临床护士绩效考核满意度现状及影响因素分析

[目的]了解目前临床护士绩效考核满意度情况,并分析与其相关的影响因素。[方法]采用自行设计的一般资料问卷和临床护士绩效考核满意度问卷。对620名工作1年以上的临床护士进行调查。[结果]临床护士绩效考核满意度水平较高,总体得分为(4.30±0.70)分,其中考核体系满意度(4.24±0.72)分,考核主体参与满意度(4.15±0.73)分,考核应用满意度(4.43±0.74)分;每周工作时间、工作年限、所在科室对临床护士绩效考核满意度有一定影响。[结论]应关注临床护士对护理绩效考核的满意度,不断完善绩效考核管理,提高临床护士对护理绩效考核的满意度,从而提高其工作积极性。     

军队医院与疗养院文职护士工作满意度调查分析

目的对比军队医院与疗养院文职护士工作满意度现状。方法采用护士工作满意度量表对广州军区两家军队医院临床科室和两家军队疗养院的文职护士进行工作满意度测评并对比分析。结果军队医院文职护士与军队疗养院文职护士工作满意度总分无差异。两组文职护士在护士间的相互影响、职业价值、医护间关系及工作中的自主权方面得分较高,得分比在50%以上;业务内容、机构政策、收入方面得分较低,得分比在50%以下。医院文职护士在收入、业务内容、职业价值方面得分高于疗养院文职护士(P<0.05),而疗养院文职护士医护间关系及工作中的自主权方面得分高于医院文职护士(P<0.05),差异有统计学意义。结论两组文职护士工作满意度得分均偏低,护理管理者应提高文职护士的薪酬和待遇,提高护士的职业自豪感,提升护士工作满意度。     

护士分层绩效考核的管理与实践

目的探讨在民营医院管理体制下如何从护理部层面有效地实施护士分层绩效考核管理,从而提高护士对分配制度的满意度,降低人才流失率。方法对护士按照工作岗位、业务能力等九个方面进行综合考核,考核得分进入全院排名,按得分从高到低分为4个等级,除一级护士外不同级别的护士分别给予相应的绩效工资,考核周期为1年。结果实施护士分层绩效考核后护士对分配制度的满意度提高,护士的流失率降低,与考核前比较差异均有统计学意义(均P0.05)。结论实施护士分层绩效考核管理有效地提高了护士对分配制度的满意度,降低了护士流失率,对护士的工作积极性也起到了一定的推动作用。     

绩效考核在眼科优质护理服务中的应用评价

目的:建立适用于眼科优质护理服务的绩效考核体系,并对其应用效果进行评价.方法:以医院下发的绩效考核制度为指导,结合各类质量控制指标和评价方法,对眼科优质护理服务工作实施分组、分层次考核,并将考核结果与科室奖金挂钩.结果:实施绩效考核3个月后,不记名投票显示91.30％的护士赞成绩效考核,认为能调动护士工作的积极性,护理质量较实施之前得到了明显提高,患者满意度测评显示,实施之后的半年满意度较实施前明显提高(P＜0.05).结论:建立合适的绩效考核体系,可以有效地激励护士的工作积极性,调动护士的主观能动性,从而提高护理质量和患者满意度.     

军队医院聘用护士满意度认知调查分析与对策

目的:分析军队医院聘用护士满意度现状与护士对自身、护理专业及医院认知的关系.方法:采用自行设计的聘用护士满意度认知调查问卷对104名军队医院聘用护士进行调查.结果:102名被调查军队医院聘用护士工作满意度总分为(93.86±12.51)分,条目均分为(4.02±0.41)分.其中67名(65.69%)自我认知项得分高于均值,而对职业认知项得分低于均值.结论:聘用护士整体工作满意度呈增高趋势,说明各种提高满意度的具体措施成效明显;聘用护士满意度与对自身认知和职业认知显著相关;护理管理者在采取各种措施提高聘用护士满意度的过程中,也要重视职业素养教育,使聘用护士加强自我和职业认识,提高认同感,增加满意度.     

