不同等级医院护士工作场所暴力发生现况研究

目的了解不同等级医院护士工作场所暴力发生情况并分析其差异性,为针对性开展WPV预防提供参考。方法采用整群随机抽样法,分别选取苏州市2所三级医院、4所二级医院护士1 305人和632人进行问卷调查。结果二级医院护士工作场所暴力发生率(69.94%)显著高于三级医院(62.61%),且语言攻击发生率差异有统计学意义(均P0.01);二级医院护士听说过工作场所暴力等4个条目认知率显著低于三级医院护士,对医院鼓励上报、有处理工作场所暴力科室等4个条目选择率低于三级医院护士(P0.05,P0.01)。结论护士遭受工作场所暴力现象较普遍;二级医院护士工作场所暴力发生率高于三级医院护士,但暴力认知(及对所在医院暴力事件处理方式的评价)低于三级医院护士。应加强对二级医院护士工作场所暴力的关注,加强暴力应对培训,提升医院管理部门对暴力事件的重视,从而降低暴力事件的发生。     

护理人员工作场所暴力与工作倦怠调查分析

目的了解工作场所暴力对护理人员工作倦怠的影响。方法抽取上海市宝山区3所二级以上医院护理人员904人,应用护理人员工作场所暴力问卷、Maslach工作倦怠问卷和领悟社会支持量表进行调查。结果 69.91%的护理人员曾遭受暴力,其中遭受躯体暴力8.41%,心理暴力61.50%。遭受心理暴力组护士情绪疲倦感、工作冷漠感及成就感低落程度显著高于未遭受心理暴力组,遭受躯体暴力组护士情绪疲倦感及工作冷漠感程度显著高于未遭受躯体暴力组(P0.05,P0.01);多元线性回归分析显示工作场所暴力是护士情绪疲倦感和工作冷漠感的影响因素,领悟社会支持是护士工作倦怠的影响因素(P0.05,P0.01)。结论护理人员遭受医院场所暴力的发生率高,工作场所暴力加剧工作倦怠感;应采取有效措施防范暴力事件,提高护士的社会支持度等,维护其心身健康。     

不同科室护士遭受工作场所暴力调查分析

目的比较不同科室护士在医院工作场所遭受暴力状况,为预防暴力事件的发生及维护护理人员的身心健康提供依据。方法自编医务人员医院暴力发生状况调查问卷,对171名护士进行有关遭受工作场所暴力情况的问卷调查。结果因肇事者醉酒、药物滥用、精神障碍或意识障碍患者引发的暴力,急诊科发生率显著高于普通病房(P0.05,P0.01);普通病房因患者病情无好转而引发的暴力发生率显著高于急诊科(P0.05);急诊科施暴源来于患者、患者家属或朋友显著高于普通病房(均P0.01);急诊科遭受暴力类型中躯体冲突、威胁性事件或姿势有2种躯体损伤情况显著高于普通病房(均P0.01);急诊科护士无助感和缺乏安全感显著高于普通病房(均P0.01);未受过正规防范工作场所暴力知识培训的急诊科护士显著多于病房护士(P0.01)。结论急诊科护士遭受工作场所暴力的问题较为严重,应加强法律、法规、防范暴力知识的培训及心理疏导,以有效防范医院暴力事件发生,维护护理人员的身心健康。     

护士工作场所暴力氛围感知现况调查

目的 了解护士对工作场所暴力氛围感知现状,为有针对性干预提供参考.方法 采用分层随机整群抽样法,以护士工作场所暴力氛围感知量表对荆州地区不同级别医院的997名在岗护士进行调查.结果 护士工作场所暴力氛围感知总分(97.11±23.74)分,组织管理维度得分率(71.30％)高于暴力事件处理(70.49％)、暴力预防(66.61％).不同年龄、工作年限、科室、医院级别、暴力事件经历的护士工作场所暴力氛围感知总分比较,差异有统计学意义(P＜0.05,P＜0.01).结论 护士工作场所暴力氛围感知处于中等水平,需注重暴力防范与处理,为护士创造安全的执业环境.     

