消化内镜护士的角色职能及专业实践能力发展现状

我国消化内镜护士已发展成为具备相对专业特征的护士群体.近年来,国内很多地区或医院正在探索消化内镜专科护士的发展.而确定实践标准、角色职能及实践能力,是设立消化内镜专科护士的基础.本文主要阐述内镜护士体系发展较为成熟的一些国家及地区关于内镜护士的角色职能及实践能力,回顾我国消化内镜护士发展现状以及近年来专科护士教学培训等...     

刍议内分泌科护士糖尿病护理胜任力现状与影响因素

目的对内分泌科护士糖尿病护理胜任力现状展开调查,分析相关的影响因素,制定解决措施。方法通过便利抽样的方法,选择该省2012年3月—2014年3月5所地级市3级医院的150名内分泌科护士,以问卷调查的方式来判定内分泌护士糖尿病护理胜任力现状。结果经过临床调查后发现,内分泌科护士糖尿病护理胜任力总分为(4.24±0.52)分,法律意识得分为(4.41±0.60)分,人际关系、沟通能力为(4.29±0.55)分,临床护理能力得分为(4.27±0.54)分,领导能力得分为(4.18±0.59)分,专业发展、科研能力得分为(4.05±0.58)分。结论护理管理人员在今后的工作中,可以尝试通过提高护士专业兴趣,提升专业胜任力,需加强对内分泌科护士胜任力的培养工作。     

刍议内分泌科护士糖尿病护理胜任力现状与影响因素

目的对内分泌科护士糖尿病护理胜任力现状展开调查,分析相关的影响因素,制定解决措施。方法通过便利抽样的方法,选择该省2012年3月—2014年3月5所地级市3级医院的150名内分泌科护士,以问卷调查的方式来判定内分泌护士糖尿病护理胜任力现状。结果经过临床调查后发现,内分泌科护士糖尿病护理胜任力总分为(4.24±0.52)分,法律意识得分为(4.41±0.60)分,人际关系、沟通能力为(4.29±0.55)分,临床护理能力得分为(4.27±0.54)分,领导能力得分为(4.18±0.59)分,专业发展、科研能力得分为(4.05±0.58)分。结论护理管理人员在今后的工作中,可以尝试通过提高护士专业兴趣,提升专业胜任力,需加强对内分泌科护士胜任力的培养工作。     

叙事护理实践对提高消化内科护士叙事能力、共情能力的效果研究

目的 调查消化内科护士叙事、共情能力现状,探讨叙事护理实践对提高消化内科护士叙事、共情能力的效果。方法 选取我院消化内科在岗注册护士29名作为研究对象,前期3个月进行叙事护理相关知识培训,通过晨间业务学习及叙事案例分析、叙事护理查房、故事分享等,使其充分了解叙事护理的核心技术与内涵,再进行为期3个月的临床叙事护理实践。实践前后采用医护人员医学叙事能力量表和杰弗逊共情量表对护士进行评价,采用患者满意度调查表进行患者满意度测评。结果 实践前消化内科护士医学叙事能力量表总分(82.73±7.67)分,属于中下水平,杰弗逊共情量表总分(69.25±3.67)分,属于中下水平,患者满意度调查表得分(90.51±5.56)分;实践后消化内科护士医学叙事能力量表总分(121.29±3.28)分,属于中上水平,杰弗逊共情量表总分(118.29±3.34)分,属于中上水平,患者满意度调查表得分(97.51±2.39)分;实践前后得分比较具有统计学差异(P<0.01)。结论 叙事护理培训与临床实践可显著提高护士叙事能力与共情能力,改善护患关系,提高患者对护理服务满意度,从而提升护理质量。     

