Advanced Nurse-Patient Communication System

Effective communication is the most important part of any healthcare organization. For many years, hospital nurse call solutions had been stand-alone systems with occasional integration to pocket paging for outputting patient call alerts to mobile staff. In the late 1990’s, technology enabled in-building wireless phones to supplement or replace paging systems as a means of not only sending alerts, but also enabling voice communication between mobile staff and patients. Today’s nurse call market requires integration of additional information from location and ADT (admit, discharge, transfer) systems into what have traditionally been nurse call applications. This system information is required not only at the nursing station, pagers, and phones, but also at PC’s placed on each patient care floor in hallways, nurse stations, and offices, and at areas away from the patients, including administrator and clinical engineering offices. It is crucial that nurses have the latest patient information in their hand wherever they go in the hospital. In this paper, MatchMaker.NET has been developed to integrate all these technologies into the hospital’s LAN to improve nurse-patient communication.     

实施流动护士站住院患者满意度调查

目的探讨流动护士站实施对住院患者满意度的影响。方法采用本院实行的住院患者满意度调查表,随机抽取住院患者或家属自行填写的2010年1月—2010年12月流动护士站实施前住院患者调查表120份及2011年1月—2011年12月流动护士站实施后住院患者调查表120份,将与本调查有关的调查结果汇总分析。结果流动护士站的实施,缩小了护患距离,提高了住院患者的生活护理到位率和健康知识知晓率,缩短了护士到病房的时间,降低了护患纠纷发生率,提高了住院患者满意度。结论流动护士站的实施不仅提高了护士的工作效率,而且提高了住院患者的满意度。     

我院护理人力资源现状分析与对策

通过对全院护理人力资源配置现状进行分析,发现病区护理人员编制严重不足,按开放床位与护理人员之比是1:0.39,住院病人按最低的960人/日计算,床护之比仅为1:0.325,而且医护比例失调,低于1:2的部颁标准,加之护理工作范围不断延伸扩大,治疗观念的改变等原因造成了护理人力资源的短缺.另外,病区护理人员基础学历低,高职称技术人员少,未能做到按职称上岗,使护理人员不能得以合理使用.针对以上问题提出了转变观念,科学合理地确定护理人员需要量.同时,完善后勤保障系统,实行护工制,提高护理人力资源的使用率,而且要统一调配护士,做到按职称上岗,还要建立合适的激励机制,挖掘护士的最大潜能,提高护士工作效率.     

呼吸内科病区噪声的监测与分析

目的 了解呼吸内科病区的噪声状况,为控制病房噪声,采取干预措施提供参考.方法 应用噪声测量仪连续动态测量呼吸内科病区72 h的每小时等效声级、最大声级、最小声级及各种噪声源的A声级.结果 呼吸内科病区昼间与夜间噪声强度都超过规定标准,其中护士站的等效声级高于病房,差异有统计学意义（P＜0.05）.交流说话声、呼叫声、电视机及收音机播放声、吸痰声、输液架及床护栏碰撞声等噪声源均超过80 dB,成为呼吸内科病区的主要噪声来源.在设置相同床位数的基础上,有危重患者的病房噪声水平高于无危重患者的病房;在普通病房中,3人间、4人间病房的噪声水平高于2人间,差异有统计学意义（P＜0.05）.结论 呼吸内科病区的噪声水平超过我国和WHO规定的标准,存在有多种来源的噪声.护士站、危重患者和床位数设置较多的病房应作为噪声控制的重点对象.     

护士分层级管理在NICU中的应用

目的探讨NICU分层级管理的方法和效果,以充分发挥各层次护士作用。方法2007年1月-2007年12月采用传统排班,2008年1月至2008年12月期间实施连续性排班,设置护理组长、责任护士及助理护士岗位职责,进行分层级管理及使用,比较分层级管理前后护士满意度、医生满意度以及实习护生满意度。结果（1）分层次管理实施前后22名护士对护士之间的团结合作性、工作积极性、工作效率等9方面满意度评分比较,差异具有统计学意义（P〈0．01）,实施分层次管理后护士满意度评分明显提高。（2）实施分层次管理后医生在执行医嘱及时性和及时准确发现患儿前瞻性信息等5方面满意度明显提高（P〈0．01）。（3）实施分层次管理后实习护生在自我管理能力和学习积极性等5方面满意度明显提高,差异具有统计学意义（P〈0．01）。结论实施分层级管理充分体现高年资护士的职业价值,对低年资护士起到了传帮带的作用,同时也减轻了年轻护士独立上班时的精神压力,利于护士成长;深入了解患儿病情,更快落实医生治疗方案,确保医疗护理安全,利于建立和谐医护关系;激发护生学习积极性,利于培养护生临床思维能力。     

