对儿童血液肿瘤科护理人员进行能力本位培训的效果评价

目的确定开展能力本位培训对儿童血液肿瘤科护理人员专科知识及技能的影响。方法选择2003年在上海儿童医学中心血液肿瘤科全体临床护理人员26名。根据美国St.Jude儿童研究医院的认证经验和相关文献设立儿童血液肿瘤科护理人员的专科能力本位培训内容与方法;每项项目是重复3次的滚动式标准培训,培训共持续8个月。根据培训内容设计知识试卷和操作评分标准;培训前用知识试卷进行前测,培训结束后用同一张试卷进行后测,比较前测和后测结果。同时培训后用操作评分标准测试操作技能。结果培训后临床护理人员的知识水平比以前有显著提高,P=0.000;培训后护理人员操作第1次合格率为96.2%。结论系统的标准临床专科能力本位培训能显著提高儿童血液肿瘤科护理人员的专科核心能力。     

人文关怀护理干预对门诊护理服务满意度的影响

目的了解通过人文关怀护理干预后就诊者对门诊护士满意度影响。方法护理服务质量满意度调查表共设置17条,每条项目有"满意"、"基本满意"、"不满意"3项选择或"是"与"否"2项选择。"满意"、"基本满意"、"是"项列入优良项目数,"不满意"、"否"项列入不良项目数。对人文关怀护理干预及常规护理的就诊者各50例采用门诊现场问卷调查和集中填表相结合的方式进行满意度调查。结果分别收到人文关怀护理干预组及常规护理组就诊者对门诊护理服务综合评价不良项目179条和21条,两者比较有统计学意义(P<0.05)。结论对门诊就诊者进行人文关怀护理干预可提高门诊护理服务质量及就诊者的满意度。     

衡水市医院感染科医务人员心理健康调查及因素分析

目的:帮助感染科医务人员迅速发现并调整不良心理状态,促进感染性疾病的防治工作。方法:对衡水市二级以上综合医院感染科医务人员116名,采用SCL—90症状自评量表测评。结果:感染科医务人员躯体化、强迫、焦虑、恐怖等因子与全国常模比较,差异有统计学意义。结论:职业性危险因素长期作用于感染科医务人员,造成不良心理状态,及时进行心理干预,以保持心理健康,促进感染性疾病的防治工作。     

Effect of a bundle-approach intervention against contamination of blood culture in the emergency department

BackgroundTo prevent contamination when taking blood culture, there are various effective interventions. Whether there is greater efficacy by using a combination of these interventions has not been widely evaluated.MethodsOur six-element intervention bundle aimed to prevent contamination of blood culture in our emergency department (ED). Elements were: use of 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, using sterile gloves, using holed sterile cover, and selection of upper extremities as the site of venipuncture. We compared the contamination rate of blood culture between the pre- and the post-intervention periods among all cases with two or more blood cultures taken in our ED. We also evaluated the rate of patients receiving vancomycin among all those transferred to the hospital from the ED.ResultsDuring the pre- and post-intervention periods, 460 and 450 cases were included in analysis, respectively. Contamination of blood culture occurred in 29 pre-intervention cases (6.3%) and five post-interventional cases (1.1%) (relative risk 0.18, 95% confidence interval 0.07 to 0.45; P < 0.001). After bundle implementation, there was significant increase in adherence to using 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, and using holed sterile covers. Among patients admitted to hospital, fewer patients received vancomycin during the post-intervention period than in the pre-intervention period (5.4% vs. 3.2%, P = 0.03).ConclusionsOur intervention bundle dramatically reduced the contamination rate when drawing blood culture in our ED.     

对急诊科护士进行专业英语培训的探讨

目的探讨提高急诊科护士专业英语水平的有效培训模式。方法对60名急诊科护士进行为期2年的专业英语培训,自学为主、结合临床工作,注意听、说、读、写、译英语综合运用能力的训练。应用自行设计的问卷和试卷,对培训情况进行调查分析。结果86.7%的急诊科护士认为有必要进行专业英语培训,培训后护士的专业英语运用能力及相关的工作能力显著提高,培训前后英语测试的各项成绩差异均具有统计学意义。结论应重视急诊科护士的专业英语掌握情况,根据实际情况采用合适的培训方法,可有效提高其专业英语水平及相关的工作能力,促进急救护理事业的发展。     

Evaluation of a Bedside Whole-blood Rapid Troponin T Assay in the Emergency Department

Objective : To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods : A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results : Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6%, 59.0%, and 69.7% at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0% (p = 0.18), 69.6% (p = 0.04), and 79.8% (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9%, 64.5%, and 81.0%; and 43.8%, 77.4%, and 71.4%, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions : The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.     

影响急诊科护士健康状况的社会心理因素

目的研究工作压力、社会支持、应对方式、自尊在维护急诊科护士健康状况中的作用.方法采用整群抽样方法,用自测健康评定量表、护士工作压力量表、社会支持评定量表、简易应对方式问卷、自尊量表调查了北京市10家三级甲等综合性医院急诊科的407名护士.结果多元逐步回归分析表明,工作压力是生理健康的最强预测指标,可以解释8.6%生理健康的变异;工作压力和自尊分别可以解释15.7%和8.5%心理健康的变异;对支持的利用度和自尊可以解释13.9%和5.3%社会健康的变异.结论工作压力对急诊科护士健康状况影响最大;社会支持中对支持的利用度对社会健康的保护作用最强;自尊在维护健康中起着重要的作用,主要保护心理健康和社会健康.