国际肝病学会分委员会对急性和亚急性肝功能衰竭命名的建议

SKAcharya编者按：本期刊出国际肝病学会分委员会有关专家对急性肝功能衰竭（AHF）和亚急性肝功能衰竭（SHF）命名的建议。此命名将AHF和SHF视为两个独立的疾病,而不是一个综合征的两个亚型,与我国1995年“病毒性肝炎防治方案”中的重型肝炎分类有诸多差别：①病因方面：AHF和SHF由各种病因（病毒、药物和毒物等）所致,而重型肝炎仅以病毒性肝炎为病因;②病程和时间：AHF在症状出现后4周内、SHF在症状出现后1～6个月内发生,而急性或亚急性重型肝炎均在症状出现后10天内或以后（有的定为4～8周内）发生;③症状特征：AHF及…     

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators

Student evaluation of the implementation of evidence‐based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high‐fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student‐evaluation instrument was an effective means of measuring student‐related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.     

Using participatory action research to foster nurse leadership in Australian rural hospitals

This paper outlines the processes and results of a participatory action research study undertaken to identify issues that may impact on strategies to foster nurse leadership in rural hospitals. Five Directors of Nursing from rural regions of Victoria, Australia participated. The group activities involved discussion and analysis of previous research, a review of current literature and critical reflection of the leadership performance of their organization. The analysis identified five key themes; dispel the myths, adopt big‐picture thinking, connect with colleagues, reflect on your own conduct, and create organizational buy‐in. It is essential to have an awareness of contextual challenges, an understanding of the importance of your own conduct as a visible leader, and the need for effective communication to inform the development of strategies that may be used to foster nurse leadership in rural hospitals. The platform to discuss and critically analyze leadership saw a group consensus that affirmed the need for any approach to nursing leadership to be tailored to the individual healthcare organization.     

Safety,risk, and aggression: Health professionals’ experiences of caring for people affected by methamphetamine when presenting for emergency care

The crystalline form of methamphetamine, commonly known as crystal meth (crystal methamphetamine) or ICE, is a highly‐addictive and powerful stimulant. Users of crystal meth often require emergency care, and are associated with a substantial burden of care by emergency care providers. The aim of the present qualitative study was to explore health professionals’ experiences of providing care for patients affected by ICE who presented to the emergency department (ED). Nine semistructured interviews were conducted. The major theme, ‘staying safe’, was revealed, in which participants described their experiences of being exposed to potentially unsafe situations, and their responses to challenging behaviours, including aggression. The findings highlight the need for ED staff to understand the nature of ICE use and its adverse impact on the mental and physical health of users. Furthermore, it is clear that establishing and maintaining safety in the emergency care setting is of utmost importance, and should be a priority for health‐care managers.     

Staff perceptions of leadership during implementation of task-shifting in three surgical units

Background Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. Objective This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. Methods Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. Results Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses’ opinions of leadership. Conclusion Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. Implications for nursing management Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.