PDCA循环法在临床护理带教老师培训中的实践效果

目的:探讨PDCA循环法在临床护理带教老师培训中的实践效果。方法:选择2014年5~12月我院临床护理带教老师79名,采取PDCA循环法进行教学能力培训,比较临床护理带教老师培训前后在教学理论成绩、授课技能得分以及护生满意度方面的差异。结果:经PDCA循环法培训后79名临床护理带教老师的教学理论成绩、授课技能得分以及护生对带教老师专业知识及技能、带教方法及技巧、授课方式方面的满意度均显著高于培训前(P0.05)。结论:PDCA循环法用于临床护理带教老师的教学能力培训,可增强带教老师的教学能力,提高护生满意度,改善带教质量,值得大力推广应用。     

本科护生临床带教老师对自身岗位能力需求认识的调查分析

[目的]了解本科护生临床带教老师对自身岗位能力需要认识的现状,为提高临床带教老师的岗位能力提供参考依据。[方法]采用中文版的临床护理带教老师有效行为量表(NCTEI)对武汉某三级甲等医院128名临床带教老师进行调查分析。[结果]本科护生临床带教老师对自身岗位能力需求认识情况:教学能力得分为(6.359±0.957)分,护理能力得分为(6.264±0.939)分,评估能力得分为(6.269±0.797)分,人际关系得分为(6.107±0.855)分,人性特征得分为(6.098±0.668)分;教学能力维度中讲解清晰得分最高为(6.834±0.412)分;人格特征维度中精力充沛得分最低为(4.882±0.572)分;不同学历的临床带教老师护理能力、人际关系和个性特征维度得分比较差异有统计意义(P0.05)。[结论]不同学历的临床带教老师对自身岗位能力需求认识存在差异,临床护理教育部门应该针对性培训不同学历的临床带教老师,以达到与本科护生对临床带教老师能力需要相契合的目的,最终提高临床带教老师的岗位能力。     

实习护生对带教老师能力评价的影响因素的调查与分析

目的通过横断面调查的方法了解护生对实习带教老师能力的评价及护生认为带教老师哪方面带教行为对自身影响最为重要。方法采用整群抽样,使用自设调查问卷对湖南省长沙市某大专院校实习归来的护生进行问卷调查。采用多元线性回归分析确定影响,采用因子分析法确定带教老师各方面评分的指标权重。结果在多方面评分中,带教老师对护生学习实习的关心得分最低,带教老师专业知识及操作得分最高。结果不同性别的护生对带教老师专业评分、带教老师态度评分、带教老师综合评分有差异(P0.05),男护生评分高于女护生。独生子女对带教老师对实习生出错态度评分高于非独生子女,差异有统计学意义(P0.05)。在对带教老师专业知识水平得分、带教老师操作技能得分、带教老师法律法规知晓得分、带教态度得分、对于出错学生态度得分上,非常愿意从事护理工作评分高于非常不愿意从事护理工作,差异有统计学意义(P0.05)。各条目权重分析发现:带教老师关心护生学习实习评分,带教老师的专业评分、带教老师的操作评分三个条目对护生评价带教老师带教能力影响最大。结论湖南省多家医院护理带教老师带教能力评价优良,但是带教老师对实习护生学习及实习关心较少,带教老师更关注于专业知识及技能,对护理行业未来的接班人人文关怀不足,还存在提升空间。建议各实习点医院培训带教老师更多关注关心实习护生的实习及学习,对护理行业人才未来的发展起到保护和促进的作用。     

PDCA循环法在临床护理带教老师培训中的实践

目的探讨PDCA循环法在临床护理带教老师教学能力培训中的实践效果。方法应用PDCA循环法对临床护理带教老师进行教学能力培训。比较PDCA循环法培训前后带教老师教学理论成绩、授课技能成绩及护生对带教老师满意度情况。结果应用PDCA循环法对护理带教老师培训后,带教老师教学理论成绩、授课技能成绩,护生对带教老师教学方法及技巧、授课方式方面满意度较培训前明显提高,前后比较,均P0.05,差异具有统计学意义。结论应用PDCA循环法对临床护理带教老师进行教学能力培训实践,有效提高带教老师教学能力和护生对带教老师教学满意度,从而提高护理带教质量。     

