果

目的 分析研究小儿先天性巨结肠患儿行腹腔镜辅助改良 Soave 术治疗时配合围术期细节护理的临床效果。方法 选取我 院 2019 年 12 月至 2022 年 12 月收治的 100 例小儿先天性巨结肠患儿展开回顾性分析。依据护理方式差异划分为对照组和观察 组，每组各 50 例。对照组实施常规护理，观察组实施细节护理。比较两组的家属满意度、并发症、护理质量、生活质量及患 儿依从性。结果 观察组家属满意度高于对照组（P<0.05）。观察组的并发症发生率低于对照组（P<0.05）。观察组护理质量高于 对照组（P<0.05）。观察组生活质量高于对照组（P<0.05）。观察组的患儿依从性高于对照组（P<0.05）。结论 小儿先天性巨结 肠患儿实施腹腔镜辅助改良 Soave 术治疗配合使用围术期细节护理，能够减少并发症、提高依从性，家属满意度，护理质量及 生活质量。     

小儿扁桃体摘除术54例舒适护理

目的:探讨扁桃体摘除术患儿的舒适护理方法。方法:将2011年3～10月在我科行小儿扁桃体摘除术的54例患儿作为实验组,将2010年7月～2011年2月行小儿扁桃体摘除术的47例患儿作为对照组。实验组在优质护理基础上分别于围术期采取舒适护理,对照组进行术前宣教和术后常规护理。比较两组患儿术后不良反应、对护理依从性、术后并发症发生率及家属对护理工作的满意度。结果:实验组患儿在咽部疼痛、恶心、失眠等不适反应方面轻于对照组(P<0.01),患儿对护理依从性和患儿家属对护理工作的满意度高于对照组(P<0.01),术后并发症发生率低于对照组(P<0.05)。结论:舒适护理可减少患儿术后不适,提高患儿护理依从性,减少术后并发症,提高患儿家属对护理工作的满意度。     

腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的护理

[目的]总结腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的术中护理配合.[方法]对6例先天性巨结肠患儿采用腹腔镜辅助下改良Soave根治术,术前给予心理护理,术中正确安置体位、维持体温稳定、严密观察病情、防止体位性低血压发生等,同时器械护士给予密切配合.[结果]6例患儿平均住院9 d,均痊愈出院.[结论]做好腹腔镜辅助下改良Soave根治术治疗先天性巨结肠的护理,可确保患儿手术顺利,有效避免手术风险.     

Putting policy into practice: pre- and posttests of implementing standardized languages for nursing documentation

Aims and objectives. To describe the change in documentation of the nursing process in all inpatient wards in a 900‐bed university hospital. Major research question was what are the differences between before and after implementation of documentation policy related to the steps of the nursing process? Background. Implementation of standardized languages has been shown to be difficult to accomplish in clinical practice. Patients are the source of data and their conditions, responses and well‐being should be reflected in the nursing record. As such, nursing documentation can create the premises for the development of new knowledge in nursing and the improvement of nursing performance and can provide data and information necessary for nursing researchers to evaluate the quality of interventions and participate in the formulation of healthcare policy. This study is part of longitudinal project to prepare nurses for electronic documentation within the interdisciplinary health record and to improve documentation of nursing using standardized languages. Design and method. A cross‐sectional study design was used: a pretest (n = 355 nursing records) for baseline status of nursing documentation, an intervention and a post‐test (n = 349 nursing records) to obtain data on nursing documentation. The year‐long intervention comprised planned work in groups, and educational and supporting efforts. Results. A statistically significant improvement was found in the use of Functional Health Patterns for documentation of nursing assessment, NANDA for nursing diagnoses and Nursing Interventions Classification for nursing interventions in documentation of daily nursing care for inpatients. Conclusion. At all organizational levels intervention aimed at putting policy regarding documentation into clinical practice considerably improved daily use of standardized nursing languages. Relevance to clinical practice. Nurses need to use standardized language to document patient care data in the electronic health record and to demonstrate contributions to nursing care.     

Structure and content in Norwegian nursing care documentation.

In 1994, the Norwegian Board of Health (NBH) published recommendations for nursing care documentation. The two-fold purpose of the present study was to see if 5 wards in 2 Norwegian hospitals fulfilled the proposed NBH recommendations and guidelines regarding documentation, and to evaluate them in terms of the proposed structure and key words of the VIPS model. Results showed that all nursing records (n = 55) had an admission assessment. A nursing care plan was present in 62% of the records. Nursing goals were lacking in the remaining 38%, diagnosis and planned interventions were absent in 18%, and 45% of the diagnoses lacked information concerning patient progress or outcome. The nursing care plans were updated in only 40% of the records and discharge notes were present in 35%, confirming that NBH recommendations were not met in this sample. The key words of the VIPS model covered all information present in the records, and high interrater reliability was obtained for the majority of key words categorized by two independent researchers. It is suggested that the VIPS model components and key words can contribute to a reliable and uniform model for nursing care documentation and enhance comprehensive and systematic documentation, which is presently lacking in Norwegian records.     

