护理本科生毕业实习不同时期的压力源、压力水平及其变化趋势

[目的]描述护理本科生不同实习时期的压力源、压力水平及其变化趋势。[方法]以基本情况调查表、实习护生压力源量表为工具,对方便抽样的北京和山东4所护理学院的145名本科护生于1周、1个月、3个月和实习5个月时进行了4次调查。调查学生其压力源及压力水平。[结果]不同实习时期本科护生面临的前10位的压力源及其排序有所不同,6个方面的压力源均产生了中等以上水平的压力,不同实习时期各个方面的压力均有统计学意义(P<0.05),且随着实习时间的推移均呈下降趋势。[结论]本科护生实习期间面临的压力源给护生带来了较大的压力,但随着实习时间的推移呈下降趋势。     

护生临床实习不同时期压力源和应对方式的量性与质性研究

[目的]通过量性和质性相结合的方法对实习护生在实习不同阶段的压力源及应对方式进行调查。[方法]采取目的抽样的方法,将天津医科大学护理学院2005级本科护理专业、在天津市内医院实习护生纳入研究,应用压力源量表和简易应对问卷,在实习不同时期进行问卷调查,并从中选取8名护生进行焦点团体访谈。[结果]实习前压力水平最高,随着实习时间的延长,总体呈现递减的趋势,但均处于中等及以上水平,压力源排序前3位的为对知识和技能的需求、监督与评价、教学安排;实习护生积极与消极应对随实习变化趋势不对应,出现较大波动。[结论]实习护生压力随实习时间延长而减低,但面对众多压力源;且应对方式并未随实习时间延长而呈现积极应对持续升高。     

护生临床实习不同时期压力源和应对方式的量性与质性研究

[目的]通过量性和质性相结合的方法对实习护生在实习不同阶段的压力源及应对方式进行调查。[方法]采取目的抽样的方法,将天津医科大学护理学院2005级本科护理专业、在天津市内医院实习护生纳入研究,应用压力源量表和简易应对问卷,在实习不同时期进行问卷调查,并从中选取8名护生进行焦点团体访谈。[结果]实习前压力水平最高,随着实习时间的延长,总体呈现递减的趋势,但均处于中等及以上水平,压力源排序前3位的为对知识和技能的需求、监督与评价、教学安排;实习护生积极与消极应对随实习变化趋势不对应,出现较大波动。[结论]实习护生压力随实习时间延长而减低,但面对众多压力源;且应对方式并未随实习时间延长而呈现积极应对持续升高。     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系。[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查。[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义（P〈0.01）;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大。②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关（r=0.148,P〈0.01）。③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关（r=-0.145,P〈0.05）。[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平。     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系.[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查.[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义(P＜0.01);不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大.②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关(r=0.148,P＜0.01).③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关(r=-0.145,P＜0.05).[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平.     

不同实习阶段专科护生压力源及压力水平的调查分析

[目的]探讨专科护生不同实习阶段压力源及压力水平的状况,为广大护理教育者及临床带教老师动态了解其压力状况,进行有针对性的心理干预提供依据。[方法]采取问卷调查的方法,对227名专科实习护生实习早期、中期及后期的压力源及压力水平进行跟踪调查。[结果]专科护生各个实习阶段前10位压力源排序在不断变化,其中持续性压力源包括:处理病人紧急情况的能力、实习中出现差错、带教老师的评价、病人与家属的评价;阶段性压力源在实习早期主要是环境与工作流程的不熟悉,实习中期主要是动手操作机会与病人家属的不配合,实习后期主要是考试与就业的压力。压力水平总分及6个维度的压力水平各期均处于中等以上水平,除了"考试及就业方面"维度的压力水平呈现递增趋势外,其余5个维度的压力水平及总分均表现为随着实习阶段的持续而呈下降趋势。[结论]各实习阶段专科护生均处于中度以上的压力水平,在不同实习阶段应根据其压力源不同采取针对性的措施,缓解其压力状况,将压力变为动力,帮助护生圆满完成临床实习计划。     

