临床新护士规范化管理中存在问题及对策

新护士规范化管理是护理人力资源管理的重要组成部分,分析规范化管理中存在的问题,建议从严格准入关,加强规范化管理;严格培训关,提高新护士自身素质和基本技能;严格带教教师关,提高带教质量;严格考核关,加强护理管理等手段,不断提高规范化管理的质量。     

儿科新护士换液操作的系统培训

目的对儿科新护士换液操作进行专项培训,提高新护士安全意识与应对能力,确保患儿输液安全。方法将2004年1月至2009年12月进入儿科工作<3年的护士45名设为对照组,2008年1月至2011年10月进入儿科工作<3年的护士82名设为观察组。对照组采用常规上岗带教培训方法;观察组采用系统培训方法,包括理论讲授、操作示范、角色换位训练与考核、上岗考核等。结果观察组护士培训后理论和操作成绩显著优于对照组(均P<0.01),与换液有关护理不良事件发生率显著低于对照组(P<0.01)。结论规范化的换液培训可提高儿科新护士输液操作水平,有效地减少护理不良事件的发生。     

现场追踪与mini-CEX考核在新护士独立上岗前考核中的应用

目的探索现场追踪与迷你临床演练评估(mini-cex)考核法在新护士独立上岗前临床综合实践能力考核中的效果。方法将2013年的230名新护士作为对照组,2014年的201名新护士作为观察组。对照组按传统床边实践能力考核法进行考核,观察组则采取现场追踪与mini-cex相结合的方法,评价新护士护理面谈技能、护理评估检查能力、专业态度、临床判断与解决问题、沟通技能、组织效能、整体临床胜任能力。计算两组考核所需时间及患者拒绝或不满的次数。并于考试结束后对新护士及教师进行考核方法的满意度调查。结果观察组新护士护理面谈技能等7项能力平均分都达到合格要求,但单项能力未达合格比例为5.0%~15.9%,观察组考核所需时间及患者拒绝或不满频次显著少于对照组(均P0.01);新护士及教师对追踪与mini-CEX考核方法的满意率为88.6%~100.0%。结论现场追踪与mini-CEX考核法是一种客观、有效、贴近临床且被考核双方接受及认可的临床综合能力考核方法。     

新护士岗前技能培训中小组公约法的应用

目的探讨小组公约法在新护士岗前技能培训中的效果。方法按时间段将新护士103人分为对照组51人和观察组52人;对照组采用示教室老师授课培训法,观察组采用小组公约激励模式带教。15项基础护理操作技术,共90学时。结果培训后观察组15项操作技能考核成绩显著优于对照组(均P0.01)。结论在新护士岗前技能培训中采用小组公约法有利于提高培训效果。     

新护士规范化培训研究进展

从规范化培训对象与周期、规范化培训内容、规范化培训形式、规范化培训考核内容与形式4个方面,综述了近年来国内新护士规范化培训的研究进展。提出在新护士培训中可借鉴目前我国实行的住院医师规范化培训模式,按要求完成相应学科的轮转,并明确新护士在所有科室必须完成的具体理论及操作考核内容,有关部门出台一套内容更加详实、要求更加明晰、更具操作性、全国通用的临床护士规范化培训方案,使新护士实现从学生到专业护理人员的角色转变,尽快胜任临床护理工作。     

新护士阶梯式培训的实施与效果

目的探讨阶梯式培训法在新护士培训中的应用效果。方法对2006～2008年入院的81名新护士(对照组)采取传统培训方法,对2009～2011年入院的117名新护士(观察组)采取阶梯式培训方法。结果观察组新护士理论、操作考核成绩显著优于对照组(均P<0.01)。结论阶梯式培训方法可提高新护士的临床实际工作能力和业务素质。     

《新入职护士规范化培训大纲》的践行与效果评价

目的贯彻落实国家卫生与计划生育委员会颁布的《新入职护士规范化培训大纲(试行)》,探索肿瘤专科医院新入职护士规范化培训与管理方法,提高肿瘤专科护士岗位胜任能力。方法根据《新入职护士规范化培训大纲(试行)》要求,结合肿瘤专科医院特点制定新入职护士培训方案。对37名新护士采用全脱产集中理论授课培训、模拟病房和临床路径的操作培训方案,考核方法采用微信推送题目考核、个案考核、临床实践能力考核。结果新护士培训后理论知识考核(87.08±6.64)分,操作技能(93.59±0.75)分;科室对新入职护士各方面表现的过程考核10名优秀,22名良好,5名合格;对新入职护士晚夜班能力考核26名优秀,11名良好。结论新护士规范化培训使其临床护理能力得到全面提高。专科医院应以《新入职护士规范化培训大纲(试行)》为蓝本,制定适合自己医院的新入职护士培训大纲,以提高临床护士岗位能力。     

