单侧唇裂功能性修复320例护理体会

目的:探讨单侧唇裂功能性修复的护理特点和方法。方法:对我院320例行单侧唇裂功能性修复患儿的护理行回顾性分析和总结。结果:患儿及家属能积极配合,患儿术后恢复良好,家属满意。结论:在常规护理的基础上,患儿特别是家属对疾病和手术方案的认识将对手术和护理效果产生重要影响。     

更新护理观念 促进护理学科发展

随着新的医学模式的确立，护理学科的核心思想已从以疾病为中心的功能护理逐步发展为以病人为中心的整体护理阶段。其内涵：把病与病人，反生物学的病人与社会和心理学的人，把病人与其所处的环境，把病人从入院－出院－康复都作为一个整体，目前，我国护理工作主体仍处于以疾病为中心的护理思考指导下的功能制护理，局限了护理学科的发展，近年来，我国护理界引进了整体护理，并将其思想应用于临床护理工作中，进行了多方位探讨，旨     

吉林省38所医院护理工作抽查情况分析

吉林省第一周期的医院评审工作基本结束,为了巩固成果,防止滑坡,吉林省医院评审委员会多次组织专家对38所二三级甲乙等医院护理工作进行现场抽查。对吉林省护理工作的概况及抽查中发现的共性问题进行了分析。同时建议:加强护理人员的职业道德教育;解决护理人员编制不足问题;提高护理人员技术劳务价值;运用激励手段提高护理工作质量。     

人本原理在医院管理中的应用价值

目的:研究人本原理在护理管理中的应用。方法:把人本原理的管理原则、动力原则、行为原则、能级原则应用于护士长的管理中,尊重、关心、帮助和激励护士,人人参与管理。选择2005年上半年住院病人180例作为改革组,应用人本原理管理。2004年下半年住院病人150例作为传统组,用传统方法管理。结果:通过人本原理管理原则的应用,提高了护理质量,各项指标应用后高于应用前(P<0.05或P<0.01),无投诉、无差错事故发生,病人满意度一直在95%以上,护士参与管理意识增强,团队精神加强,护士按期晋升。护士对病人实行人性化服务,为医院赢得了相应的社会效益和经济效益。结论:人本原理应用于护理管理行之有效,值得推广。     

甲基强的松龙冲击疗法治疗重型脱髓鞘脑病患者的护理

采用大剂量甲基强的松龙治疗脱髓鞘脑病患者１５例。在治疗过程中，积极预防应激性溃疡，加强呼吸道及人工冬眠护理。经５次治疗，１４例症状明显改善。     

总责任护士主导的医护一体化护理模式在创伤骨科的应用

目的探讨总责任护士主导的医护一体化临床护理模式在创伤骨科的应用效果。 方法选择2016年7月至2017年6月在南京大学医学院附属鼓楼医院创伤骨科行手术治疗的骨折患者200例，按照入院先后顺序分为对照组90例(实施创伤骨科常规护理)和观察组110例(实施医护一体化工作模式，包括成立医护合作小组、实施总责任护士主导的医护一体化查房、个体化诊疗方案的共同决策、疼痛管理、早期出院计划与延续护理)。比较2组患者的术后护理效果和医护合作满意度。对数据行t检验和χ²检验。 结果总责任护士主导的医护一体化模式下，观察组患者术后72 h内数字评分法(NRS)评分为(4.09±1.64)分，疼痛干预有效率为77.57%，对照组术后72 h内NRS评分为(5.15±1.69)分，疼痛干预有效率为57.95%，2组比较差异均有统计学意义(P值均小于0.05)；观察组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为2、1、3，对照组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为9、7、11，两组比较差异均有统计学意义(χ²＝4.486、4.296、6.812，P＝0.027、0.036、0.009)。观察组术后康复开始时间为(21.48±6.41)h，术后住院时间为(11.08±2.19)d；对照组术后康复开始时间为(36.48±10.75)h，术后住院时间为(13.95±2.93)d，2组比较差异均有统计学意义(t＝11.670、－7.616，P值均小于0.05)。2组医护合作满意度结果显示，观察组患者信息的交流得分为(3.78±0.85)分，共同参与治疗或护理决策得分为(3.86±0.87)分，医师和护士的关系得分为(4.00±0.84)分，总分为(3.87±0.67)分；对照组患者信息的交流得分为(3.32±1.00)分，共同参与治疗或护理决策得分为(3.23±0.93)分，医师和护士的关系得分为(3.45±0.96)分，总分为(3.33±0.84)分，2组比较差异均有统计学意义(P值均小于0.05)。 结论总责任护士主导的医护一体化护理模式的应用，以亚专科为核心，重新整合医护资源，共同参与制订患者的诊疗护理方案，共同聚焦患者安全与质量，加强了医护间的配合，提高了医疗护理服务质量，提升医护合作满意度。     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。     

Nursing Home Residents’ Functional Trajectories and Mortality After a Transfer to the Emergency Department

ObjectiveTo describe nursing home residents’ (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED).DesignCase-control observational multicenter study.Setting and ParticipantsIn total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016.MethodsFinite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions.ResultsTrajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2?time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness.Conclusions and ImplicationsIdentified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.     

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

ObjectivesTo determine what information is most important to registered nurses' (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents.DesignWeb-based discrete choice experiment with 19 clinical scenarios.Setting and ParticipantsOnline survey with a convenience sample of RNs (N = 881) recruited from a health care research panel.MethodsClinical scenarios used information from 10 categories of resident characteristics: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical examination, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions (self-paced, n = 437 and forced deliberation, n = 444). The degree to which evidence- and non–evidence-based information was important to decision-making was estimated using unconditional multinomial logistic regression.ResultsFor all nurses (22.8%) and the self-paced group (24.1%), lower urinary tract status had the highest importance scores for the decision to call a clinician about a suspected UTI. For the forced-deliberation group, body temperature was most important (23.7%), and lower urinary tract status was less important (21%, P = .001). The information associated with the highest odds of an RN calling about a suspected UTI was painful or difficult urination [odds ratio (OR) 4.85, 95% confidence interval (CI) 4.16–5.65], obvious blood in urine (OR 4.66, 95% CI 3.99–5.44), and temperature at 101.5° (OR 3.80, 95% CI 3.28–4.42). For the self-paced group, painful or difficult urination (OR 5.65, 95% CI 4.53–7.04) had the highest odds, whereas obvious blood in urine (OR 4.39, 95% CI 3.53–5.47) had highest odds for the forced-deliberation group.Conclusions and ImplicationsThis study highlighted the importance of specific resident characteristics in nurse decision-making about suspected UTIs. Future antimicrobial stewardship efforts should aim to not only improve the previously studied overprescribing practices of clinicians, but to improve nurses' assessment of signs and symptoms of potential infections and how they weigh resident information.     

自我角色认同护理在躁狂症护理中的应用效果分析

目的探讨自我角色认同护理在躁狂症中的应用效果。方法选取2017-2019年沈阳市铁西区精神卫生中心收治的成人躁狂症发作期患者50例,随机分为对照组和干预组各25例。对照组给予常规护理,干预组给予自我角色认同护理。分别采用激越行为量表和社交技能量表对两组的干预效果进行评价。结果干预后两组激越行为量表和社交技能评定目录量表各维度评分及总分差异均有统计学意义(P<0.05)。结论自我角色认同护理能进一步改善躁狂症患者的激越行为和社交技能,值得临床推广应用。