不同实习阶段专科护生压力源及压力水平的调查分析

[目的]探讨专科护生不同实习阶段压力源及压力水平的状况,为广大护理教育者及临床带教老师动态了解其压力状况,进行有针对性的心理干预提供依据。[方法]采取问卷调查的方法,对227名专科实习护生实习早期、中期及后期的压力源及压力水平进行跟踪调查。[结果]专科护生各个实习阶段前10位压力源排序在不断变化,其中持续性压力源包括：处理病人紧急情况的能力、实习中出现差错、带教老师的评价、病人与家属的评价;阶段性压力源在实习早期主要是环境与工作流程的不熟悉,实习中期主要是动手操作机会与病人家属的不配合,实习后期主要是考试与就业的压力。压力水平总分及6个维度的压力水平各期均处于中等以上水平,除了“考试及就业方面”维度的压力水平呈现递增趋势外,其余5个维度的压力水平及总分均表现为随着实习阶段的持续而呈下降趋势。[结论]各实习阶段专科护生均处于中度以上的压力水平,在不同实习阶段应根据其压力源不同采取针对性的措施,缓解其压力状况,将压力变为动力,帮助护生圆满完成临床实习计划。     

本科护生实习前压力与护理专业自我概念的相关性研究

[目的]了解本科护生实习前的压力状况和护理专业自我概念水平,探讨本科护生实习前的压力状况与护理专业自我概念的关系,为培养护生积极的专业自我概念及采取有效措施缓解护生实习前压力提供理论依据。[方法]采用护理专业本科生实习前压力源及压力水平量表、护理专业自我概念量表(PSCNI)对104名实习前本科护生进行问卷调查。[结果]本科护生实习前压力得分为2.43分±0.51分,处于中度压力水平;护理专业自我概念得分为2.84分±0.28分,具有较为积极的专业自我概念水平;本科护生护理专业自我概念与其实习前压力水平呈负相关(r=-0.290,P0.05)。[结论]护理专业自我概念对本科护生实习前压力水平有影响,学校和实习医院应积极培养本科护生良好的专业自我概念,采取针对性措施缓解本科护生实习前压力,帮助其树立良好心态,提高临床实习效果。     

不同学历护生临床实习后期的压力源比较

目的 调查本科及大专护生在临床实习后期的压力源及其压力水平.方法 于2015年4月抽取100名在我院实习的2015届的护生,按学历层次分成本科组(40名)和大专组(60名),采用"实习护生压力源量表"调查其所面临的压力来源和压力水平,并比较两组间的差异.结果 两组护生在临床实习后期处于前10位的压力源大致相同,尤其前5位完全一致.本科组在临床实习后期的总压力源得分为(1.18±0.44)分,为中等水平的压力;大专组得分(0.90±0.42)分,为低水平的压力,两组比较差异有统计学意义(P<0.05).两组护生在临床实习后期经历的6大方面的压力源,除"患者的情况"外,另外5大方面的压力源比较差异均具有统计学意义(P<0.05),本科组高于大专组.结论 护生在临床实习后期面临不同来源、不同程度的压力,临床带教老师应针对实习后期主要的压力源,制定及采取相应措施,帮助护生顺利渡过实习期,协助护生顺利完成角色转换,走上工作岗位.     

不同学历护生临床实习心理压力和应对方式的调查研究

[目的]了解不同学历护生临床实习心理压力和应对方式。[方法]采取问卷调查法,中国护士工作压力源量表、简易应对方式问卷对190名护生进行护生临床实习心理压力和应对方式的调查。[结果]大专护生压力源评分为87．56分±19．04分,本科为95．44分±16．37分,均处于重度压力水平;大专和本科护生工作压力源中管理及人际关系方面问题评分比较,差异有统计学意义（P〈0．05）,而应对方式评分比较,差异无统计学意义（P均〉0．05）。[结论]护生实习过程中压力较高,应该加强护生学习前心理辅导,但造成本科与专科护生的压力源不同,故对不同层次的护生在临床实习前心理辅导的侧重点应不同。     

Intervention studies to reduce the prevalence and incidence of pressure sores: a literature review

Much has been written about the prevention of pressure sores. However, electronic and manual searches located only 10 studies within the literature in the UK that described interventions able to reduce either their incidence or prevalence. All the studies located contained serious methodological flaws. Apparent success in reducing the number or severity of pressure sores could have resulted because staff involved in data collection were aware that the study was being undertaken and thus took more interest in pressure area care. From the review findings it is apparent that there is a dearth of research evidence upon which to base practice in the sphere of pressure sore prevention and further research is urgently required.     

