健康教育在少数民族地区的应用

随着社会的不断进步，发展，护理工作已不是单纯的治疗和护理。二十一世纪医学模式将由原来的纯生物模式转变为生理-心理-社会-环境的模式；将由纯医疗模式转变为群体-保健-预防和主动参与的模式。医学模式的转变对护理工作提出了更高的要求。健康教育的实施是医院功能的扩展，能使更多的人群获取健康知识。我院地处偏远山区，是彝族聚居地。由于文化、语言、生活习俗差异，给护理健康教育工作带来了一定难度。     

寓健康教育于临床医疗全程中

生物-心理-社会医学模式是美国医学家Engle于1977年正式提出的，反对现有的生物医学模式的心身二元论、生物还原论观点，提倡以整体论系统论的思想去认识人的健康和疾病，强调心理社会因素和生物学因素一样对人的健康和疾病产生重要影响。随着医学模式向生物-心理-社会医学模式的转变，随着经济的发展，人民生活水平的提高，医患纠纷的频发，对临床医疗工作提出了更高的要求，挑战与机遇并存，寓健康教育于临床医疗全程中，就可以进一步做到临床医疗工作的与时俱进。医学模式的转变使得临床医疗工作由单纯医疗转向医疗、预防、康复和保健的综合医治；即以“疾病”为中心转向以“病人健康”为中心的变革。     

急诊科护士必须具备的心理品质

当今医疗服务已彻底打破旧的模式，提倡“以病人为中心”的服务方式。医学由生物医学模式向生物心理社会医学模式转变，从而要求护理工作看到的不仅是病更主要是人，想到的不仅是理化、生物因素在疾病中的作用，同时考虑到心理社会因素对疾病发生的影响。由此要求急诊科护士必须具备有良好的心理品质，在每天面对不同层次、不同疾病类型、不同年龄的病人时做好相应的护理工作。     

护理人员的继续医学教育

医疗技术水平不断提高和发展取决于医学技术干部队伍的培养，技术是医院竞争的资本．是医院的生命所在。护理人员又是临床第一线的技术人员。俗话说：“三分治疗、七分护理”。由于生物——心理——社会医学模式的形成，使护理模式发生了转变，护理工作由疾病护理转向以护理“病人”为中心的整体护理，因此对护理人员提出更高的要求。护士其掌握一般疾病护理知识和护理技术已不能满足医疗保健的需要，还必须要掌握心理医学、社会医学等，更新护理知识，适应新医学模式的需要，就必须提高护理人员的素质。     

浅谈心理护理在临床护理中的主要性

因为目前世界各地身心疾病大幅度增加，使得人们对身心疾病的认识越来越深刻，甚至在整个医疗观念上发生了极大的变化。形成了生物-心理-社会医学模式。医学模式的转变，新的护理模式和护理观念也形成了，使护理工作从单一的功能制护理发展为身心及对社会因素的整体护理。[第一段]     

临床各科心理护理的教学研究

随着新型医学模式的发展，要求临床护理模式与医学中生物-心理-社会模式相适应，这一模式将病人看作生物、心理、社会、文化等各方面处于动态变化中的人。在过去的临床护理工作中，普遍认为只有精神科病人才需要心理护理，而忽视了临床各科室病人的多种心理需求。在强调整体护理的今天，对临床新老护士进行心理护理的培训已经越来越受到重视。我们在专业教学和临床学习中，比较重视生物医学知识和操作技能的教学，而实际临床工作中，由于护理工作的繁琐，造成了临床护理工作，重躯体轻心理的状况。我们需要从病人切身需要和临床工作的切实可行性两方面入手，努力搞好对各科病人的心理护理，充分体现医疗人文关怀，帮助病人更早康复。     

伦理学与新生儿患者的护理

伦理学与新生儿患者的护理２０００３２上海医科大学儿科医院龚梅随着医学事业不断发展，护理事业同样需要不断发展和改进。现代医学的模式已由过去的＂生物医学＂模式转为＂生物－心理－社会＂医学模式即整体医学。在医疗护理过程中，由过去的以＂医生、护士、医院＂立场...     

