基于Kano模型的养老机构老年人护理服务需求属性分析

目的 分析养老机构老年人护理服务需求属性,为制订针对性干预措施提供参考.方法 基于Kano模型设计养老机构老年人护理服务需求调查问卷,对天津市7所养老机构共687名老年人进行调查.结果 养老机构老年人护理服务需求34个条目中,魅力属性需求10条(29.4％),均位于保留区Ⅳ;期望属性需求10条(29.4％),其中7条位于优势区Ⅰ;必备属性需求11条(32.4％),其中7条位于待改进区Ⅱ;无差异属性需求3条(8.8％),均位于次要改进区Ⅲ.生理健康与医疗需要维度中,魅力属性2条,期望属性4条,必备属性5条,无差异属性1条;安全需要维度中,期望属性1条,必备属性4条,无差异属性2条;尊重需要维度中,魅力属性1条,期望属性3条,必备属性2条;爱与归属需要维度中,魅力属性4条,期望属性2条;自我实现需要维度的3条均为魅力属性.结论 养老机构老年人必备、期望属性护理服务需求主要集中在生理健康与医疗、安全及尊重需要,魅力属性需求主要集中在爱与归属、自我实现需要.养老机构应在维持和完善必备、期望属性需求的基础上,发展和创新魅力属性需求,客观分析和优化改造无差异属性需求.     

基于Kano模式的儿科住院患者护理服务需求属性分析

目的探讨儿科住院患者对护理服务需求的属性,找出顾客期望的服务需求,为提高儿科服务水平提供参考。方法基于Kano模式自行设计儿科住院患者护理服务需求调查问卷,对295名住院患儿家长进行问卷调查。结果63项护理服务需求中,39项为期望属性,19项为魅力属性,2项为必备属性,3项为无关属性;50%魅力属性的一级指标为健康教育。结论儿科护理管理人员应根据Kano分析的结果,首先满足患者认为的必备属性,其次为期望属性,最后应开发魅力属性,从而提高优质护理服务质量管理水平。     

住院患者就医体验的质性研究

目的了解住院患者就医的真实体验,探究患者住院过程中关注的体验要素,为提高医疗服务质量提供参考。方法采用质性研究中的现象学研究方法,对26例住院患者进行半结构式深入访谈,采用Colaizzi 7步分析法对访谈资料进行整理分析。结果提炼出5个主题:服务水平,后勤保障,信息支持,服务效率,情感安全。结论患者的就医体验要素既存在共性又具有个性化,医疗机构应针对这些要素改进服务质量,提升患者体验。     

基于体验的协同设计在临床护理实践的应用进展

介绍基于体验的协同设计的概念，分析基于体验的协同设计实施的参与、计划、探索、发展、决策与改变六要素，并系统综述其在癌症服务、急诊环境、精神卫生保健服务及其他护理领域中的应用进展，以期为临床护理人员关注患者体验，促进服务质量改进提供参考。     

儿科门诊护理服务质量及需求属性研究

目的联合应用服务质量(SERVQUAL)模型和KANO模型评价儿科门诊护理服务质量,探究低水平护理服务项目的服务需求属性。方法采用SERVQUAL模型问卷和KANO模型问卷,对儿科门诊就诊的289例患儿的家属进行调查。通过SERVQUAL模型分析不符合患儿家属期待的低水平护理服务项目,再通过KANO模型调查上述低水平护理服务项目的需求属性。结果护理服务质量总分为-1.77分;SERVQUAL模型问卷38个条目中,20个条目护理服务质量处于低水平,其中必备属性服务9项,魅力属性服务8项,期望属性服务3项。结论儿科门诊护理服务总体未达到患儿家属满意,管理者需要根据不同服务需求属性采取针对性对策。     

