普外科高级责任护士业务查房实施与效果

目的:探讨高级责任护士业务查房的方法和效果。方法:建立高级责任护士业务查房流程,对普外科患者实施了436例次高级责任护士业务查房;观察实施高级责任护士查房前后护理不良事件的发生率,调查护士对于实施高级责任护士查房后的评价。结果:实施高级责任护士查房后护理不良事件发生率明显减少(P<0.01)。96%的人认为能指导临床护理工作;93%的人认为能提高专科理论和专科技能水平;83%的人认为能提高工作积极性和主动性;75%的人认为能促进医护关系和谐;82%的人认为能体现层级护理。结论:高级责任护士查房是一项有效的提高护士素质和临床护理工作质量的途径。     

老年住院患者跌倒预防护士培训大纲的构建

目的 基于最佳证据构建老年住院患者跌倒预防护士培训大纲。方法 对老年住院患者跌倒风险评估与预防相关文献进行回顾,制定培训大纲初稿,运用Delphi法经13名专家进行2轮问卷咨询后确定大纲各指标。结果 构建的老年住院患者跌倒预防护士培训大纲包括10个培训主题,40个条目内容,内容涉及培训目标、培训方式和考评方式;专家判断系数为0.9、权威系数为0.895及熟悉程度系数为0.89。结论 本研究构建的培训大纲具有良好的代表性和权威性,对老年住院患者跌倒预防的护士培训有一定的临床指导意义。     

责任护士应用Morse跌倒评估量表情况分析

目的探讨责任护士应用Morse跌倒评估量表情况。方法责任护士应用Morse跌倒评估量表对21378例患者进行评估,采用自行设计调查表,了解责任护士应用Morse跌倒评估量表对患者跌倒风险评估情况;选择跌倒风险评估时机,同时了解跌倒风险患者发生跌倒情况。结果本组21378例患者中,有222例患者存在跌倒风险。责任护士在跌倒风险评估中对跌倒史、超过1个医学诊断、静脉输入的条目评估准确率较高,为91.6%以上;对行走辅助、步态、认知状态的条目评估准确率较低,为86.0%以下。责任护士在患者入院时、Morse跌倒评估得分≥24分、转科和跌倒后评估时机选择准确率较高,为90.2%以上;在患者病情变化、口服了会导致跌倒药物时评估时机选择准确率较低,为67.9%以下。结论加强护士培训,提高量表的使用及评估时机选择的准确率,使防跌倒的评估和预防工作贯穿于临床护理工作中,最大限度地预防患者跌倒事件的发生。     

以护士为主导的多学科团队干预对预防老年患者跌倒的效果研究

目的探讨以护士为主导的多学科团队干预模式对预防老年患者跌倒的效果。方法根据SPSS 19.0软件生成的随机化编码,将370例老年患者分为对照组和观察组各185例,对照组采用挂警示标识、健康教育等预防跌倒的常规护理方法,观察组采用护士为主导的多学科团队综合干预模式。干预6个月后比较两组患者跌倒发生率、跌倒可以预防知晓率、Tinetti平衡和步态量表评分、Morse跌倒评估量表评分、中文版跌倒效能量表评分。结果观察组患者跌倒发生率低于对照组,跌倒可以预防知晓率高于对照组,Tinetti平衡和步态量表及中文版跌倒效能量表评分均高于对照组,Morse跌倒评估量表评分低于对照组,比较差异均有统计学意义(P0.05)。结论以护士为主导的多学科团队综合干预模式可改善老年患者对跌倒的认知,改善老年患者躯体功能状态,从而降低跌倒发生率。     

流程管理在预防老年住院病人跌倒中应用的研究

[目的]探讨流程管理在预防老年住院病人跌倒的应用方法。[方法]成立预防住院老年病人跌倒质控小组,制定预防跌倒护理管理流程,并在老年病区内开展实施,定期收集结果、总结、反馈。[结果]研制了预防住院病人跌倒的流程,使老年病区病人满意度由99.91%上升至99.96%;住院期间老年病人跌倒率由0.23%降至0.07%。[结论]制订预防老年病人跌倒护理流程并切实落实流程可以有效预防老年病人跌倒的发生。     

流程管理在预防老年住院病人跌倒中应用的研究

[目的]探讨流程管理在预防老年住院病人跌倒的应用方法。[方法]成立预防住院老年病人跌倒质控小组,制定预防跌倒护理管理流程,并在老年病区内开展实施,定期收集结果、总结、反馈。[结果]研制了预防住院病人跌倒的流程,使老年病区病人满意度由99.91%上升至99.96%;住院期间老年病人跌倒率由0.23%降至0.07%。[结论]制订预防老年病人跌倒护理流程并切实落实流程可以有效预防老年病人跌倒的发生。     

