巴林特小组对军队医院聘用制护士工作压力的应用效果

目的 在了解军队医院聘用制护士工作压力的基础上,探索巴林特小组对国内护士工作压力的应用效果.方法 采用方便抽样方法,分别对军队两所三甲医院的210名、188名聘用制护士进行工作压力调查.选取有自主意愿、工作压力得分中度以上的前10名护士作为干预对象,以医院为单位各成一组,开展为期6次的巴林特小组训练.结果 两所医院护士工作压力程度接近,压力水平较高;综合医院组对象干预前后在 "护理工作"维度得分上差异非常显著(P＜0.001);"时间与工作量、环境与设备、管理与人际关系"3个维度得分均差异显著(P＜0.005);专科医院组对象干预前后在 "护理工作、环境与设备、患者护理、管理与人际关系"4个维度得分上差异非常显著(P＜0.001);"时间与工作量"维度得分差异显著(P＜0.005);两组对象合并后干预前后在"护理工作、时间与工作量、环境与设备、患者护理、管理与人际关系"5个维度得分上差异非常显著(P＜0.001).结论 管理者应对临床护士的工作压力引起重视;巴林特小组能够有效减轻护士工作压力;对象要有选择性,并要调动其积极性;选用高素质的小组主持人;巴林特小组技术的长期效果需要深入研究.     

聘用制护士压力源的影响因素分析

目的探讨聘用制护士压力源的影响因素,并提出相应的干预对策。方法选取我院78名正式在编护士及聘用制护士为研究对象,采用问卷调查法,调查两组护士的一般资料,工作满意度和工作压力源的情况。结果聘用制护士的工作满意度总体处于中等偏低水平,为3.12±0.61分。聘任制护士在专业及社会地位、工作量、工作环境和资源方面压力源方面的得分显著高于在编护士(P0.05)。结论聘用制护士的工作满意度较低,管理者应重视对聘用制护士压力应对能力的培养,并采取必要的措施满足聘用制护士的需求,提高其工作满意度。     

初级护士压力源分析及其应对措施

目的 通过了解初级护士工作压力源及其在工作中应对措施的调查进行研究分析,有利于初级护士在工作过程中保持积极的状态,以提高护士护理质量及其工作效率。方法 随机抽取郑州市某三甲医院100名初级护士,统一发放问卷,当场收回,回收率100%,有效率97%,进行分析研究。结果 初级护士的压力源主要以下几个方面:护士的工作量较大及福利待遇较低、护士管理及工作时间分配、护士社会地位太低、人们生活水平有所提高对我们的护理服务也有所改变等。不同职称护士其面对压力的承受能力程度不同,资历越深的护士其调节能力越强。有效积极的应对护理工作中遇到的压力能够大大的提高护理质量及其工作效率。结论 初级护士工作压力较高,建议关注护士工作的主要压力源,加强初级护士心理知识的教育,从从根本减少护士工作的压力源,提高护士工作的积极性。     

军队医院临床护士工作压力源现状调查

目的：了解军队医院临床护士工作压力源现状。方法对14所军队医院临床护士进行问卷调查。其中工作压力源量表,采用李小妹等编译的中国护士工作压力源量表。结果军队医院护士在专业及工作维度感受到的压力最大,工作薪酬低居首位;聘任制护士感受到的压力高于军人、文职护士;总院、外科系统、手术室护士群体感受到更多的压力;月收入与护士工作压力源得分呈负相关。结论军队医院领导及护理管理者应结合不同护士群体工作压力源现状特点及影响因素,针对重点环节、重点人群持续进行重点关注。     

本科学历护士工作压力源状况及其应对方式的调查分析

目的了解本科学历护士的工作压力源及应对方式状况并探讨两者的关系。方法采取便利抽样的方法选取某三甲医院81名本科学历的在职护士进行自填式问卷调查,内容包括一般人口学资料、护士工作压力源量表、简易应对方式问卷。结果本科学历护士的工作压力源评分为(2.26±0.54)分,属于中等程度压力,其各维度压力源得分由高到低依次是工作量及时间分配问题、护理专业及工作方面问题、病人护理方面问题、管理及人际关系方面问题、工作环境和资源方面问题。本科学历护士的积极应对方式得分为(1.88±0.53)分,消极应对方式得分为(1.04±0.55)分。本科学历护士工作压力源得分与消极应对得分呈正相关(r=0.294,P<0.01)。结论本科学历护士工作压力源与其消极应对方式呈正相关,针对本科学历护士应进行人际、医患以及与管理者关系处理的训练,提高其积极应对技巧,避免采取消极应对方式。     

军队医院招聘护士的工作压力源及应对方式调查

目的了解军队医院招聘的护士工作压力源和常用的应对方式,帮助护士减轻工作压力,改善护士身心健康。方法采用问卷调查法对重庆市某军队医院招聘的护士进行压力源和应对方式的调查,发放问卷295人份,有效问卷289人份,有效回收率为97.96%。结果军队医院护士的工作压力源依次为工作量及时间分配[(2.75±0.86)分]、护理专业及工作[(2.65±0.96)分]、患者护理[(2.3±0.73)分]、工作环境及资源[(2.12±0.82)分]、管理及人际关系[(1.94±0.75)分]。工作压力源单项得分位于前2项的是"工作量太大"和"工资及其他福利待遇低",分别为(3.04±0.85)分和(3.10±0.88)分。应对方式:积极应对方式为(1.84±0.47)分,高于常模;消极应对方式为(1.27±0.52)分,低于常模。结论工作量大、工资及福利待遇低是军队医院招聘护士的主要工作压力源,应对方式以积极应对为主,管理者应给予足够的重视。     

军队医院聘用护理人员流失原因调查

目的分析军队医院聘用护士离职原因。方法采用自制问卷对某区军队医院聘用护理人员流失的主要原因进行调查。结果在影响聘用制护士离职的因素中,最重要的是基本福利待遇,其次是工作压力、工作强度、职业发展和个人因素。结论建立合理薪酬保障制度;创造公平公正竞争环境;建立护理人员流失预警机制;重视护士地位,以维护护理队伍稳定,提高护理服务质量,促进军队医院的可持续发展。     

西北地区军队医院护士职业认同感与离职意愿调查

目的 对西北地区4所军队医院不同编制护士职业认同感与离职意愿进行调查,以期提高军队医院护士职业认同感、降低离职意愿,以稳定军队医院护理队伍建设、提高护理质量.方法 采用问卷调查法发放问卷530份,分析军队医院不同编制护士职业认同感与离职意愿.结果 聘用制护士职业认同感、离职意愿得分均高于正式在编护士,对两者离职意愿进行独立样本t检验,结果P＜0.05,差异具有统计学意义.结论 聘用制护士职业认同感较高,离职意愿较高;管理者应引起高度重视,降低聘用制护士离职意愿.     

南京某三甲医院外科护士工作压力的调查研究

目的：了解南京某三甲医院外科护士的工作压力状况,为医院管理部门及护士正确认识工作压力、提高工作效率和护理质量提供参考依据。方法：采用问卷抽样调查法,对南京某三甲医院外科护士的工作压力进行调查研究。结果：调查对象的工作压力总体得分平均为2.904 ± 0.535,处于轻度压力（2分）与较大压力（3分）之间,不同护龄、技术职称的护士工作压力总体得分的差异均有统计学意义。调查对象在工作中最大的压力来源是“担心工作中出现差错事故”、“病人的要求太高或太过分”、“病人的家属不礼貌”。结论：建议从管理角度减少护士工作压力源,医院管理部门可通过增加护士人员配置,改进护理支持系统,减少针对护士的不必要检查和考核,关心护士家庭生活等方法缓解护士工作压力,同时对护士进行应对工作压力的心理辅导,从而提高护理工作满意度,保障护理质量和医疗安全。     

聘用制护士离职意愿相关因素分析

目的为了稳定医院护理工作人员,提高临床护理质量,分析探讨当前聘用制护士离职的原因以及建议与对策.方法随机选取2012年在该院工作的护理工作人员400例,其中编制护士和聘用护士各200例,通过填写问卷和谈话方式对其展开调查,调查内容包括工作时间、工作压力情况、福利待遇满意度、个人专业发展机会、今后打算等等,并将调查情况进行详细记录.结果聘用制护士工作时间、福利待遇明显低于编制护士,而工作压力却明显高于编制护士,对于今后的打算,聘用护士思考会很多,其职业规划很全面,而编制护士相对考虑得要少一些,职业规范也很局限.另外,聘用制护士个人专业发展机会明显低于对照组.结论聘用护士离职意愿相关因素主要有三方面,①由于是聘用制所以工作时间短,不像编制护士期限长;②在福利待遇方面明显低于编制护士,这对他们来说很受打击;③合同续签前他们就会考虑去留问题.为了稳定护理工作人员,提高临床护理质量,我们应在这方面加强改革.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.