西安市医护人员疼痛管理知识、态度和行为调查

目的 对西安市医护人员疼痛管理知识、态度和行为进行调查,并分析其影响因素,为医护人员疼痛管理的持续改进提供科学依据。方法 采用自制的医护人员疼痛管理知识、态度和行为调查问卷对西安市4家三甲医院医护人员进行调查,采用描述流行病学分析方法对医护人员疼痛管理知识、态度和行为情况进行分析,并采用单、多因素分析方法对疼痛管理知识、态度和行为的影响因素进行分析。结果 1 018名医护人员对疼痛管理知识、态度和行为的答题得分率分别为45.80%、40.73%和46.09%。多重回归分析结果显示,工作年限（β'=0.116）、职称（β'=0.089）、疼痛科/肿瘤科相关科室工作经历（β'=0.249）、接受疼痛知识教育或培训（β'=0.357）是医护人员疼痛管理知识得分的影响因素;工作年限（β'=0.227）、疼痛科/肿瘤科相关科室工作经历（β'=0.416）、接受疼痛知识教育或培训（β'=0.269）、知识得分（β'=0.263）是医护人员疼痛管理态度得分的影响因素;工作年限（β'=0.176）、疼痛科/肿瘤科相关科室工作经历（β'=0.263）、接受疼痛知识教育或培训（β'=0.242）、知识得分（β'=0.203）、态度得分（β'=0.237）是医护人员疼痛管理行为得分的影响因素。结论 医护人员疼痛管理知识、态度和行为水平均处于较低水平,亟待进一步提高,对医护人员的疼痛管理继续教育应予以重视。     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。     

医疗机构护理人员肌肉骨骼患病现况及影响因素研究

目的 调查医院护理人员肌肉骨骼患病情况并分析影响因素,指导制定有效的干预措施。方法 于2021年2—6月采用肌肉骨骼疾患调查表评估郑州市二级及以上医院护理人员肌肉骨骼患病情况,同时参照快速上肢评估方法评估人体工效学负荷等级,收集护理人员的人口学资料等,分析肌肉骨骼疾患发生的影响因素。结果 最终纳入1 031名护理人员,肌肉骨骼患病率为77.21%,以颈、肩、腰部患病更多见。多因素Logistic回归分析结果显示年龄（OR=1.520）、BMI≥24.0 kg/m²（OR=1.960）、有生育过（OR=1.114）、工龄（OR=2.208）、医院级别（OR=2.751）、科室（内科：OR=0.451、儿科：OR=0.671、妇产科：OR=0.184、急诊：OR=2.487、其他科室：OR=0.191）、人体工效学负荷等级（OR=2.560）是医院护理人员肌肉骨骼患病的影响因素。结论 医院护理人员肌肉骨骼患病率处于较高水平,受到多种因素影响,应当针对性采取干预措施帮助护理人员减少不良工作姿势、改善工作环境,降低肌肉骨骼患病率,提高医护人员身体健康水平。     

护理人员应付方式的相关因素分析

目的 探讨影响护理人员应付方式的相关因素。方法 采用应付方式问卷和艾森克个性问卷对303名护理人员进行评定。结果 护理人员的应付方式与个性心理特征相关性较大,与年龄和护龄不呈线性关系,与是否倒班和不同的科室无关。4－5年和6－8年护龄的护理人员在应用解决问题应付方式上,比其他护龄组明显减少。结论 应加强护理人员,尤其是工作4－8年的护理人员的应付方式的指导。     

Measuring quality and outcomes in intensive care

While quality measures are integral to the maintenance of a high standard of patient care, high-quality care remains a complicated concept to define in the context of acute care. In this article we explore how quality can be measured in the intensive care unit. Standard outcome metrics such as mortality are tangible comparators, but do not offer a comprehensive assessment of quality for the complex heterogeneity of the intensive care population. We explore the Donabedian model as a means to describe the importance of outcomes, processes, structure and environment to inform the measurement of quality. These concepts can be more abstract and difficult to measure but can provide significant insight into the culture of a unit and the resulting performance, and thus provide a more comprehensive measure of quality.     

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.     

PDCA循环在提高ICU医务人员手卫生依从性中的应用

目的 探讨PDCA循环管理工具在提高医务人员手卫生依从率中的应用。方法 应用PDCA循环管理工具,通过逐步开展现况调查、原因分析、对策拟定、对策实施、效果确认、标准化等程序对上海市某三甲专科医院ICU医务人员的手卫生依从率进行持续质量改进,观察PDCA实施前后的效果。结果 实施PDCA循环之后,ICU医生的手卫生依从率从实施前的42.3%提升到70.9%(χ2=28.3,P<0.001),护士从56.0%提升到75.6%(χ2=21.0,P<0.001),且差异均有统计学意义。结论 应用PDCA循环管理工具进行持续质量改进,可有效提高医务人员手卫生依从率。     

Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019

Background/AimInfluenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019.MethodsDemographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all three years. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination.ResultsFrom a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19–0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03–0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22–0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27–0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group.ConclusionThe significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.