急诊科分组排班的成效

目的探讨护理人员分组排班在急诊科实际应用的成效。方法将护理人员分为院前急救组、急诊抢救组、急诊留观组、门诊急诊输液组4个小组分开排班,每个小组设一名小组长协助护士长管理。结果实行两年多分组排班使护理质量明显提高,每个小组都有所作为,获得医生、患者和护理部的好评。结论通过分组排班,调动了护士的积极性,在科内形成良好的学习气氛,提高了护士专业水平和临床工作质量,密切了医护关系。     

“人文＋心理”护理理念在临床护理中的研究与应用

目的：探讨“人文关怀＋心理护理”理念在临床护理工作的应用效果。方法：通过加强护士人文关怀及心理护理理念的培训,改变以疾病为中心、专科护理的理念,转变为人文关怀＋心理护理的整体护理理念,将理念渗透到护理工作的各个细节中。结果：患者对护理人员的护理服务满意度明显提高,全面提升了医院的护理服务品质。结论：“人文关怀＋心理护理”整体理念在临床护理工作应用中,改善了护患关系,减少了护患纠纷,提高了医院护理服务品质。     

Quality improvement key to changing nurse-MD relations

The nursing profession is changing, the medical profession is changing, the professional job market is changing, and hospitals are changing. So it should come as no surprise to anyone that nurse-physician relations are also undergoing considerable changes these days. And although the relationship between hospital nurses and physicians has been a topic of ongoing concern for hospital executives for years, only recently has its improvement become an action item. Experts say a number of factors have brought new opportunity to the quest: the push for cost containment, the rising acuity of patients, continuing nursing shortages, societal and workplace changes, and, most of all, the drive toward systemwide quality in hospitals.     

护理质量与护士长职责

文从加强护理质量与护士长职责的重要性出发,分析了护士长与护理质量的关系,在此基础上,介绍了增加业务培训和考核的办法,最后讲解了完善护理质量体系的策略。最后得出:要想提高护理质量,必须从护士长出发,加强自身学习,带动其他护理人员,并建立护理质量体系,只有这样,才能从根本上提高医院的护理质量。     

优质护理服务示范工程对护士工作压力与职业倦怠的影响

目的 探讨开展“优质护理服务示范工程”活动对护士工作压力与职业倦怠的影响.方法 将参加“示范工程”的3个病区60名护士为试验组,其他选择未参加“示范工程”的3个病区42名护士为对照组,两组均采用护士工作压力量表和工作倦怠量表.结果 试验组护士在护理专业及工作方面的问题、患者护理方面问题工作压力明显低于对照组护士.两组护士在护理专业、时间分配、工作环境、患者护理,以及工作压力源总分方面有统计学差异（P＜0.01）,但在管理方面得分无统计学差异（P＞0.05）;试验组护士在情绪耗竭、倦怠和成就感低落方面明显高于对照组,差异有统计学意义（P＜0.01）.结论 “示范工程”和护士工作压力源与职业倦怠存在相关性.     

Predicting Nurses’ Turnover: The Aversive Effects of Decreased Identity,Poor Interpersonal Communication,and Learned Helplessness

Through a social identity theoretical lens, this study examines how nurses’ identification with their working small group, unit, or floor, nursing role (e.g., staff ER nurse, nurse practitioner), and nursing profession relate to nurses’ interaction involvement, willingness to confront conflict, feelings of learned helplessness, and tenure (employment turnover) intentions. A cross-sectional survey (N = 466) was conducted at a large, quaternary care hospital system. Structural equation modeling uncovered direct and indirect effects between the five primary variables. Findings demonstrate direct relationships between nurse identity (as a latent variable) and interaction involvement, willingness to confront conflict, and tenure intentions. Feelings of learned helplessness are attenuated by increased nurse identity through interaction involvement and willingness to confront conflict. In addition, willingness to confront conflict and learned helplessness mediate the relationship between interaction involvement and nurses’ tenure intentions. Theoretical extensions include indirect links between nurse identity and learned helplessness via interaction involvement and willingness to confront conflict. Implications for interpersonal communication theory development, health communication, and the nursing profession are discussed.     

三甲医院对“托管”二级医院实施护理管理改革的措施及效果

目的探索三甲医院对“托管”二级医院实施护理管理改革的有效措施。方法通过调研,结合当地医院实际,采取组织培训、对被托管医院的护理管理者及护理骨干轮换到托管医院进修学习、并由托管医院委派一名护理部副主任到被托管医院具体把关、沟通交流等措施,协助被托管医院建立健全各项规章制度,落实APN排班制度、大包干责任制,开展护士床边工作制,建立和完善护理质量标准体系与安全管理体系、护理质量持续改进的长效机制、护士培训体系等。提高被托管医院优质护理服务工作。结果被托管医院管理人员及患者的满意度调查结果显示,医院管理者、医生对护理工作满意度较以前提高,医护沟通协作密切,基础护理较以前到位,护士对护理工作总体感觉满意。病区管理质量、护士技术操作、护理文书质量、护理安全管理、护理服务满意度均优于实施前（P〈0．001）,差异有统计学意义。结论有效的托管能提高二级医院的护理水平,对提高区域内护理服务水平、将优质护理服务向三级医院靠近有着积极的意义。     

A model for empowerment of nursing in Iran

Background  

While the Iranian nursing profession tries to reach to its full capaCity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. When considering the importance of nursing services in any health system, the 54th World Health Assembly recommended that programs be designed to strengthen and promote the nursing profession. Since empowerment is crucial to the role of nurses, a qualitative study was conducted and aimed at designing a model for empowering nurses in Iran.     