基于Kano模型的PICU危重患儿家属需求调查

目的基于Kano模型对PICU危重患儿家属需求进行调查,为提高PICU护理服务质量提供参考。方法采用便利抽样法选取PICU 150名危重患儿家属为研究对象,基于Kano模型对其需求进行问卷调查。结果危重患儿家属的期望需求中11项在优势区(第一象限);必备需求9项全部在待改进区(第二象限);无差异需求8项均在次要改进区(第三象限);魅力需求中13项在维持区(第四象限)。结论在PICU以患儿及其家庭为中心的护理工作中,满足必备需求为首要改进的内容,期望需求是危重患儿家属满意度、重要度最高的需求,在满足前两种属性需求的基础上,落实魅力需求的满足措施可提升PICU人性化护理品质。     

病区护士长对患者实施人文关怀体验的质性研究

目的 了解病区护士长对患者实施人文关怀的体验，为制定关怀改进策略提供参考。方法 采用现象学研究方法，对7所医院的17名护士长进行半结构深入访谈，采用Colaizzi 7步分析法分析资料。结果 提炼出5个主题：重要性感知、关怀措施丰富、多层面获益、存在阻碍因素、期望关怀与支持。结论 病区护士长对患者实施人文关怀的体验中有收获、有困难，医院管理层应针对现况完善管理机制，促进病区护士长更全面、更深入地开展患者人文关怀。     

国内肾移植术后患者心理体验的质性Meta整合

目的系统评价肾移植患者术后心理体验。方法计算机检索数据库中国知网、万方数据库、维普数据库、中国生物医学文献数据库,搜索关于肾移植患者术后真实体验的质性研究,检索时限从建库至2018年5月。进行文献质量评价后,采用Meta整合方法对研究结果进行归纳、诠释。结果共纳入8篇文献,提炼出52个结果、6个类别和3个整合结果,分别为肾移植术后患者消极心理、肾移植术后患者对未来与生命的心理感受、肾移植术后患者的自身健康需求与期望。结论医护人员应充分了解肾移植术后患者心理体验,做好针对性心理干预,引导患者调整认知和行为方式,提高患者的术后生活质量,并且增强患者对未来生活的心理资本。     

患者就医体验研究进展

综述了患者就医体验研究方法、测量工具以及患者就医过程中的体验与感受。提出随着患者导向医疗模式的转变，患者就医需求与体验受到医疗服务管理者的关注，患者体验成为医疗服务品质提升及持续改进的重要指标与考核工具。应进一步开发和研制普遍实用、操作性强的测定量表，并将研究结果运用于实际服务工作中，为患者提供个性化、人性化、亲情化的医疗服务。     

烧伤患者疼痛体验及疼痛管理期望的质性研究

目的探讨烧伤患者疼痛体验及疼痛管理需求,为采取针对性疼痛管理措施提供依据。方法采用目的抽样法对11例住院烧伤患者进行半结构式访谈,资料分析采用Nvivo10.0软件。结果共析出4个主题:烧伤患者经历了剧烈的疼痛;烧伤疼痛管理的现状不容乐观;家属的支持和医护人员的鼓励对患者缓解疼痛很重要;患者期望更好的疼痛管理方法。结论烧伤患者身心经历了镇痛不完善的体验,应建立规范的烧伤疼痛管理模式,加强烧伤患者疼痛知识方面的健康教育,为烧伤患者提供方便、安全、有效的疼痛控制策略,从而缓解烧伤患者疼痛。     

小切口胆囊切除术手术体会

目的：探讨小切口胆囊切除术实施要点及效果。方法本次研究选取100例急性、良性胆囊炎患者作研究对象,均于我院普外科2013年1月～2014年1月收治,随机分组,就开腹胆囊切除术（对照组, n=50）与小切口胆囊切除术（观察组,n=50）效果进行比较。结果观察组选取病例手术切口选取长度、平均手术操作所需时间、平均围术期出血量、肛门在术后恢复排气时间、术后进食恢复时间、平均住院天数均少于对照组,差异有统计学意义（P＜0.05）。观察组并发症率为5.0%,明显低于对照组22.5%,差异有统计学意义（P＜0.05）。结论临床采用小切口胆囊切除术对在选择的急性胆囊炎病例展开治疗,创伤程度较低、术后机体可尽快恢复、有较高安全性,与最小创伤手术原则符合,且费用低,宜在基层医院推广应用。     