A comparative study of the cardiorespiratory effects of continuous positive airway pressure breathing and continuous positive pressure ventilation in acute respiratory failure

Positive end expiratory pressure (PEEP) produces cardiopulmonary effects whether administered by controlled positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP). In eight patients with acute respiratory failure, the effects of 20 cm PEEP administered via CPPV and CPAP were compared. An esophageal balloon was used to calculate the transmural vascular pressures. The control values under mechanical ventilation with no PEEP (IPPV) for PaO₂ and QS/QT (FiO₂ being 1.0) were respectively 132±15 mmHg and 31±3%; CPPV gave a PaO₂ of 369±27 mmHg and QS/QT fo 14±1.6%, CPAP 365±18 mmHg and 18±1.3% respectively. The two different modes of ventilation (CPPV and CPAP) gave identical blood gas improvement through the same level of end expiratory transpulmonary pressure despite marked differences between absolute mean airway and esophageal pressures. Conversely, hemodynamic tolerance was very different from one technique to the other: CPPV depressed cardiac index from 3.4±0.3 to 2.4±0.2 l/min/m² as well as decreasing transmural filling pressures, suggesting a reduction in venous return. Conversely, filling pressures maintained at control values during CPAP and cardiac indexes were unchanged.Abbreviations IPPV intermittent positive pressure ventilation; mechanical ventilation (controlled mode) with zero end expiratory pressure (ZEEP) - CPPV continuous positive pressure ventilation: mechanical ventilation (controlled mode) with a positive pressure during expiration - CPAP continuous positive airway pressure; spontaneous ventilation with a positive pressure maintained during expiration - PEEP positive end expiratory pressure, whatever the ventilatory mode; spontaneous (CPAP) or mechanical (CPPV) Presented in part at the 44 th annual meeting of American College of Chest Physicians, Washington DC, October 1978     

Positive end-expiratory pressure (PEEP) and cerebrospinal fluid pressure during normal and elevated intracranial pressure in dogs

The effect of up to 15 cm H₂O positive end-expiratory pressure (PEEP) on cerebrospinal fluid pressure (Pcsf) was investigated in five anaesthetised, mechanically ventilated dogs during normal and then elevated (40–50 cm H₂O) intracranial pressure (ICP). Stepwise elevations of PEEP in 5 cm H₂O increments resulted in small rises in Pcsf at normal ICP and in significantly larger rises when ICP was elevated. The regression equations for the relationships between Pcsf and end-expiratory pressure (EEP) were as follows: Pcsf=12.95+0.82 EEP for normal ICP, and Pcsf=46.41+2.06 EEP for elevated ICP. Mean PaCO₂ rose from 39.7±2.5 to 47.6±5.0 torr during normal ICP, and from 34.2±2.9 to 50.9±5.3 torr at elevated ICP as PEEP was elevated to 15 cm H₂O. We conclude that PEEP raised Pcsf, and that this increase is more severe under conditions of elevated ICP. The rise in Pcsf due to PEEP may be explained by either the rise in intrathoracic pressure or the rise in PaCO₂, or both.Dedicated to Professor Dr. Johannes Linzbach, Göttingen, on the occasion of his 70th birthday     

有创血压监测值与无创血压监测值相关性分析

目的 探讨有创血压监测值与无创血压监测值之间的线性关系,为临床血压监测提供参考.方法 选取ICU监测无创血压与有创血压的患者32例,采取自身对照的方法,同时监测患者有创血压及无创血压值,采集数据资料进行比较,并进行线性关系分析.结果 采集有效数据98对,所得数据有创血压收缩压及舒张压值分别为(146.93±21.426),(71.32±13.152) mm Hg,均高于无创血压值的(124.02±19.417),(68.86±15.251)mmHg,差异均有统计学意义(t分别为15.301,3.363;P＜0.05);有创血压与无创血压存在线性关系(r =0.880,P＜0.05).结论 有创血压与无创血压所得监测值之间有差异,不可相互替代,可使用无创血压监测值推导计算有创血压监测值.     

