手术室医护人员锐器损伤原因分析及防护措施

目的探讨锐器损伤发生的原因及防护措施,提高医护人员防护意识,防止职业暴露的危险.方法对2005年本院手术室发生的26人次锐器损伤原因,损伤过程进行调查分析.结果损伤原因为防护意识淡薄,工作经验不足,缺乏正规的防护教育培训,缺少必要的防护设施等.结论避免锐器损伤,应加强防护意识,采取严格的防护措施,以减少锐器对医护人员造成的损害.     

医护人员锐器损伤原因分析及防护措施

目的:探讨锐器损伤的防护措施,提高医护人员职业防护意识,防止职业暴露的危险.方法:对2010年所发生的50人次锐器损伤原因、损伤过程进行调查分析.结果:损伤原因为防护意识不强,工作经验不足,缺乏严格的防护教育培训,缺少必要的防护设施等.结论:避免锐器损伤,应采取严格的防护措施,以减少锐器对医护人员造成的损害.     

口腔专科门诊医护人员锐器伤的调查分析

目的了解口腔专科门诊医护人员在临床工作中发生医疗锐器伤情况，增强医护人员自我防护意识。方法以问卷方式对临床医护人员进行调查。内容包括：职业、科室、锐器伤种类、锐器伤时间段、锐器伤后处理等。结果被调查235名医护人员均有一次或两次以上锐器伤史，多见扎伤、刺伤、划伤等，其中以诊疗操作过程和护理配合准备过程及整理器械物品中发生锐器伤最常见，占锐器伤的64．18％；〉2次以上锐器伤者占66．87％。结论口腔门诊医护人员锐器损伤发生率高且普遍。因此，提高医护人员全面性预防意识教育，建立职业安全防护措施，规范执行诊疗护理操作技能，最大限度地避免或减少职业伤害，是当前口腔专科医院管理者与全体医护人员职业防护面临的重要课题之一。     

手术室医护人员血源性感染职业暴露风险与防范

目的了解手术室医护人员血源性感染职业暴露风险的现状及职业防护的重点,为完善职业防护措施提供科学依据。方法对93名手术室医护人员采用自行设计问卷,调查2009年1月-2010年3月血源性病原体职业暴露情况。结果 63名医护人员发生锐器伤,发生率为67.74%,37名医护人员发生血液/体液暴露,发生率为39.78%;锐器伤的种类主要是缝合针,占27.81%、手术刀剪占25.83%,其次是玻璃占21.85%;主要在医护间配合传递器械,占39.07%,掰安瓿占21.19%,配加药治疗及处理使用后锐,各占10.60%等环节容易发生锐器伤;锐器伤人员中,20.63%未进行乙型肝炎疫苗预防接种、30.16%发生锐器伤时未戴手套、7.94%锐器伤后处理伤口欠规范。结论手术室存在较高的血源性职业暴露风险,是锐器伤的高发场所,管理者应提供科学的职业安全防护措施,有效地预防与减少医护人员职业暴露的发生。     

医护人员血源性职业暴露监测分析与预防策略

目的 了解建立防止血源性职业暴露防护体系后医护人员职业暴露情况,为完善职业防护策略提供科学依据,实现规范化职业安全管理模式.方法 建立血源性职业暴露防护体系,采用前瞻性和回顾性调查相结合的方法,调查医院522名医护人员2009年7月-2011年6月医源性锐器伤发生、血液/体液暴露、锐器伤人员的防护意识、全员标准预防依从性执行情况.结果 522名医护人员中,共发生职业暴露180人,发生率为34.48％,其中锐器伤152人,发生率为29.12％,血液/体液暴露28人,发生率为5.36％;锐器伤种类主要是注射针头、玻璃,其次为带翼针头及缝合针,分别占34.25％、27.12％、13.70％及10.41％;锐器伤操作环节主要是掰安瓿,其次为配加药时和处理使用后锐器,分别占26.58％、14.25％、11.23％;职业暴露人员中,69.44％未进行乙型肝炎疫苗预防接种、6.67％未穿戴防护用品、3.89％未规范处理伤口.结论 职业安全防护体系的建立与实施,有效地预防与减少了医护人员血源性职业暴露的发生,降低了职业暴露的风险.     

