急诊科护士遭受躯体暴力的预测线索探讨

目的探讨急诊科护士发生躯体暴力的预测线索。方法对四川省和重庆市5所医院的急诊科进行观察性研究,由专人观察和记录患方的行为线索,并根据行为变化是否转化为躯体暴力分为躯体暴力组和非躯体暴力组,统计分析两组行为变化的例数和躯体暴力的行为方式,采用Logistic回归分析确定护士发生躯体暴力的特定预测线索。结果共观察287例患者,非躯体暴力组219例,转化为躯体暴力组68例,躯体暴力发生率23.7%。Logistic回归分析显示当患方出现紧握双拳(OR=6.334)、挑衅(OR=5.672)、抵制护理措施(OR=5.164)、大声争吵(OR=4.651)、紧跟护理人员(OR=3.334)或鲁莽(OR=3.172)是发生躯体暴力的最强预测线索(P0.05,P0.01)。结论急诊科发生躯体暴力比较普遍,应快速、方便、有效地评估患方潜在的躯体暴力风险,采取相应的防范措施,以减少躯体暴力风险的发生,避免急诊科护士受到身体和心理伤害。     

结核病专科医院临床护士营养知识态度现状调查分析

目的了解结核病专科医院护士的营养知识和态度的现状,分析其相关性,为针对性地进行营养知识培训提供依据。方法采用方便抽样的方法,对某三甲结核病专科医院的256名临床护士的营养知识和态度进行调查。结果护士营养知识正确率53.74%,得分(16.12±4.56)分,其中良好、一般、差者分别占1.2%、41.0%、57.8%;不同年龄、工作年限、学历、职务、编制、工作状况护士的营养知识掌握情况比较,差异有统计学意义(P0.05,P0.01);态度得分为(94.56±10.53)分,持正性、中性、负性态度者分别占64.5%、33.6%、1.9%,不同职称护士的营养态度得分差异有统计学意义(P0.01);营养知识与态度呈正相关(P0.01)。结论护理管理者应加强对护士营养知识的培训,端正其对营养的态度,从而提高营养护理质量。     

联络护士强化培训对冠心病合并糖尿病患者低血糖管理的影响

目的 探讨联络护士强化培训在冠心病合并糖尿病患者低血糖管理中的运用效果.方法 通过对心内科联络护士强化培训管理,对82例冠心病合并糖尿病患者实施低血糖管理,比较治疗前后患者低血糖情况及血糖 监测结果差异.结果 干预后,患者低血糖发生时机(Z=-0.756,P=0.450)、临床症状及诱因(Z=-1.105,P=0.269)差异无统计学意义;而低血糖发生率明显降低(x2=-2.000,P=0.046),低血糖监测频率(Z=-3.282,P=0.005)、应急处理(Z=-2.075,P=0.037)均较干预前改善.结论 对联络护士强化培训,可提高非糖尿病专科的患者低血糖风险防范意识,促进低血糖管理行为建立,减少低血糖发生.     

Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey

Background

Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries.

Objective

We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden.

Methods

This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring.

Results

The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers “how are we going to do it?” (categories include structure and resource), health care professionals themselves “what do we need to know and do” (reservation), and barriers related to patients “not everybody would benefit” (internal and external shortcomings).

Conclusions

Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients’ hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.