恶性肿瘤患者临终关怀护士岗位胜任力指标体系的构建

目的构建恶性肿瘤患者临终关怀护士岗位胜任力指标体系。方法在质性研究基础上,拟定初期指标体系及专家函询问卷,通过两轮Delphi专家咨询,确定指标及各级指标权重。结果两轮函询问卷的有效回收率分别为100.00%和88.89%,专家的权威系数为0.875,两轮函询总指标重要性的专家意见肯德尔协调系数由0.123增至0.379(P<0.01)。最终构建了涵盖4个一级维度、14个二级维度和83个三级条目的恶性肿瘤患者临终关怀护士岗位胜任力指标体系。结论本研究构建的恶性肿瘤患者临终关怀护士岗位胜任力指标体系符合我国基本国情,对恶性肿瘤患者临终关怀护士的岗位培训、考核评价、能力培养等具有借鉴意义。     

以SMG为视角的社区老年人健康管理能力评价指标体系构建

目的探讨社区老年人健康管理能力评价指标体系。方法基于社会现状和政策导向,采用文献回顾法和头脑风暴法初步拟定评价指标,通过修正式德尔菲法对28位专家进行两轮专家咨询,进一步遴选指标,采用层次分析法确定各指标权重。结果两轮咨询的专家积极系数分别为93.33%、100.00%,专家的权威系数、判断系数和熟悉程度系数分别为0.76、0.87、0.66。最终确定的指标体系包含3个一级指标、14个二级指标和75个三级指标。结论构建的指标体系科学性与系统性良好,涵盖老年人健康管理的核心要素,能够科学准确地评价社区老年人的健康管理能力。     

社区-居家式老年人长期护理的服务内容

目的 探讨社区-居家式老年人长期护理应当包含的各类服务项目内容,为政府和相关部门提供参考依据.方法 采用文献分析法和Delphi法,对18名专家进行两轮专家咨询.结果 两轮专家咨询积极系数分别为85.7%、100%;所选专家涉及公共卫生、卫生管理、临床护理、护理教育、社会工作领域,具有较好的学科代表性,专家权威程度达到0.822;两轮专家意见的肯德尔协调系数均有显著性,说明专家意见协调性好;最终确定社区-居家式老年人长期护理服务内容三大类共16项.结论 专家咨询积极性和权威性好,专家意见协调性好,有较强可靠性,得出包含日常生活照料等在内的社区-居家式老年人长期护理服务内容体系共计三类16项内容.     

输入性疟疾再传播风险评估指标体系的构建

目的　构建输入性疟疾再传播风险评估指标体系。方法　通过文献综述、专题讨论初步构建输入性疟疾再传播风险评估指标体系。选择26名疟疾防治专家,采用德尔菲法对指标体系开展2轮专家咨询,根据专家对每项指标的熟悉程度、判断依据和重要性评价计算专家积极系数、专家权威系数、专家协调系数、各指标变异系数,根据上述结果进行指标筛选并计算各指标权重;采用Cronbach’s α系数评价指标体系信度,采用专家权威程度系数评价指标体系的内容效度,采用KMO检验和因子分析评价指标体系的结构效度。结果　共23名专家完成2轮专家咨询,最终构建了一个包含3个一级指标、7个二级指标、21个三级指标的输入性疟疾再传播风险评估指标体系。第2轮专家积极系数（100.00% vs. 88.46%）和专家协调系数（0.372 vs. 0.286, P均< 0.01）均高于第1轮。第2轮专家咨询后,各级指标专家权威程度系数为0.757～0.930,一、二、三级指标变异系数分别为0.098～0.136、0.112～0.276、0.139～0.335;指标体系整体Cronbach’s α系数为0.941;一（KMO值= 0.523,[χ2] = 18.192,P < 0.05）、二（KMO值= 0.694,[χ2] = 51.499,P < 0.01）、三级指标（KMO值= 0.519,[χ2] = 477.638,P < 0.01）KMO值均有统计学意义;三级指标6个主成分累积贡献率为84.23%。传染源、传播条件及防控能力3个一级指标归一化权重分别为0.337、0.333和0.329;归一化权重居前3位的二级指标依次为输入性病例数及虫种（0.160）、输入性病例入境及就诊情况（0.152）、媒介种类及密度（0.152）;归一化权重值居前5位的三级指标依次为输入性病例虫种（0.065）、媒介种群（0.064）、患者发病至就诊时间间隔（0.059）、输入性病例数（0.056）及从就诊至确诊时间间隔（0.055）。结论　成功构建了输入性疟疾再传播风险评估指标体系,为消除后开展输入性疟疾再传播风险评估和加强重点风险因素防控提供了科学依据。     

