应用Delphi法对助产士处方权申请资格的探讨

[目的]探讨我国助产士申请处方权的条件,以期为未来助产士处方权相关政策制定提供参考。[方法]应用Delphi法对省内外多所三级甲等医院从事助产的护理专家20人,医疗专家16人进行了两轮专家咨询。[结果]专家对助产士处方权申请者最低学历认同率最高为本科,占70.59%;对助产士处方权申请者的最低技术职称认同率最高为主管护师,占85.29%;对助产士处方权申请者的科龄认同率最高为产科5年,占50.00%;对申请者所在医院级别认同率最高为三级医院,占91.18%。[结论]建议将助产士处方权申请资格设为:本科学历、主管护师职称且在三级医院的产科从事助产工作满5年。     

广州市13家医院助产人力资源现状与需求分析

目的:调查广州市助产人力资源现状与需求情况。方法:采用方便抽样法选取广州市内的医院13家,采用自行设计的问卷和专家访谈法进行调研。结果:(1)助产士学历以大专、本科为主(占86.3%);职称以初级为主(占76.5%);专业以助产为主(占84.8%);工作年限以4~20年为主(占71.1%);助产士编制以合同制为主(占66.0%)。(2)现有助产士人数及医院产床数的配置均未达到标准。(3)三级和二级医院流失的助产士占现有助产士人数的12.5%,流失的助产士学历以大专和本科为主,全部是初级职称,编制均为合同制。(4)除专业技能外,医院对助产士的人文素质提出了很高的要求。结论:助产人才学历、职称偏低,各级医院助产士缺乏现象严重,助产士人才流失较多,未来需求量大,医院对助产士的知识和能力提出了更高要求,我国应大力发展助产高层次教育,医院管理部门应采取对策稳定助产士人才队伍。     

高职助产专业学生就业情况分析

[目的]了解高职助产专业毕业生就业情况。[方法]对我院2009届、2010届、2011届3届助产专业毕业生就业情况进行回顾性分析。[结果]3届助产专业学生就业率均为100.0%,专业对口率达93.0%以上,主要就业岗位在广东省二级以上医院,主要从事助产士和护士工作。[结论]高职助产专业学生就业形势较好,但还需向更高就业层次迈进。     

助产护生实习前职业防护的认知及培训需求调查

由于助产士工作环境和服务对象的特殊性,在日常工作中常不可避免地暴露于各种职业危害性因素中.Beltrami等[1]的研究表明,分娩室是具有职业危害的高危科室,但职业安全相对薄弱[2].实习助产士的职业防护意识及知识相对薄弱,因此在实习工作的过程中更易受到职业危害.为了解我院助产护生实习前职业防护现状及对培训需求情况,在护生中开展职业防护教育提供依据.笔者于2010年3月对即将实习的助产专业的护生进行问卷调查,现将调查结果报告如下.     

浙江省助产士结构与需求现况调查

目的调查研究浙江省医疗机构对助产士结构及需求情况,了解医疗机构对助产本科专业人才的需求情况。方法自行设计浙江省助产士结构与需求现况调查问卷,调查浙江省272所设有产科的医疗机构。结果本次调查的272所医疗机构现有产科床位数为10068张,年分娩总数734528名,现有助产士总人数为3899名。医疗机构对未来3年助产士需求量大,预计需增加助产士1581名,尤其是本科及以上学历助产士,约占40.8%。结论目前助产专业不仅人员匮乏,还存在缺乏独立的高等教育体系,高层次、高素质的助产士是未来市场需求的导向,助产专业的高等教育刻不容缓。     

助产士流失原因探讨

近年来,助产士大量流失已经成为许多医院所面临的重要问题。这些流失的助产士人群主要是参加工作5～15a,既富有临床工作经验又年富力强,是助产专业发展及临床工作中的骨干力量。流失可能永远离开助产岗位,这个问题给助产工作及医院管理者带来了多方面的不利影响,从而引起一系列问题如助产质量下降,在岗助产士人心不稳定,并成为新一轮人员流失的诱发因素,而造成恶性循环[1,2]。本文针对我院近年来助产士流失情况和原因进行分析,为寻找相应的管理策略提供科学依据。对象与方法1.研究对象。对近10年来从我院产房调出的助产士15人,并从在岗助产…     

助产士职业暴露低报告现象原因分析

[目的]分析助产士职业暴露情况调查中低报告现象的原因,以寻求降低助产士职业感染危险性的有效方法.[方法]采用问卷调查法,对我院19名助产士在1年内发生职业感染及上报情况进行调查分析.[结果]被调查的助产士发生针刺伤或血液、体液污染后,每次都上报的为0,大多数时候上报占15.8%,偶尔上报占47.4%,从来不上报占36.8%.[结论]低报告现象主要与助产士对职业暴露危害性认识不足、与医院内无完善的职业暴露上报体系、无有效的职业防护措施有关.     

