静脉治疗护理质量评价指标的构建

目的构建静脉治疗护理质量指标评价体系。方法在文献查阅及深度访谈的基础上,采用Delphi法对32名静脉治疗专家进行2轮函询。结果 2轮函询的专家积极系数分别为91.43%、100.00%,专家权威系数分别为0.898、0.909,Kendall协调系数分别为0.286、0.328。构建的静脉治疗护理质量评价指标包含3个一级指标、19个二级指标。结论以护理要素、环节、终末质量模式为框架,运用Delphi法构建的静脉治疗护理质量评价指标科学、可信,可用于静脉治疗护理质量评价。     

住院患者肠内营养护理质量敏感性指标的构建

目的构建适用于住院患者肠内营养护理质量的敏感性指标,为提高肠内营养护理质量提供参考。方法在文献检索基础上,以结构—过程—结果质量管理模式为理论依据,结合专题会议讨论构建住院患者肠内营养护理质量敏感性指标初稿,对20名专家进行两轮函询。结果最终构建的住院患者肠内营养护理质量的敏感性指标包含一级指标3项,二级指标11项。两轮专家积极系数为100%,Kendall协调系数分别为0.305和0.368(均P0.01),专家权威系数分别为0.870和0.860。结论构建的住院患者肠内营养护理质量敏感性指标可为专科护理质量评价提供客观、可量化的参考。     

介入专科护士核心能力评价指标的初步构建

目的初步构建介入专科护士核心能力评价指标,旨在为介入专科护士的培养、考核、评价与管理提供参考。方法采用德尔菲法对18名专家进行2轮函询,并确定介入专科护士核心能力指标及权重。结果2轮函询专家的积极性分别为100%、88.89%;专家的权威系数为0.90;一、二、三级指标的协调系数分别为0.357、0.401、0.436(均P0.01)。最终确立的评价指标包括理论知识能力、实践操作能力、批判性思维能力、人际交往能力、护理临床管理能力、科研学习能力、指导能力7项一级指标,23项二级指标,56项三级指标。结论介入专科护士核心能力评价指标的专家意见集中,可信度高,可为介入专科护士的培养、考核、评价与管理提供参考。     

临床护士信息安全素养评价指标体系的构建研究

目的 构建临床护士信息安全素养评价指标体系,为临床护士信息安全培训及考核评价提供参考。方法 以知信行理论为指导,通过文献研究、现场调研的方法初步拟定指标体系并编制专家函询问卷,邀请全国20名专家进行2轮德尔菲法专家函询,采用层次分析法确定各指标权重。结果 2轮函询问卷有效回收率均为100%,专家权威系数分别为0.945、0.950,肯德尔和谐系数分别为0.179、0.193(均P<0.05)。最终确定的临床护士信息安全素养评价指标体系包括信息安全知识、信息安全意识及信息安全行为3项一级指标、12项二级指标、59项三级指标。结论 构建的临床护士信息安全素养评价指标体系内容全面、科学可靠,可为临床护士信息安全培训及考核评价提供客观的量化依据。     

基于德尔菲法构建泌尿外科护理安全管理评价体系

目的 构建泌尿外科护理安全管理评价体系,为提高泌尿外科护理安全管理提供依据。方法 通过文献回顾初步构建泌尿外科护理安全管理评价体系初稿,采用德尔菲法（Delphi）对16名泌尿外科护理专家进行2轮函询,最终形成泌尿外科护理安全管理评价体系。结果 2轮函询中问卷回收率分别为100%、94.12%,专家意见的集中程度波动在4.25～5.00,专家意见的协调程度波动在0.00～0.20,专家权威系数分别为0.910、0.929,专家Kendall’s W协调系数分别为0.119和0.114,最终构建包含10项一级指标,55项二级指标,41项三级指标的泌尿外科护理安全管理评价体系。结论 构建的泌尿外科护理安全管理评价体系内容全面,具有较高的科学性、权威性、实用性,为提高泌尿外科护理安全管理提供参考。     

鼻咽癌放疗患者专病护理质量评价指标体系的构建

目的构建鼻咽癌放疗患者专病护理质量评价指标,为鼻咽癌放疗护理质量评价提供工具。方法基于三维质量结构模型,在半结构式访谈、文献回顾法基础上拟定指标体系初稿,采用Delphi法对分别对23名、21名专家进行两轮函询。结果 2轮函询问卷的有效回收率分别为91.30%、100%,专家权威系数Cr值分别为0.869、0.876。最终形成的指标体系包括结构、过程、结果3项一级指标、9项二级指标和41项三级指标。结论鼻咽癌放疗患者专病护理质量评价指标体系构建科学、可靠,专病特色突出,进一步验证后可作为专病护理质量评价工具。     

三级综合医院护理质量敏感性指标的构建

目的构建三级综合医院护理质量敏感性指标,为医院护理质量评价提供相关依据。方法通过证据总结与半结构式访谈法对护理质量敏感性指标进行初步设计,通过德尔菲法进行专家函询确定最终护理质量敏感性指标。结果最终构建的护理质量敏感性指标包含一级指标3个,二级指标20个。3轮专家函询积极系数为94.12%~100.00%,权威系数为0.84,变异系数为0.00~0.22,协调系数为0.09~0.24(均P0.01)。结论通过循证、半结构式访谈及德尔菲法构建的护理质量敏感性指标具有科学性、严谨性,对护理管理及临床护理工作具有一定的指导意义。     

