临床护士核心能力与自我效能感及 自主学习能力的关系研究

目的 了解临床护士核心能力、自我效能感、自主学习能力现状及三者的关系,探讨临床护士核心能力的影响因素,为制定临床护士核心能力培训方案提供依据。方法 采用便利抽样法抽取延吉市2所3级综合医院的临床护士605人,采用一般资料调查表、注册护士核心能力测评量表、自我效能感量表、成人学习属性量表进行调查。结果 临床护士的核心能力得分为3.56±0.83,自我效能感得分为2.70±0.66,自主学习能力得分为3.68±0.79;护士核心能力与自我效能感、自主学习能力呈正相关（均P＜0.05）;临床护士核心能力的主要影响因素有自我效能感、自主学习能力及工作年限(均P＜0.05）,可解释总变异的45.9%。结论 延吉地区临床护士核心能力处于高等水平,自我效能感、自主学习能力是临床护士核心能力的主要影响因素。管理者需培养临床护士自我效能感及自主学习能力,从而提高临床护士核心能力。     

实习护生健康教育能力与自主学习能力及自我效能的相关性

目的 了解实习护生（护生）的健康教育能力与自主学习能力、自我效能的现状及其相关性,为护理教育者提高护生健康教育能力提供参考。 方法 采用护理人员健康教育能力测评量表、护理专业大学生自主学习能力测评量表及一般自我效能量表对409名护生进行问卷调查。 结果 护生健康教育能力得分为74.40±16.82,自主学习能力得分为65.77±11.42,一般自我效能感得分为22.21±15.26,护生健康教育能力与自主学习能力、一般自我效能呈正相关（均P＜0.01）。 结论 护生健康教育能力有待提高,增强自主学习能力及自我效能感可提高护生的健康教育能力。     

自我效能感在护士感知的高绩效工作系统与工作幸福感间的中介作用

目的 探讨护士感知的高绩效工作系统、一般自我效能感及工作幸福感之间的关系。方法采用感知高绩效工作系统量表、一般自我效能感、工作幸福感量表,对327名护士进行调查。结果护士感知的高绩效工作系统得分为（64.21±9.54）分,一般自我效能感得分为（30.61±6.57）分;护士工作幸福感中积极情感和工作满意度维度与感知的高绩效工作系统呈正相关（均P<0.05）;积极情感和工作满意度维度与一般自我效能感呈正相关（均P<0.05）;感知的高绩效工作系统与一般自我效能感呈正相关（P<0.05）,一般自我效能感是护士感知的高绩效工作系统和积极情感的中介变量,中介效应占总效应的17.25%,一般自我效能感是护士感知的高绩效工作系统和工作满意度的中介变量,中介效应占总效应的27.65%。结论护士感知的高绩效工作系统和一般自我效能感影响护士的工作幸福感水平,医院建立一套科学合理的高绩效工作系统可以提高护士的工作幸福感,同时自我效能的提高也会使护士的工作幸福感提高。     

医联体医院护士静脉治疗核心能力现况及影响因素研究

目的 调查医联体医院护士静脉治疗核心能力现状,分析影响因素,以完善其静脉治疗培训方案、 提高护士核心能力。 方法 采用方便抽样法,选取陕西省8所医联体医院2 405名护士为研究对象。采用一般资料调查表、护士静脉治疗核心能力评价量表及一般自我效能感量表进行调查。 结果 2 405名医联体医院护士静脉治疗核心能力总分为115.67±22.78,一般自我效能感总分为32.20±6.13;多元线性回归结果显示,是否参加过静脉治疗相关培训及一般自我效能感是护士静脉治疗核心能力的影响因素（均P＜0.05）,共解释总变异的43.0%。 结论 医联体医院护士静脉治疗核心能力处于中等偏上水平,参加过静脉治疗相关培训和一般自我效能感较高的护士其静脉治疗核心能力较好。护理管理者可加强相关培训,并通过提升护士的一般自我效能感,进而提高其静脉治疗核心能力。     