计算机在护理工作中的应用与发展

计算机在护理工作中的应用与发展周枫，孙毅军，王玉荣随着医学模式由生物医学模式向生物心理社会医学模式的转换，护理工作已不再只是简单的打针、发药。护理人员需要掌握多项技能，学会使用多种医疗仪器，完成现代医学对护理工作提出的新要求。医院内各种现代化的医疗仪...     

对老年疗养员护理的几点体会

随着医学模式和医疗水平的不断提高，护士的言行举止，技术水平对疗养员的生理、心理都会产生至关重要的影响，这对从事老年疗养员护理工作的人员提出了新的要求和新的挑战。考虑到疗养员需求的多样性，我们通过采取健康宣教、安全护理、心理护理、人性化护理等措施，内容涉及生理、心理、医疗及社会环境等多个方面，取得了较好效果，现将体会介绍如下。     

职业病病人的心理需要及护理

随着医学模式由生物医学向生物-心理-社会医学模式的转变，要求医护人员在病房医疗实践活动中，不能只见病，不见人，及物化现象。病人不仅是一个生物体，而且是有思想的，有行为的，属于社会的一员。实践证明，病人的心理活动与疾病的疗效和预后有密切的关系，本文就住院病人普遍具有的心理需要及护理作一下介绍。     

Blunting Occam's razor: aligning medical education with studies of complexity

Clinical effectiveness and efficiency in medicine for patient benefit should be grounded in the quality of medical education. In turn, the quality of medical education should be informed by contemporary learning theory that offers high explanatory, exploratory and predictive power. Multiple team‐based health care interventions and associated policy are now routinely explored and explained through complexity theory. Yet medical education – how medical students learn to become doctors and how doctors learn to become clinical specialists or primary care generalists – continues to refuse contemporary, work‐based social learning theories that have deep resonance with models of complexity. This can be explained ideologically, where medicine is grounded in a tradition of heroic individualism and knowledge is treated as private capital. In contrast, social learning theories resonating with complexity theory emphasize adaptation through collaboration, where knowledge is commonly owned. The new era of clinical teamwork demands, however, that we challenge the tradition of autonomy, bringing social learning theories in from the cold, to reveal their affinities with complexity science and demonstrate their powers of illumination. Social learning theories informed by complexity science can act as a democratizing force in medical education, helping practitioners to work more effectively in non‐linear, complex, dynamic systems through inter‐professionalism, shared tolerance of ambiguity and distributed cognition. Taking complexity science seriously and applying its insights demands a shift in cultural mindset in medical education. Inevitably, patterns of resistance will arise to frustrate such potential innovation.     

新医学模式下的心理干预发展现状

生物心理社会医学模式认为人体是由生物因素、心理因素、社会因素三者共同构成的一个统一整体,生物因素、心理因素、社会因素三者共同制约着人的健康和疾病,有时其中某个因素起主导作用,但三者总是相互影响的。然而,目前我国综合医院服务对象基本上都是躯体疾病,心理因素所引起的精神疾患基本被忽视。根据这种现状,我们初步制定相应的对策。     

Prognostic ability of practitioners of traditional arabic medicine: comparison with Western methods through a relative patient progress scale

The ancient Greek medical theory based on balance or imbalance of humors disappeared in the western world, but does survive elsewhere. Is this survival related to a certain degree of health care efficiency? We explored this hypothesis through a study of classical Greco-Arab medicine in Mauritania. Modern general practitioners evaluated the safety and effectiveness of classical Arabic medicine in a Mauritanian traditional clinic, with a prognosis/follow-up method allowing the following comparisons: (i) actual patient progress (clinical outcome) compared with what the traditional ‘tabib’ had anticipated (= prognostic ability) and (ii) patient progress compared with what could be hoped for if the patient were treated by a modern physician in the same neighborhood. The practice appeared fairly safe and, on average, clinical outcome was similar to what could be expected with modern medicine. In some cases, patient progress was better than expected. The ability to correctly predict an individual''s clinical outcome did not seem to be better along modern or Greco-Arab theories. Weekly joint meetings (modern and traditional practitioners) were spontaneously organized with a modern health centre in the neighborhood. Practitioners of a different medical system can predict patient progress. For the patient, avoiding false expectations with health care and ensuring appropriate referral may be the most important. Prognosis and outcome studies such as the one presented here may help to develop institutions where patients find support in making their choices, not only among several treatment options, but also among several medical systems.     