Biological defense research: charting a safer course

Jacobson and Rosenberg comment on aspects of the U.S. Army's Biological Defense Research Program and propose shifting some responsibility for biological defense research to a civilian agency such as the National Institutes of Health. They call for more openness in the conduct of such research, and report on Congressional efforts to reinforce the 1972 Biological Weapons Convention. Finally, they suggest ways in which physicians can be sure that research on biological agents is conducted safely and appropriately and can work to decrease the threat of a biological arms race.     

护理伦理观念下以人为本的护患关系的建立

剖析护患关系目前存在的护士对护理职业道德的认识不到位、沟通方式不恰当、沟通技巧缺乏等问题,从六个方面提高护士的沟通能力,即:通过学习护理伦理学提升护士职业道德、牢固树立“以人为本”护患关系、搭建信任的平台、善用沟通技巧与艺术体现个性化沟通、善于运用护患沟通的形式、预防护患双方的不良情绪对沟通的影响.     

急危重症护士护理能力发展学习系统的研发

急危重症护士的护理能力对各类急危重症患者的初期救治质量和护理安全起着至关重要的作用。调研资料显示，新疆喀什地区急危重症专科护士培训资源匮乏。目前，我国尚未形成完善的急危重症专科护士培训体系，现有的急危重症专科护士培训资源也不能辐射至偏远的新疆地区。本文介绍了以案例模拟教学为基础的急危重症护士护理能力发展学习系统的研发，以期为新疆喀什地区各医院急危重症护士提供系统的专科培训。     

层级责任制护理模式在儿科中的应用

目的探讨层级责任制护理模式在儿科临床工作中的应用。方法将儿科病区13名护士进行分层级管理责任于人进行管床,设立护士长一高位责任护士一初级责任护士,按岗位分管床位,全面负责患儿的病情观察、治疗、护理、病区安全及家属沟通,使患儿得到及时、最适合的治疗和护理措施。结果基础知识技能、专业技能、急救技能、综合能力、病区安全管理、护理质量、护理文书等项目,实施层级责任制后显著优先实施前（P〈0．05）。患者对护理服务满意度差异有统计学意义（P〈0．05）;护士压力感降低。结论护理人员分层级管理,充分调动护士工作积极性,加强工作责任感,护士的综合素质和护理质量得到提升,充分利用现有护理人力资源,能提高工作质量和效率,使患儿得到更好更全面的照料,患者满意度提高,进一步提高了儿科优质护理服务的内涵。     

Assessing the Relative Performance of Nurses Using Data Envelopment Analysis Matrix (DEAM)

Assessing employee performance is one of the most important issue in healthcare management services. Because of their direct relationship with patients, nurses are also the most influential hospital staff who play a vital role in providing healthcare services. In this paper, a novel Data Envelopment Analysis Matrix (DEAM) approach is proposed for assessing the performance of nurses based on relative efficiency. The proposed model consists of five input variables (including type of employment, work experience, training hours, working hours and overtime hours) and eight output variables (the outputs are amount of hours each nurse spend on each of the eight activities including documentation, medical instructions, wound care and patient drainage, laboratory sampling, assessment and control care, follow-up and counseling and para-clinical measures, attendance during visiting and discharge suction) have been tested on 30 nurses from the heart department of a hospital in Iran. After determining the relative efficiency of each nurse based on the DEA model, the nurses’ performance were evaluated in a DEAM format. As results the nurses were divided into four groups; superstars, potential stars, those who are needed to be trained effectively and question marks. Finally, based on the proposed approach, we have drawn some recommendations to policy makers in order to improve and maintain the performance of each of these groups. The proposed approach provides a practical framework for hospital managers so that they can assess the relative efficiency of nurses, plan and take steps to improve the quality of healthcare delivery.     