助产士在职培训需求调查分析

目的调查助产士在职培训需求,为优化助产士在职培训计划及提高培训效率提供依据。方法选取2017年1—12月中山市各医院助产士253名为研究对象,采用自行设计的助产士在职培训需求调查表进行问卷调查。结果助产士在职培训需求迫切程度前4位为高危孕产妇产程中的管理、产科急救知识及技能培训、助产专业新内容与新进展、瘢痕子宫再次阴道分娩接生技术。不同层级助产士在职培训需求不同,N0级助产士对产科急救知识及技能培训需求最多,N1级助产士对高危孕产妇产程中的管理需求最迫切,N2级助产士对助产专业新内容与新进展需求最多,N3级助产士更关注高龄产妇心理问题及孕产妇的营养策略。结论通过助产士在职培训需求调查,为制定规范化、有针对性的助产专业培训提供依据,对快速提升专业素质和能力、适应时代需求、保障母婴安全具有积极作用。     

基于岗位胜任力的情景教学法在助产专业教学中的应用

<正>我国将助产士培养定位于技术应用型人才。教育部《关于全面提高高等职业教育教学质量的若干意见》指出:课程建设与改革是提高教学质量的核心,应改革教学方法和手段,强化护生能力的培养。高职高专助产专业的核心任务是培养符合岗位需求的高级助产士[1]。目前助产士工作场所主要限于产房,助产士的专业技能侧重在分娩期的管理[2]。情景教学法是在模拟真实岗位的情景中,学生以小组的形式在教师的指导下     

上海市51所医院消毒供应中心专科护士的现状调查

[目的]了解上海市医院消毒供应中心专科护士现状及需求情况,为提高医院消毒供应中心专科护士的综合素养提供依据。[方法]采用分层抽样法对上海市16个区县51所医院消毒供应中心的专科护士进行调查。[结果]医院消毒供应中心专科护士人数(9.04±4.99)人;本科学历以上专科护士占33.4%;54.9%医院对专科护士的操作岗位有资质要求,49.0%医院对专科护士的管理岗位有最低资质要求;94.1%医院对专科护士进行院内培训,84.3%医院在近1年期间选派本院专科护士参加院外培训;98.0%医院认为专科护士所具备的能力及职业素养与学科发展有很大关系。[结论]医院管理者和卫生管理部门应重视消毒供应中心专科护士培养,加强消毒供应中心护士的培养,提高其综合素养,建立专科护士的岗位说明,提升科研力量。     

Reflective education for professional practice: discovering knowledge from experience

To continually develop as a discipline, a profession needs to generate a knowledge base that can evolve from education and practice. Midwifery reflective practitioners have the potential to develop clinical expertise directed towards achieving desirable, safe and effective practice. Midwives are 'with woman', providing the family with supportive and helpful relationships as they share the deep and profound experiences of childbirth. To become skilled helpers students need to develop reflective skills and valid midwifery knowledge grounded in their personal experiences and practice. Midwife educators and practitioners can assist students and enhance their learning by expanding the scope of practice, encouraging self-assessment and the development of reflective and professional skills. This paper explores journal writing as a learning strategy for the development of reflective skills within midwifery and explores its value for midwifery education. It also examines, through the use of critical social theory and adult learning principles, how midwives can assist and thus enhance students learning through the development of professional and reflective skills for midwifery practice.     

Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview

Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. AIM: The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. METHODS: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. FINDINGS: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. CONCLUSION: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.     

助产士对疤痕子宫产妇阴道分娩行会阴切开决策影响因素的质性研究

目的 探索助产士对疤痕子宫产妇阴道分娩行会阴切开术的决策影响因素.方法 采用目的抽样的方法,选取广州市3家医院的10名助产士进行半结构式访谈,采用内容分析法对访谈内容进行整理分析.结果 共总结出除会阴切开指征以外的4个主题因素:助产士个人因素;产科医生的决策;产妇自身因素;医疗机构管理因素.结论 需加强疤痕子宫孕妇的产...     

中国助产士人力资源现状调查研究

目的 通过调查了解全国的助产士人力资源现状。方法 2017年12月—2018年11月,通过判断抽样和便利抽样法选取中国妇幼保健协会成员机构中的三级和二级医院作为调查对象,使用自行编制的中国助产士人力资源现状调查表进行数据收集,调查单位覆盖国内22个省、自治区、直辖市。结果 共发放问卷1 254份,共回收有效问卷1 213份,问卷的有效率为97.4%;国内产科平均床位使用率为90%;平均每所医院拥有助产士12名,以25~34岁、工作年限<10年、初级职称的助产士为主;助产士的平均外出培训率为12%;不同等级和类型医院的年分娩量、产科床位使用率、助产士人数和构成比较,差异有统计学意义（P<0.05）。 结论 国内助产士的人员紧缺状况有所缓解但人力仍不足,助产士的学历提升,但助产人员内部构成仍不合理,且不同等级和类型助产医疗机构的资源利用率不同,需进一步开展助产专科教育和培训,优化助产士人力资源配置,实现合理利用助产资源。     