北京市艾滋病护理人员循证护理实践知识 态度 行为及其影响因素调查

目的了解北京市艾滋病定点医院内从事艾滋病工作的护理人员循证护理实践知识、态度和行为现状,探讨循证护理实践的影响因素,分析循证护理实践中存在的问题,为推行循证护理实践提供参考。方法采用临床护士循证护理实践水平调查问卷(EBPQ)及循证实践影响因素问卷(DEBPQ)对北京地坛医院、第五医学中心、北京协和医院、北京佑安医院的艾滋病科118名在职护士进行调查。结果 118名护士EBPQ总分均分为(4.91±0.91)分,态度维度均分为(5.35±0.98)分,知识技能维度均分为(4.68±0.96)分。DEBPQ总分均分为(3.16±0.58)分,知识来源维度均分为(3.60±0.59)分,查找评价证据障碍因素维度均分为(3.07±0.68)分,应用证据障碍因素维度均分为(3.08±0.73)分,促进因素维度均分为(2.91±0.93)分,知识技能维度均分为(2.39±0.99)分。多因素Logistic回归分析显示,循证实践水平与DEBPQ知识来源维度、知识技能维度呈正相关(P 0.05)。结论北京市艾滋病定点医院内从事艾滋病工作的护理人员的循证态度得分较高,知识技能得分较低,循证实践的影响因素以缺乏相关循证知识技能、临床工作繁忙为主。建议加强对此护士群体护理领导支持变革的力度,制定符合临床实际情况的循证护理实践方案,加强对护理人员循证护理的相关知识和技能的培训,以达到提升临床护理人员循证实践水平的目的,促进循证护理实践的开展。     

消化内镜专科护士培养方案的建立

目的:探索消化内镜科对专科护士培养的需求,调查目前消化内镜专科护士培养的现状,为合理设置消化内镜专科护士标准培养方案提供参考.方法:在文献研究和权威资料整理分析的基础上,由研究小组讨论确定访谈提纲,采用焦点团体访谈的方法访谈了17名来自各省市的消化内镜中心护士长.结果:培养消化内镜专科护士有其必要性,而目前的培养方案不规范、不统一;培养内容应包含综合护理技能和内镜专科技能两大块;培训方式包括理论教学、视频教学、模拟教学、"手把手"教学等,且应采取分级培训.结论:消化内镜专科护士培养应制定统一规范,在掌握其专科技能的基础上注重综合能力的培养,培养时以能力为本位进行分级培养.     

北京市某医院结核科护士压力源调查分析

目的 对结核科护士工作压力源进行调查分析.方法 自行设计调查问卷,采用便利抽样方法,对首都医科大学附属北京胸科医院88名结核科护士工作压力源进行调查.结核科护士平均年龄为（33.04±9.07）岁,工作年限（12.70±9.04）年,每月夜班数（4.25±2.25）个.本研究结核科护士工作压力源问卷分为8个维度,共有61个条目,采用分量法计分.其中,没有压力1分,压力程度一般为2分,压力程度较高为3分,压力程度非常高为4分,可能的得分范围为61～244分,分数越高,表明护士所承受的压力越大.采用问卷调查法,调查前向被调查者说明调查的目的、方法,取得知情同意.由研究者亲自发放调查问卷,30 min后当场收回.本次共发放问卷90份,回收88份,有效88份,有效回收率97.8％.结果 （1）结核科护士压力源总体得分为（154.81±36.03）分.（2）压力源各维度得分从高到低依次是：结核护理专业特殊性的问题（3.07±0.81）分;工作环境及资源方面的问题（2.88±0.81）分;工作量及时间分配问题（2.67±0.78）分;社会环境带来的问题（2.63±0.78）分;护理专业发展方面的问题（2.55±0.74）分;患者护理方面的问题（2.52±0.68）分;护理专业及工作方面的问题（2.45±0.74）分;管理及人际关系方面的问题（1.89±0.64）分.（3）得分排在前10位的压力源条目分别是：长期接触排菌、耐药肺结核患者（3.55±0.78）分;担心自己患上结核病（3.47±0.88）分;同伴被确诊患上结核病（3.36±0.89）;担心消毒防护设施的效果（3.28±0.94）分;担心工作中出现差错事故（3.21±0.95）分;工作环境差（3.18±0.92）分;病区拥挤（3.02±1.07）分;收入差距大（2.98±0.94）分;工作量太大（2.97±0.94）分;经常倒班（2.94±1.03）分.结论 结核科护士承受着较高的工作压力,护理管理者应采取有针对性的措施,指导护士积极应对,减轻护士工作压力.     

