美国医保支付制度改革对我国康复护理服务的启示

梳理了美国医保支付制度改革进程,总结了捆绑支付模式内涵及其对康复护理服务的影响。结合我国国情,借鉴美国医保支付制度改革经验,认为我国应建立基于价值评价的康复护理服务医保支付制度,充分发挥医保基金的引导和保障作用,健全多元化的复合型医保支付体系,创建“以人民的健康为中心”的连续型医疗服务保障体系。     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。     

“六新”模式推动临床护理高质量发展:以陕西省人民医院为例

护理学科高质量发展促进公立医院高质量发展。介绍了陕西省人民医院以符合时代要求的护理管理、患者体验、人才队伍、学科建设、效率提升、文化建设为切入点的临床护理高质量发展“六新”模式,对实施成果进行总结分析,并从信息化建设角度思考如何进一步推进临床护理高质量发展,为推动临床护理高质量发展提供参考。     

基于“互联网+”模式教学在肝胆胰外科护理教学中的效果分析

目的：探究基于“互联网+”模式教学在肝胆胰外科护理教学中的效果。方法：选取河南省人民医院2022年1月至2022年10月来肝胆胰外科实习护生200名作为研究对象,按照随机数字表分组方法分为对照组与观察组,各100例。对照组采用常规护理教学模式,观察组采用“互联网+”模式教学。比较两组实习护生考核成绩、学习能力、批判性思维能力及教学满意度。结果：观察组实习护生考核成绩、学习能力、批判性思维能力及教学满意度均高于对照组,差异具有统计学意义（P <0.05）。结论：在肝胆胰外科护理教学中采用“互联网+”教学模式可提升实习护生考试成绩、学习能力及批判性思维能力,并使其获得较高的教学满意度。     

护理风险管理对急性心肌梗死PCI治疗患者风险事件发生的影响

目的探讨护理风险管理对急性心肌梗死PCI治疗患者风险事件发生的影响。方法选取2019年1月至2019年12月在我院行PCI治疗的107急性心肌梗死患者,根据护理方法不同分为对照组(n=53)和观察组(n=54)。对照组行常规护理,观察组在对照组基础上行护理风险管理。比较两组患者PCI治疗后风险事件发生情况及护理满意度。结果观察组PCI治疗后风险事件发生率为7.41%,明显低于对照组的22.64%(P <0.05)。观察组护理满意度为98.15%,明显高于对照组的83.02%(P<0.05)。结论护理风险管理对急性心肌梗死PCI治疗患者的效果显著,可明显减少风险事件的发生,提高患者对护理工作的满意程度。     

Nursing Home Residents’ Functional Trajectories and Mortality After a Transfer to the Emergency Department

ObjectiveTo describe nursing home residents’ (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED).DesignCase-control observational multicenter study.Setting and ParticipantsIn total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016.MethodsFinite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions.ResultsTrajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2?time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness.Conclusions and ImplicationsIdentified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.     

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

ObjectivesTo determine what information is most important to registered nurses' (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents.DesignWeb-based discrete choice experiment with 19 clinical scenarios.Setting and ParticipantsOnline survey with a convenience sample of RNs (N = 881) recruited from a health care research panel.MethodsClinical scenarios used information from 10 categories of resident characteristics: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical examination, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions (self-paced, n = 437 and forced deliberation, n = 444). The degree to which evidence- and non–evidence-based information was important to decision-making was estimated using unconditional multinomial logistic regression.ResultsFor all nurses (22.8%) and the self-paced group (24.1%), lower urinary tract status had the highest importance scores for the decision to call a clinician about a suspected UTI. For the forced-deliberation group, body temperature was most important (23.7%), and lower urinary tract status was less important (21%, P = .001). The information associated with the highest odds of an RN calling about a suspected UTI was painful or difficult urination [odds ratio (OR) 4.85, 95% confidence interval (CI) 4.16–5.65], obvious blood in urine (OR 4.66, 95% CI 3.99–5.44), and temperature at 101.5° (OR 3.80, 95% CI 3.28–4.42). For the self-paced group, painful or difficult urination (OR 5.65, 95% CI 4.53–7.04) had the highest odds, whereas obvious blood in urine (OR 4.39, 95% CI 3.53–5.47) had highest odds for the forced-deliberation group.Conclusions and ImplicationsThis study highlighted the importance of specific resident characteristics in nurse decision-making about suspected UTIs. Future antimicrobial stewardship efforts should aim to not only improve the previously studied overprescribing practices of clinicians, but to improve nurses' assessment of signs and symptoms of potential infections and how they weigh resident information.     

正常分娩综合性实验在产科护理教学中的应用研究

目的探讨在产科护理教学中应用正常分娩综合性实验教学取得的效果研究。方法选取2018年9月—2019年6月在该院实习120名护理本科生作为研究对象,依据奇数偶数分配原则分为两组,其中对照组60名学生进行常规的消毒操作和外阴清洁考核,观察组的60名学生应用正常分娩综合性实验进行考核,对比两组学生护理技能测试成绩以及取得的教学效果。结果观察组优良率(98.33%)高于对照组(88.33%),差异有统计学意义(P<0.05);观察组团队协作能力、学习兴趣、解决问题能力、沟通能力及操作能力评分高于对照组,差异有统计学意义(P<0.05)。结论产科护理教学中应用正常分娩综合性实验教学取得的效果显著,能提升教学成绩,让实习护理本科生更快掌握护理技巧,为医院输送优质护理人才,能缓解产科护理人员缺乏的现象,正常分娩综合性实验教学方案值得应用。     

自我角色认同护理在躁狂症护理中的应用效果分析

目的探讨自我角色认同护理在躁狂症中的应用效果。方法选取2017-2019年沈阳市铁西区精神卫生中心收治的成人躁狂症发作期患者50例,随机分为对照组和干预组各25例。对照组给予常规护理,干预组给予自我角色认同护理。分别采用激越行为量表和社交技能量表对两组的干预效果进行评价。结果干预后两组激越行为量表和社交技能评定目录量表各维度评分及总分差异均有统计学意义(P<0.05)。结论自我角色认同护理能进一步改善躁狂症患者的激越行为和社交技能,值得临床推广应用。     

慢性病护理质量评价指标体系研究现状及启示

对国内外慢性病护理质量评价指标体系构建的理论框架、方法以及构建范围进行归纳总结,认为我国慢性病护理质量评价指标体系中应加强对患者结局指标的关注,应注意指标体系构建方法的科学性,还应积极探索多病种慢性病护理质量评价指标体系,构建统一的适合我国国情的慢性病护理质量评价指标体系。