交叉判卷法在护士考核中的应用

目的探讨能充分发挥鉴定、改进、导向和激励功能的考试方法,提高护士的培训效果。方法对护理人员按护理部年度培训计划实施培训,考核时应考护士答题完毕不离开考场,主考老师收卷后公布评分方法和试题答案,由应考人员自行交叉判卷,要求判卷人在认真判卷的同时,也找出自身的错误和偏差之处,牢固记忆正确答案。护理部现场登记分数,对于名列前茅者当场给予表彰。结果 95.1%应考护士认为提供了讨论错误答案的机会,94.4%应考护士认为有助于发现自身薄弱点,93.3%应考护士认为可提高理解和综合知识的能力,76.7%应考护士认为提高了学习积极性。结论交叉判卷法使护士对自身理论知识的掌握情况得到及时的反馈,内容得到及时强化,提高了培训效果。     

清单式形成性评价体系在新入职护士培训中的应用

目的 基于核心能力清单构建形成性评价体系,了解其在新入职护士培训中的应用效果。方法 采用我院建立的护士核心能力清单框架,将培训内容以清单的形式展现,建立形成性评价体系并在2020级57名新入职护士(观察组)中实施;并与采用常规规范化培训的2019级53名护士(对照组)进行理论、操作考核成绩及核心能力评分比较。结果 观察组理论合操作考核成绩显著优于对照组,核心能力总分及法律和伦理实践能力、临床护理能力、人际关系3个维度评分显著优于对照组(均P<0.05)。结论 基于清单的形成性评价体系在新入职护士培训中的应用和实践,使培训目标更清晰和具体,评价更加具有针对性和多元化,有利于护士在理论和临床实践能力的提升。     

肿瘤专科医院新护士规范化培训方法探讨

目的 探讨肿瘤专科医院新护士规范化培训方法,为进一步完善护士毕业后规范化教育提供依据.方法 建立新护士规范化培训组织管理体系、加强护理"三基"理论与"三基"操作培训、针对不同学历护士采用不同培训方法和考核标准、根据肿瘤专科医院的特点加强专科知识培训.结果 新护士规范化培训后,理论知识及操作技能考核成绩均分在85分以上.结论 对新护士实施规范化培训,能使他们尽快适应角色改变,提高专业理论和护理技术操作水平,可提高临床护理质量,保证医疗安全.     

Clinical strategies to avoid blood transfusion

Both transfusion and anaemia in the perioperative period are associated with increased risk to the patient. With the advent of patient blood management programmes, we are reminded that the clinical strategies to avoid blood transfusion should be multidisciplinary, begin pre-operatively and involve every stage of the patient pathway.     

Clinical strategies to avoid blood transfusion

A multifactorial approach to anaesthesia and surgery can reduce the requirements for perioperative allogeneic blood transfusion. First, the patient is optimized preoperatively to ensure the RBC mass is maximized. This process may include treatment with iron, folate, B12 or erythropoietin. Preoperative autologous blood donation may be appropriate for some patient groups. Intraoperative anaesthetic techniques include acute normovolaemic haemodilution, careful patient positioning, the use of regional anaesthesia where appropriate, avoidance of hypertension and use of controlled hypotension, and RBC salvage. These are combined with appropriate surgical techniques such as minimally invasive surgery, use of tourniquets where possible, and coagulating dissecting instruments. This multifactorial approach is necessary because of the known inherent risks of allogeneic blood transfusion, and also because of the increased pressure on the precariously balanced UK blood supply.     

Problems in the refusal of blood transfusion

Three examples of refusal of blood transfusion by patients (Jehovah's witnesses) are presented to discuss the medicolegal and ethical problems anaesthetists may be faced with in daily clinical routine. For many cases deliberate hypotension is recommended. The primary aim has to be to comply with the patient's wish, but in case of acute and extraordinary bloodloss, there might develop a conflict from an ethical as well as a legal view between the patient's desire and the medical opinion.     