提升护理服务综合价值的研究

目的:研究护理综合价值的提升。方法:分析护理价值研究背景,阐述护理价值研究进展结果:提出护理价值研究途径。结论:有利于达成一种共识,使广大护理人员认识护理价值、研究护理价值、开发护理价值,重视护理综合价值研究和提升。 护理服务价值是护理服务劳动产品的价值和服务本身所创造的价值的总和,即使用价值与价值的统一。目前日本、美国、德国和中国都在加强护理价值研究的探索,但仍存在使用价值与价值研究分离问题。因此,我们应不断加强护理综合价值研究,以适应卫生事业改革对护理管理的挑战。本研究主要在分析国内外护理价值研究的基础上,提出综合护理价值研究途径,以达到合理评价护理价值的目的。     

Towards an aesthetics of nursing

Towards an aesthetics of nursing This paper re-appraises the work of Barbara Carper on aesthetics and the art of nursing. It identifies serious flaws in Carper's original arguments and the way in which she and subsequent authors have conflated the concepts of art and aesthetics in nursing. The paper explores a broader approach to aesthetics and proposes a way in which a theoretical approach to nursing aesthetics could be developed. The paper concludes that nursing is a fit object of aesthetic appreciation and that aesthetic quality is a necessary attribute of good nursing practice.     

Research and the configuration of nursing services

• ? This paper is concerned with the way in which nursing research has influenced changes in the organization of nursing services, particularly the shift from so-called traditional nursing to new nursing. To this end published research and professional literature are selectively reviewed.
• ? The case is made to support the view that change in nursing has been driven forward by the evangelical zeal of opinion leaders rather than evidence.
• ? It is suggested that holistic care as embodied in new nursing is no longer affordable. Market pressures have precipitated a revisiting of the task basis of nursing. An effective anchor would have been a solid body of research evidence pointing up the value new nursing may have. Regrettably not enough research was done prior to the diffusion of new nursing. What was done was not always adequate, and what was adequate was not effectively deployed by nurse leaders.
• ? Nursing is the largest workforce in the NHS and has attracted a great deal of policy interest. It is suggested that it will become increasingly important for nursing to be more strategic, and develop its own professionally driven research agenda.
• ? The future of the nursing profession is uncertain. It is clear that evidence-based practice is centre stage, and there is a need for nursing to re-negotiate its professional boundaries and to develop intellectual partnerships in order to move the knowledge base of practice forward.

     

我国护理行业的改革与发展

从我国护理行业的现状、卫生体制改革以及基本国情出发 ,着重探讨护理管理、护理教育、护理环境、护理经济与管理体系、护理立法等方面的发展途径     

基层医院整体护理的实施与对策

目的:总结实施整体护理的经验,提高护理质量。方法:全面综合分析实施整体护理的对策和措施。结果:经验:领导的高度重视和大力支持,是实现整体护理模式转变的坚实基础;提高人员整体素质,确保整体护理的有效开展;多做少写,以点带面,实行非模式病房开展整体护理工作;积极开展健康教育,巩固整体护理效果;实施整体护理质量管理的措施。体会:领导的重视和支持,是开展整体护理工作的根本保证;提高了社会公众对护理工作的认可程度和护士的社会地位;显示了护士的自身价值;改善了护患关系,提高了病人满意度,同时也密切了医护关系;护理队伍整体素质提高,敬业精神增强。结论:实施整体护理,促进了护理学科的发展。     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

整体护理病房三级护理查房的体会

我院自1999年7月开始在整体护理模式病房中实施三级护理查房。1年多来,对800例危重病人进行了护理查房,查房的形式为责任护士每天查,主管护师或护士长每周查,副主任护师以上或科护士长每月抽查,护理部主任每季抽查。通过查房,明显提高了危重病人的护理质量,病人得到了更为优质的服务,护理服务满意率提高;对护理人员来说,提高了业务水平,锻炼了口头表达能力;对护理管理来说,及时了解护士对护理程序的应用情况,掌握危重病人的护理质量,对护理中存在的不足及时提出指导意见。     

晨间护理缺陷分析及对策

目的提高晨间护理质量。方法通过向住院病人和护士发放问卷调查及每周不定期检查各病区晨间护理质量,了解晨间护理工作中存在的缺陷,提出整改的措施。结果晨间护理工作中存在的主要缺陷:51.8%的病人认为护士与病人的沟通少,进病房时未向病人问好,整理病房时未向病人解释,口腔清洁率70.3%,头发清洁率45.3%,皮肤清洁率69.5%,病房安静整洁率67.3%,床单位整洁率86.5%,病情关注情况67.9%,健康教育执行情况48.6%,协助生活不能自理的病人进食、入厕、更衣、床上排便等占75.4%,时间安排满意度75.6%,护士认为晨间护理重要的占30%,晨间护理内容知晓率占60.9%,认为工作量大来不及做的占56.7%。结论提高护士对晨间护理的认识,规范晨间护理内容和程序,加强与病人的沟通,提供符合个体化需要的晨间护理,合理安排护理人员、工作重点和时间,持续质量改进,有助于提高晨间护理质量。