我国护士院内培训存在的问题及发展趋势

医院开展的以在职护士为对象的院内培训应从属于继续护理教育下的一个分类，具有继续教育的众多特征。概述目前护士院内培训的情况，探讨其在计划、经费、时间、内容等方面存在的问题。建议未来的护士院内培训可采取合作式、个别式、开放式的模式。     

儿科进修护士静脉穿刺遭拒的原因分析及对策

目的 调查和分析儿科进修护士静脉穿刺遭拒的原因，提出对策。方法 对36名儿科进修护士92例次遭拒情况进行分析。结果 重复穿刺遭拒次数占总次数的68．5％，头皮静脉穿刺遭拒次数则是四肢静脉穿刺的3．8倍。遭拒原因：与患儿家属有关的55例次，占59．8％；与进修护士自身素质有关的37例次，占40．2%。结论 儿科进修护士静脉穿刺遭拒与患儿家属的认知有关，也与进修护士自身素质有关。     

Fear of patients related to coronary arteriography

The purpose of this paper is to describe and evaluate the ability of instruments to produce information about the presence and intensity of fear before, during and after coronary arteriography. Information about patient fear was measured from cognitive, physiological and behavioural dimensions. The sample of the study was 243 patients who were due to have a scheduled coronary arteriography in a university hospital in Finland. Fear was measured by the Visual Analogy Scale (VAS), Hospital Anxiety and Depression (HAD) Scale and State-Trait Anxiety Inventory (STAI). Physiological measurements (blood pressure and heart rate) were obtained. The VAS was given to 46 nurses and seven nurse assistants to measure nurses' perception of patient fear. Over 80% of the patients reported fears. Nurses perceived that the patients had more fears than they reported. Changes in physiological measurements were small but significant. One-third of the patients felt increased fear after the coronary arteriography. VAS, STAI and HAD produced reliable information about the patient fear. The correlations between the instruments suggest that each is a valid and appropriate measure of fear. Nurses need to develop their communication and observation skills in order to develop their recognition of the patients' fear.     

HMI education for HIMs

This paper analyses the curricula of the four Australian university programs for health information managers (HIMs) in relation to their coverage of health and medical informatics (HMI). The overlap between HIMs and HMIs should be increased through exchange of information at conferences such as this as well as communication and co-operation between the Schools of HIM and those offering health informatics related training at other Australian universities.     

Anticoagulation therapy and primary care internal medicine

The anticoagulation clinics at the University of Virginia Health Sciences Center and the University of California at Davis Medical Center are nurse-practitioner-operated, are affiliated with the general medicine clinic, and rely on portable prothrombin time (PT) monitors that use whole blood and provide timely as well as accurate results reported in PT seconds or as the international normalized ratio (INR). On-site PT/INR testing at these clinics simplifies anticoagulation, mandates direct patient contact, and facilitates primary as well as comprehensive care for patients requiring multispecialty services in large tertiary care centers. Encounters are relatively brief, averaging 19 minutes; 72% of the encounter time involves anticoagulation care and 28% involves primary care. Anticoagulation results using portable PT/INR monitors are safe and accurate based on comparisons with results from clinics relying on standard instruments. Supported in part by VA grants IIR 87-063 and IIR 90-036.     

医院中层管理人员的培训需求分析

医院的生存和发展面临着日益激烈的竞争。如何在竞争中始终保持优势，30％归功于高层管理者的正确决策，70％在于中层管理者良好的执行。了解中层管理人员的培训需求，结合组织行为学要求，采取适当的形式与方法，有针对性制订和实施培训计划。     

血液透析专科护士应具备专业知识的调查研究

目的探讨血液透析专科护士应具备的专业知识,为培养血液透析专科护士设置培训内容提供依据。方法应用德尔菲法对北京、上海和黑龙江等地35位专家就血液透析专科护士应具备的专业知识进行2轮函询与论证。结果专家的权威程度为0.85,专家意见的集中程度高;2轮调查专家意见的和谐系数分别为0.27、0.41（均P〈0.01）。血液透析专科护士应具备的专业知识包括专科理论知识、专科实践知识和护理相关知识3大类34个条目。专家意见较一致的前几个条目为透析设备的管理、血管通路的管理、血液透析的观察技术、血液透析中即刻并发症的处理、血液透析患者及家属的心理护理、血液透析患者生活质量的评价、血液透析中心的护理风险管理等。结论专家对确定的血液透析专科知识协调程度较高,可将其作为血液透析专科护士培训内容,以提高护士专业知识水平。     

How public health nurses understand mothers of abused and neglected children: The perception of 'Shindosa' in mothers

Aim: The purpose of this paper is to describe the practical knowledge that public health nurses use in identifying and providing assistance to the mothers of child abuse victims. Methods and Results: A grounded theory qualitative research method was used to collect and analyse semistructured interviews of 22 public health nurses from health centers in Osaka, Japan. The data was systematically analysed by using a constant comparison process. The participants had an average age of 46.2 years with an average of 21.6 years of experience in their profession. The research examined the perspective of the public health nurses regarding the mothers of child abuse victims. The key factor ‘shindosa’, which is a sense of fatigue, defeat, or lack of energy, emerged from the data. In addition, public health nurses used a two‐step process of perception. First, public health nurses began providing assistance to mothers by noticing the presence of shindosa in thems. Nurses became concerned by the state of the mothers and the way they interacted with their children. They perceived that the mother might be experiencing shindosa. Second, through continuous involvement with the mothers, public health nurses came to ascertain the essence of shindosa in mothers. Thus, their initial vague impression of the presence of shindosa became the catalyst to providing assistance to the mothers, and as a result, they gradually understood the fundamental nature of shindosa. Conclusion: By focusing on mothers as well as children, public health nurses successfully achieved their goal to provide the appropriate and specific care to each mother with shindosa as a solution in the prevention of child abuse.     

Said Another Way. Is the ADN Graduate Prepared to Practice in Community Settings?

The downsizing and closing of acute care facilities and the movement to community-based healthcare services are decreasing the need for RNs in acute care facilities. In the past, the associate-degree nurse (ADN) has filled the majority of positions in acute care. With the trend to provide health services in community setting, will the ADN be prepared for positions in community facilities? ADN educators must reevaluate how they are educating students for practice. The author reviews the 1995 recommendations from the Pew Health Professions Commission and relevant current directives from the National League for Nursing.