不同手术配合中护士工作强度的分析与研究

目的通过对手术室护士工作强度的研究分析,探讨更加科学的体现手术室护士工作强度的评价指标,为手术室管理者根据现有的人力资源进行排班和目标管理考评提供更加合理的依据。方法根据手术室护士配合的手术种类不同,进行定量分析,调查在相同护理时间内,护士工作强度的差异。结果在护理工作时间相同的情况下,手术配合的种类不同,工作强度是不同的。结论工作时间是反映护士工作量的因素之一,但工作强度也是反映护士工作量的重要因素之一。工作强度不同,单位时间内工作强度的消耗也就有所差别。工作强度高,单位时间内劳动消耗多;反之则少。     

The reliability and validity of the therapeutic activity index

PURPOSE: To assess the psychometric properties of the Simplified Therapeutic Intervention Scoring System (TISS 28) scale. MATERIALS AND METHODS: A prospective observational design was used. Patients were recruited from a medical-surgical intensive care unit (ICU) and 4 rehabilitation wards of 2 university-affiliated hospitals in Hong Kong. RESULTS: Data necessary for the calculation of the TISS 28, the Therapeutic Intervention Scoring System (TISS 76), and severity of illness scoring system (Simplified Acute Physiology Score [SAPS II]) were recorded for each patient during the first 24 hours after his/her admission to an ICU. A significant positive correlation was found between the TISS 76 and the TISS 28 scores as well as the TISS 28 and the SAPS II scores. There was a significant difference between the TISS 28 scores among ICU patients and patients in rehabilitation wards. A significant correlation was found between the TISS 28 scores of the first and second set of TISS 28 scores. CONCLUSIONS: Although the findings supported the validity and reliability of the TISS 28, there were limitations of the TISS 28 in measuring nursing workload in ICUs. Hence, continued amendment and validation of the TISS 28 on larger samples in different ICUs would be required so as to provide clinical nurses with a valid and reliable assessment of nursing workload.     

Optimising workflow processes in an advanced medication dispensary

The workload measurement of an inpatient hospital dispensary is critical to improve efficiency in the face of limited budgets. This single-centre pilot study used work sampling to observe and identify areas to improve efficiency of dispensing prescribed medications at one tertiary level acute care teaching hospital. Workload sampling was conducted at a 1096-bed hospital in Calgary, Alberta, Canada. The dispensary services the entire hospital, 24 h per day, seven days per week. Pharmacists are solely involved in clinical screening. The hospital uses a tech-check-tech practice. The observer was a registered pharmacist who collected data in the dispensary over two-hour blocks during November 14–24, 2017. A pre-made data collection sheet was used to record observations. Pharmacists duplicated tasks performed by dispensary technicians, such as ensuring STAT orders were delivered or identifying floor stock medications. Assistants inconsistently organised orders for filling. The assistant delivering STAT medications was difficult to find. Not all STAT medications were delivered first on a scheduled delivery route. Overall, areas for improvement in the dispensary process may include reinforcing the pharmacist clinical duties, establishing clinical competency baseline, supporting the full scope of practice of registered technicians, and consistent training of assistants, and clarifying communication processes.     

Nursing workforce deployment and intensive care unit strain during the COVID-19 pandemic in Victoria,Australia

BackgroundThe COVID-19 pandemic demanded intensive care units (ICUs) globally to expand to meet increasing patient numbers requiring critical care. Critical care nurses were a finite resource in this challenge to meet growing patient numbers, necessitating redeployment of nursing staff to work in ICUs.ObjectiveOur aim was to describe the extent and manner by which the increased demand for ICU care during the COVID-19 pandemic was met by ICU nursing workforce expansion in the late 2021 and early 2022 in Victoria, Australia.MethodsThis is a retrospective cohort study of Victorian ICUs who contributed nursing data to the Critical Health Information System from 1 December 2021 to 11 April 2022. Bedside nursing workforce data, in categories as defined by Safer Care Victoria’s pandemic response guidelines, were analysed. The primary outcome was ‘insufficient ICU skill mix’—whenever a site had more patients needing 1:1 critical care nursing care than the mean daily number of experienced critical care nursing staff.ResultsOverall, data from 24 of the 47 Victorian ICUs were eligible for analysis. Insufficient ICU skill mix occurred on 10.3% (280/2725) days at 66.7% (16/24) of ICUs, most commonly during the peak phase from December to mid-February. The insufficient ICU skill mix was more likely to occur when there were more additional ICU beds open over the ‘business-as-usual’ number. Counterfactual analysis suggested that had there been no redeployment of staff to the ICU, reduced nursing ratios, with inability to provide 1:1 care, would have occurred on 15.2% (415/2725) days at 91.7% (22/24) ICUs.ConclusionThe redeployment of nurses into the ICU was necessary. However, despite this, at times, some ICUs had insufficient staff to cope with the number and acuity of patients. Further research is needed to examine the impact of ICU nursing models of care on patient outcomes and on nurse outcomes.     