我国护患关系存在的问题及对策

摘要“三分治疗七分护理”,在患者的治疗、康复过程中,护理工作起到了重要作用,而护患关系良好与否直接影响护患双方的心理状态与行为,进而影响疾病的治疗与恢复。当前我国护患关系并不十分和谐,护患纠纷时有发生。这其中既有护士方面的原因,也与患者要求不合理、信息不对称、医院管理以及社会不正确的舆论有很大关系。减少护患纠纷,建立和谐的护患关系,需要护士提高各方面的能力和素质,也需要医院管理方、政府及社会的共同努力。     

护士长目标管理的应用研究

目的探讨实施目标管理在护士长岗位管理中的应用效果。方法对25个护理单元31名护士长实施岗位目标管理责任制,签订目标管理责任书,制定量化考核方案及实施效果评价。年终评出优秀、合格、警戒、不合格4个等次,若连续两年考核不合格,劝辞护士长职务。结果实施岗位目标管理责任制前后比较：护士长主动管理意识增强,能力提高,奖励人数明显增多（P〈0.05）;护理质量、满意度以及科研均显著提高（P〈0.05）,医疗纠纷与投诉显著下降,管理前后比较差异有统计学意义（P〈0.05）。结论实施护士长岗位目标管理责任制,目标管理考核结果与护士长岗住能否续聘相结合,充分调动了护士长的积极性,促进了护理质量与医患满意度的提高,使护理学科进入可持续性的良性发展。研究结果表明,护士长目标管理是一种有效的激励管理模式,具有推广应用价值。     

儿科两种责任包干排班模式效果比较

目的:探讨适应于新生儿科患者的责任包干排班模式,提高优质护理的内涵质量。方法:两种排班方法均是将患者分为两大组,责任护士按照层级管理要求分组管床,每个患者都有固定的责任护士,每一个护士都有固定的分管患者。第一种排班模式,所有护士均上"APN"班;第二种排班模式,按照层级管理要求,N2级以上护士为责任护士上白班,每天工作7.5 h,每周休息1.5 d,N1级护士为机动护士,上"APN"班,每班工作8 h,每周休息2 d,责任护士每周有5.5 d负责自己的患者,休息时由同组的机动护士代管。然后,比较两种责任包干排班模式,住院患者对优质护理开展的知晓率,对责任护士知晓率和责任护士提供的生活照顾的满意度。结果:第二种排班模式住院患者满意度明显高于第一种排班模式。结论:合理的排班模式,是保证责任护士,对患者从入院直至出院全过程,均做到全面、协调、个体护理的关键。     

本科护士规范化培训的探讨

随着护理高等教育的发展，越来越多的护理本科生将走向临床，从事护理工作；结合护理本科生的特点，通过一年有计划、有目标、有针对性地规范化培训，可以使新护士尽快适应医院环境，完成从学生到护士的角色改变，更好适应临床护理工作。     

Factors affecting the future employment of new graduate nurses as home-visiting nurses: a cross-sectional study in Japan

Objective: In Japan, home-visiting nurse (HVN) stations are at the frontline of providing home-based medical care and end-of-life care. The nursing authorities aim to establish an education program that allows new graduate nurses to become home-visiting nurses. However, previous studies have indicated gaps in education between new graduates recently employed as HVNs and experienced home-visiting nurses. The present study further investigates the factors influencing the recruitment of new graduates as home-visiting nurses.Methods: Self-administered questionnaires were sent to 2,000 HVN stations randomly selected from the 5,565 registered home-visiting nurse stations throughout Japan. The survey covered three main areas, namely, those concerning the respondent (6 items), the home-visiting nurse station (8 items), and the nursing services provided (12 items).Results: Four of the 26 items were statistically significant, and only one of these was determined by multivariate logistic regression analysis to be an independent factor for accepting new graduates as home-visiting nurses. This factor was undergraduate home-visiting nurse training for student nurses (OR=1.916, CI=1.124–3.267).Conclusion: To increase the recruitment of new graduates as home-visiting nurses, these findings suggest that nursing schools nationwide and home-visiting nurse stations should further cooperate with the specific aim of increasing the provision of practical training at home-visiting nurse stations for pre-graduation student nurses.     

