麻醉护理现状调查与专业构建思路

目的了解广东省医院麻醉护理人力资源现状,据此提出麻醉护理专业设置思路,为护理院校正式设置麻醉护理专业提供参考。方法采用自行设制的问卷对广东省117所医院麻醉科护理人力资源现状进行调查。结果117所医院麻醉科4项机构设置中除均设立了临床麻醉外,麻醉恢复室、麻醉ICU及疼痛诊疗的设置分别为43所、22所及50所医院;有麻醉医生1278人、麻醉护士505人,医护比为1：0.40;手术台与麻醉护士比为1：0．11,麻醉恢复室床护比为1：1．00,麻醉ICU床护比为1：1．91。麻醉护士学历：中专54．1％,专科38．4％,本科7．5％;职称：初级73．8％,中级21．4％,高级4．8％。结论广东省医院麻醉机构设置不完善,护理人力资源短缺,学历、职称偏低。尽早设置规范的本科层次麻醉护理专业是从根本上改善上述状况的有效途径。     

孝感市新生儿病区护理人力资源配置与人员结构调查

目的了解孝感市新生儿病区护理人力资源配置与人员结构,为当地卫生行政主管部门及医院管理者制定相关政策与管理策略提供依据。方法自行设计调查表,采取实地查看、查阅资料、询问护士等方式,对孝感市辖区内15所二级及以上医疗保健机构的新生儿病区护理人力配置与人员结构状况进行调查。结果15所医疗保健机构普通病房核定床护比为1∶0.75～1∶1.15,NICU核定床护比为1∶1.87～1∶2.17;三级医院与综合医院NICU实际床护比分别为1∶1.06与1∶1.58,中医医院实际床护比达1∶3.40。92.2%护士学历为大专及以上,但职后学历占63.6%,初级职称(护师与护士)占83.1%,30岁以下护士占70.1%,护士工作年限、专科工作年限5年内者分别占58.5%、64.3%。结论孝感市新生儿病区核定床护比已达卫生部配置标准,三级医院与综合医院NICU人力资源实际配置不足,中医院存在护理人力过剩现象;护理队伍呈低年资、低职称现状;护理人力资源存在分布不均、结构梯队不合理现象。     

广东省三级医院麻醉科护士工作岗位现状调查

目的 了解广东省三级医院麻醉科护士人力、工作岗位现况,为麻醉护理单元的建设提供参考。方法 采用自制问卷,对广东省76所三级医院麻醉科护士及工作岗位、时长进行调查。结果 76所医院共有麻醉科护士547名,麻醉医护比例为1∶0.25。工作岗位开展中最高为总务工作,开展率96.05%,最低为麻醉诱导室护理（18.42%）。工作周时长最高56 h,最低8 h,中位数37 h。结论 广东省三级医院麻醉科护士工作岗位开展不均,下一步学科建设应以人力配备、工作规范及专科培训为主。     

广东省卫生机构护理人力资源现状分析

目的 了解广东省护理人力资源的动态变化,为制定符合医疗机构实际情况的相关护理人力资源改革政策提供参考.方法 对目前广东省及全国卫生机构护理人力资源的数量、构成、年龄、学历、职称结构等资料进行收集和分析.结果 2011年广东省护士人数占卫生技术人员总数的37.84％;每千户籍人口占有注册护士人数为2.12人;医护比为1∶1.01;整体结构以女性、34岁以下、中专学历、初级及以下职称居多.结论 广东省卫生机构护理人力资源正逐年好转,但仍存在数量不足,医护比例不合理,护理人员性别比例失衡、年轻化趋势明显、学历层次偏低、职称结构不合理等现状,有待进一步调整.     

新疆地区二级及以上医院重症监护现状调查分析

目的 了解新疆地区ICU的配置、人力资源及培训需求现状,为今后开展ICU专科护士培训提供依据.方法 自行设计问卷,对新疆地区37所二级及以上医院的护理部进行调查.结果 37所医院中仅25所(67.6%)设有ICU,且76.0%为近5年内开设,8种重症监护常用设备的配置比例不及50.0%,ICU床护比为1: 1.2,77.9%ICU护士为中专及大专学历,78.9%为初级及以下职称,仅18.0%参加过ICU专科护士培训,94.6%医院认为ICU护士应接受规范的专科护士培训.结论 新疆地区重症监护硬件设施整体水平有待提高,立足于新疆地区重症监护的实际,探索具有区域特色的ICU专科护士培训模式势在必行.     

新疆中等卫生学校护理专业教师师资结构调查与分析

目的 了解新疆中等护理专业教师师资队伍的人数、年龄、学历、职称结构,为满足护理教育的需求提供参考.方法 自行设计问卷对新疆12所中等卫生学校护理师资情况进行调查.结果 全疆中等护理专业教师与在校学生的平均师生比1∶153;12所学校的护理教师学历博士、硕士、本科、大专、中专构成比为0、2.7%、77.7%、16.9%、2.7%;职称正高、副高、中级、初级构成比为0、12.8%、40.6%、46.6%;护理教师＜25岁、25～岁、35～岁、45～岁、≥55岁的构成比为8.1%、39.2%、40.5%、11.5%、0.7%.结论 护理专业教师人员严重匮乏,职称和学历结构偏低,年龄结构不合理,断层现象严重,不能满足护理教育需求,有待改善和提高.     

荆州市二级医院护理人员科研现状调查分析

目的了解荆州市二级医院护理人员科研现状,为提高二级医院护理人员科研能力及相关部门制订政策提供参考。方法采取实地调查及查看原文献的方式调查荆州市7所二级医院2010~2012年护理人员现况及护理科研情况。结果 7所二级医院有床位4 795张,有护士2 567人,其中一线护士1 827人,一线护士床护比为1∶0.38;高级、中级及初级职称构成比为3.5%、29.1%、67.4%;本科、大专及中专学历构成比为18.1%、68.3%、13.6%、没有高考起点的全日制本科学历护士。发表论文221篇,论文发表率8.6%;市级课题14项,专利1项,专著2部。结论护士人力资源不足,整体学历及科研能力偏低。须以岗位管理为切入点改革现有管理模式,引进高学历护士,合理配置人力资源,加强科研培训,以提高二级医院护理人员整体素质。     

我院护理人力资源现状研究

目的:分析我院护理人力资源现状,探讨解决对策.方法:采用分层抽样方法,问卷调查我院各科室护理人力资源状况.结果:床护比偏低,护理人员短缺,学历职称结构不合理.结论:提高床护比,增加护理人员,优化学历职称结构,优化组合我院护理人力资源,是适应我院发展的需要.     

上海市医院麻醉科护士人力资源管理现状调查

目的 调查并分析上海市医院麻醉科护士人力资源的配置、工作内容及管理情况,为上海市麻醉科护理人员的配置与管理提供参考依据.方法 采用自制调查表,应用整群抽样法,以电子邮件方式对上海市99家二级及以上医院进行调查分析.结果 回收问卷98份,调查的98家医院共有麻醉科护士401名,21.4%的医院未配备麻醉科护士;仅有22.1%的医院设置了专门的麻醉科护士长岗位;麻醉科护士目前主要以PACU患者护理、麻醉药品管理、麻醉前准备、镇痛泵配置与术后镇痛随访等为工作内容,围麻醉期护理尚未成为其工作重点.结论 目前,上海市医院麻醉科作为一级临床科室人力资源配置不合理;麻醉科普遍存在护士配备不足、麻醉护士数量和素质难以适应麻醉学科发展与围麻醉期护理实践需求等问题.     

三级甲等综合医院优质护理服务示范病区护理人力配置研究

目的探讨优质护理人力资源配置方式,为相关管理部门制定"优质护理服务人力资源配置标准"提供参考。方法采用现场观察法,由培训后的30名观察员对一所三级甲等综合医院30个优质护理示范病区在班护士工作量进行现场24h观察、记录,连续2周。结果30个病区床护比为1∶0.37;平均每日护理总时数209 176.2min,其中白班占56.09%,小夜班占17.36%,大夜班占26.55%;直接护理总时数占54.84%,间接护理占39.46%;病区平均护理时数前5位为神经外科、神经内科、脊柱外科、心胸外科、产科;示范病区共需增配护士784人,增配后床护比1∶0.66,其中A类病区为1∶0.75,B类病区1∶0.68,C类病区1∶0.57。结论现行床护比严重偏低,应尽快制定适应优质护理人力配置标准,根据工作量合理定编,改善临床护士不足的现状。     

Muskelrelaxanzien in Deutschland 2005

Aim of this study was to evaluate application customs of muscles relaxants in hospitals compared to their use in private practice. Of the 3,260 questionnaires sent-out, 66.9% could be analyzed. Of these 54% were from anesthetists in private practice, 41% from heads of hospital anesthesia departments and 5% from heads of level one hospital anesthesia departments. The first difference between private practices and hospitals was the number of available muscle relaxants: 87% of private practices use 1-3 relaxants, whereas 79% of hospitals use 3-5. Another apparent difference was the relationship between general anesthesia and the number of intubations: 60% of private practices have over 80% of general anesthesia cases, but only 50% of these patients are intubated. On the contrary, two thirds of the hospitals have 50-80% general anesthesia cases and 60-70% of patients are intubated. The main wish for an ideal muscle relaxant was independent of private practice or hospital, short onset time, followed by fast recovery. In accordance 74% of anesthetists in hospitals and 72% of anesthetists in private practice voiced the wish for a non-depolarizing succinylcholine substitute. The results of this nationwide survey suggest that time pressure in combination with an increased specialization of anesthetists in private practice are the main factors for availability and use of muscle relaxants in routine anesthesia.     

Muscle relaxant use for tracheal intubation in pediatric anaesthesia: a survey of clinical practice in Germany

Objectives:  Aim of this Germany-wide study was to evaluate the use and application customs of neuromuscular blocking drugs (NMBDs) for tracheal intubation in children of age 5 years or younger.
Material and Methods:  In the year 2005, a total of 3260 questionnaires were sent out to all heads of anesthesia departments at all types of hospitals as well as ambulatory anesthesia centers in Germany. The fields covered by the questionnaire were regarding institutional size, amount of general anesthesia and specifically pediatric cases, number of intubations and NMBDs used, frequency of use of the individual relaxants and techniques utilized when administering muscle relaxants.
Results:  Of the sent-out questionnaires 66.9%could be analyzed: 82% of hospitals use 1–3 muscle relaxants in children; 91% of the ambulatory anesthesia centers use a repertoire of 1–2 neuromuscular blockers for pediatric cases. However, general anesthesia with tracheal intubation in children is often induced without using any NMBD at all. Mivacurium is the predominantly used NMBD for pediatric intubation in Germany. In contrast, the use of succinylcholine is far less in ambulatory anesthesia centers than in hospitals. Despite controversial discussion, precurarization, priming, and timing are still utilized in German anesthesia practice.
Conclusion:  In Germany, mivacurium, with its favorable pharmacologic profile for short cases, is the predominantly used NMBD for pediatric tracheal intubation. Despite the known adverse effects of intubation without muscle relaxation, this technique is also wide-spread, especially among German anesthetists in ambulatory anesthesia centers. Surveys like these are important to determine a status quo of use and application customs of NMBDs in pediatric anesthesia and provide a basis for numerous other studies.     

Key issues and barriers to obstetrical anesthesia care in Ontario community hospitals with fewer than 2,000 deliveries annually

Purpose

Lack of the availability of anesthesia services may be a factor in the closure of maternity services in rural Canada, limiting the capacity for Cesarean delivery and intensifying the urbanization of maternity care. Unlike other professions involved in maternal newborn care, health services research in obstetrical anesthesia is virtually non-existent. This study explored barriers physicians encountered in providing obstetrical anesthesia care in Ontario community hospitals experiencing low volumes (fewer than 2,000) deliveries per annum (PA). Solutions proposed by a mixed focus group of academic and community hospital leaders were also described.

Methods

Following Research Ethics Board approval, the authors performed a secondary analysis of qualitative data from 18 anesthesiologists and family practitioner (FP/GP) anesthetists who had participated in a larger provincial study that was also conducted by the authors. Participants were leaders from community hospitals with fewer than 2000 deliveries PA and university-based teaching programs from across Ontario. Fourteen community physicians participated in focus groups that explored key issues and barriers to care and their potential solutions. A final group of eight academic and community physician key informants further explored solutions.

Findings

Three themes emerged: Obstetrical Anesthesia in the “Periphery”, “Key Issues and Barriers to Obstetrical Anesthesia Care”, and “A Multi-faceted but Context-Specific Solution is Required.” The physicians identified barriers within the greater context of those encountered during the provision of anesthesia services in the periphery, including lack of time, need for continuing medical education (CME), need for hospital infrastructure support to develop and implement best practice protocols, and need for resources and anesthesia mentorship supports from the system. Difficulties were greatest for FP/GP anesthetists in rural communities who described lack of locums, need for relevant CME, and worsening physician shortages threatening provision of services in some rural hospitals. Family practitioner anesthetist multi-taskers were described as the best solution to the provider shortage in rural communities. Participants described the need for increased numbers of FP/GP anesthetists and the development of formal funded networks for knowledge transfer between academic and community hospitals as a mechanism to provide supports.

Conclusions

Physicians in community hospitals face significant barriers in the provision of obstetrical anesthesia care. These are greatest among FP/GP anesthetists and in rural hospitals where physician shortages and lack of supports threaten provision of services in some hospitals. Local context-specific and systems-level solutions are required.     

46所医院手术用物清点与记录现状调查

目的了解手术室护士执行手术用物清点制度的现状，提出手术室护理工作中潜在的法律问题。方法采用自行设计的问卷，于2005年9月对中南三省46所医院的151名手术室护士进行调查，内容包括医院级别、月手术量、被调查者年龄、职称及手术用物清点与记录情况。结果全部手术清点器械者42人（27．81％），全部记录29人（19．20％）。不同级别医院手术用物清点和记录状况比较，差异有显著性意义（均P〈0．01）。月均手术量越多，手术用物清点和记录状况越好（均P〈0．01）。结论手术室护士用物清点及记录现状不容乐观，应在完善手术用物清点制度、细化清点内容及对象的基础上，加强法律知识学习，提高法律意识，预防医疗事故，保证患者安全。     

Process Analysis in Outpatient Knee Surgery: Effects of Regional and General Anesthesia on Anesthesia-controlled Time

Background: The performance of anesthetic procedures before operating room entry (e.g., with either general or regional anesthesia [RA] induction rooms) should decrease anesthesia-controlled time in the operating room. The authors retrospectively studied the associations between anesthesia techniques and anesthesia-controlled time, evaluating one surgeon performing a single procedure over a 3-yr period. The authors hypothesized that, using the anesthesia care team model, RA would be associated with reduced anesthesia-controlled time compared with general anesthesia (GA) alone or combined general-regional anesthesia (GA-RA).

Methods: The authors queried an institutional database for 369 consecutive patients undergoing the same procedure (anterior cruciate ligament reconstruction) performed by one surgeon over a 3-yr period (July 1995 through June 1998). Throughout the period of study, anesthesia staffing consisted of an attending anesthesiologist medically directing two nurse anesthetists in two operating rooms. Anesthesia-controlled time values were compared based on anesthesia techniques (GA, RA, or GA-RA) using one-way analysis of variance, general linear modeling using time-series and seasonal adjustments, and chi-square tests when appropriate. P < 0.05 was considered significant.