消化内镜检查患者心理应激反应对调整护理方案的影响

目的:探讨不同护理方案对消化内镜检查患者心理应激反应作用的效果.方法:选取浙江省台州市立医院自2014-03/2015-03收治的进行消化内镜检查的患者80例,按随机数表的方法随机分为观察组和对照组,每组40例.对照组给予基础的心理干预措施,观察组则进行专门的记录及统计分析,综合评定患者心理应激反应情况,在了解观察组患者基本资料和进行专项调查之后,合理安排专业医护人员进行沟通与疏导,增进护患交流,及时地对患者产生的各种不良心理状态采取应对措施,逐步消除病患的紧张焦虑情绪,助其完成检查.在两组患者预约进行和实施消化内镜检查之前分别进行问卷调查,采用自制一般资料调查问卷和焦虑自评量表(Self-rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating Depression Scale,SDS)对患者的基础情况和心理应激反应进行调查.在上述时间点分别记录患者平均动脉压(mean artery pressure,MAP)和心率(heart rate,HR)的水平.结果:观察组发生轻度焦虑3例,重度焦虑1例,而对照组分别发生8例轻度焦虑和2例重度焦虑,差异具统计学意义(P0.05);实施检查前,观察组和对照组SAS评分为51.45分±9.55分和58.37分±15.02分,SDS评分为49.91分±10.63分和54.58分±14.37分,差异具有统计学意义(P0.05);对照组MAP和HR值都上升明显,观察组不显著.结论:患者在进行消化内镜诊疗时,易发生不同程度的心理应激反应,医护人员通过心理干预措施,能显著减轻患者的心理不良反应,助其顺利完成检查.     

国内外消化内镜专科护士培养模式的比较与思考

近年来,消化内镜诊疗技术飞速发展,在临床中应用广泛,由此对消化内镜专科护理提出新的挑战.本文根据护理专科化培养趋势,对比国外消化内镜专科护士培养体系,对我国消化内镜专科护士培养模式在培养制度、培养内容、考评体系等方面提出反思.以期能促进消化内镜专科护理事业的发展,提高广大消化内镜护理工作者专业水平,更好地为患者服务.     

心脏外科手术室护士能力培训

目的对我院心脏外科手术室内护士能力培训的方法进行分析与探讨。方法选取我院心脏外科手术室护士12名作为研究对象,将核心能力作为培训理论,结合本科室的临床特点制定出一套详细的培训理论,通过讲座以及实践相结合的培训方式,对其从2014年4月~2015年4月进行一系列的培训。结果通过1年的培训后,我院心脏外科手术室护士的各项综合能力均得到了提升,培训后12名护士的操作考核评分为(90.45±3.4)分,理论考核评分为(95.45±1.63)分,患者的总体满意程度为96.57%;培训后满意程度、操作评分以及理论评分明显高于培训前,差异有统计学意义(P0.05)。结论对心脏外科的护士采取能力培训的综合计划,可有效的提高其临床操作能力以及专业理论知识,对患者的满意程度的提升也起到了一定的促进作用,值得在临床推广及应用。     