院校联合办学与护理学科建设研究

目的 探讨院校合作办学对医院护理学科建设的效果。方法 在学生和医院双向选择的基础上组建医院高护专业驻点教学班，每年组建一个班，学生在学院完成第一学年的基础理论课程学生，第二学年来医院完成临床理论课程的学习，第三学年在医院完成临床实习。结果 11项授课老师自评项目中，得分最高的是语言表达能力（4.42±0.65），其次是教学责任意识（4.31±0.67）和沟通交流能力（4.25±0.60），得分最低的是授课互动能力（3.89±0.75）；办班前后，护理学科建设在学历提升人次，论文发表数，护理理论和操作考试合格率及护理质量合格率方面差异有统计学意义（P<0.01）。结论 医院与学院联合办学有利于护理学科的发展，同时也为医院培养高素质的实用型护理人才。     

护理职业文化建设在提高护士素质中的作用

目的通过护理职业文化建设提升护士素质。方法将护理职业文化建设运用到护理管理中,评价护士素质。结果护士职业认可度提升,服务观念转变,三基考核合格率上升,护士素质提高,患者满意度上升。结论开展护理文化建设是提高护士素质的有效手段,护士专业能力的提升也是在素质的基础上,经过教育和培训,并在临床实践中逐步发展和提高的。     

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.     

团体心理咨询在合同制护士心理调适中的应用

目的探讨团体心理咨询对合同制护士工作压力的影响。方法选取某军队医院合同制护士80名作为干预组进行6周团体心理咨询,同时选取该院80名合同制护士作为观察组,不进行任何心理干预。采用自编护士一般资料调查表、护士工作压力源量表对两组护士分别进行评估。结果两组护士在年龄、级别、受教育程度、工作年限和婚姻状况方面均无统计学差异（P〉0.01）;采取干预措施后干预组护士在护理专业及工作方面的问题、时间分配及工作量问题、患者护理方面问题、管理及人际关系方面的问题工作压力明显低于观察组护士。两组护士在护理专业、时间分配、工作环境、患者护理、管理以及工作压力源总分方面有统计学差异（P〈0.01）。结论团体心理咨询有助于帮助合同制护士了解自己、减轻工作压力、改善人际关系,提高工作积极性和效率。     

Authentic intention: Tempering the dehumanizing aspects of technology on behalf of good nursing care

The nursing profession has a responsibility to ensure that nursing goals and perspectives as these have developed over time remain the focus of its work. Explored in this paper is the potential problem for the nursing profession of recognizing both the promises and pitfalls of informational technologies so as to use them wisely in behalf of ethical patient care. We make a normative claim that maintaining a critical stance toward the use of informational technologies in practice and in influencing the thought patterns of the younger generations of nurses is a moral imperative of the discipline, because without this practice can become subverted from professional goals in various ways. We use a synthesized concept we call “intentional authenticity” derived from the writing of Heidegger and Feminist care ethics to provide a foundation for the development of nurses who understand the importance of the nurse‐patient relationship and how the unthoughtful use of informational and other technologies can militate against effective or good nursing care.     

A career open to the talents—Nurses’ doing and focus during the history

Based on a historical and a contemporary fieldwork at a Danish hospital, this article offers a genealogical and philosophical exploration of the development of nurses’ doing and focus within a hospital setting from the 1800 s to the present day. This exploration finds that nurses’ doing has changed during history, which is reflected in their focus. Thus, nurses’ focus has developed from, what the Danish philosopher Uffe Juul Jensen refers to as a situation-oriented, to a disease-oriented practice, and while new values are established, the conception of care as a core value in nursing seems to have receded. This article also argues that today's nurses are doing what doctors did in the 19th century. The French philosopher Michel Foucault discusses how things repeat themselves in new ways and new contexts. The nursing profession has become ‘a career open to the talents’ where nurses with the appropriate skills and talents are able to build a career, within which they provide status, position and legitimacy. The conclusion of the article discusses the significance of this development for patients and the nursing profession.     