老年跌倒骨折患者跌倒恐惧体验的纵向质性研究

目的 探讨老年跌倒骨折患者跌倒恐惧体验的变化,为制订有效的针对性护理干预措施提供参考。方法 采用纵向质性研究方法,以目的抽样法选取骨科病房16例老年跌倒骨折患者进行半结构式访谈,并对资料进行横断面和纵向分析。结果 共提炼出3个主题及8个亚主题：跌倒恐惧情绪体验的变化(负向情绪发展,正向情绪调节),跌倒恐惧认知体验的变化(成因多元化,自我效能降低),跌倒恐惧应对体验的变化(保持谨慎态度,树立康复信心,提升知识储备,寻求外部支持)。结论 老年人跌倒恐惧体验是一个复杂的现象,呈现动态的变化过程,临床医护人员在跌倒预防计划中应早期识别存在跌倒恐惧的老年人,并通过多学科团队实施预防性护理干预。     

男性乳腺癌患者患病体验的质性研究

目的揭示男性乳腺癌患者就医经历和体验,为优质护理服务提供参考。方法对7例男性乳腺癌患者采用深度访谈法收集资料,运用现象学分析法分析资料。结果访谈资料共提炼出9个主题,分别归属于正性、负性体验。正性体验包括理性接受现实和对家庭支持的感知,负性体验包括就医延迟、震惊与绝望、尴尬与不自在、不确定感、不能承担社会及家庭责任、经济负担沉重以及信息支持不足。结论男性乳腺癌患者负性体验明显多于正性体验,存在较多的社会及心理问题,有必要对男性乳腺癌患者进行心理干预,并在公众尤其是在男性群体中普及男性乳腺癌知识。     

尿道下裂15年诊治经验总结

目的：总结过去15年尿道下裂外科诊治经验，进一步提高其治疗水平。方法：对过去15年收治的272例尿道下裂患者临床资料进行回顾性研究。272例患者年龄1.5-27岁，平均10.13岁，其中阴茎头冠状沟型47例（17.28%)，阴茎体型120例（44.12%)，阴茎阴囊型88例（32.35%)，会阴型17例（6.25%)。手术方式主要为皮条埋藏法（Denis browne术）、膀胱粘膜代尿道法、横裁包皮岛状皮瓣尿道成形术（Duckett术）及阴囊中缝岛状皮瓣尿道成形术等。结果：一次手术成功率由1987－1991年的39.3%升高到1992－1996年的60.4%，近5年来（1997－2001年）达到76.4%；尿瘘发生率由1987－1991年的45.9%减少到1992－1996年的29.7%，近5年来再减少到16.4%，其他并发症也相应减少。结论：随着手术方式的改进，外科技术水平及缝线质量的提高，尿道下裂一次手术成功率逐年上升，并发症逐年下降。如果指定专人手术，加强术后护理，可望进一步提高手术成功率。     

