基于柯氏模型的双向六环护理培训模式在重症医学科呼吸机亚专科小组培训中的应用

目的 探讨基于柯氏模型的“双向六环”培训模式在重症医学科呼吸机亚专科小组培训中的应用效果。方法 以目的抽样法选择重症医学科的70名护士为研究对象,应用基于柯氏模型的“双向六环”培训模式对研究对象进行呼吸机管理小组培训及考核;采用柯氏模型反应层次、学习层次、行为层次和结果层次观察其培训效果。结果 反应层：培训后护士的满意度由80%提高至97.1%,培训前后满意度比较,差异有统计学意义(P<0.05)。学习层：培训后呼吸机专科理论成绩由76.81分提高至89.40分,操作考核成绩由77.79分提高至94.66分,培训前后专科理论及专科操作考核成绩比较,差异均有统计学意义(P<0.05)。行为层：培训后护士总核心能力及临床护理、领导能力、人际关系、法律、专业发展及教育咨询等方面的能力与培训前比较,具有明显提高,差异均有统计学意义(P<0.05);培训前后护士的批判性思维、科研能力比较,差异无统计学意义(P>0.05)。结果层：培训后,重症医学科呼吸机相关性肺炎(VAP)发病率及气管插管非计划性拔管发生率比培训前有显著降低,差异均有统计学意义(P<0.05)。结论...     

柯氏评估模型分析综合病例站点式考核在呼吸与重症医学科护士培训中的应用

目的探讨柯氏评估模型分析综合病例站点式考核在呼吸与重症医学科护士培训中的应用效果。方法选择2019年3月-9月我院呼吸与重症医学科进行培训的护士共27人,以综合病例站点式考核为培训模式进行护理技能培训、危重症护理理论培训和考核。利用自身前后对照,培训结束后进行反应层、学习层、行为层和结果层的效果考核。结果不同学历层次的护士对培训方式较为满意,差异无统计学意义(P>0.05),培训后护士理论成绩和技能操作评分均高于培训前(P<0.05);培训后护士行为能力评分较培训前显著提高,医师对护理工作的满意度较培训前提升(P<0.05)。结论以综合病例站点式考核为培训方法能够提升呼吸与重症医学科护士解决临床护理问题的综合能力,提高护士的危急重症理论知识成绩和技能操作成绩,培训后护士的各项行为作为评分较培训前明显提升;且医师对护理工作满意度较培训前显著提高,提高了抢救水平和护理质量。     

减少身体约束护理方案在重症医学科气管插管病人中的应用

目的:探讨减少身体约束护理方案在重症医学科气管插管病人中的应用效果。方法:按照随机数字表法将2018年2月—2019年1月综合重症监护室(ICU)收治的240例气管插管病人分为对照组与观察组各120例,对照组给予常规护理方案干预,观察组给予减少身体约束护理方案干预。比较两组病人约束时间、身体约束率、非计划性拔管(UEX)发生率、皮肤损伤情况,调查两组病人护理满意度,干预前后采用症状自评量表(Self-reporting Inventory)评估病人心理健康水平。结果:观察组病人约束时间短于对照组,身体约束率、UEX发生率、皮肤损伤发生率低于对照组,护理满意度高于对照组(P<0.05);观察组病人干预后症状自评量表评分低于对照组(P<0.05)。结论:在重症医学科气管插管病人中应用减少身体约束护理方案可缩短约束时间,降低身体约束率、UEX和皮肤损伤发生率,提高病人护理满意度,改善病人心理状况。     

浅谈青年医师在重症医学科的培训

重症医学科是一门相对新兴的临床医学专业学科,是医院集中监护和救治危重病人的医学平台。2008年,国家卫生部对重症医学进行了认定,在学科分类标准中将重症医学确定为临床医学二级学科;2009年,卫生部颁发了关于在《医疗机构的诊疗科目名录》中增加     