高级责任护士综合考评方法与体会

目的通过对高级责任护士的综合考评,以提高高级责任护士的综合素质和专科水平。方法考评分首次和再次考评,首次考评包括理论、技能、教学、业务查房、计算机考评及民意测评;再次考评是在首次考评的基础上对核心能力训练落实检查及患者满意度进行调查。每次综合考评后都发放鉴定表。结果经过首次和再次综合考核,共有25名责任护士入选护理部高级责任护士人才库,成为各相应专业科室的高级责任护士,其中5～10年护龄的8人,占32%。患者满意度逐渐上升,2006年第3季度96.3%、2006年第4季度97.1%,2007年第1季度98.6%;全院护理质量总平均分逐渐提高,2006年第3季度93.1分、2006年第4季度94.3分,2007年第1季度96.1分。结论选拔了一批实用型和能力型的高级责任护士,建立了一套科学可行的高级责任护士考评管理体系,提高了临床护理质量。高级责任护士综合考评对提高责任护士工作的有效性和工作潜能的发挥及促进护理质量的提高起着至关重要的作用。     

高级责任护士在产科临床护理中的作用探讨

目的探讨层级管理中设立高级责任护士对产科护理质量和病人对护理工作满意度的影响。方法通过制定高级责任护士的选拔标准和考评办法,择优录用于产科临床护理,并从产科护理质量、病人对护理工作满意度与设立高级责任护士前相比,进行差异性分析。结果设立高级责任护士后产科的护理质量和病人对护理工作满意度明显提高,差异具有统计学意义（P〈0．01）。结论设立高级责任护士能提高产科护理质量和病人对护理工作满意度,是先进的护理模式。     

老年病专科护士预防患者跌倒的工作模式探讨

目的探讨老年病专科护士在全院开展患者防跌倒工作的模式及效果。方法老年病专科护士制订防跌倒工作计划,对全院的护理管理人员、临床护士进行患者防跌倒知识培训,通过专科护士巡查检查督促患者预防跌倒措施落实情况,并开展复杂疑难病例会诊讨论。对医院发生的跌倒病例进行资料回访,定期进行总结分析。结果护理人员及患者或其家属的防跌倒知识知晓率提高。2008年全院跌倒发生率(0.059%)较2007年(0.29%)有明显下降。结论专科护士发挥职能,结合自身的角色特点创建新的工作模式,在全院开展患者防跌倒工作,保障了患者的安全,降低了跌倒的发生率。     

高级责任护士在产科临床护理中的作用探讨

目的 探讨层级管理中设立高级责任护士对产科护理质量和病人对护理工作满意度的影响.方法 通过制定高级责任护士的选拔标准和考评办法,择优录用于产科临床护理,并从产科护理质量、病人对护理工作满意度与设立高级责任护士前相比,进行差异性分析.结果 设立高级责任护士后产科的护理质量和病人对护理工作满意度明显提高,差异具有统计学意义(P＜0.01).结论 设立高级责任护士能提高产科护理质量和病人对护理工作满意度,是先进的护理模式.     

The role of exercise in falls prevention for older patients

Falls prevention is a key area of health promotion that is familiar to all nurses who work with older people. However, the suggestion that t'ai chi should be used as a prevention intervention may be new to many nurses. The evidence supporting t'ai chi and many other forms of exercise have been evaluated within the National Institute for Clinical Evidence (NICE) falls guidance. This should enable nurses to look at the prevention interventions that they currently recommend and question the evidence for or against their effectiveness. Nurses should also be able to identify factors that may present as barriers to participation.     

The increase in illegal private duty nurses in public Greek hospitals

fouka g., plakas s., papageorgiou d., mantzorou m., kalemikerakis i. & vardaki z. (2013) Journal of Nursing Management  21 , 633–637 The increase in illegal private duty nurses in public Greek hospitals Aim To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. Background Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. Evaluation Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. Key issues Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. Conclusions It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. Implications for nursing management Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.     

病房护理管理中责任护士的量化考核

目的探讨临床护理管理中对责任护士实施量化考核的效果。方法量化考核住院病人满意度、健康教育落实、病历书写质控、病房管理和基础护理5个方面。结果量化考核实施前后责任护士考核平均成绩经t检验,P<0.01,病人满意度、护理病历合格率、基础护理质量合格率及病房管理分别经字2检验,P<0.01或<0.05,有显著性差异。说明实施量化考核后,责任护士考核的平均成绩、病人满意度、护理病历合格率、基础护理质量合格率及病房管理合格率5个方面均提高。结论对责任护士进行量化考核,有效提高责任护士素质,提高病人满意度和护理质量,使护理管理科学化。     