沧州市助产技术人员的现状及知识能力需求调查

目的了解沧州市区助产技术人员人才层次结构与知识能力需求,为助产专业人才培养模式改革提供依据。方法采用自行设计的问卷对4所医院98名助产技术人员进行调查。结果助产士、护士第一学历及职称均偏低,专业不对口现象严重;多数被调查者认为所列知识能力项目均应为助产技术人员所必备。结论应提升助产专业学历结构、职称水平;扩展知识结构,提高临床能力,以适应产科服务新模式。     

'From the sphere of Sarah Gampism':The professionalisation of nursing and midwifery in the Colony of Victoria

In the nineteenth century, while the Colony of Victoria was still a fledgling settlement, many of the hospitals of England, Scotland, Ireland, and Europe had instituted forms of nursing and midwifery training. When graduates of these training schemes emigrated to Australia with their knowledge, skills and experience, they found health practice to be haphazard and lacking in organisational standards. Individual immigrant women rose to prominence as managers of Victorian hospitals, and superintendents of homes for trained nurses. Through professional networks of their peers and compatriots, these women succeeded in placing the profession of nursing on a firm footing, and were instrumental in the emergence of professional organisations for trained nurses and midwives in Victoria, including the Melbourne District Nursing Society, the short-lived Nurses Association of Australasia (1892), and the Victorian Trained Nurses Association (1901). Their leadership was to have a profound influence on the way nursing and midwifery were regulated in twentieth century Victoria. In this historical review, we trace the movement to professionalise nursing and midwifery which emerged in the Colony of Victoria during the late nineteenth and early twentieth centuries.     

华东地区助产士对适度保护会阴分娩技术应用倾向及影响因素分析

的 调查华东地区助产士对于适度保护会阴分娩技术的临床选择及其相关影响因素，为规范适度保护会阴分娩技术的临床应用提供科学依据，以期进一步完善助产教育与培训体系。 方法 采用微信填写方式，应用自编调查表对华东地区5个省市共78家医院分娩室的1884名在职助产士进行横断面调查。 结果 71%的助产士在临床操作中会优先选择适度会阴保护；logistic回归分析显示，医院属性、助产工作年限、适度保护会阴分娩技术操作培训是影响助产士选择适度会阴保护分娩技术的影响因素；助产士对于适度保护会阴分娩技术的临床应用与推广持积极态度，对其教育培训和社会推广的需求很高。结论 华东地区助产士在临床工作中会优先选择适度保护会阴分娩技术，为规范这一技术的临床实践提供参考意见。后续应进一步完善助产教育体系建设和助产培训机制以满足助产士的相关需求。     

新助产士进行强化培训的探讨

目的 探讨新助产技术士强化训练后的效果.方法 护理部通过重视管理、注重岗前培训及师资的培训、制定培训和训练计划、培养新护士的动手能力的方法来强化培训新助产士.结果 新助产士在母婴保健合格证考试、考核中通过率达到98%,16名新助产士成为科室的技术骨干.结论 通过注重强化培训新的助产士,提高了新助产士助产技术服务水平,使新助产士达到了母婴保健技术服务所要求的相应资质.     

Decision-making theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives

Jefford E, Fahy K, Sundin D. International Journal of Nursing Practice 2011; 17 : 246–253 Decision‐Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives What are the strengths and limitations of existing Decision‐Making Theories as a basis for guiding best practice clinical decision‐making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico‐Deductive Theory, from which medical clinical reasoning is based; intuitive decision‐making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision‐Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision‐Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision‐making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision‐Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico‐deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision‐making in midwifery.     

导乐陪伴分娩开展现状的调查

目的 调查导乐陪伴分娩开展现状并分析未开展的原因,为今后开展助产适宜技术培训及制定相关政策提供参考依据。方法 2017年12月—2018年11月采用自行设计的“助产士人力资源及适宜技术应用现况”调查表,对全国22个省、直辖市、自治区,共1 213所二级及以上的助产医疗机构的导乐陪伴分娩开展现状进行调查。结果 1 213所医院中,开展导乐陪伴分娩的医院有679所（56.0%）,其中410所（60.4%）在孕妇宫口开至3 cm时开始进行导乐陪伴,523所（77.0%）将导乐陪伴持续至第四产程,393所（57.9%）的医院员工主要是利用上班时间完成导乐陪伴,606所（89.2%）由助产士来完成导乐陪伴,433所（63.8%）有导乐仪器;未开展导乐陪伴分娩的主要原因是人员不够、空间不足和不能收费。结论 导乐陪伴分娩技术还未得到广泛普及,开展状况参差不齐,应在人力资源、空间和经济上对开展导乐陪伴分娩提供支持。