湖北省综合医院医护人员职业感染及管理对策

[目的]了解综合医院医护人员职业感染及管理对策。[方法]采用多阶段分层随机抽样的方法,以湖北省8家综合医院医护人员为调查对象,对797名医护人员的职业感染现状进行现场调查。[结果]医护人员职业感染率为33.25％,以上呼吸道感染、结核、甲肝和乙肝为主;工作中被锐器损伤581人,占72．90％,其中483人曾被污染的锐器刺伤;被锐器刺伤的原因排序为单独操作、配合时、病人躁动和被其他操作者刺伤;手术科室与非手术科室之间（X^2=48．3969,P〈0．01）,内、外、妇、儿科室之间（X^2=64．0316,P〈0．01）,医生与护士之间（X^2=10．9625,P=0．0009）锐器刺伤情况存在差异;65．37％医护人员主观认为发生职业损伤的两大主要原因是医护人员自身疏于防范和病人不配合;此外,发生职业暴露后的心理状态亦有不同。[结论]锐器损伤是医护人员常见的职业性损伤;不同职业、科室医护人员锐器损伤存在差异;职业损伤在不同性别、职业和职称的医护人员间存在差异;医护人员自我防护意识淡薄,甚至一些医护人员在工作中未采取防护措施。医院应加强管理,最大限度地减少锐器伤发生,并加大医务人员职业感染防护知识培训。     

医护人员艾滋病病毒职业暴露的原因分析及防护措施

目的 探讨医护人员面临艾滋病职业暴露的高危因素,强调职业暴露重在预防;探讨医护人员对艾滋痛自身防护措施,提高对艾滋病病毒(HIV)职业暴露的防护意识,防止医护人员感染HIV的危险,确保医护人员职业安全.方法 对2008年、2009年和2011年所发生的15人次HIV职业暴露的原因和过程进行调查分析;采取问卷方式对150名医护人员进行有关职业暴露防护知识的调查.结果 医护人员防护意识不强、工作经验不足、缺乏严格的防护教育培训和必要的防护设施等.结论 加强医务人员艾滋病安全操作和职业防护知识培训,避免医护人员因锐器伤和自身皮肤破损等原因被HIV感染;准确及时的评估和有效合理用药是避免职业暴露发生HIV感染的重要措施.遵照标准预防原则,采取严格的防护措施,以减少甚至杜绝医护人员感染HIV.     

121例医务人员锐器伤监测分析

目的：调查医护人员医疗锐器损伤的相关因素,探讨有效的职业防护管理措施。方法采用前瞻性研究方法,监测医务人员医疗锐器损伤发生情况。结果2012年1-12月医务人员发生职业暴露共130人其中发生医疗锐器损伤121名、占93．08％,皮肤黏膜接触8人、占6．15％,离体残肢端刺伤1人、占0．77％;内外科病房和门诊输液厅是锐器伤主要发生场所;各种诊疗穿刺和注射、采血操作是常见的锐器伤环节;暴露源为乙型肝炎者占首位为33．06％;一级暴露7人、占5．79％,二级暴露114人、占94．21％。所有医疗锐器损伤的医务人员经追踪观察,无一人发生血源传播性疾病。结论医疗锐器伤是医疗操作中常见的职业暴露,遵守操作规程,重视自身的防护是降低职业性感染的有效方法。     

卫生员医疗锐器伤的调查分析与防范措施

卫生员是暴露于多种职业危害因素之中的高危人群,同时又是最易被忽视的人群.为了解卫生员在工作中锐器损伤及自我防护的情况,笔者对73名卫生员锐器损伤以及防护措施的现状进行了调查,现将结果报道如下.     

我院医护人员刺伤状况的调查分析

医疗锐器伤是医护人员在工作中最常见的职业性损伤，各种血源性疾病都可经医疗锐器伤传给医护人员。长期以来，大家非常关注血源性疾病在患者中传播，对医护人员因职业暴露感染血源性疾病危险的关注较少。因我院发现2例HIV患者后，医院领导非常重视医护人员的职业防护问题。为此，对我院医护人员刺伤状况进行调查，结果报告如下。     

移动医护查房系统的设计与实现

移动医护查房系统是基于无线网实现医生、护士在床旁对病人信息的及时交互和实时查询、诊断、处理等工作。本文详细阐述了关于移动医护查房系统的设计思路与具体实现的方法。     

Doctor and nurse perception of inter-professional co-operation in hospitals.