成都地区中老年居民脉压及脉压指数与高尿酸血症关系研究

目的 分析成都地区中老年居民脉压(pulse pressure,PP)及脉压指数(pulse presure index,PPI)与高尿酸血症(hyperuricemia,HUA)的关系.方法 利用2007年5月代谢综合征研究调查资料(共1 061人),依据PP[≤60 mm Hg(1 mm Hg=0.133 kPa)...     

A comparison of extradural and intraparenchymatous intracranial pressures in head injured patients

The reliability of extradural pressure measurements for the measure of intracranial pressure (ICP) is still controversial. This study was undertaken to assess the limits of agreement between extradural and intraparenchymatous pressures using respectively the Plastimed extradural sensor and the Camino fiberoptic system. The study took place in a neurosurgical intensive care unit. Ten head injured patients were included in the study, leading to the comparison of 1032 pairs of hourly ICP values. Although the measures were significantly correlated, there was no agreement between the two methods of ICP monitoring. Extradural pressure was higher than intraparenchymatous pressure (bias 9 mmHg; 95% confidence interval of bias-9.8 to 27.8 mmHg). The lack of agreement between the two methods is probably due to the unreliability of extradural pressure for the measurement of ICP.     

Clinical evaluation of the Takeda Medical (A & D) TM 2420 ambulatory blood pressure monitor. Practical experience and comparison with direct and indirect measurements

Takeda Medical (A & D) TM 2420 is an automatic ambulatory blood pressure monitoring system employing the auscultatory technique. The device was used under stable conditions and compared to readings from the Hawksley randomzero sphygmomanometer using a double headset stethoscope and a Y-connection. We tested 85 subjects (aged 13–89 years, systolic blood pressure 85–212 mmHg, diastolic blood pressure 40–116 mmHg) and found a difference amounting to 1.6±6.7 mmHg (mean±SD) for systolic and 2.1±4.5 mmHg for diastolic readings (Hawksley-TM 2420). In 62 subjects a comparison with simultaneous measurement on the opposite arm with the Hawksley manometer showed similar results. When comparing intra-arterial readings from 10 subjects, a difference (intra-arterial-TM 2420) of -1.9±12.1 mmHg was found for systolic pressures, while the diastolic difference was -10.7±8.7 mmHg. Twenty-four hour monitoring was performed on 80 subjects; 70 of these yielded usable tracings. The proportion of successful recordings was acceptable, but the device was not suitable for bicycle stress testing. The quality of the accessories provided with the equipment could be improved, but in spite of this the monitoring system was found to be recommendable for clinical use.     

正常人血压变异性分析方法及生理意义

目的　建立正常人长时血压变异参数的正常参照值上限 (95 %可信限 ) ,并探讨其生理意义。方法　选择 6 2名正常人行 2 4h动态血压监测 ,性别和年龄匹配 ,以各时间段血压的标准差作为血压变异指标。结果　① 2 4h收缩压与舒张压变异各 <12 90、5 0 1;白昼收缩压与舒张压变异各 <11 31、4 2 3;夜间收缩压与舒张压变异各 <9 90、2 6 7。②L BPV强度依次为 2 4h收缩压变异 >白昼收缩压变异 >夜间收缩压变异 ;2 4h舒张压变异 >白昼舒张压变异 >夜间舒张压变异。③ 2 4h收缩压与舒张压变异在正常男女间比较差异均无显著意义 (P >0 0 5 ) ;不同年龄段的 2 4h收缩压变异性比较差异无显著意义 (P >0 0 5 )。结论　交感与迷走神经功能的动态平衡是血压变异得以维持在生理范畴的重要机制。增强的血压变异与体力及脑力劳动有关 ,而睡眠是降低血压变异的有效方法。     