护理部全垂直绩效考核下消毒供应中心二次考核分配探讨

目的在护理部全垂直绩效考核体系下,尝试建立与之相匹配的医院消毒供应中心工作人员绩效考核分配方案,合理分配消毒供应中心各级各类人员绩效。方法成立科室绩效考核分配领导小组,结合医院护士岗位管理、绩效考核分配原则和指导方案,确立考核分配模式和考核指标,对科室护士、工勤人员进行绩效考核分配。比较考核分配前后消毒供应中心工作人员的满意度和临床科室对消毒供应中心的满意度。结果考核分配后,消毒供应中心工作人员的满意度较前提高(P0.01),临床科室对消毒供应中心满意度也较前提高(P0.01)。结论消毒供应中心绩效考核分配,公平、合理,体现了多劳多得、优劳优得和同工同酬,有效激发了工作人员的工作积极性。     

军队传染病医院护士工作满意度调查分析及管理对策

目的了解军队传染病医院护士工作满意度的现状,并提出管理对策。方法应用Mueller／McCloskey满意度量表对随机抽取的193名军队传染病医院的护士进行问卷调查。结果军队传染病医院的护士对工作的满意度较低,其中对福利待遇及排班的满意度最低,不同年龄、学历、科室和编制的护士对工作不满意的程度不同。结论多种因素导致了军队传染病医院护士对工作的不满意,护理管理者应采取有针对性的管理对策和改进措施,提高护士对工作的满意度,进而提高护理质量,减少护理人员的大量流失。     

医院内训师对护士进行培训的方法及效果研究

目的探讨医院内训师对护士进行培训的方法及效果。方法对我院228名护士分6期由医院内训师进行培训,根据调研结果明确培训目标,设计培训课程,创新培训方法,发挥内训师熟悉医院情况的优势,考核跟进提高培训后期效果。培训前与培训后3个月进行问卷调查,比较培训前后总体幸福感得分、护士职业倦怠改善情况。结果培训后总体幸福感得分、护士职业倦怠得分优于培训前(P<0.01)。结论医院内训师培训能提升护士工作幸福感,减轻护士职业倦怠,有利于稳定护理队伍。     

岗位层级管理模式在医院人事改革眼科护理中的应用

[目的]探讨岗位层级管理模式在医院人事改革眼科护理中的应用。[方法]实行层级岗位管理护理模式,进行岗位设置、护士配置。护理部统筹全院护士绩效考核分配,门诊、手术室结合量化考核,提高临床夜班护士系数等。眼科护士分N0-N5共6个层级别培训和考核,制定层级培训手册。护理质量管理实行科室护理单元自控、护士长交叉检查、护理部组织护理质量管理委员会下设的专业小组管理、项目小组管理、护理总值班督导、护理部主任行政业务督导等质控考核,考核结果与绩效挂钩。比较人事制度改革实施前后病人满意度、护士岗位工作满意度及护士对统筹绩效考核分配满意度。[结果]实施岗位层级管理模式后,各层级护士对岗位工作满意度由90.55%提高到98.42%,护士对统筹绩效考核分配满意度由91.33%提高到96.06%,病人满意度由91%提高到97%。自2013年始医院护理质量评价每年获市级评估"A级",无护理服务投诉,无护理差错事故,护士离职1人离职率2.8%,离岗率0。[结论]在人事制度改革中,眼科护理实行岗位层级管理模式,护理部统筹绩效分配,能有效地实现同工同酬,能保证护理质量及提高病人满意度,为病人提供持续科学的优质护理服务,有效减少护理差错及护理人才流失,不同程度地引导眼科护士走向临床岗位,满足临床病人需求。     

护士对医院管理工作的满意度调查

目的:通过调查护士对医院管理各方面的满意度,了解组织管理上的成绩与不足,以改善组织管理,提高护士的满意度和工作绩效。方法:以3家医院的护士为调查对象,就影响护士对医院管理工作满意度的相关因素进行调查。结果:护士对医院管理工作的总体满意度不高。影响满意度的因素有福利待遇、工作年限等方面。结论:医院管理者应注重护士不满意情绪的管理,完善管理制度,增加护士的培训机会与晋升空间,提高护士的工作稳定性,提升绩效考核管理的效力,提高护士工作的积极性。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.