OBJECTIVE: To explore doctor and nurse perception of inter-professional co-operation in hospitals; discuss professional differences as reflections of cultural diversity in the perspective of quality improvement. DESIGN: Cross-sectional survey data from a stratified sample of 15 Norwegian hospitals, September 1998: 551 doctors and 2050 nurses at medical and surgical wards. Measures. Doctor and nurse evaluation of their inter-professional co-operation was mapped. Logistic regression models predicting their satisfaction were compared. RESULTS: Doctors were significantly more often than nurses satisfied with the inter-professional co-operation of the two groups. Satisfaction with inter-professional co-operation was predicted by a number of work situation variables. Some of them contribute differently to doctor and nurse satisfaction. CONCLUSIONS: Doctors and nurses not only evaluate their inter-professional co-operation differently, they also appear to define the concept in different ways. Hospital managers should include an understanding of this cultural diversity into the basis of their quality improvement efforts.     

口腔科医务人员职业暴露调查分析

目的 探讨口腔科医务人员发生职业暴露的危险因素与预防措施.方法 对医院2008年1月-2010年1月医院感染管理科登记在案的职业暴露进行统计分析.结果 共发生职业暴露30人,其中口腔内科12例,占40.00％,病房5人,占16.66％,其他科室散在分布;暴露中锐器伤24人,占80.00％;医师12例,占40.00％,护士15人,占50.00％,其他人员占10.00％;职业暴露的种类主要是车针类小器械以及注射器刺伤、划伤为主,占90.00％;受伤部位主要集中在手指、手背等部位.结论 口腔科医师、护士均易发生职业暴露,主要原因是安全防护意识差、自身防护不够、操作不规范以及医护配比不足所致;应完善报告处理制度、加强职业安全教育、加强自身防护、合理人员配置等措施减少职业暴露发生,切实保护医务人员的职业安全.     

Experience and hopes for telehealth in Tokelau

The two key factors affecting healthcare in Tokelau are its small population and its great isolation. Both of these make telehealth a critical issue for the development of health services and it is hard to see how the services can develop to a modern standard without a larger component of telemedicine. The Tokelau islands consist of three roughly equal atolls usually served by 1-2 doctors who deal with all aspects of medical care. There is a small hospital on each atoll and each is staffed by a Nurse manager, two staff nurses and some nurse aides. There is a need for a communication facility for the nurse on the atoll(s) without a doctor to consult with a doctor about medical cases; doctors to consult each other; and for doctors to consult outside specialists about the management of cases. Distance education for health care staff is another perceived need. The current communications systems are still basic and although there is a PeaceSat terminal on each atoll it has largely failed to provide the above communication needs and most is still done by the costly telephone system. Recently ITC has been made a priority for the health department.     

United We Stand — Divided We Fall

ABSTRACT: In June, 1992, the NSW Health Department released their Discussion Paper on 'The Role and Function of Nurse Practitioners in NSW'. The paper recommends legislative changes to enable nurse practitioners to initiate certain diagnostic tests, prescribe from a limited list of drugs, refer directly to specialist medical officers in certain circumstances and be reimbursed for some of the services they provide. Strict criteria for accreditation and evaluation are also recommended. Overseas literature confirms that nurse practitioners provide a safe, competent and cost effective service, which is well accepted by consumers. Opponents of the nurse practitioner concept in Australia have argued that it would be 'dangerous practice' and a 'duplication of services' to implement the Discussion Paper's recommendations. These arguments can not be substantiated. Of more concern is the attempt to divide nurses and nursing on the issue. To suggest that it is acceptable for nurse practitioners to provide services where doctors don't choose to practice or to provide service to disadvantaged groups of people, with whom doctors don't choose to work is unacceptable to nursing. Nurses provide nursing care, they do not provide medical care. Wherever nurses happen to be located, nurses are nurses and do nursing. Whether or not there is a doctor available is not the issue. Nurses do not seek to be doctors. Nurses do not seek to practice medicine. Nursing as a profession stands alone. This paper discusses the nurse practitioner concept as it is proposed for NSW, the implications for urban, rural and remote area nurses, the deliberate attempts to create division amongst nurses on the issue and the need for nurses to stand together to protect, validate and legitimise nursing practice.     