102例危重病患者有创血压和无创血压的对比

目的比较102例危重病患者有创血压（IBP）和无创血压（NBP）测量结果的一致性。 方法收集2016年3~9月在西安交通大学第二附属医院重症医学科住院治疗的102例危重病患者的尺/桡动脉IBP和同侧上臂NBP数据1072对,先对所有数据分别按收缩压、舒张压、脉压（PP）和平均动脉压（MAP）进行配对t检验;再将数据分为高血压组（MAP≥107 mmHg）（1 mmHg=0.133 kPa）、正常血压组（70 mmHg≤MAP<107 mmHg）和低血压组（MAP<70 mmHg）三个亚组,分别进行IBP和NBP的收缩压、舒张压、PP以及MAP间的配对t检验。以P<0.05为差异具有统计学意义。 结果有创收缩压和无创收缩压之间比较,差异具有统计学意义［（128.08±35.48）mmHg vs（122.56±24.84）mmHg,t=7.896,P<0.001）］;有创舒张压和无创舒张压之间比较,差异具有统计学意义［（65.66±13.69）mmHg vs（67.98±13.31）mmHg,t=-8.294,P<0.001］;有创PP和无创PP之间比较,差异具有统计学意义［（62.42±28.93）mmHg vs（54.58±20.00）mmHg,t=11.697,P<0.001］;有创MAP和无创MAP之间比较,差异无统计学意义［（86.47±18.94）mmHg vs（86.17±15.33）mmHg,t=0.867,P=0.386］。亚组分析显示高血压组（n=254）：有创收缩压和无创收缩压之间比较,差异具有统计学意义［（163.75±33.93）mmHg vs（152.16±16.78）mmHg,t=6.52,P<0.001］,有创舒张压和无创舒张压之间比较,差异具有统计学意义［（79.17±11.03）mmHg vs（83.69±9.50）mmHg,t=-6.85,P<0.001）］,有创PP和无创PP之间比较,差异具有统计学意义［（84.57±31.50）mmHg vs （68.47±20.72）mmHg,t=9.76,P<0.001］;正常血压组（n=687）：有创收缩压和无创收缩压之间比较,差异具有统计学意义［（122.66±24.74）mmHg vs（118.70±15.14）mmHg,t=5.071,P<0.001）］,有创舒张压和无创舒张压之间比较,差异具有统计学意义［（63.97±10.34）mmHg vs（65.60±8.49）mmHg,t=-5.049,P<0.001）］,有创PP和无创PP之间比较,差异具有统计学意义［（58.69±23.05）mmHg vs （53.10±11.90）mmHg,t=7.682,P<0.001］;低血压组（n=131）：有创收缩压和无创收缩压之间比较,差异无统计学意义［（87.35±24.33）mmHg vs（85.41±11.99）mmHg,t=1.109,P=0.269］,有创舒张压和无创舒张压之间比较,差异具有统计学意义［（48.32±8.27）mmHg vs（49.98±8.06）mmHg,t=-2.073,P=0.040］,有创PP和无创PP之间比较,差异具有统计学意义［（39.03±24.00）mmHg vs（35.43±13.97）mmHg,t=1.806,P<0.001］。 结论有创收缩压大于无创收缩压、有创舒张压小于无创舒张压、有创PP大于无创PP,而有创MAP等于无创MAP。采用MAP数值较采用收缩压和（或）舒张压数值可以消除IBP和NBP测量之间的差异。     

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients

BackgroundForearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution.ObjectivesTo determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity.DesignSingle centre comparison study.SettingAdult Emergency Department, Tertiary Trauma Centre.ParticipantsForty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board.MethodsA random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland–Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg.ResultsThe forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p = 0.002, F-statistic = 11.09). Blood pressure disparity was not associated with participant characteristics.ConclusionsForearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg.