临床护士循证护理认知与实践现状的调查分析

目的了解临床护士循证护理认知与实践的现状,探讨改善措施,旨在促进循证护理在我国的发展。方法采用分层整群抽样的方法对某三甲医院临床护士进行问卷调查,通过Epidata3．1软件录入数据,运用SPSS18．0软件进行统计学分析。结果①不同学历、不同职称的临床护理人员对循证护理的认知情况差异有统计学意义（X2值分别为13．028、10．468,P值均小于0．05）,学历越高、职称越高的临床护理人员对循证护理认知度越高（线性及线性组合）（z值分别为10．600、12．029,P值均〈O．01）。②护士实行循证护理的最大障碍：不了解统计学原理,没有时间进行相关研究,研究成果无法推广,英文文献难以理解等。③护士认为的最佳改进措施：提高管理层的支持（73．O％）,令研究报告更容易查询（70．8％）,提供同事间的支持机制（70．1％）等。结论临床护士普遍缺乏循证护理理念,应从改善护士自身素质、提高管理层支持等角度出发,推动循证护理在我国的发展。     

The effect of an electronic health record system on nursing staff time in a nursing home: a longitudinal cohort study

Background

Nursing homes are increasingly introducing electronic health record (EHR) systems into nursing practice; however, there is limited evidence about the effect of these systems on nursing staff time.

Aims

To investigate the effect of introducing an EHR system on time spent on activities by nursing staff in a nursing home.

Method

An observational work sampling study was undertaken with nursing staff between 2009 and 2011 at two months before, and at 3, 6, 12, and 23 months after implementation of an EHR system at an Australian nursing home. An observer used pre-determined tasks to record activities of the nursing staff at nine-minute intervals.

Results

There was no significant change in registered nurses and endorsed enrolled nurses’ time on most activities after implementation. Personal carers’ time on oral-communication reduced, and time on documentation increased at most measurement periods in the first 12 months after implementation. At 23 months, time on these activities had returned to pre-implementation levels. Nursing staff time on direct care remained stable after implementation. No considerable change was observed in time spent on other activities after implementation.

Conclusion

Findings suggest that successful introduction of an EHR system in a nursing home may not interfere with nursing staff time on direct care duties. However, there is scope for improving the support provided by EHR systems through incorporation of functions to support collaborative nursing care.     

Cardiac arrest resuscitation policies and practices: a survey of Australian hospitals

OBJECTIVE: To describe the policy and practice relating to cardiopulmonary resuscitation (CPR) and defibrillation in cardiac arrest in Australian hospitals. DESIGN: Cross-sectional postal survey conducted in December 2001, using a semi-structured, four-page questionnaire. PARTICIPANTS: Australian hospitals with more than 10 beds. MAIN OUTCOME MEASURES: Type of defibrillator; provision of CPR/defibrillation training for healthcare professionals; hospital policy as to who can use the defibrillator. RESULTS: Of the 878 hospitals surveyed, 665 (76%) responded. All but one hospital indicated that CPR training was provided for nursing staff, with 12-monthly or more frequent updates; only 55% of hospitals (366) indicated that CPR training was provided for doctors. 21 of the 665 responding hospitals (3.2%) indicated that they did not have a defibrillator. 43% of hospitals had one or more defibrillators with shock advisory capacity (ie, automated external defibrillators [AEDs]). Of the 644 hospitals with defibrillators, 16% (101) indicated that registered nurses were not permitted to defibrillate; this included 9% of hospitals with AEDs. CONCLUSIONS: The importance of CPR in cardiac arrest has been accepted by Australian hospitals, but the overwhelming evidence that "time to defibrillation" is the single most important determinant of cardiac arrest outcome seems less accepted. All Australian hospitals should review their resuscitation policies and practices to reflect this fact, with defibrillation by nurses, who are usually first on the scene, providing the best opportunity to minimise time to defibrillation.     

Taking stock of interprofessional learning in Australia

Changes in health service delivery and issues of quality of care and safety are driving interprofessional practice, and interprofessional learning (IPL) is now a requirement for medical school accreditation. There is international agreement that learning outcomes frameworks are required for the objectives of IPL to be fully realised, but there is debate about the most appropriate terminology. Interprofessional skills can be gained in several ways - from formal educational frameworks, at pre- and post-registration levels to work-based training. Research activity suggests that many consider that IPL delivers much-needed skills to health professionals, but some systematic reviews show that evidence of a link to patient outcomes is lacking. Australian efforts to develop an evidence base to support IPL have progressed, with new research drawing on recommendations of experts in the area. The focus has now shifted to curriculum development. The extent to which IPL is rolled out in Australian universities will depend on engagement and endorsement from curriculum managers and the broader faculty.     

Nursing functions and computer support

Computer-based information system (CBIS) support for nursing functions has typically been a by-product of some other automation effort such as communication, admission-discharge-transfer, or finance. Support specifically for nurses has been narrow in scope and little used, in spite of ongoing discussion about its need. However, the situation seems to be improving of late. But is the situation really improving? Or, are we merely witnessing unproductive machinations? Herein, we discuss three basic conditions that have slowed NIS evolution. Following that, however, we offer some evidence of real progress in computer-based support for nursing functions.     

广东省54名赴港培训ICU专科护士临床护理实践角色调查

目的 分析2007-2009年赴港进修ICU专科护士在临床护理实践中的角色定位,寻求科学的专科护士发展路径,更好地适应临床护理实践的发展.方法 通过对2007-2009年54名赴港进修ICU专科文凭的护士进行问卷调查,对其赴港前后临床护理实践角色进行分析.结果 该54名护士目前工作模式多为专科护士兼护士长,充当临床护理...     

手术室护士术中安全用药管理的循证实践

目的：探讨基于最佳证据的手术室护士术中安全用药的干预方法并评价其效果。方法：通过循证护理得出证据并将证据本土化后应用于临床，制订手术室护士术中安全用药的审查标准，规范手术室护士的术中用药行为；采用多样的培训方式，对手术室护士进行最佳证据的培训与考核，比较应用最佳证据前后，手术室护士对于药物相关知识的知晓率和手术室安全用药实践核查落实率。结果：应用最佳证据后，手术室护士对药物核对流程、药物分区摆放、药物标识应用等方面的知晓率有所提高，差异有统计学意义（P ＜0.05）；手术室护士安全用药实践6项核查内容的落实率实施后较实施前均有上升，差异均有统计学意义（P ＜0.05）。结论：通过应用最佳证据，以科学高效的方法管理手术室护士术中安全用药的问题，可提升手术室护理质量。     

骨科护士岗位管理对下肢深静脉血栓形成护理预防技能的影响

目的研究骨科护士岗位管理对提升护士早期辨识下肢深静脉血栓形成能力及护理预防技能的影响。方法选取我院骨科任职的26名护士为研究对象,从2015年4月起实施骨科护士岗位管理,比较实施前后1年护理工作质量、下肢深静脉血拴相关知识、护理预防技能以及护理不良事件。结果骨科护士岗位管理实施1年后的护理工作质量总分、下肢深静脉血拴知识水平总分、下肢深静脉血拴预防技能总分、护理不良事件发生率分别为(376.59±14.41)分、(34.85±2.99)分、(43.32±3.05)分、0.39%与实施前的(336.16±35.76)分、(22.32±8.56)分、(27.26±11.43)分、1.08%比较差异显著(P0.05)。结论骨科护士岗位管理实践通过岗位分级、培训、评价等,能增强护理人员早期辨识下肢深静脉血栓形成能力,提高护理预防技能。     

135名护生职业认同现状及影响因素分析

目的了解实习护生职业认同现状并分析其影响因素,为提升护生职业认同提供理论依据。方法采取方便抽样,对135名实习护生采用护士职业认同量表及自编人口学资料调查表进行测评分析。结果护生职业认同总均分为（3．88±0．57）分,各维度得分由高至低依次为职业社会支持、职业自我反思、职业挫折应对、职业社会交往技能、职业认知评价;本科生职业认同各维度得分均低于专升本及大专生（P〈0．01）;不同性别、是否独生子女、家庭人均收入之间无统计学差异（P〉O．05）;逐步多元回归结果提示：年龄、学历、职业选择与自身兴趣、实习满意度是影响护生职业认同的主要因素。结论实习期间护生是职业认知发展的关键时期,医院护理教育者应充分利用此契机,引导护生形成积极的职业认知。     

围手术期护理诊断理论与实践探讨

目的 :研究围手术期常见护理诊断条目、适用范围和临床指导性 ;从理论和实践两方面探讨诊断方法、鉴别诊断和使用 ;从质量管理角度 ,探讨理论培训与临床指导的方法及效果。　方法 :抽查外科系统 1 0个科室患者的护理诊断 1 0 5 0条 ,从中筛选出常见的 2 0条 ,采用集中授课 -分科使用 -床边考核 -汇总分析 -发现问题 -查找原因 -改进措施的循环模式 ,在临床护理中边用边改 ,并抽查护理诊断的符合率和患者问题的解决结果。　结果 :2 0 0 2年 1 0个科的护理诊断符合率较 2 0 0 1年有明显提高。　结论 :2 0条常见诊断在外科临床有广泛实用性和指导性 ,理论培训和应用指导是确保护理诊断和护理质量的关键     

Standardizing Nursing Information in Canada for Inclusion in Electronic Health Records: C-HOBIC

The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project introduced systematic use of standardized clinical nursing terminology for patient assessments. Implemented so far in three Canadian provinces, C-HOBIC comprises an innovative model for large-scale capture of standardized nursing-sensitive clinical outcomes data within electronic health records (EHRs). To support this activity, nursing assessment and outcomes concepts were mapped to the International Classification for Nursing Practice (ICNP®). By comparing serial data on a patient across multiple time points, the C-HOBIC model can generate nursing-sensitive patient outcome reports. A principle benefit of the C-HOBIC model is that it provides nurses with information critical to planning for and evaluating patient care. Inclusion of nursing information in either provincial databases or EHRs in three Canadian provinces promotes continuity of patient care across sectors of the healthcare systems in those provinces and also facilitates aggregation and analysis by administrators and policy makers. The C-HOBIC model provides standardized, consistent, interoperable clinical information that reflects nursing practice throughout the Canadian healthcare System.     

某三甲医院实行优质护理工作前后护士工作满意度调查

目的：调查实行优质护理工作前后护士工作满意度的变化,为临床开展优质护理提供一定的依据。方法采用护士工作满意度量表对某三级甲等医院优质护理示范病房135名护士在实行优质护理前后进行问卷调查。结果实行优质护理后护士工作满意度较实施前有所提高,并且有统计学意义（P＜0.05）。结论实行优质护理工作后护士满意度有所提高,但整体满意度仍偏低,应合理配置护理人力资源,改善护士福利待遇,以更好提高护士工作满意度,更好地在临床上推行优质护理服务工作。     

Oncology nurses ... who are we?

Oncology nursing has matured into a well-established specialty in nursing. The scope of practice for the oncology nurse is broad and spans the continuum of cancer care. Oncology nurses have important roles in all aspects of cancer care. The ONS is the largest organization of oncology professionals in the United States with a membership of about 30,000 and has contributed to the development of oncology nursing through its many educational programs, support of research, opportunities for networking, establishment of certification examinations, and development of an active foundation.     

实习护生与新护士人格特征分析

目的探讨实习护生和新护士人格特征,优化其个性。方法采用卡特尔16种个性因素量表对实习护生和新护士进行测试。结果①实习护生与新护士在聪慧、稳定、有恒、世故、忧虑、自律性6项主要人格因素存在显著差异,在适应与焦虑、心理健康因素、创造能力、新环境成长能力4项次级因素也存在显著差异。②新护士与实习护生同样存在低敢为性、低独立性、低世故性及低心理健康因素,忧虑、怯懦不果断。结论新护士与实习护生独立和适应能力低,不善于表达,处理问题和心理耐受调节能力差,在实践中需加强其个性特征培养和优化。     

Automation in nursing decision support systems: A systematic review of effects on decision making,care delivery,and patient outcomes