防拔管手部约束具在重症医学科手部约束患者中的应用

目的:探讨防拔管手部约束具在重症医学科手部约束患者中的应用方法及效果。方法:将166例经评估需要手部约束且带管路的患者随机分为观察组和对照组各83例,对照组采用传统约束带,观察组采用纯棉布、硬质塑料瓶制作的简易防拔管手部约束具,比较两组临床效果。结果:两组患者意外脱管情况、约束期间皮肤损伤情况及护士对约束具使用满意度比较差异均有统计学意义(P0.05)。结论:防拔管手部约束具是一种安全、简便、有效的防拔管工具,适合在重症医学科手部约束患者中推广应用。     

身体约束规范化培训在内科重症监护病房中的应用与效果

目的探讨内科重症监护病房(medical intensive care unit,MICU)护士身体约束规范化培训的方法及效果。方法对MICU 48名护士进行身体约束规范化培训,比较培训前后护士采用身体约束的情况。结果培训后护士对患者身体约束时长、护理观察记录间隔时间和知情同意签署比培训前有所改善(P<0.01);培训后护士对患者身体约束数目、患者发生身体约束合并症包括约束肢端水肿加重和皮肤损伤情况比培训前少。结论身体约束规范化培训可以有效减少不必要的身体约束,预防和处理身体约束合并症,保障患者治疗安全,促进患者生理和心理康复。     

目标管理结合层级培训在重症医学科护理人员临床培训中的应用及效果评价

目的 探讨根据重症医学科专业特点应用目标管理方法对护理人员进行岗位层级培训的方法及效果。 方法 选取重症医学科42名护理人员为研究对象,根据学历、职称、工作年限、专业技术水平将参与培训与考核的护理人员分为高级护士(专科护士)、中级护士(护理组长)、初级护士(岗位能手)及新手护士,制定各级人员的岗位职责及培训计划,应用目标管理方法进行分层级培训、考核及管理。比较培训前后不同层级护理人员基本理论知识、操作考核成绩及护理质量检查评分情况。 结果 应用目标管理方法进行层级培训后,护理人员的理论和操作成绩及病区临床护理质量检查评分均高于培训前。 结论 目标管理运用于重症医学科护理人员层级培训中,能充分调动护理人员主动学习的积极性,提高他们的专业知识、协调能力和管理水平,促进病区临床护理质量的提高。     

医护合作培训在重症医学科镇痛和镇静安全管理中的应用

目的：研究医护合作培训方法在重症医学科镇痛和镇静安全管理中的应用效果。方法选取在我院重症医学科工作的61名医护人员,进行关于镇痛和镇静安全方面的医护合作培训,比较培训前后程序化镇痛和镇静（ PSA）落实情况及医护人员核心能力,并比较2014年1—12月收治患者1095例与2015年1—12月收入1217例患者非计划拔管（ UE）与VAP发生率。结果实施后,重症医学科患者的PSA落实率为89.0％,高于实施前;重症医学科镇痛和镇静患者的UE发生率1.03‰与VAP发生率1.65‰,均低于实施前,差异均有统计学意义（χ2值分别为388.95,7.20,7.31;P〈0.05）,重症医学科护士核心能力评分均升高[（70.66±13.82）,（91.46±21.74）分],差异有统计学意义（t＝15.079,P〈0.05）。结论医护合作培训方法能够显著提高护士核心能力,提高重症医学科患者的PSA落实率,降低患者的UE与VAP的发生率。     

身体约束在ICU患者中的应用及分析

目的分析身体约束在重症监护病房（ICU）的应用现状,提出相应的护理对策。方法对2011年1月～8月入住我院ICU并实施身体约束或发生非计划性拔管的患者进行回顾性分析。结果 25例非计划性拔管事件中,约束患者较非约束患者多;胃管拔除率最高,其次为尿管,气管插管居第三位;因拔管引起医患纠纷1例。结论约束护理有待进一步规范,关键在于明确约束指征、加强约束告知、改善约束方法、应用保护性约束记录巡视单、加强约束教育等。     