活动能力测试对社区老年人跌倒风险的预测价值

目的 研究一个预测模型,用于社区居家老年人跌倒筛查,并量化活动能力与跌倒的关系.方法 随机选取北京四个社区65岁以上老年人144例,根据过去1年是否跌倒分为跌倒组和非跌倒组,其中跌倒组50例,非跌倒组94例.对两组受试者进行功能性步态测试(FGA)、Berg平衡量表(BBS)评定、功能性伸展测试(FRT)、感觉整合和平衡的临床改良测试(CISIB)、单腿站立(OLS)、记时起立行走实验(TUGT)、10米步行时间,功能性伸展实验.跌倒组和非跌倒组之间各项测试的差异进行分析,除了睁眼、闭眼平地站立和睁眼抬头平地站立外,其余均具有统计学差异,并对其进行logistic回归分析.结果 2组受试者除睁眼平地站立、闭眼平地站立和睁眼抬头平地站立外,其余各项测试组间比较,差异均有统计学意义(P＜0.05).Logistic模型结果显示,FGA总分和mCISIB中的睁眼站立海绵垫上对跌倒的预测最有意义,其中敏度性为80％,特异度为74.2％.FGA和睁眼站立海绵垫上的敏感度和特异度分别为76％,74.2％和56％,81.6％.模型的受试者工作特征曲线(ROC曲线)下面积为0.845.结论 该模型可用于社区居家健康老年人跌倒的筛查,预测社区老年人跌倒的敏感性优于FGA和睁眼站立海绵垫上,特异性与FGA相似.量化社区居家老年人活动能力与跌倒的关系,为跌倒预防提供数据.     

资深护士管理对策探讨

资深护士是护理事业的宝贵资源,通过连续性排班、分层管理、实施护理会诊、护理查房,合理分流、积极培养专科护士等措施,资深护士在护理领域中发挥了充分作用,体现其专业价值,同时保证了护理工作质量。     

主责护士带班制在临床护理中的应用研究

[目的]探讨主责护士带班制在控制护理缺陷、提高护理质量中的作用。[方法]2006年1月—2008年12月在临床护理工作中对所有病例实施主责护士带班制,比较实施前（2003年1月—2005年12月）与实施后（2006年1月—2008年12月）基础护理合格率、技术操作合格率、护理措施落实率、健康教育覆盖率及病人满意度等指标的变化。[结果]实施主责护士带班制后上述各项指标均较实施前提高（P〈0.001）。[结论]实施主责护士带班制可促使各项护理质量指标均达标,保障了病区护理工作质量持续稳步提高。     

Evaluation of a peer-led falls prevention program for older adults

Waters DL, Hale LA, Robertson L, Hale BA, Herbison P. Evaluation of a peer-led falls prevention program for older adults.

Objective

To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group).

Design

Quasi-experimental evaluation with 12-month follow-up.

Setting

Community.

Participants

Older adults with increased fall risk (N=118; mean age, 75.5y; age range, 65–94y), with 23% drop out at 12 months.

Intervention

Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist–administered program and comparison group (n=25) 1-hour weekly seated exercise classes.

Main Outcome Measures

Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months.

Results

At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48–1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group.

Conclusions

This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.     

Effectiveness of an educational intervention on improving knowledge level of Chinese registered nurses on prevention of falls in hospitalized older people--a randomized controlled trial

Falls are highly prevalent in hospitalized older people. Although many factors contribute to this, registered nurses (RNs) lack of knowledge about how to prevent hospitalized older people falls was identified as one of the major factors. This study explored the effects of an educational intervention on improving knowledge level of RNs on prevention of falls in hospitalized older people. It was a randomized controlled trial. 374 RNs from 4 acute care hospitals in ChongQing were recruited to the study. Data were collected before the intervention and at the 3-month follow-up. After the intervention, knowledge scores increased significantly from baseline in the intervention group and significant differences were detected between the scores of the two groups at the 3-month follow-up. The results reflected that the educational intervention was an effective strategy for improving knowledge level of RNs on prevention of falls in hospitalized older people.     

护士分层管理的方法与效果

目的 探索护士分层管理模式,以提高护理质量和患者满意度.方法 医院成立护理专业能力进级评审委员会,设计护士分层管理方案及各层级护士进级方案,并对6个科室护士进行分层管理.结果 实施护士分层管理后,护理质量及患者满意度得到提高（P＜0.01或P＜0.05）.结论 护士分层管理体现了护理岗位的能级对应,成为对现行护理职称制度的一种补充管理手段,达到了较好的管理效果.     

设立儿科夜班护理二线值班对缓解一线护士压力的效果分析

目的了解设立护理二线值班对一线夜班护士压力的缓解情况。方法采用自设问卷,对64名儿科夜班护士进行调查。结果夜班中设立护理二线值班对一线夜班护士来源于环境和个人自身素质的压力起到了明显的缓解作用;对来源于患儿及护理工作本身的压力缓解作用不明显。结论夜班中设立护理二线值班能够缓解一线夜班护士在工作环境和自身素质方面的压力,该制度有一定应用推广价值。