糖尿病护理团队合作思路在护理风险管理中的作用

目的探讨糖尿病护理团队合作思路在护理风险管理中的作用。方法回顾性分析我院开展护理风险管理前收治的糖尿病患者468例,记为对照组,选取开展护理风险管理后我院收治的糖尿病患者512例,记为干预组。对照组患者均进行常规护理操作,干预组患者针对其具体情况成立糖尿病护理风险管理合作团队,明确团队中各小组的职责及任务,合作探讨出个性化、全面、具体的护理及治疗方案,训练护理人员的风险防范意识。比较两组患者的护理安全事故发生率及护理满意度。结果干预组患者护理安全事故发生率明显低于对照组(P0.05);干预组患者的护理满意度明显高于对照组(P0.05)。结论糖尿病护理团队合作思路的实施,不仅增强了护理人员的工作责任感,深化了互相协作的重要性,提升了优质护理服务的内涵,而且提高了护患双方的安全意识,改善了护患关系,提高了护理工作满意度,有利于护患双方共同合作提高治疗效果。     

急诊科护士职业压力源的调查研究

目的了解并探讨急诊科护士职业压力源情况。方法采用问卷调查法对广州市某三甲医院急诊室护士的职业压力来源进行探讨。结果急诊科护士的职业压力源依次为：时间分配及工作量问题,工作环境及仪器设备问题,护理专业及工作方面的问题,病人护理方面的问题,管理及人际关系方面的问题。结论建议从管理角度减轻或消除护士职业压力源,并对护士进行减轻工作压力的训练。     

床边责任制护理模式在神经内科的应用

目的探讨责任护士固定分管床位床边责任制护理模式在神经内科的应用效果。方法在新的护理模式实施前、后分别随机抽查120位病人的护理质量和病人的满意度。实施前是开展分组责任制护理模式,实施后是开展责任护士固定分管床位床边责任制护理模式,比较实施前后病人的护理质量及病人满意度。结果实施责任护士固定分管床位床边责任制护理模式前后病人的护理质量和患者满意度比较差异有统计学意义(P<0.01)。结论实施责任护士固定分管床位床边责任制护理模式能提高护理质量,融洽护患关系,提高病人对护理工作的满意度,同时也增强了护士的工作积极性和责任心,提高了工作效率。     

分层次管理对ICU护理质量及护士职业疲惫感的影响

目的探讨分层次管理模式对重症监护病房（ICU）护理质量及护士职业疲惫感的影响。 方法2014年10月-2015年10月对医院ICU护士应用分层次模式实施管理,具体措施包括实施分级分层管理,实行APN排班制度等,并对实施前后ICU护士护理质量及职业疲惫感进行比较。结果实施后ICU基础护理、专科护理、危险患者管理、护理记录、病房环境/安全、急救药品/器械及总护理质量评分显著高于实施前（P<0.05）,而ICU护士情绪衰竭、工作冷漠感、低成就感、职业疲惫感总分和SAS、SDS评分显著低于实施前（P<0.05）。     

Quality of care of patients with chronic obstructive pulmonary disease provided by specialized community nurses: a process evaluation

An ageing population, shorter periods of hospitalization, and advances in medical technology have meant that community nurses have become increasingly confronted with patients demanding skilled and specialized nursing care. The quality of care provided by 47 general and eight specialized community nurses was studied in a group of 115 patients with severe chronic obstructive pulmonary disease (COPD) after discharge from hospital. Four process variables were studied: the content of the home visit, the time spent on the home visit, the quality of the report, and the number of home visits. Results show that the content of the home visit differed between general and specialized community nurses. General nurses were more focused on analysing care needs and specialized nurses paid more attention to psycho-social problems. The number of home visits and the time spent on the care provided did not differ significantly between both groups. The quality of the report of specialized nurses was significantly higher. In conclusion, specialized community nurses demonstrated a higher clinical competence in the care of patients with COPD. Further research is required to conclude whether positive changes in nursing process result in positive patient outcomes.     

住院患者护理安全管理模式的构建与效果探讨

目的探讨住院患者护理安全管理模式的构建对护理质量的控制效果。方法设立二级护理质量控制组对47个病区通过质量监控、建立临床护理不良事件上报分析系统、建立护理风险预警防范机制、开展分层次理论技能培训、鼓励患者参与医疗安全管理等措施．降低护理风险发生,确保患者安全。结果实施住院患者护理安全管理模式后：从实施前2005年至实施后2012年的7项护理质量指标达标率逐年提高．各项护理质量指标达标率均在97．0％以上,且实施后2012年与实施前2005年比较．差异有统计学意义（P〈0．05）。按照住院患者对护理工作满意率≥95．O％的标准,内科各病区达标率从实施前2005年的81．3％提高到实施后2012年的98．6％;患者对护理工作满意度均在95．0％以上,最高为99．5％。不良事件上报率明显提高。实施后不良事件上报数量从2010年的17例上升至2012年的112例并制定了42项系统整改制度。实施后从2006年至今．共协助科室完成183次危重患者抢救．解决161例疑难护理问题。结论住院患者护理安全管理模式能够有效提高护理质量,有效保障患者安全。在提高护理质量、保障患者安全方面起到了一定作用。