柯氏评估模型在护士专业形象与行为规范培训中的应用

目的探讨柯氏评估模型在护士专业形象与行为规范培训中的应用方法与效果。方法便利抽样法选择原解放军广州总医院2015-2017年新入职的230名护士作为观察组,将柯氏评估模型运用于护士专业形象与行为规范培训中;选择2012-2014年新入职的230名护士作为对照组,采用传统教学方法进行授课,评价并比较两组护士培训后的理论、实践考核成绩及观察组护士的自我评价。结果培训后观察组护士的理论、实践考核成绩均优于对照组,观察组护士培训后的自我评价优于培训前,差异均有统计学意义(均P0.05)。结论将柯氏评估模型应用于护士专业形象与行为规范培训中能对培训需求和效果进行全方位的评估,有利于动态地调整培训方法和手段,促进培训质量的持续改进。     

An international survey of training in adult intensive care medicine

Objective The aim of this international survey of training in adult intensive care medicine (ICM) was to characterise current structures, processes, and outcomes to determine the potential for convergence to a common competency-based training programme across national borders. This survey is the first phase of a 3 year project which will use consensus methods to build an international competency-based training programme in ICM in Europe (CoBaTrICE).Methodology A survey by questionnaire, email, and direct discussion was undertaken with national ICM representatives from seven geographical regions.Results Responses were obtained from 41 countries (countries which share common training programmes were grouped together; n=38). Fifty-four different training programmes were identified, 37 within the European region; three (6%) were competency-based. Twenty (53%) permitted multidisciplinary access to a common training programme; in nine (24%) training was only available within anaesthesia. The minimum duration of ICM training required for recognition as a specialist varied from 3 months to 72 months (mode 24 months). The content of most (75%) ICM programmes was standardised nationally. Work-based assessment of competence was formally documented in nineteen (50%) countries. An exam was mandatory in twenty-nine (76%).Conclusion There are considerable variations in the structures and processes of ICM training worldwide. However, as competency-based training is an outcome strategy rather than a didactic process, these differences should not impede the development of a common international competency-based training programme in ICM.Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-005-2583-7The authors wrote this article on behalf of the CoBaTrICE Collaboration. For details see Appendix 3     

Chemical restraint and nursing care in the intensive care unit

The intensive care unit (ICU) presents patients with an environment that is unfamiliar and isolating. In addition to the relative severity of diseases treated, ICUs frequently employ tube therapy, complex medical treatments and diverse nursing routines. Such elevates the chances that patients will experience pain and anxiety, which, in turn, raise the likelihood of patient agitation and reduce ultimate treatment effectiveness. Research has shown that 71& of ICU patients experience agitation. Nurses have main caring responsibilities in such circumstances because they provide the greatest percentage of bedside care. The role of nurses is not only to assess patient needs in a timely fashion, but also to discuss with ICU physicians the level of chemical restraint needed in order to relieve patient pain and anxiety. As chemical restraints involve side effects, a study of patient airway status and breathing and circulation needs must be done prior to application. In terms of breathing, patient breathing sounds, patterns and saturation levels must be monitored regularly in order to identify airway distress preemptively. In terms of blood circulation, patients should have their blood pressure and body fluid status monitored concurrently at regular intervals. With such data, should a patient become hypovolemic, appropriate intravenous fluid support may be administered prior to chemical restraint use in order to help prevent advanced hypotension. Based on such, it is clear that ICU team members must work closely together in order to monitor and assess patients prior to administering chemical restraints and to put into place a patient-tailored safety care plan.     

理论与实践交叉培训模式在新护士危重症护理能力训练中的应用

目的探讨理论与实践交叉培训模式在新护士危重症护理能力训练中的应用效果。方法根据新护士对急危重症护理知识的需求情况,应用理论-实践交叉的培训模式对新护士实施培训。结果培训后新护士的理论成绩、技能成绩和临床综合能力较培训前提高,经统计学分析,均P0.01,差异具有统计学意义。结论理论与实践交叉的培训模式充分发挥了新护士的主体作用,使培训在时间和内容得以整合,相互贯通,护士综合素质得到提高。     

Expanding intensive care medicine beyond the intensive care unit

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.     

International standards for programmes of training in intensive care medicine in Europe

Purpose  

To develop internationally harmonised standards for programmes of training in intensive care medicine (ICM).