Nurses working in GI and endoscopic practice: a review

BACKGROUND: Over the last 10 years, nurses increasingly perform tasks and procedures that were previously performed by physicians. OBJECTIVE: In this review, we investigated what types of GI care and endoscopic procedures nurses presently perform and reviewed the available evidence regarding the benefits of these activities. DESIGN: Review of published articles on nurses' involvement in GI and endoscopic practice. RESULTS: In total, 19 studies were identified that evaluated performance and participation of nurses in GI and endoscopic practice. Of these, 3 were randomized trials on the performance of nurses in flexible sigmoidoscopy (n = 2) and upper endoscopy (n = 1). Fourteen nonrandomized studies evaluated performance in upper endoscopy (n = 2), EUS (n = 1), flexible sigmoidoscopy (n = 7), capsule endoscopy (n = 2), and percutaneous endoscopic gastrostomy placement (n = 2). In all studies, it was found that nurses accurately and safely performed these procedures. Two further studies demonstrated that nurses adequately managed follow-up of patients with Barrett's esophagus and inflammatory bowel disease. Four of the 19 studies showed that patients were satisfied with the type of care nurses provided. Finally, it was suggested that costs were reduced if nurses performed a sigmoidoscopy and evaluated capsule endoscopy examinations compared with physicians performing these activities. CONCLUSIONS: The findings of this review support the involvement of nurses in diagnostic endoscopy and follow-up of patients with chronic GI disorders. Further randomized trials, however, are needed to demonstrate whether this involvement compares at least as favorably with gastroenterologists in terms of medical outcomes, patient satisfaction, and costs.     

Training non-physicians to do endoscopy: Feasibility,effectiveness and cost-effectiveness

Colorectal cancer (CRC) is one of the most common cancers in women and men worldwide. Training non-physicians including nurses, nurse practitioners, and physician assistants to perform endoscopy can provide the opportunity to expand access to CRC screening as demand for endoscopic procedures continues to grow. A formal program, incorporating didactic instruction and hands-on practice in addition to oversight, is required to train non-physicians to perform endoscopy as safely and effectively as physicians. Additionally, the context in which the non-physician endoscopy program is organized will dictate key program characteristics including remuneration, participant recruitment and professional and legal considerations. This review explores the evidence in support of non-physician based endoscopy, potential challenges in implementing non-physician endoscopy and requirements for a high-quality program to support training and implementation.     

Correlates of Case Managers' Advance Care Planning Practices

Advance care planning is an increasingly important aspect of professional practice with older adults. Community-based geriatric case managers handle growing caseloads of frail older adults with future care needs that can be anticipated in advance. However, practice in this area is not well understood. A model of factors contributing to health professionals' practice behavior is used as a conceptual framework to study whether advance care planning practices are influenced by professional attributes and experiences, and perceptions of role, knowledge, skills, and barriers in this area. This study surveyed community-based case managers (n = 148) in the state of Florida to examine factors associated with their advance care planning practices. Factors that predicted advanced care planning practice included years of experience, the amount of advance care planning training experiences, perceived skill in geriatric practice competencies, perceived barriers to practice, and experience in advance care planning of a personal nature. Implications for enhancing practice in this area are discussed.     

Perception of gastrointestinal endoscopy by patients and examiners with and without background music

BACKGROUND/AIMS: Several studies have reported improved patient comfort with music in the preoperative setting, however music has seldom been assessed during gastrointestinal endoscopy. We aimed to assess how background music may influence the perception of patients and examiners involved in endoscopic examinations. METHODS: 301 patients (128 females, 173 males; mean age 59 years) were included in the study (EGD and colonoscopy) in a prospective fashion. 90 EGD and 61 colonoscopies were performed with music (50.17%) and 102 EGD and 48 colonoscopies without music (49.83%). Patients, nurses and endoscopists completed a questionnaire. RESULTS: No significant differences in demographic data were found between the patients examined with or without music. Tolerance to the examination, pain sensation and perception of the endoscopy room ambiance were similar in both groups. The majority of patients (83.4%) expressed a preference for music during any future endoscopic examination and none perceived the music as disturbing. During the 151 examinations, music was considered unpleasant in 14 examinations by the physicians (9.3%) and in 11 examinations by the nurses (7.3%). CONCLUSIONS: Music has little influence on patients' experience of gastrointestinal endoscopy. Nevertheless, the majority of patients felt music to be helpful and expressed a preference for music during any future examination. This positive attitude to music of patients is in contrast with the assessment of some endoscopists and nurses.     