住院患者肠造口护理质量敏感性指标体系的构建

目的 构建住院患者肠造口护理质量敏感性指标体系，为住院患者肠造口护理管理提供监测依据。方法 基于循证和小组讨论法，拟订肠造口护理质量敏感性指标初级条目池；通过2轮专家函询，修订并确立住院患者肠造口护理质量敏感性指标体系。结果 2轮函询专家积极系数均为100%，权威系数为0.898与0.908，协调系数为0.189～0.239与0.215～0.258（均P＜0.05）。构建的住院患者肠造口护理质量敏感性指标体系包含3项一级指标、6项二级指标、22项三级指标。结论 构建的住院患者肠造口护理质量敏感性指标体系严谨、全面，可用于住院患者肠造口护理质量管理。     

肿瘤专科医院护理质量评价指标体系的初步构建

目的构建一套实用有效的、适用于肿瘤专科医院护理质量评价的指标体系。方法基于"结构-过程-结果"模式,应用德尔菲法通过2轮专家函询确定指标体系。结果 22名护理专家参加本研究,2轮函询专家积极系数85.2%、95.7%,权威系数0.89,肯德尔和谐系数0.26、0.33。最终确定的肿瘤专科医院护理质量评价指标体系包括一级指标3项,二级指标10项,三级指标56项。结论函询专家积极性和权威程度高,对指标意见集中,函询结果可靠。最终确定的指标体系可测量性强,突出了肿瘤护理专科特点。     

血液透析室医院感染风险因素评价指标的构建

目的构建血液透析室医院感染风险因素的评价指标。方法采用德尔菲法选择36名专家进行2轮函询,对评价指标进行筛选和修改,确定血液透析室医院感染风险因素的评价指标及其权重。结果 2轮咨询专家积极系数分别为83.3%、96.7%,专家权威系数为0.90,第2轮肯德尔和谐系数为0.30(P0.05);最终形成包括结构、过程、结果3个一级指标、21个二级指标、80条评价标准的评价体系并确定各级指标权重。结论血液透析室医院感染风险因素评价指标获得专家认可,能够为各级感染管理部门科学、合理地评价血液透析室医院感染风险提供有效的工具。     

Establishment of intravenous lines for long-term intravenous therapy and monitoring

Our experience at this institution indicates that the greater the individual and the institutional experience, the lower the complications of central venous lines. The techniques of double catheter insertions in one vein or region, as described, are safe, cost-effective, and useful. These catheters can remain in place for up to 8 weeks. Insertion of double catheters is ideal for intravenous feeding to avoid premixing amino acids and glucose, thus minimizing the hazards of contamination as well as saving time and cost for mixing. Special unconventional techniques for vascular access when indicated in patients who have limited accessible sites may be lifesaving. Except for fibrinous clots around the catheters, the complications in our series have diminished as our experience has grown. Vascular access techniques and long-term care should be formally taught to committed individuals. Well-trained, concerned, experienced personnel available 24 hours a day, 7 days a week is the most important factor in the reduction of complications of vascular access technique and the long-term maintenance of intravenous lines.     

Total intravenous anaesthesia

Driven by better understanding of the pharmacokinetic principles involved and improvements in infusion pump technology, total intravenous anaesthesia (TIVA) has become more popular and has many potential advantages. Safe and effective use of TIVA requires the practitioner to have a sound understanding of the pharmacokinetics involved and the pharmacokinetic behaviour of many drugs can be described by a three-compartment model. Mathematical modelling can be used to calculate the blood and theoretical effect-site concentrations of anaesthetic drugs for a given dosing regimen. Following consideration of the three-compartment model, manual regimes were developed to permit TIVA, but such regimes were insufficiently flexible to provide adequate anaesthesia for all patients in all circumstances. Target controlled infusion (TCI) systems are computerized infusion systems capable of delivering variable infusion regimes based on a complex mathematical solution to the pharmacokinetic models. Such systems allow the anaesthetist to achieve and maintain any desired target drug concentration appropriate to an individual patient and level of surgical stimulation. TCI systems have facilitated the increased use of TIVA over the past decade such that this technique has become ‘mainstream’ throughout much of the world.     

Total intravenous anaesthesia

Total intravenous anaesthesia (TIVA) is a technique to induce and maintain general anaesthesia exclusively with intravenous anaesthetic agents, thereby avoiding the use of inhalational agents. It is essential that all practicing anaesthetists are competent in the delivery of TIVA and able to perform it safely. TIVA is necessitated in a wide variety of clinical situations when the delivery of inhalational agents is absolutely or relatively contraindicated; for example, in patients with malignant hyperthermia or severe postoperative nausea and vomiting. In other situations, it may not be possible or practical to deliver inhalational anaesthesia such as during patient transfer or anaesthesia for airway surgery. This article describes the use of target controlled infusion models and principles, which enable anaesthetists to deliver TIVA safely. The Association of Anaesthetists of Great Britain and Ireland and the Society of Intravenous Anaesthesia have produced Guidelines for safe practice of TIVA in 2018.     

Total intravenous anaesthesia

Total intravenous anaesthesia (TIVA) is the induction and maintenance of general anaesthesia exclusively via intravenous anaesthetic agents. TIVA provides an anaesthetic alternative when inhalational agents are relatively or absolutely contraindicated and is also used in a number of practical situations where delivery of inhalational anaesthetic is not feasible, such as during patient transfers. It is essential that all anaesthetists understand the pharmacokinetic principles involved with TIVA and are confident in their ability to deliver TIVA safely. This article describes the key pharmacokinetic principles and models used for TIVA with additional focus on practical and safety aspects during its use.