Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

ObjectiveTo examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points.Data SourcesMedical record data from nine hospitals in Washington State from January 2016 through September 2018.Study DesignRetrospective, observational cohort design using an aggregated database of birth records.Data Collection/Extraction MethodsChart‐abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse‐ and physician‐level CD rates at three attribution time points and the reliability of these methods compared.Principal FindingsThe sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse‐level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse‐level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician‐level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery.ConclusionFeedback on nurse‐level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual‐level and unit‐level information. To reliably distinguish individual nurse performance, larger sample sizes are needed.     

用层析法研究X—CT的论证问题

为改善技术论证的定量程度，作者用层析法对Ｘ－ＣＴ的选型操作进行了研究，并提出此方法可推广应用于一般医院的大型装备。     

Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions

The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.     

Nursing home residents' perceptions of relocation

Summary

• ? The lived experience of relocating to a nursing home is explored from the perspective of 19 residents of Australian nursing homes.
• ? The interpretative research methodology is informed by hermeneutic phenomenology.
• ? In-depth interviews were conducted with 19 nursing home residents living in nursing homes in NSW. Interviews were audiotaped, transcribed and analysed to identify emergent themes.
• ? The themes are described and interpreted to provide an understanding of the relocation experience.

     

护理人员信息管理系统的开发与应用

本文回顾了国内护理人员信息系统研究的背景和现状,介绍了作者自行研制的护理人员信息管理系统的结构和功能,并将其用于护士继续教育和规范化培训的管理过程,已取得较好成果。护理人员信息管理系统的开发与应用旨在适应未来护理的发展需求,促进护理管理的现代化。     

The Use of Humor in Addressing the Sexuality of Elderly Nursing Home Residents

This paper is drawn from a large phenomenologically based study which investigated the nursing home carers' experiences of elderly residents' sexuality. Joking and teasing with the residents was an acknowledged way for staff to deal with sexuality in the nursing home. Whilst humor can be used in a therapeutic way to establish and maintain rapport, as well as to deal with incidents which are uncomfortable, joking is also known to be an effective way to manipulate and control people. Teasing can be used as an effective strategy to discourage certain types of behavior.     

睡眠呼吸暂停综合征患者夜间睡眠呼吸参数的变化及护理对策(英文)

目的：探讨睡眠呼吸暂停综合征（ＳＡＳ）患者夜间睡眠呼吸参数的变化及相应护理对策。方法：对１６例ＳＡＳ住院患者在治疗前、睡眠姿势训练、气道持续正压（ＣＰＡＰ）呼吸机治疗三种状态下,进行整夜多导睡眠仪监测。结果：在ＳＡＳ整夜呼吸紊乱中,零点以后其危险因素大大增加,出现严重低氧血症,血压升高,心律失常,尤其是呼吸暂停时间延长,次数增加。而侧卧位可显著地改善低氧血症,最低血氧饱和度（ＳａＯ２）从（６２±１９）％升高至（８３±１１）％（Ｐ＜０．０１）,ＣＰＡＰ呼吸机治疗能使呼吸调节障碍得到明显的恢复,呼吸暂停由（４４．３±２２．６）次降至（０．２５±０．５４）次（Ｐ＜０．０１）。结论：护理上应密切观察病情变化,特别是零点以后应加强巡视,除观察呼吸运动外还应警惕脑血管病及心脏疾病的发生,对不具备ＣＰＡＰ呼吸机治疗条件者宜采取睡眠时督促取侧卧位。对ＳＡＳ患者进行健康教育也是减少危险因素的重要护理措施。     

住院病人焦虑的原因及护理对策

目的：分析住院病人焦虑的原因,有效地减轻住院病人的焦虑程度。方法：使用焦虑自评量表（SAS）及问卷对347例住院病人进行焦虑原因的调查分析。结果：问卷20题中有13项肯定组与否定组的SAS评分存在显著差异或非常显著差异;不同年龄、不同文化程度、不同住院时间、治疗费用不同支出方式的住院病人SAS评分也存在显著差异。结论：明确住院病人焦虑原因,可有针对性地对其做好心理护理。