The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey

BACKGROUND: Lower reimbursements for endoscopic procedures and increasing demand for screening endoscopy over the past decade have spurred efforts to increase efficiency in the performance of endoscopic procedures. Two dichotomous approaches have emerged: (1) unsedated endoscopy and (2) propofol sedation. The aim was to determine national practice patterns of unsedated endoscopy and propofol sedation, and to assess endoscopists' attitudes toward unsedated screening with an electronic survey. METHODS: A short survey was developed and then was converted to a Web-based format. All national members of the American Society for Gastrointestinal Endoscopy (ASGE) were invited via electronic mail (e-mail) to participate. Survey data were collected electronically. RESULTS: Two e-mails elicited responses to the Web survey from 18% (724) of national ASGE members contacted, within 2 weeks. Of the respondents, 45% do not routinely offer unsedated EGD and colonoscopy, and only 15% of those respondents plan to incorporate unsedated endoscopy into their practice in the next year. Of the 55% who currently perform unsedated endoscopy, 85% do no more than 25 unsedated procedures per year. Lack of patient acceptance was the most common reason cited for not offering unsedated endoscopy. Most endoscopists felt that the availability of unsedated esophagoscopy or colonoscopy would not significantly increase screening for Barrett's esophagus or colonic polyps/colorectal cancer, respectively. Routine use of propofol sedation for EGD, colonoscopy, and ERCP/EUS was reported by 19%, 22%, and 19%, respectively. Community practitioners were more likely to use propofol than those at academic centers (p < 0.0002 for all). Of those not currently using propofol, 43% plan to incorporate it into their practice within the next year. Over 70% of respondents would themselves choose to be sedated for routine endoscopic procedures. CONCLUSIONS: Electronic surveys allow for rapid distribution and data collection but suffer from a limited response rate. The survey suggests that unsedated endoscopy has limited acceptance in the United States, and, without a major intervention that affects endoscopists' attitudes, its use is not likely to increase significantly. Unsedated endoscopy will not have a great impact on endoscopic screening. In contrast, propofol sedation has already gained acceptance in the community, and the routine use of propofol in endoscopy units will likely increase in the future.     

Characterizing the clinical practice and professional behaviour of rheumatology nurse specialists: a pilot study

Background: There is a need to characterize the practice of nurse specialists, for several reasons: to identify the skills and knowledge required for the role, to safeguard the role and to facilitate appropriate remuneration of activities. Objective: To develop an instrument, which characterizes the clinical and professional activities of rheumatology nurse specialists (RNSs). Methods: A questionnaire was produced, informed by the Nursing and Midwifery Council (NMC), to assess competencies in advanced nursing practice and completed by senior clinical rheumatology nurses in the UK undertaking an MSc in rheumatology nursing. Consenting respondents were also interviewed, to enable triangulation of the data. Results: A 38‐item questionnaire was produced. It comprised four sections: clinical activities, non‐patient‐based activities, professional behaviour and perceived confidence in a number of areas of practice. Thirteen nurses completed the questionnaire and seven of these took part in a telephone interview. All RNSs were engaged in the follow‐up care of patients with rheumatoid arthritis, providing education, psychological support, monitoring and changing of drug treatments, and referrals to other health professionals. The RNSs produced guidelines, conducted audits and provided mentorship. They had low levels of confidence in seeing new patients, presenting the results of an audit at a conference, and writing a business case. Conclusions: We have begun the process of developing a questionnaire that can identify the clinical activities, perceived self‐competence and professional behaviour of RNSs. This method of characterizing advanced nursing practice offers potential as a model for nurse specialists in other disciplines. Further work is required to validate the questionnaire on a large cohort of RNSs. Copyright © 2010 John Wiley & Sons, Ltd.     