Clinical experience with the Pierre Robin sequence

The Pierre Robin sequence manifests itself in the neonatal period with symptoms of respiratory distress and feeding difficulties. We report our experience in the clinical management of this entity over 14 years and present an appraisal of risk factors for the surgical treatment of the cleft lip/palate and late outcome. Between 1986 and 1999, out of a series of 159 consecutive patients operated in our department for cleft palate closure, 30 had Pierre Robin sequence. Conservative pediatric management included positioning and cardiorespiratory monitoring. In the case of failure of the conservative treatment, endotracheal intubation and/or different surgical procedures were used. The cleft palate was closed according to Maleks technique. Associated malformations were found in 10 cases (33%) with cardiorespiratory immaturity in five of those patients. Acute respiratory distress was present in 12 newborns (40%). Among them, endotracheal intubation was necessary in seven cases and maintained for 1 to 4 days in three patients. Glossopexy or subperiosteal release of the floor of mouth musculature was done in four of these patients followed by tracheotomy in two. Nasogastric feeding was needed in 14 infants (47%) for a variable period with a mean of 57 days (range 1–210 days). Polysomnography studies, done in 24 patients, showed significant obstructive apnea episodes in 10 infants. Gastroesophageal reflux was found in 11 patients (37%). Hearing loss was found in 29 infants (96%) with a mean threshold of 40 dB. Sensorineural hearing abnormalities were revealed in 10 patients (33%). Palate repair was done at the average age of 5 months (range 3–12 months). Difficulties of intubation were encountered in all the cases with severe malformations (five infants). Myringotomy and/or ventilation tubes were used in 21 infants at the same time of palate closure. An early palatal plate was used before surgery in 18 cases (60%). Immediate postoperative complications included two local hemorrhages and in one of them a surgical exploration was needed to control the bleeding. Postoperative oronasal fistula occurred in eight patients (23%) and further surgery was needed for five of them (16%). Newborns who had associated malformation or severe respiratory distress presented more postoperative complications than those with minimal clinical problems (6/10 vs 2/20 patients respectively, p=0.007).     

Near-death experience in a boy undergoing uneventful elective surgery under general anesthesia

Near-death experience (NDE) is a complex subjective experience, which may include affective elements such as a sense of peacefulness, paranormal components such as a sensation of floating out of the body, and a perception of being in a dark tunnel and seeing a brilliant light. It is usually reported to occur in association with a wide range of life-threatening situations, as for instance, cardiopulmonary resuscitation. We report on an episode of NDE that occurred in a 12-year-old boy who underwent a general anesthesia for an elective uncomplicated surgery. To our knowledge, this is the first case of NDE in a child that has been reported in this context.     

Lithostar multiline. Initial clinical experience with a new multipurpose lithotripter

Summary After > 10 000 treatments – our HM3/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80 × 5 mm) and a digital fluoroscopy unit. Stone localization is achieved in a − 10° and + 30 ° position without movement of the patient. The treatment table itself allows most endourologic and percutaneous auxiliary procedures. Additionally, an intergrated inline ultrasound is available. From 10/94 to 08/95, 204 male and 96 female patients with a mean age of 50.7 (4–92) years underwent ESWL with the Lithostar multiline. The mean stone diameter was 10.3 (2–20) mm with 53 % ureteral and 47 % renal stones. 300 patients underwent 480 treatments (average shocks 3673, range 793–8000; mean energy level 5.5, range 1–9). Stone localization was achieved after 5 (1–39) min (mean fluoroscopy time 3.1 (0.5–16.2) min). In 92.7 % no analgesic premedication was done. 56 % of the patients needed no analgesics at all during ESWL. 44 % received 8.1 (2–15) mg Piritramid intravenously. Epidural anesthesia was performed in only 2.3 % for a second treatment. 95 % of the patients had complete stone disintegration. In 68 % disintegration was achieved in one session. ESWL was repeated for further disintegration in 18.5 %, because of an unsuccessful treatment in 11.5 % and because of technical interruption of the previous session in 2.5 %. We saw subkapsular haematomas in 2 %. Auxiliary procedures following ESWL were necessary in only 9.2 % of the patients. In situ ESWL with the new Lithostar Multiline seems to be as effective as the Dornier HM3/4. Analgesia-free treatment was performed in more than 50 % of the patients. Auxiliary procedures were less frequently necessary as compared to our previous experience with in situ ESWL.      

Free tissue transfer at an army medical center

Free tissue transfer has been demonstrated to be an effective modality of treating a variety of wounds and conditions in the civilian population. The use of these procedures has been underreported by American military surgeons. Military surgeons face unique hurdles that make the effective performance of these procedures difficult. We report our experience with free flap reconstruction at an American Army medical center. We performed 44 free flaps in 38 patients; although operative times and hospital length of stay were comparatively long, our success rates were excellent with only one partial flap loss. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.