基于德尔菲法构建老年健康状况评价表

目的构建适用于中国国情的老年健康状况评价表,提高老年健康评估水平。方法首先采用文献分析法,全面检索PubMed、Springer、CNKI、维普及万方数据库,筛选与老年健康评价密切相关指标、量表和问卷,建立备选指标池。然后采用Delphi法,收集国内相关领域专家的意见,筛选指标。最后以专家咨询结果为基础,根据第三级指标的操作定义编制问卷。结果共纳入66个量表和问卷,合并重复指标后形成3个一级指标、8个二级指标和84个三级指标。开展的两轮专家咨询专家积极系数分别是86.0%、100.0%;专家权威系数是0.860;重要性评分Kendall和谐系数是0.405(P0.05),建立的问卷包括64个条目,分属"社会适应"、"生理健康"、"精神健康"8个维度。结论采用文献分析法和Delphi法,成功编制了老年健康状况评价表,为老年健康评估提供科学依据。     

高原山区血吸虫病防治效果评价指标的研究

目的构建高原山区血吸虫病防治效果评价指标体系,为该地区综合评价血防效果提供科学依据。方法应用文献分析法初步确定一级、二级评价指标;经第1轮专家咨询法对指标进行筛选,通过第2轮专家咨询法得到各个指标的权重值。结果血防效果评价指标体系包括3个一级指标和6个二级指标。一级指标中“家畜感染”的权重系数最大,为0.36;二级指标中“家畜感染率”的权重系数最大,为1.00。结论建立了符合高原山区实际的血防效果评价指标体系。     

基于德尔菲法的老年衰弱筛查量表研究

目的通过德尔菲法筛选、优化老年衰弱筛查评估量表的维度与条目,为制定老年衰弱筛查量表提供依据。方法在前期文献复习并形成条目池的基础上,编制老年衰弱专家咨询表,对27名老年相关研究领域的专家进行德尔菲专家咨询。结果两轮专家咨询问卷的回收率均为92.6%,权威系数均数分别为0.85和0.87。两轮条目的内容重要性协调系数分别为0.104、0.107,评价可行性协调系数分别为0.153、0.154。初步纳入条目池3个一级指标、10个二级指标、共37条目,经过专家咨询,删除11条目并修改11条目。经筛选修改后的量表含有2个一级指标、8个二级指标共22条目。结论通过对有代表性的专家进行德尔菲咨询,本研究形成了符合WHO内在能力理论的衰弱筛查量表,为后续量表修订和信效度奠定了基础。     

县级免疫规划工作综合评价指标体系的构建

目的建立一套科学可行且能较好地评价县级免疫规划工作的指标体系。方法采用德尔菲法(Delphi)进行3轮专家咨询筛选指标,并确定权重,应用加权评分法进行综合评价实证分析。结果经过3轮专家咨询,删除了15项三级指标,并对部分指标进行了合并修改,最终确定一级指标4项、二级指标16项、三级指标64项的免疫规划评价指标体系,专家对一级、二级和三级指标的Kendall’s W分别为0.54、0.11和0.19,差异均有统计学意义(均P0.001),专家意见协调程度较好,实证分析应用良好。结论建立的免疫规划综合评价指标体系结构合理、内容全面、针对性强,适于县级评价工作,可推广应用。     