Part I: How to ergonomically design a modern endoscopic suite

The endoscopy suite is the central hub of activity where most gastroenterologists spend a majority of their time in clinical practice. With the evolution of more complex diagnostic and therapeutic procedures, an ergonomically designed and dedicated gastrointestinal endoscopic unit is not only desirable but a necessity. Such a unit will ensure optimal workflow efficiency and throughput, as well as both patient and physician safety. It is important to plan meticulously upfront by seeking input from all stakeholders including engineers, physicians, nurses, technicians and architects. This will ensure a highly desirable work environment including procedural areas and the scope cleaning/sterilization section while optimizing patient and instrument flow. The procedure room should be ergonomically designed to allow for adjustability and optimize utilization of space for endoscopists, technicians, nurses, anesthesiologists, and trainees as well as the equipment required to perform the endoscopic procedures. This article provides practical tips on how to plan and develop an endoscopy suite, taking into consideration ergonomic and regulatory aspects, and is based on real life experience with designing a modern gastroenterology procedural suite.     

Endoscopy in GERD: Boondoggle, Diagnostic Test, or Risk Management Tool?

The role of endoscopy in reflux disease is debated. Diagnostic certainty is attractive to patients and physicians, to affirm health and to ensure the absence of serious disease, but it is expensive and the majority of patients will have no endoscopic abnormalities. Empirical treatment with acid suppression in patients with symptoms of gastroesophageal reflux disease (GERD) is now widely practiced in primary care in many countries but in others, endoscopy is mandatory to receive approval from the payors for proton pump inhibitor therapy. In patients with dysphagia, endoscopy has a role in ruling out an obstructing lesion. A "once-in-a-lifetime" endoscopy has been proposed as a way to improve our ability to diagnose Barrett's esophagus, but cost-models suggest that this strategy is not cost-effective if current surveillance guidelines are followed after the diagnosis of Barrett's esophagus is made. The role of routine endoscopic examination in GERD is therefore questionable and needs better definition in carefully designed trials.     

Techniques in unsedated endoscopy

The evolution of gastrointestinal endoscopy in the United States has led to the near-universal practice of performing all endoscopic procedures under conscious sedation. Performing endoscopy without sedation has intuitive benefits and may play a larger role in the future of endoscopic practice. Esophagogastroduodenoscopy (EGD) or esophagoscopy using small caliber endoscopes may be the most promising application of unsedated endoscopy. Most upper endoscopies are done for diagnostic purposes and such unsedated procedures may be completed in less than ten minutes. Unsedated EGD has been shown to be tolerable, feasible, and safe. Despite such reports, unsedated endoscopy has not gained widespread use in the United States. The goals of this chapter are to review the technical aspects of unsedated upper endoscopy in an attempt to promote its more widespread practice.     

Appropriateness of upper-GI endoscopy: an Italian survey on behalf of the Italian Society of Digestive Endoscopy

BACKGROUND AND OBJECTIVE: Open-access endoscopy allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. An evaluation of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-access setting. The aim of this Italian multicenter study was to assess the appropriate use of upper endoscopy (EGD) in an open-access system and to establish the yield of diagnostic information relevant to patient care. DESIGN AND SETTING: Cross-sectional, prospective, multicenter study. PATIENTS: A total of 6270 patients referred to 44 Italian centers for open-access EGD during 1 month were prospectively enrolled. INTERVENTIONS: The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relation between the appropriate use of EGD and the presence of relevant endoscopic findings. MAIN OUTCOME MEASUREMENTS AND RESULTS: The rate for "generally not indicated" EGDs was 22.9%: 29.4% for primary care physicians and 12.9% for specialists (P < .01). A relevant endoscopic finding was detected in 2929 examinations (46.7%). The diagnostic yield was significantly higher for "generally indicated" EGDs compared with "generally not indicated" procedures (52% vs 29%; odds ratio [OR] 2.65, 99% confidence interval [CI] 2.23-3.20; P < .01). Of the 133 malignant lesions diagnosed, all but 1 were diagnosed in patients with an appropriate indication (OR >20, 99% CI 3 to >100; P < .01). CONCLUSIONS: Open-access EGD is an useful procedure for clinical practice. Because most of the relevant findings were detected during examinations performed for appropriate indications, the use of ASGE guidelines emerges as crucial to the cost-effectiveness of an open-access system.