Results: RA was associated with the lowest anesthesia-controlled time (11.4 +/- 1.3 min, mean +/- 2 SEM). GA-RA (15.7 +/- 1.0 min) was associated with lower anesthesia-controlled time than GA used alone (20.3 +/- 1.2 min).     

Pollution of the workplace by anesthetic gases. Causes and prevention

Waste anesthetic gas concentrations were measured in areas corresponding to the breathing zones of the anesthetists and operating room nurses for personal exposure (n = 27, time-weighted values) and during special work practices (n = 65). Leaks related to anesthetic machines and high-pressure nitrous oxide components were investigated during (n = 60) and after anesthesia (n = 85). The effect of a local scavenging system on occupational exposure during inhalation induction of anesthesia in children was studied (n = 60). Concentrations of nitrous oxide, halothane, isoflurane, and enflurane were determined by using active dosimeters (SKC 222) and different infrared gas-analyzers. Factors that increase waste anesthetic gas concentrations in operating rooms can be divided into several categories, such as low air conditioning systems, anesthetists' work practices, equipment leakage, including leakage from high-pressure nitrous oxide systems, and inadequate scavenging devices. Equipment leakage is almost invariably present in low-pressure components of the anesthesia machine because so many seals and joints are necessary to permit disassembly for cleaning and replacement. Waste anesthetic gases are also distributed in the exhaled air of patients recovering from anesthesia. To restrict the levels, exposure must be as low as can be achieved with reasonable efforts. Thus, the anesthetic equipment should be designed to avoid leakage, leakage tests should be performed before the use of anesthetic machines, and waste anesthetic gases should be scavenged by central as well as by local systems. Regular and periodic use of a trace gas analyzer permits direct observation of gas leakage and enables anesthetists to modify their work technique in order to reduce avoidable leakage.     

A strategy for deciding operating room assignments for second-shift anesthetists.

We developed a relief strategy for assigning second-shift anesthetists to late-running operating rooms. The strategy relies on a statistical method which analyzes historical case durations available from surgical services information systems to estimate the expected (mean) remaining hours in cases after they have begun. We tested our relief strategy by comparing the number of hours that first-shift anesthetists would work overtime if second-shift anesthetists were assigned using our strategy versus if the anesthesia coordinator knew in advance the exact amount of time remaining in each case. Our relief strategy resulted in 3.4% to 4.9% more overtime hours for first-shift anesthetists than the theoretical minimum, as would have been obtained had perfect retrospective knowledge been available. Few additional staff hours would have been saved by supplementing our relief strategy with other methods to monitor case durations (e.g., real-time patient tracking systems or closed circuit cameras in operating rooms). IMPLICATIONS: A relief strategy that relies only on analyzing historical case durations from an operating room information system to predict the time remaining in cases performs well at minimizing anesthetist staffing costs.     

A retrospective study of the incidence and causes of failed spinal anesthetics in a university hospital

One hundred sequential spinal anesthetic procedures were reviewed retrospectively to study specifically the incidence and causes of spinal anesthesia. Variables examined included the patient population, the technical aspects of performing subarachnoid tap and subsequent blockade, and the level of training of the anesthetists. We found a 17% incidence of spinal failure, defined as the need to use general anesthesia during the surgical procedure. Failure was found to be significantly associated with a lack of free flow of cerebral spinal fluid, the use of tetracaine without epinephrine, and an increased administration of intravenous supplementation. Forty-one% of the failures represented errors in judgement, either in not properly anticipating the duration of surgery or injecting local anesthetic solution in the absence of a free flow of cerebral spinal fluid. An incidental finding was the lack of documentation in many of the variables examined. We attribute the high incidence of failed spinal anesthesia mainly to technical reasons, most of them avoidable. The use of local and regional anesthesia requires considerable technical skills and demands a precise and total understanding of regional anatomic relationships. With the decreasing use of regional anesthesia in our operating rooms, only those regional anesthesia techniques that require minimum dexterity, such as spinal and epidural anesthesia, continue to be utilized widely; and even these techniques, safe as they are, are being poorly taught.