Blood transfusion strategies for total knee arthroplasty: Minimizing autologous blood wastage,risk of homologous blood transfusion,and transfusion cost

In this nonrandomized study, alternative strategies were suggested to 10 orthopaedic surgeons to minimize autologous blood wastage, the risk of homologous blood transfusion, and cost associated with blood product usage after total knee arthroplasty (TKA). One hundred fifty-five patients with 177 consecutive TKAs over a 2-year period were studied. Group 1 patients had undergone unilateral TKA and did not predonate; 1A patients (n = 19) were drained with a Hemovac, and 1B patients (n = 28) with a postoperative blood recovery system. Group 2 patients (n = 47) predonated one packed red blood cell (pRBC) unit. Group 3 patients (n = 20) predonated 2 pRBC units. Group 4 patients had undergone bilateral sequential TKAs (n = 21) and had predonated 2 pRBC units. Group 5 patients (n = 14) had undergone revision TKA procedures and their blood requirements were individualized. Group 6 patients (n = 6) had preexisting anemia and were excluded from the study. There was no significant difference in total blood loss (909 mL) between groups. Female sex was associated with significantly lower admission hematocrit. Homologous blood was required for 4% of patients in the entire study and the percentage was not statistically different between groups. Twenty-five percent of patients who predonated autologous pRBCs did not use all or some of it. In group 1, the postoperative blood recovery system had a significant effect on reducing postoperative hematocrit drop (P = .0001), but it was not a significant factor if autologous pRBCs were available. The costs associated with group 1A were significantly less (P = .0001) compared with the other groups; group 1A had the highest admission hematocrit (43.2). Transfusion with autologous pRBCs was related to lower admission hematocrit rather than to increased postoperative blood loss. An algorithm is presented to provide cost-effective management of blood products after TKA.     

Evaluation of transfusion strategies during craniosynostosis repairs

OBJECTIVE: To evaluate the changes in transfusion practices during craniosynostosis surgery in children, with consideration of the transfusion-associated risks. STUDY DESIGN: Retrospective study. PATIENTS: The study included 64 consecutive craniosynostosis repairs by the same neurosurgical and anaesthetic team, over a period of 17 years. METHODS: The children were allocated into two groups. In group I (1980-1991), blood loss was compensated precisely from scalp incision on. In group II (1992-1996), transfusion was only started when blood loss crossed a calculated limit considered as acceptable. The mean criterion of judgment was the quantity of transfused blood in comparison with the theoretical blood volume. Mean preoperative and postoperative haemoglobin concentrations, estimated blood losses, volume of replaced blood and number of transfused patients were compared between the two groups with a two tailed Student's t test. RESULTS: The rate of non transfused children increased from 6% before 1991 to 39% after 1992%; conservely the rate of postoperative transfusions increased from 3 to 39%. CONCLUSION: The risks of blood transfusion favoured the development of new of more restrictive transfusion practices, even in haemorrhagic surgery. To limit blood transfusion in craniosynostosis surgery, a harmonious cooperation between surgeons and anaesthetists is essential and blood replacement must be based on a definite determination of the acceptable blood losses.     

外科患者输血应注意的几个问题

输血是外科常用的治疗手段。近年来,随着输血对人体的不利影响日益受到重视以及输血技术的不断提高,输血观念已发生根本转变,但在外科临床工作中不合理输血仍屡有发生,外科医生在树立科学的输血观、规范临床合理用血方面仍需不断努力。目前,由于血源紧张,医疗用血供需矛盾日趋突出,外科医生在对待输血问题上,应具备高度的责任感,从严掌握输血适应征,充分衡量输血的得与失,做到科学、合理用血,努力减少异体输血。     

Postoperative metabolic stress: interventional strategies

More and more evidence accumulates suggesting that the reversal of the catabolic responses to surgery is associated with better outcome. The potential for anesthesiologists to be involved in altering outcome by simply preserving a normal blood glucose, providing optimal pain control and perioperative feeding is tremendous.     

Autologous transfusion: an alternative to transfusion with banked blood during surgery for cancer

Autologous blood transfusion in surgery for cancer has been avoided because of the metastatic potential of reinfused malignant cells. This study determined whether viable tumour cells remain in the red cell concentrate after separation and whether blood transfusion filters remove these tumour cells before reinfusion. Units of banked blood were inoculated with tumour cell lines: breast cancer SKBr3; colon cancer COLO 320; lymphoma Daudi; erythroleukaemia K562. After processing with the Cell Saver, aliquots of the red cell concentrate and waste saline wash were examined for tumour cells and cultured. Tumour cells from all four cell lines were identified in the red cell concentrate but not in the waste saline wash. All the cell lines except Daudi grew from the red cell concentrate. Experiments on two of the cell lines (SKBr3 and COLO 320) were performed in which the red cell concentrate was either unfiltered (control) or filtered with SQ40S blood transfusion filter or RC100 leucocyte depletion filter. Both cell lines were present in the control samples and after filtration with SQ40S filters, and cells from these samples grew normally in culture. No tumour cells were evident after filtration with the RC100 filters and no growth of either cell line was found after 1 week in culture. The Cell Saver in combination with RC100 filters may be suitable for use during the surgical treatment of malignant disease.