ObjectiveThe study sought to summarize research literature on nursing decision support systems (DSSs ); understand which steps of the nursing care process (NCP) are supported by DSSs, and analyze effects of automated information processing on decision making, care delivery, and patient outcomes.Materials and MethodsWe conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, CINAHL, Cochrane, Embase, Scopus, and Web of Science were searched from January 2014 to April 2020 for studies focusing on DSSs used exclusively by nurses and their effects. Information about the stages of automation (information acquisition, information analysis, decision and action selection, and action implementation), NCP, and effects was assessed.ResultsOf 1019 articles retrieved, 28 met the inclusion criteria, each studying a unique DSS. Most DSSs were concerned with two NCP steps: assessment (82%) and intervention (86%). In terms of automation, all included DSSs automated information analysis and decision selection. Five DSSs automated information acquisition and only one automated action implementation. Effects on decision making, care delivery, and patient outcome were mixed. DSSs improved compliance with recommendations and reduced decision time, but impacts were not always sustainable. There were improvements in evidence-based practice, but impact on patient outcomes was mixed.ConclusionsCurrent nursing DSSs do not adequately support the NCP and have limited automation. There remain many opportunities to enhance automation, especially at the stage of information acquisition. Further research is needed to understand how automation within the NCP can improve nurses’ decision making, care delivery, and patient outcomes.     

护理人员轮转护理部体验的质性研究

目的 了解护理人员轮转护理部的体验及护理部干事应具备的特质,为护理部选择干事及改进轮转中的问题提供参考.方法 采用质性研究中现象学方法对8名轮转护理部的干事进行访谈,并以Giorgi6步分析法分析资料.结果 提炼出5个主题,分别为轮转前对护理部干事的职责不了解、轮转后认为岗位职责需细化,轮转期间感到压力,轮转经历对职业生涯有积极的影响,轮转获得多方面的收获.结论 护理部在选择护理干事时应进行综合评估,制定相应的培训计划,给予心理疏导,明确职责、重视感受,提高工作能力,保证护理部工作的高效率运转.     

男护士在院前急救护理工作中的优势及管理探讨

随着中国护理事业的深入发展,男护士在护理工作中的作用日益显著,所以原本以女性为主体的护理队伍开始逐渐形成了含有男性的加盟队伍,而且调查实践表明,男护士工作正处于不断认可和支持的上升发展局面,对于当前临床护理工作发挥着积极的影响意义。为了探讨男护士在院前急救工作中的优势及管理。该文在生理、心理、学习、应急、服务5个方面分析了男护士在院前急救护理工作中的特点,并总结了对该群体特殊管理的经验。     

Advanced nurse roles in UK primary care

Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.     

护理人员对护理问题认知状况的调查

目的:了解护理人员(包括护士和护生)对护理问题及相关知识的认知状况。方法:采用现状调查法,把120名护理人员分为4组进行问卷调查。结果:四个组的得分有显著差异(F=5.93,P<0.01)。在对护理问题概念的认识上,认为是护士工作的偏差的有5人,占4.27%;认为是病人的健康问题的有41人,占35.04%;认为是病人健康的、现存的、潜在的特殊问题的有71人,占60.68%。结论:不同学历护理人员对护理问题及相关知识的看法不一,有必要对护理人员进行培训,同时需要对护理诊断、护理问题及健康问题有一个统一的认识,以便于护理人员交流和总结经验,促进护理事业的发展。     

应用日记提升新护士专业承诺水平的方法研究

目的探索应用日记提高新护士专业承诺水平的方法,评价实施效果,为临床新护士培训提供可靠的参考依据。方法采用专业承诺问卷,对17名新护士在书写日记、实施干预措施前后进行调查。结果 17名新护士共书写日记4464篇,其中情感类1150篇(25.8%),学习认知能力篇3051篇(68.3%),其他263篇(5.9%)。新护士专业承诺水平显著提高,P<0.05,差值具有统计学意义。新护士书写日记与专业承诺水平呈正相关性。其中情感承诺和理想承诺水平提高幅度较大。结论日记帮助护理管理者及时了解新护士情绪及专业能力发展情况,稳固和提升新护士的专业承诺水平,帮助新护士在护理专业上个性化发展,对护理队伍的稳定有着重要的意义。