改良早期预警评分系统结合SBAR沟通模式在急诊内科病房中的应用价值

目的 探讨改良早期预警评分系统结合SBAR沟通模式在急诊内科病房中的应用价值.方法 选取该院2019年1—6月急诊病房以采用常规病情观察模式为对照组,另选2019年7—11月采用改良早期预警评分系统评估病情为观察组,对照组护士以常规病情观察情况向医生报告病情;观察组护士以SBAR沟通模式向医生报告,对两组医护沟通、救治...     

Patient knows best: blinded assessment of nonadherence with antituberculous therapy by physicians, nurses, and patients compared with urine drug levels

BACKGROUND: Adherence with therapy is a wide spectrum of behavior rather than a categorical state. While extreme nonadherence is readily apparent, it is rare compared to lesser degrees of nonadherence, which are difficult to predict. AIMS: To compare the accuracy of doctor, nurse, and patient prediction of adherence with antituberculous therapy with urine isoniazid levels. METHODS: A prospective, blinded clinical study was conducted, comparing adherence to antituberculous therapy as reported by patients, doctors, and nurses with urine isoniazid levels. We studied 173 patients with active tuberculosis (TB) recruited over 3 years in two TB clinics in Victoria, Australia. Adherence was defined as six random urine isoniazid (INH) levels being >0. Blinded assessment of adherence was completed by doctors, nurses, and patients. Lid opening and closing of computerized pill bottles were measured in a random subsample. RESULTS: Of 173 patients, the rate of nonadherence was 24% (41/173) by urine INH, 54% (93/173) by patient self-report, 11% (19/173) by doctor assessment, and 7% (12/173) by nurse assessment. The sensitivity of prediction of nonadherence was 76% for patient self-report, 24% for doctor assessment, and 19% for nurse assessment. The 10 patients who used computerized pill bottles were all (100%) noncompliant at some stage. CONCLUSION: Nonadherence is common and poorly predicted by doctors and nurses, even those with extensive experience in treating TB. Contrary to popular belief, patient self-report is more reliable than doctor or nurse assessment of nonadherence. As clinicians, asking patients about adherence may be more valuable than attempting to judge for ourselves.     

护士长形体语言在临床工作中的应用

护士长作为一个专科或一个病区中多个专科的护理领导者,其形体语言直接影响着所在病区护士的效仿结果,护士长在临床工作中应注意培养正确的形体语言,可因对象(如护士、病人、医生)不同,因时间不同,因情境的不同而灵活运用眼神、面部表情、手势、身体姿势和空间距离等形体语言,充分发挥领导者的非语言作用,真正体现出"以身作则"的领导作用,从而带领出一批合格的高标准的护士.     

The infrastructure of telecare: implications for nursing tasks and the nurse‐doctor relationship

Telecare can offer a unique experience of trust in patient‐nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen‐mediated conferences were observed and two workshops, centring on nurses’ photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of ‘infrastructure’ and Mol, Moser and Pols's ideas of care as ‘tinkering’. Infrastructure is understood as human and non‐human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision‐making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor.     

The technological mediation of the nursing-medical boundary

Norwegian medical emergency communication (AMK) centres are staffed by nurses, who administer requests for ambulance services or access to a doctor. The central position of nurses and the fact that they communicate with doctors by telephone and radio, make this a setting where the doctor-nurse relationship is highly visible. A two-year study of AMK centres showed that much of the work of these centres proceeds quite independently of doctors, as nurses function as competent suppliers of advice or 'medical oracles'. The doctor-designed Index for Medical Emergency Assistance is deficient as a tool for guiding nurses' decisions, since it fails to take account of the dynamics of real nursing practice, which is based on experiential knowledge, support from colleagues and collective learning. Data on nursing work in the AMK centres suggest that these nurses have more influence and autonomy in the nurse-doctor interaction than most past studies have indicated.