儿童医院护士护理研究自我效能与组织支持感的相关性

目的探讨儿童医院护士护理研究自我效能与组织支持感的现状,分析二者的相关性,为儿童医院护士科研管理方案的优化提供参考。方法采用一般资料调查表、护理研究自我效能量表及组织支持感量表对1所儿童医院护士491人进行问卷调査。结果护士护理研究自我效能总均分为(2.50±0.97)分,组织支持感总均分为(3.17±0.94)分;护理科研自我效能总分及各维度得分与组织支持感呈正相关(均P0.01)。结论儿童医院护士护理研究自我效能有待提高,组织支持感尚不足,其护理研究自我效能与组织支持感相关。医院和护理管理者应重视组织支持的作用,以提高护士护理研究自我效能。     

临床护理带教老师工作压力及自我效能和带教行为的调查分析

目的分析临床护理带教老师工作压力、自我效能和带教行为水平及其相关因素。方法采用临床教师带教行为问卷、护士工作压力源量表和一般自我效能量表对江苏省3所三级甲等综合医院的139名临床带教老师进行调查。结果临床护理带教老师临床带教行为量表总均分为4.35±0.49,各维度中知识领域得分最低;工作压力源量表总均分为2.54±0.57,在时间分配及工作量问题维度上得分最高;一般自我效能感总均分为2.68±0.61。带教行为与工作压力源呈负相关,与一般自我效能感呈正相关(均P0.01)。结论医院护理管理者应重视提高带教老师的自我效能,降低其工作压力,不断提升临床护理工作和教学质量。     

护士自我效能感及其影响因素调查

目的 探讨护士自我效能感的水平及其影响因素.方法 采用个人基本情况调查表及一般自我效能感量表对湖南省7所非营利性三级甲等医院的407名在职注册护士进行问卷调查.结果 护士自我效能感得分为26.67±5.30;影响护士自我效能感的因素包括科室、护龄和职称(均P＜0.05).结论 临床护士的自我效能感较高,影响护士自我效能感的因素较多,护理管理者需采取针对性措施,提高护士自我效能感.     

生活技能训练对手术室护士自我效能及工作压力的影响

目的 探讨生活技能训练对手术室低年资护士心理健康水平的影响.方法 采用方便抽样的方法选取手术室护士42名,开展为期6周的生活技能训练.采用基本信息表、一般自我效能感量表、护士工作压力源量表于训练前后进行评价.结果 训练后,护士一般自我效能感较培训前显著提高(P＜0.01);工作压力总分和管理及人际关系维度评分较培训前显著降低(均P＜0.01).结论 生活技能训练能有效提高护士一般自我效能感,减轻护士工作压力.     

脑卒中吞咽障碍患者习得性无助感现状及影响因素分析

目的 了解脑卒中吞咽障碍患者习得性无助感现状，并分析影响因素，为制订针对性干预措施提供参考。 方法 便利选取236例接受康复治疗的脑卒中吞咽障碍患者为研究对象，采用一般资料调查表、习得性无助感量表、脑卒中自我效能感问卷、领悟社会支持量表、心理一致感量表进行调查。 结果 患者习得性无助感得分为（76.07±5.63）分，自我效能、心理一致感、社会支持得分分别为60.40±7.24、62.24±8.96、52.81±6.75。分层回归分析结果显示，文化程度、家庭人均月收入、吞咽障碍程度、自我效能感、社会支持、心理一致感为习得性无助感的主要影响因素（均P＜0.05），可解释习得性无助感总变异的48.40%。 结论 脑卒中吞咽障碍患者存在较严重的习得性无助感。医护人员可通过提高患者社会支持水平、增强自我效能感与心理一致感，从而降低其习得性无助感。     

护士情绪劳动表现策略与自我效能的相关性分析

目的 了解护士情绪劳动表现策略与自我效能的相关性,为临床护理管理者制订措施减轻护士的情绪紧张和工作倦怠感提供依据.方法 采用情绪工作量表(ELS)和一般自我效能感量表对389名护士进行调查.结果 护士在情绪劳动中,最常采用的表现策略是自然表现,其次是深层表现,最后是表面表现;护士的自我效能感显著高于常模(P＜0.01),不同自我效能感水平护士自然表现和深层表现得分比较,差异有统计学意义(P＜0.05,P＜0.01);自我效能感与自然表现、深层表现呈正相关(均P＜0.01),与表面表现无显著相关性(P＞0.05).结论 自我效能高的护士更多运用自然表现与深层表现策略,提高自我效能水平可以增加自然表现和深层表现策略的运用.管理者应通过各种措施增强护士的自我效能感,使其在工作中能够更多地采用自然表现和深层表现策略调节情绪,提高心理应激水平.     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.