急诊科护士工作场所心理暴力问题调查研究

目的了解急诊科护士工作场所心理暴力的流行病学特征。方法根据世界卫生组织关于工作场所暴力的定义设计调查表，对广州市16所医院273名急诊科护士工作场所心理暴力发生情况进行调查。结果273名急诊科在职护士心理暴力发生率为87.91％，其中78.75％的受害者多次遭受暴力。辱骂与威胁是心理暴力的主要表现形式。心理暴力更容易在小医院发生。护士站是急诊科发生心理暴力的常见工作场所；60．42％的急诊心理暴力事件发生在晚／夜班。急诊科护士处理心理暴力的主要方式是耐心解释(64．58％)和忍让回避(45，42％)；27．50％的受害者未将暴力遭遇告诉别人。心理暴力的主要危险因素依次为病人(或其陪同者、探视者)的要求未能得到满足、肇事者酗酒或药物滥用、候诊时间过长等。病人亲属和病人本人是主要肇事者。结论心理暴力以极高发生率存在于急诊科护士人群。需针对医院特点开展工作场所暴力防范与应对措施教育，提高急诊科护士防范心理暴力能力。     

不同科室护士遭受工作场所暴力调查分析

目的比较不同科室护士在医院工作场所遭受暴力状况,为预防暴力事件的发生及维护护理人员的身心健康提供依据。方法自编医务人员医院暴力发生状况调查问卷,对171名护士进行有关遭受工作场所暴力情况的问卷调查。结果因肇事者醉酒、药物滥用、精神障碍或意识障碍患者引发的暴力,急诊科发生率显著高于普通病房（P〈0．05．P〈0．01）;普通病房因患者病情无好转而引发的暴力发生率显著高于急诊科（P〈0．05）;急诊科施暴源来于患者、患者家属或朋友显著高于普通病房（均P〈0．01）;急诊科遭受暴力类型中躯体）中突、威胁性事件或姿势有2种躯体损伤情况显著高于普通病房（均P〈0．01）;急诊科护士无助感和缺乏安全感显著高于普通病房（均P〈0．01）;未受过正规防范工作场所暴力知识培训的急诊科护士显著多于病房护士（P〈0．01）。结论急诊科护士遭受工作场所暴力的问题较为严重,应加强法律、法规、防范暴力知识的培训及心理疏导,以有效防范医院暴力事件发生,维护护理人员的身心健康。     

护士工作场所暴力现状与对策研究进展

医疗机构中暴力事件以护理人员发生的概率最高。介绍国内外护患暴力、护士间暴力研究的现状及护士在遭受工作场所暴力后出现的生理、心理、社会功能异常。提出应分别从加强沟通、护士自身、政策、医院管理寻找对策,以期降低暴力事件的发生率。     

急诊护士工作场所暴力应对策略的SWOT分析

运用SWOT方法对急诊护士应对工作场所暴力的优势、劣势、机会、挑战进行综合分析,提出急诊护士工作场所暴力应对策略,即建立预防工作场所暴力指南和工作机制,建立完善的监测和评估系统;加强对急诊护士培训,提高急诊护士职业素质;优化医院环境和流程,以及以社区医院为依托,急诊专科护士为主导,提高居民院前急救技能和医学基本知识;对降低急诊护士遭受医院工作场所暴力事件发生有重要作用。     

急诊科工作场所暴力和职业倦怠对护士共情疲劳的影响

目的了解急诊科护士工作场所暴力、职业倦怠和共情疲劳状况,分析影响急诊科护士共情疲劳的因素。方法采用工作场所暴力测定频度量表、工作倦怠量表和共情疲劳量表对286名急诊科护理人员进行调查。结果急诊科护士工作场所暴力零频度占25.52%、低频度41.61%、中频度23.43%、高频度9.44%;职业倦怠零倦怠占22.38%、轻度倦怠44.76%、中度倦怠24.83%、高度倦怠8.04%;共情疲劳轻度16.43%、中度40.56%、重度43.01%;工作场所暴力和职业倦怠不同程度影响共情疲劳(P0.05,P0.01)。结论急诊科护士工作场所暴力发生率较高,职业倦怠及共情疲劳情况较严重,需要医院管理者采取综合措施,降低工作场所暴力发生率和职业倦怠水平,改善急诊科护士共情疲劳状况。     

不同地区两医院护理人员工作场所暴力的现状分析

目的:对哈尔滨某医院与杭州某医院医院护理人员工作场所暴力发生的情况等方面进行研究,找出两医院的差异性.方法:采用陈祖辉、王声口的《医院工作场所暴力调查问卷》对两医院各约100名护士进行调查.结果:两医院在遭受躯体攻击情况、认为“工作场所暴力”是否值得大惊小怪、是否受益于预防工作场所暴力事件的培训、是否鼓励员工遭受工作场所暴力后上报四个条目上存在差异.结论:两医院之间存在一定差异,需取长补短,预防和减少医院工作场所暴力的发生.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.