急诊科护士完美主义与专业自我概念的调查研究

目的描述急诊科护士完美主义和专业自我概念现状,探讨急诊科护士完美主义与专业自我概念的相关性。方法对149名急诊科护士运用中文版多维完美主义心理量表和护理专业自我概念量表进行测试。结果急诊科护士完美主义均分为(3.24±0.49)分,专业自我概念均分为(2.95±0.44)分,急诊科护士完美主义与专业自我概念呈显著性负相关(P<0.01或P<0.05)。结论急诊科护士完美主义、专业自我概念分别是中等水平和积极的。护理管理者可加强对急诊科护士的培训以进一步提高其专业自我概念程度。     

Injured road users' experience of care in the emergency department

Aim. To describe the patients’ perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients’ background characteristics and estimated QoC. Background. Each year 1·4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road users’ perceived QoC, or how important they rate different caring dimensions. Design. Cross‐sectional study at the ED, in the University Hospital in Umeå, Sweden. Method. A stratified consecutive sample of 166 car occupants, 200 cyclists and 199 pedestrians, aged 18–70 years, all injured in the traffic environment. Data were collected from medical records and from a mail survey using a short form of the Quality from the Patient's Perspective questionnaire, modified for ED use. The statistical methods used included Mann–Whitney's U‐test, the Kruskal–Wallis test and multiple logistic regression. Results. The perceived QoC and the subjective importance of the corresponding QoC dimensions were rated at the ‘better’ half of the rating scale, with no differences between the different road user categories. The most prominent factors associated with a positive perceived QoC rating were a short waiting time, moderate or serious injuries and high age as well as high educational level of the injury victim. For the subjective importance, a short waiting time was rated as the most important but slight differences were seen, related to education and sex. Conclusion. The association patterns between the areas of perceived reality and subjective importance indicated that expectations were higher than perceived QoC, suggesting that patients expected somewhat higher QoC than they received. Relevance to clinical practice. Information on factors causing long waiting times, adapted to patients’ age, sex and educational level, may reduce dissatisfaction among long waiting patients, especially among those with minor injuries.     

Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital

This study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54±2.36 years (range, 4–89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment (P=.053). A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). It was concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.     

粤港两地部分急诊科医护人员对哀伤关顾认识的调查分析

目的 调查粤港两地部分急诊科医护人员对哀伤关顾的认识情况,为国内开展哀伤关顾护理提供理论依据.方法 自行设计对哀伤关顾的认识调查问卷,对香港各大联网医院的急诊科医护人员、本省各地区赴港学习的急诊科专科护士和本院急诊科医护人员进行调查,了解他们对哀伤关顾的认识情况.结果 香港急诊科医护人员对哀伤关顾的认识(100.0％)、参加过哀伤关顾培训(100.0％)、实施过哀伤关顾(100.0％)以及具备的哀伤关顾技能(100.0％)都比较好,并认为有必要开展哀伤关顾(98.8％)和愿意加入哀伤关顾小组(86.3％);而赴港学习的本省急诊科专科护士和本院急诊科医护人员对哀伤关顾的认识、参加过哀伤关顾培训、实施哀伤关顾以及所具备的哀伤关顾技能基本处于较少或无的状态,对于是否有必要开展哀伤关顾和愿意加入哀伤关顾小组,赴港学习的本省急诊科专科护士有92.6％认为有必要,85.2％愿意加入;而本院急诊科医护人员84.1％认为有必要,63.2％愿意加入.结论 国内医护人员对哀伤关顾的认识以及对病人实施哀伤关顾较少,学习并引进香港以及国外关于哀伤关顾的知识,结合本国国情发展和完善本土哀伤关顾文化非常重要.     