Nursing workforce,education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: A qualitative substudy

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units.MethodsThis was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service.ResultsFour themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles.ConclusionThis study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.     

飞行(学)员人格因素与职业倦怠及工作压力相关研究

目的 通过研究飞行(学)员群体人格因素与职业倦怠、工作压力的相关关系,为飞行职业应激干预提供指导. 方法 采用Maslach职业倦怠问卷通用版(Maslach burnout inventorygeneral survey,MBI-GS)、工作压力感问卷、艾森克人格问卷简式量表中国版、航空安全控制点问卷及坚韧人格问卷,调查飞行(学)员167人(歼击机飞行员67人,直升机飞行员37人、直升机学员44人和运输机飞行员19人).按飞行机种分为歼击机飞行员组、运输机飞行员组、直升机飞行员组和直升机学员组.利用SPSS 16.0统计软件,通过单因素方差分析比较不同组受试者的职业倦怠、工作压力感的特点.采用Pearson相关分析分析职业倦怠、工作压力感与人格特征之间的关系. 结果 本组问卷回收率100％,有效率100％.MBI-GS的内部一致性系数为0.710.职业倦怠情感耗竭和玩世不恭维度在4组受试之间存在差异(F=5.864、3.726,P＜0.01、0.05);其与艾森克人格问卷内外向维度、与安全控制点总分、坚韧人格总分呈负相关(r=-0.380～-0.278,P＜0.01),与艾森克人格问卷神经质维度、安全控制点外控维度呈正相关(r=0.229～0.526,P＜0.01). 结论 人格因素对职业倦怠有预测作用,外控和情绪不稳定的飞行员职业倦怠感强,内控和人格坚韧的倦怠感低.航空安全控制点结果说明对安全控制感低的飞行(学)员职业倦怠感强,符合飞行工作是高度危险职业的特点.     

远程飞行劳动负荷特点与卫生保障措施研究进展

目的 综述远程飞行劳动负荷特点与卫生保障措施的研究进展. 资料来源与选择 国内外该领域的相关文献. 资料引用 引用国内外公开发表的文献资料47篇. 资料综合 回顾了远程飞行的主要应激因素,例如持续仪表观察、长时间活动受限、频繁出现的生物节律紊乱等.总结了民用和军事航空远程飞行的劳动负荷特点,其中民用航空飞行人员的疲劳问题非常突出:宇宙辐射损伤增加,女乘务员工作相关的肌肉骨骼症状多发;下肢水肿常见,静脉血栓形成和栓塞的发病率增加.军事航空远程飞行常常出现飞行耐力和操作能力降低,如果复合飞行疲劳与生物节律紊乱的影响将威胁飞行安全.介绍了国内外民用和军事航空远程飞行卫生保障措施,主要包括身心机能适应性训练、睡眠保障、营养调节、合理用药以及任务中疲劳监测和预警等,列举了国外远程飞行综合卫生保障的典型实例.在此基础上,提出今后开展军事远程飞行卫生保障工作的建议. 结论 针对远程飞行的劳动负荷特点,强调采用综合卫生保障措施维护飞行人员的作业能力.     

试论以工作量为基础的医院奖金分配制度

奖金关系到医院每位员工的切身利益,奖金核算对于医院的管理至关重要。公平公正的奖金分配制度能充分调动员工积极性,反之有失偏颇的奖金分配制度在打击员工工作热忱的同时制造了彼此的矛盾。本文从我院实际出发,探索以工作量为基础的奖金分配制度,以提升经营绩效,提高患者和员工的满意度。     

新型冠状病毒肺炎疫情防控期间北京协和医院产科超声工作量的同比及环比分析

目的探讨新型冠状病毒肺炎（COVID-19）疫情防控期间产科超声工作量的变化趋势。 方法回顾性分析2020年2月至5月（疫情期）北京协和医院超声医学科产科超声检查的工作量,分别与2019年2月至5月（2019年同期）和2019年10月至2020年1月（疫情前期）进行比较。不同时期不同妊娠阶段的工作量占比组间比较采用χ²检验。 结果疫情期超声医学科总工作量同比下降60.1%,环比下降61.3%,产科超声工作量为7684人次,同比下降23.0%,环比下降19.2%。产科超声工作量占全科总工作量的比例大幅上升,并与疫情严重程度呈正相关,2020年2月至5月每月产科超声工作量占比分别为35.8%、15.3%、9.8%和7.4%,其中2月工作量占比同比增长5.0倍,环比增长5.3倍。不同妊娠阶段的超声检查所占比例存在明显变化,孕早期超声检查占比同比下降6.8%,环比下降5.8%,孕晚期占比同比增长5.2%,环比增长3.1%。疫情期转会诊产科超声工作量为301人次,占产科超声总工作量比例为3.9%,与2019年同期（4.1%）和疫情前期（3.4%）相比差异无统计学意义（P＞0.05）。 结论COVID-19疫情防控期间超声医学科总工作量显著下降,而产科超声工作量占比明显上升。