现代医学影像专业学科人才的最新发展方向及在具体管理措施中应注意的若干问题

本文总结了现代医学发展的潮流方向和主要趋势，以及当前医学影像学科所发展的方向特征，讨论并强调了医疗机构管理决策者所需要具备的技术整合思维模式，以及现代影像学科“大影像发展概念”的意识等诸多方面考虑出发，来做好建设现代医学影像学人才资源发展工作的研究。     

Using a Six-Domain Framework to Include Biopsychosocial Information in the Standard Medical History

Problem: The traditional approach to physicians’ history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient’s ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients. Intervention: In 2015–2016, we introduced medical students to a 6-domain (biomedical and psychiatric conditions, behavioral health, living environment/resources, social support, and functional status) approach to history taking and instructed them to elicit information from each domain alongside the traditional approach. Students were required to obtain information from each domain in one admitting history or one daily progress note, discuss their findings with the attending physician, and involve members of the medical team in addressing concerns and barriers in the care of that patient. Students’ history notes were reviewed for completeness and compared to those from a student control group. Students also completed a 10-question evaluation of the model. Context: The intervention was conducted during a 1-month rotation on a hospitalist general medicine service from May 2015 through August 2016. Outcome: Patient history and daily progress notes were collected from 38 fourth-year intervention students and compared to 24 control students on the same service from the previous year. Compared to control students, intervention students provided more patient information (p?≤?.001) in all nonbiomedical domains except behavioral health. Intervention students reported that the 6-domain model helped them identify clinical information that could be addressed with existing resources and prompted involvement of social workers, pharmacists, and nurses in care planning. They also indicated the framework added clinically valuable information and enhanced team-based care. Lessons Learned: A domain-based framework can be used by medical students to identify clinically relevant behavioral conditions and social determinants of health tailored to individual patients while avoiding long standardized checklists. Arguably, routine collection of behavioral and social determinants of health is a necessary first step in enhancing physicians’ awareness and skills in working with health care teams to address nonbiomedical determinants of patients’ health.     

电子病历对护士工作影响的研究进展

护理工作是临床医疗工作的重要组成部分,电子病历在护理领域的应用范围及程度在很大程度上影响了整个医院电子病历的使用情况。文章从护理文书书写效率、医嘱执行率、护理质量3个方面介绍了电子病历对护士工作的影响,并对电子病历存在的不足进行了分析、探讨。     

Reporting about disability evaluation in European countries

Abstract

Purpose: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. Methods: Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. Results: Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant’s working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant’s health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. Conclusion: Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research.

• Implications for Rehabilitation

• Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability.

• Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured and scaled report forms of working capacity.

• The ICF could serve as a reference for describing work capacity, provided the ICF contains all necessary categories.

     

现代教育技术在急诊医学教育中的应用

本文通过论述现代教育技术和急诊医学教育的关系,探索通过应用先进的现代教育技术尝试新的急诊医学的教学形式,构建完整的急诊医学教育资源信息库,以逐步形成先进的急诊医学教学新模式。     

循证医学在社区卫生工作流程建立中的应用研究

[目的]应用循证医学的方法建立社区卫生工作各项流程.[方法]通过对有关社区卫生相关资料的调查采集,明确社区卫生工作存在的问题,然后通过医学网站检索相关文献,进行综合评价,以系统的方法建立社区卫生工作各项流程.[结果]实施后无菌物品合格率提高,护理人员洗手依从性提高,新入社区病人的平均检查时间从实施前的2.0 h～3.0 h缩短为0.5 h～1.0 h;治疗等候时间从1.5h～2.0 h缩短为1.0 h～1.5 h;病人对社区卫生服务工作满意度从82%提高到96%.[结论]应用循证医学的方法建立社区卫生工作流程为社区卫生服务工作提供了科学的、系统的工作方法,提高了社区卫生服务工作的满意度.