The use of multidose vials and fingerstick blood sampling devices in Korean emergency departments and intensive care units

This study was performed to compare compliance with standard precautions for the use of multidose vials (MDVs) and fingerstick devices in emergency departments (EDs) and intensive care units (ICUs). Between December 2007 and February 2008, 389 nurses from the EDs or ICUs of six university-affiliated hospitals in Korea were asked to complete the questionnaire. A total of 338 (86.9%) nurses completed the survey, corresponding to 159 of 184 ED and 179 of 205 ICU nurses. A comparison of MDV use in EDs and ICUs indicated a significant difference only in disinfection of the rubber septum of heparin vials; 88.1% of ED nurses and 96.6% of ICU nurses stated that they always disinfected the rubber septum of heparin vials whenever drawing medication (P = 0.003). The use of separate fingerstick devices for each patient (71.7% vs. 54.5%) and disinfection of these devices after each use (36.5% vs. 26.0%) were more common in ED nurses. The rate of good hand hygiene was lower in ED nurses, both before (43.7% vs. 74.3%) and after (64.6% vs. 91.6%) the use of fingerstick devices (P < 0.001 for both). There is a need to improve compliance with standard precautions, especially hand hygiene, in EDs.     

GPs' use of defibrillators and the national radio network in emergency primary healthcare in Norway

Objective

To study the geographic size of out-of-hours districts, the availability of defibrillators and use of the national radio network in Norway.

Design

Survey.

Setting

The emergency primary healthcare system in Norway.

Subjects

A total of 282 host municipalities responsible for 260 out-of-hours districts.

Main outcome measures

Size of out-of-hours districts, use of national radio network and access to a defibrillator in emergency situations.

Results

The out-of-hours districts have a wide range of areas, which gives a large variation in driving time for doctors on call. The median longest transport time for doctors in Norway is 45 minutes. In 46% of out-of-hours districts doctors bring their own defibrillator on emergency callouts. Doctors always use the national radio network in 52% of out-of-hours districts. Use of the radio network and access to a defibrillator are significantly greater in out-of-hours districts with a host municipality of fewer then 5000 inhabitants compared with host municipalities of more than 20 000 inhabitants.

Conclusion

In half of out-of-hours districts doctors on call always use the national radio network. Doctors in out-of-hours districts with a host municipality of fewer than 5000 inhabitants are in a better state of readiness to attend an emergency, compared with doctors working in larger host municipalities.     

Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study

Objective: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation.

Study design: A cross-sectional analysis of longitudinal population data. Setting. PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. Subjects: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014.

Main outcome measure: ES utilisation.

Results: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices—Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23–0.57 for UPC, 0.12–0.43 for CoCI, and 0.25–0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59.

Conclusion: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.     

Victimization from Physical Violence in Pennsylvania: Prevalence and Health Care Use

Objectives : To determine the prevalence of interpersonal physical violence (IPV) among Pennsylvania adults, to identify the personal characteristics of the victims, and to determine their health care use for resulting injuries.
Methods : Population-based data describing physical violence were obtained through a statewide telephone survey of 3,620 Pennsylvania adults selected from households by random-digit dialing in 1994. The prevalence and 95% confidence interval (95% CI) of victimization from IPV along with ED or other medical care facility use for IPV-related injuries were computed by several personal characteristics. Logistic regression was used to compare victims of IPV and their levels of health care use.
Results : The prevalence of reported victimization from IPV was 5.6% (95% CI = 4.9, 6.3). Significantly more victimization was reported by males, persons aged 18–29 years, those employed, and unmarried persons. The proportion of victims who reported to have gone to an ED or other medical care facility for IPV-related injury treatment was 12.9%. Significantly more persons with annual household incomes <$20,000 reported health care use for injuries resulting from IPV than did those with incomes of ≥$20,000 (OR = 3.98; 95% CI = 1. 27, 12.48). Health care use for injuries was not found to be related to gender, age. race, employment, or marital status.
Conclusions : This population-based study of health care use for IPV-related injuries found that victims of physical violence in Pennsylvania were not only young and unmarried men, but also employed. Health care use for resulting injuries was greater among persons with lower incomes.