Seminar教学法在临床护理带教老师小讲课能力培训中的应用

[目的]探讨Seminar教学法在临床护理带教老师小讲课能力培训中的应用效果。[方法]应用Seminar教学法对59名临床护理带教老师进行为期1年的培训,比较培训前后实习护生对临床护理带教老师小讲课质量评价以及临床护理带教老师小讲课能力自我评价。[结果]培训后临床实习护生对临床护理带教老师小讲课质量评价得分(36.21±0.62)分,高于培训前的(33.15分±1.04分)(P0.05),临床护理带教老师小讲课能力自我评价培训前后比较差异有统计学意义(χ~2=30.35,P=0.000)。[结论]应用Seminar教学法可有效提高临床护理带教老师的授课能力。     

急诊临床护理教学现状与对策

为提高急诊临床护理教学质量,分析其存在问题和影响因素:教师方面主要问题是护理人员缺乏,带教时间不足、知识脱节、授课能力较差、带教方法单一;护生方面存在问题足护生自身理论、护理技术操作不扎实,心理应对能力缺乏,理论联系实际能力较差;护理管理方面存在教学体系不健全,缺乏科学的教学评价系统等问题;病人方面存在来诊的不确定性,处于危、急状态,给急诊教学带来困难.对策:通过严格选拔带教老师、加强带教老师急诊相关护理知识、带教方法的培训与考核,提高带教老师的带教水平;加强护生岗前培训和入科教育、及时反馈信息,帮助护生转换角色;通过增加集中教学次数、编写<急诊临床护理实习手册>的方式提高授课水平和质量.通过尝试创新教学计划、设立专职教学老师,健全教学管理体系、合理的人员结构编制、建立教学双向评价系统改进护理教学管理现状,提高教学质量.     

审核评估背景下的护理专业教学过程评价体系构建探讨

目的:探讨审核评估背景下护理专业教学过程评价体系的构建及其对临床护生带教质量和综合能力的影响.方法:选取2019年6月—2019年12月在医院实习的120名护生为观察组,另将2018年6月—2018年12月在本院实习的120名护生设为对照组为对照组护生以传统教学模式开展带教,观察组护生基于结构-过程-结果的评价体系开展教学,比较两组护生教学成效和综合护理能力.结果:观察组护生护理技能得分及理论考核得分均超过对照组(P<0.05);观察组护生对轮转科室安排、带教目标、班次安排、带教老师带教水平、教学方法灵活性、带教老师对护生的态度等方面满意度高于对照组(P<0.05).结论:审核评估背景下通过构建的结构-过程-结果教学评价体系将有助于提高护生带教质量及护生对教学的满意度.     

工作教导课程在提高临床带教老师教学指导能力培训中的应用研究

目的探讨工作教导课程在临床带教老师教学指导能力培训中的应用效果。方法选取112名临床护理带教老师为研究对象,应用工作教导课程进行3个月培训,包括组建培训师资、构建培训大纲、实施培训方案。培训结束后,采用自身对照法,比较带教老师培训前后理论、技能考核成绩,临床实践指导能力及学生对教学效果满意度。结果培训后带教老师理论、技能考核成绩,临床实践指导能力及护生对临床带教老师教学效果满意度均高于培训前(P0.01)。结论工作教导课程能满足临床带教老师对教学培训需求,从而提高临床护理带教队伍教学技能、临床实践指导能力,科学指导临床护理教学过程,提高教学满意度,值得推广应用。     

手术室实习护生39名临床带教情况调查

目的:探讨手术室实习护生的临床带教情况。方法:对39名手术室实习护生进行问卷调查,开展护生座谈会,评价带教效果。结果:10.26%的护生认为带教老师的临床护理科研能力较差;47.99%的护生认为带教老师的临床护理教学能力非常好;48.72%的护生认为带教老师的临床护理水平非常好;51.28%的护生认为带教老师的专业态度非常好;56.41%的护生认为与带教老师的人际关系非常好。结论:对于手术室护理带教工作,必须及时发现问题,与实习护士进行有效沟通,优化临床护理带教模式。     

体验式教学在核应急实习护生临床带教中的应用

目的探讨体验式教学在核应急护理实习生临床带教中的应用,为护生临床带教工作提供参考。方法将2014年6月~2015年5月在本院实习的核应急护生80名随机分成实验组和对照组各40名,对照组采用常规的带教方法,实验组采用体验式教学的方法即通过情景模拟核应急事件来培养核应急护理临床实习学生的核应急护理能力。结果在带教结束时对护生的带教效果进行评价,实验组护生的核应急理论知识和操作技能考核分均优于对照组(P0.05);带教老师认为实验组护生的实践能力、应急能力、团队合作能力、沟通交流能力强于对照组(P0.05)。结论体验式教学法有利于提高护生的核应急护理能力、团队协作能力和护理教学的水平。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.