Kato-Katz法检测土源性线虫病现场评价体系的建立

目的　建立Kato?Katz法检测土源性线虫病现场评价体系,为Kato?Katz法的现场应用提供参考。方法　通过文献查询、头脑风暴法和专家咨询法初步确定Kato?Katz法检测土源性线虫病现场评价指标体系;采用专家咨询法,通过3轮专家咨询完善评价指标体系并计算各指标权重,同时计算各轮专家咨询各指标的专家权威系数和协调系数。结果　3轮专家咨询的问卷回收率分别为100.00%、100.00%和89.29%,各指标专家权威系数均> 0.85。最终确定了包含4个一级指标和15个二级指标的评价体系。一级指标中“检测效果”和“投入经费”的加权均值分别为4.53和4.49,相对高于“投入人时”和“可操作性”（加权均值均为4.34）;二级指标按重要性大小排序依次为“检测人员虫卵形态鉴别能力”、“村干部和村医配合度”、“检测人时”和“组织发动费用”,其加权均值分别为4.74、4.43、4.39和4.17。第1～3轮专家咨询各指标协调系数范围分别为0.39～0.65、0.28～0.58和0.45～0.65,且3轮专家咨询各指标协调系数差异均有统计学意义（P均 < 0.05）。结论　本研究建立了Kato?Katz法检测土源性线虫病现场评价体系。在该指标体系中,“检测人员虫卵形态鉴别能力”和“村干部和村医配合度”重要性加权均值最高。     

糖尿病足病多学科诊疗规范指标及流程的构建

目的构建我国糖尿病足病(DF)病多学科诊疗规范流程,为DF的综合管理提供框架。方法查阅国内外文献,根据DF国际临床共识,由北京市某三甲医院DF多学科团队医师撰写指标初稿并形成专家咨询问卷,对全国10个省、直辖市内分泌、修复重建外科、血管外科的28名专家进行3轮专家咨询,确立DF多学科诊疗规范指标。选取北京地区16名相关领域专家进行流程的专家论证会,最终确定规范流程。结果 3轮专家咨询问卷回复率一次为93.3%,其余100%。专家咨询的权威系数为(0.91±0.02)。第3轮专家咨询中,二级指标的重要性赋值均数3.57～4.89,变异系数0.06～0.30。通过德尔菲法专家咨询,得出DF多学科诊疗规范,共包括8个一级指标,58个二级指标,并在专家论证会讨论基础上形成流程图。结论本研究构建了DF多学科诊疗规范指标及流程,为DF患者的综合管理提供了框架。     

上海市参与新型冠状病毒肺炎危重症护理护士胜任力和应对能力现状分析

目的 ：调查上海市参与新型冠状病毒（新冠）肺炎危重症护理护士的重症监护病房（intensive care unit,ICU）胜任力和传染病突发事件应对能力现状,并分析其影响因素。方法 ：采用便利抽样法抽取上海市6所三级甲等医院参与过新冠肺炎ICU工作的护士234名为研究对象。按原科室属性分为ICU组和非ICU组,采用ICU护士胜任力调查问卷和医护人员传染病突发事件应对能力调查问卷分别进行调查。结果：回收有效问卷234份,其中ICU组44份,非ICU组190份。2组ICU护士胜任力均处于良好水平,ICU组[（82.23±10.02）分]高于非ICU组[（71.14±11.36）分]（P<0.05）,ICU组的良好及以上水平达到70.5%,非ICU组仅56.9%,而ICU组处于合格及以下水平的护士占29.5%。传染病突发事件应对能力ICU组为（3.62±0.70）分,非ICU组为（3.50±0.65）分,ICU组在准备、救援和整体应对能力均显著高于非ICU组（P<0.05）。多元线性回归显示,工作年限、是否具有突发事件应急救援经历和传染病突发事件应对能力等级是参与新冠肺炎危重症...     

An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China

BACKGROUND: In the event of a large-scale infectious disease outbreak, hospitals will play a critical role. The objective of our study is to understand the current status of hospitals preparedness for infectious disease outbreaks in Beijing and to provide basic information for infectious disease prevention and control in hospitals. METHODS: One hundred fifty-two secondary and tertiary care hospitals in Beijing were surveyed by a standardized questionnaire. Data related to hospital demographic information and their emergency plans, laboratory diagnosis capacity, medical treatment procedures for infectious diseases, stockpiles of drugs and personal protective equipment, and staff training were collected. RESULTS: Responses were received from 134 (88.2%) of the 152 hospitals surveyed. Overall, hospitals reported that the number of physicians and nurses in infectious disease accounted for only 1.8% of the total physicians and 2.5% of the total nurses, and surgery beds accounted for 8.5% of all the fixed beds. Approximately 93.3% of the hospitals surveyed reported that they had an emergency plan, and none of those reported that their laboratories were able to isolate and identify all 8 kinds of common pathogens of infectious diseases: 22.4% of the hospitals had medical treatment procedures for all these infectious diseases, 23.1% had stored specific drugs for treatment, 2.2% had all personal protective equipment, and 30.6% reported that their health care staff had been trained in hospital emergency preparedness for infectious diseases. In general, emergency preparedness for infectious diseases in tertiary care hospitals was better than that in secondary care hospitals; the preparedness at general hospitals was better than that at specialized hospitals; and that at teaching hospitals was better than that at nonteaching hospitals. CONCLUSION: Emergency preparedness for infectious disease at hospitals in Beijing was in an early stage of development during this survey. Comprehensive measures should be developed and implemented to enhance their capacity for infectious disease emergency.     

Improving hospital surge capacity: a new concept for emergency credentialing of volunteers

In the event of a large-scale terrorist attack, natural disaster, or other public health emergency, hospitals could not absorb the thousands of victims generated by the catastrophe. Even if hospitals can increase bed capacity by 20% to 30%, as some suggest, the problem of staffing these beds remains unresolved. One possibility is to rapidly increase hospital staff by providing emergency credentialing to volunteer health care professionals. Several organizations and systems currently exist that can deliver medical providers to a stricken area. Unfortunately, all of these have serious limitations that would make it difficult for hospitals to use the health care workers provided by such entities. We propose a unique concept that will allow hospitals to rapidly expand their staff with practitioners that meet their credentialing requirements. The concept is a database created by each hospital in a community that includes credentialed physicians, nurses, behavioral health professionals, and ancillary staff. The database will be limited to physicians with full privileges and all licensed hospital employees in good standing not currently facing disciplinary issues or practice restrictions. The individual databases would then be combined and stored on a single computer system housed at the county health care agency or other mutually acceptable organization, with copies sent back to participating hospitals and the state. After a large disaster, health care workers from unaffected areas, including other states, can approach affected hospitals and volunteer their services. Practitioners listed on the database could be given privileges in their specialties for 72 hours. This process is accurate, inexpensive, efficient, sustainable, and Joint Commission on Accreditation of Healthcare Organizations compliant and permits the immediate credentialing of large numbers of medical volunteers.     

Do we practice what we preach? Health care worker screening and vaccination

OBJECTIVE: To describe the current screening and immunization practices in New South Wales (NSW) hospitals and the experience of NSW nurses in relation to screening and immunization and to identify areas that can be targeted for improvement. DESIGN: This was a cross-sectional survey. SETTING: The study was performed in NSW, Australia. METHODS: We used a written questionnaire to survey the infection control/occupational health coordinators of all of the 85 private hospitals and 204 eligible public hospitals in NSW and 800 randomly sampled registered nurses. RESULTS: Response rates were high (hospitals [90%], nurses [70%]). Hospitals almost universally offered hepatitis B vaccination to nurses (251/261, 96%), but more than one quarter (132/473, 28%) of nurses reported incomplete vaccination. Provision to physicians was relatively poor (142/261, 54%). The majority of nurses (> 80%) had been vaccinated with bacille Calmette-Guérin vaccine, but hospitals reported variable tuberculosis screening practices. Both hospitals and nurses reported low rates (< 30%) of screening and vaccination provision for varicella and measles-mumps-rubella. Two thirds of NSW hospitals (174/261, 67%) provided annual influenza vaccination. CONCLUSIONS: Even though hepatitis B immunization programs were widespread, their effectiveness could be improved by ensuring that vaccination schedules are completed and by targeting physicians. Varicella and measles-mumps-rubella screening and immunization programs are currently lacking. Better strategies are needed to improve the implementation of health care worker protection guidelines in hospitals.     

Understanding level on tuberculosis among hospital nurses

Tuberculosis control in big cities should be focused on preventing defaulting from treatment, and the prevention of the emergence of multi-drug resistant tuberculosis, and the improvement of treatment success rate. Since it is needed to organize continued case management system starting from hospitalization, discharge, management of regular drug taking at outpatient clinics and final cure, close collaboration should be made between hospital nurses and public health nurses. For this purpose, there should be no difference about the understanding on tuberculosis control between clinical and public health nurses. This research was aimed to examine "How much interest and recognition do hospital nurses have about tuberculosis control." The Aichi Nursing Association cooperated with this research. The results showed that 60% of tuberculosis ward nurses were more than forty years old, and they have served more than ten years in TB word. The levels of understanding on tuberculosis among nurses working in tuberculosis hospitals were much higher than those in general hospitals. However, it is necessary to organize a collaboration system between hospitals and public health center to improve TB case management.     

不同级别医院医师对快速型心律失常急诊处理的调查

目的:调查各级医院医师对快速型心律失常急诊处理的现状及存在的问题,为进一步规范化治疗提供依据.方法:2016年1月至2019年12月对存在急诊快速型心律失常患者较多的科室(包括急诊科、心内科、冠心病监护病房、重症监护病房等)中的医师进行问卷调查.调查共纳入全国东北、华北、华东、华中等地区8家医院,包括4家三级综合医院、...     

50所三级甲等医院糖尿病教育现状调查研究

目的了解我国三级甲等医院开展糖尿病教育的现状及评估各级人员对糖尿病教育的认识和支持。方法2007年10月至2008年3月对我国50所三级甲等医院糖尿病科护士长或专职糖尿病教育护士及医院各级人员进行问卷调查。结果38所医院设置糖尿病专科护士,专职教育护士共47名,13所医院开设糖尿病教育护士门诊;76．0％医院对教育效果进行了评价,其中42．1％医院采用主观判断;48．0％医院开展了糖尿病教育科研,但高质量的论著较少。各级人员对开展糖尿病教育的认识和支持态度：所有调查对象认为糖尿病教育是必要的;非内分泌专科护士对所在医院糖尿病教育情况了解比例最少;90％以上人员都愿意为糖尿病教育活动及专科培训提供支持和帮助。结论建设完整的糖尿病教育团队、加大对糖尿病专科护士的培养工作、建立一个统一规范的糖尿病教育效果评价指标体系已迫在眉睫。     

应用德尔菲法建立寄生虫病健康教育作品评价体系

目的 应用德尔菲研究方法建立寄生虫病健康教育作品评价体系,为健康教育作品评价提供参考。方法 成立专家组,通过头脑风暴和面对面讨论确定寄生虫病健康教育作品评价指标。而后基于评价指标设计问卷,通过两轮专家咨询,最终确定各评价指标的权重,形成完整的寄生虫病健康教育作品评价体系。结果 专家组分别确定了平面作品、实物作品和影音作品的评价指标,3类作品分别包含4个一级指标和12个二级指标。通过两轮专家咨询,23位专家达成了一致意见,认为在一级指标中最重要的是作品的“科学性”和“可接受性”;而在二级指标中,“信息准确性”和“行为指导性”最为重要。结论 建立了科学、合理的评价体系,该体系可应用于寄生虫病健康教育作品的综合评价。