妇产科护理提示的作用研究

目的对妇产护理提示作用的效果进行分析评价。方法建立护理提示制度,确立提示内容,近2年对妇产科17名护士采取问卷调查的方式,同时有针对性地研究一些孕产妇或家属资料,进行统计分析。结果（1）通过护理提示工作,护士工作纪律性和成就感有很大的提高;（2）孕产妇和家属对护士提供的医疗服务比较满意,护妇关系得到很大的改善;（3）护士对内部管理工作比较满意,对职务晋升,加薪,个人评先工作的透明性感到满意;（4）护士团队精神得到改善,护士交接班工作顺利;（5）通过护士提醒等工作在妇产科的示范作用,该制度在全院得到很好的推广,并得到高度好评。结论护理提示工作可以有效地改善护妇关系,降低护士在妇产科护理工作中的压力,同时提高了工作效率和管理的透明度,护士团队精神得到有效培养。     

A computer-based,automated, telephonic system to monitor patient progress in the home setting

In this report we describe an automated, telephonic system to monitor the progress of patients convalescing at home. The system includes a computerized central station that is capable of automated voice communication over the telephone, using voice reproduction, and touch-tone recognition. Peripheral hardware in multiple monitored homes need include only a touch-tone telephone, but may also be augmented by inexpensive, rudimentary diagnostic aids, such as a scale for body weight, a thermometer, or a blood pressure cuff and manometer. Current central hardware includes a NeXT computer, a fax modem, and a specialized telecommunications modem developed specifically for voice telecommunication using the NeXT. The central station acts like a robotic nurse in that it asks patients a series of questions and records the responses. The subjective questions to be asked are patient individualized and pre-selected by the physician from a question menu including items targeted specifically for the patient's disease or condition. In addition, clinical data such as body weight, blood pressure, and body temperature obtained from in-home diagnostic aids may be transmitted to the central station over the telephone using touch tones. The time-of-day and frequency of calling are pre-selectable, according to the patient's preference and clinical status. Data obtained by the central station can be easily accessed by the duty nurse via menu driven software. Reports depicting significant responses as a function of time are generated in graphical format to facilitate rapid identification of adverse trends. Hard copy reports can be dispersed directly by fax. Results from a pilot study show patients with cardiac disease readily use the system without difficulty or complaints. In one patient a five pound increase in body weight was detected, which prompted the patient's cardiologist to adjust his medication. In this way automated telephone follow-up can provide early detection of complications before they become severe, making the home environment safer and more secure for convalescence and contributing to reduced health-care costs.     

Development of a Computer-Aided Clinical Patient Education System to Provide Appropriate Individual Nursing Care for Psychiatric Patients

A lot of researches have proven that health education can help patients to maintain and improve their health. And it also shortens the time staying in hospital to save medication resource. Because the patients are willing to get healthcare knowledge to enhance the ability of self-care, they pay more attention to the health education. In Taiwan, the clinical nurses play an important role in patient education, and the health education take most time in their daily work. Such work includes the collection, production and delivery of education materials. To generate the correct and customized health education material is the key of success of patient education. In this study, we established a computer-aided health education contents generating system for psychiatric patients by integrating the databases for disease, medicine and nursing knowledge to assist nurse generating the customized health education document suitable for different patients. This system was evaluated by clinical nurses in usability and feasibility. This system is helpful for nurse to carry out the clinical health education to patients and further to encourage patient to pay attention to self-health.     

92名急诊科护士自我效能感调查分析

目的了解急诊科护士自我效能感的现状并分析其相关影响因素,旨在为促进急诊科护理工作的进步提供一定的参考。方法以方便抽样的方法,采用自行设计的基本情况资料问卷和一般自我效能感量表,对福州市两家三级甲等综合性医院92名急诊科护士进行问卷调查。结果92名急诊科护士自我效能感平均得分为2．06±0．51分;经单因素分析,不同工作年限、编制、行政职务、夜班情况等护士自我效能比较,差异有统计学意义（P〈O．05）,经多元回归逐步回归分析,F统计量为10．80,显著性水平为0．002,行政职务是其影响因素。结论急诊科护士自我效能得分总体偏低,建议从自我综合能力培养、岗位编制等方面来提高急诊科护士的自我效能。     

分析现代护士压力源及对策

目的了解现代护理人员的工作压力应激的特征和规律,并掌握控制应激的对策。方法回顾性总结和分析护理人员工作压力应激影响因素。结果工作风险大,工作负荷重,社会地位低,自我价值感缺失与工作和家庭冲突多等均是现代护士压力源的重要因素。结论为护士提供良好的工作环境及待遇,保证护士的权益,使护士得到社会的支持及重视,协助护士提高自身的心理素质,正确认知压力和认识自身价值,可以有效缓解其工作压力,有利于护士身心健康。