胸腔镜食管癌根治术的手术室护理体会

目的:研究探讨手术室护理对胸腔镜食管癌根治术的护理效果及护理方法。方法:选取2014年3月~2016年10月在某院接受治疗胸腔镜食管癌根治术的68例患者进行护理研究,将其随机分为观察组和对照组两组,每组34例。给予观察组患者综合的手术室护理,给予对照组患者常规的手术室护理,对比两组患者的手术成功率以及术后恢复情况。结果:观察组手术成功率与患者护理满意度均高于对照组,两组有明显差异,有统计学意义(P<0.05)。结论:对接受胸腔镜食管癌根治术的患者进行综合手术室护理能够有效提升患者的手术成功率,提高患者护理满意度,综合手术室护理方法具有护理推广意义。     

腹腔镜治疗胆结石患者的手术室护理分析

目的:分析腹腔镜治疗胆结石患者的手术室护理相关内容及其护理要点。方法:将某院2016年8月~2017年8月接受腹腔镜手术治疗的86例胆结石患者作为此次研究的对象,根据患者的护理方式差异分为观察组和对照组各43例。观察组患者接受全面的手术室护理,对照组患者接受常规护理,对比两组患者护理效果差异。结果:观察组患者的手术情况明显优于对照组,观察组患者术后恢复情况以及其护理满意度要优于对照组,差异具有统计学意义(P<0.05)。结论:腹腔镜治疗胆结石手术中,为患者提供周全的手术室护理可以保障患者的手术顺利完成,提高手术质量,改善患者身体条件,促进患者康复,并且提升护理质量与患者对护理服务的满意度,应用情况良好,值得推广使用。     

Process Redesign to Improve First Case Surgical Starts in an Academic Institution

Purpose: On time start of the first surgical case improves operating room (OR) utilization, physician, and patient satisfaction and decreases delays in subsequent cases. The goal of our study was to evaluate the effect of a multidisciplinary initiative to improve first patient in the room (FPIR) and first case on time start (FCOTS) metrics in a tertiary care setting. Materials and Methods: A multidisciplinary committee focused on first case start data collection. Reasons for both anesthesia and surgical delays were analyzed. Improvement efforts focused on the timely completion of surgical consent, a requirement of a surgical, anesthesia, and nurse team member presence at the patient's bedside by specific time, and parallel processing in the OR. Results: Over 65,100 OR cases were analyzed between 2007 and 2014. There was a statistically significant improvement in FPIR (82.80% versus 69.60%, p < .0001) and FCOTS (66.60% versus 55.90%, p < .0001). Surgical consent completion rate increased from 35% baseline to 68%–100%, depending on the surgical subspecialty. Improvements appeared sustainable several years following process implementation for both FPIR (84.60% versus 69.60%, p < .0001) and FCOTS (67.60% versus 55.90%, p < .0001). Conclusions: Our study demonstrates a successful targeted, multidisciplinary initiative to improve first case surgical starts in an academic setting. Our approach was organizational rather than punitive or rewarding on an individual basis. Strategies included establishing concrete, time-specific goals and posting them visibly, empowering individuals to fulfill them, and ensuring no compromise in patient safety. In the complex environment of academic medicine including research protocols and teaching in the ORs, our organizational approach proved sustainable over several years.     

按三级学科方向培养手术室专科护士可行性的调查

目的：了解不同等级医院对手术室专科护士的需求,探索能满足不同等级医院手术室护理工作实际需求的专科护士培训方案。方法自行设计调查表,选择在江苏省手术室专科护士培训基地学习的80名手术室护士进行调查。调查内容包括一般资料、所在医院三级学科和亚专业学科细化情况、参加专科护士培训后工作状况、手术室专科护士的培养模式和按照三级学科培养手术室专科护士的实施方案4个方面。结果80名护士均认为有必要开展手术室专科护士培训,80．00％的人认为目前模式属手术室全科护士的培训;72．22％的二级医院的护士认为参加培训学习的理论知识、参加的临床实践技能能满足工作需要,可继续采取目前培养模式;74．19％的三级医院的护士认为培训知识尚能满足工作需要,但针对自己的三级学科方向还不够强、不够细,应该按照三级学科培养手术室专科护士。结论根据不同等级医院手术室护理工作的实际需求,建立统一招生、同步培训、分层培养的统分结合培养模式,能培养适应不同等级医院手术室需求的专科护士。     

Management of Pediatric Migraine Headache in the Emergency Room and Infusion Center

Migraine is a common disorder that starts at an early age and takes a variable pattern from intermittent to chronic headache with several exacerbations throughout a lifetime. Children and adolescents are significantly affected. If an acute headache is not aborted by outpatient migraine therapy, it often causes severe disability, preventing the child from attending school and social events. Treating the acute severe headache aggressively helps prevent prolonged disability as well as possible chronification. Multiple medications are available, mostly for the outpatient management of an attack and include the use of over‐the‐counter anti‐inflammatory medications as well as prescribed medications in the triptan group. These therapies do sometime fail and the exacerbation can last from days to weeks. If the headache lasts 72 hours or longer it will fall in the category of status migrainosus. Status migrainosus is described as a severe disabling headache lasting 72 hours or more by the ICHD3 criteria. Disability is a major issue in children and adolescents and aggressive acute measures are to be taken to control it as soon as possible. Early aggressive intravenous therapy can be very effective in breaking the attack and allowing the child to be quickly back to normal functioning. This article reviews what is available for the treatment of pediatric primary headaches in the emergency room.     

手术室护理安全管理评价指标体系的构建研究

目的 通过探讨影响手术室护士护理安全管理因素,为完善相关评价指标及管理体系提供依据.方法 采用质性研究的方法,初步了解手术患者对手术安全的需求以及手术室护士对安全护理管理的相关认知,为初步构建手术室护理安全管理评价指标提供参考;通过对相关专家的咨询并对初步方案进行修订,确定手术室护理安全评价管理评价指标体系.采用现况调查研究,获取手术室患者护理安全的相关情况,进一步验证既定的手术室患者安全评价指标体系并对其进行修改.结果 经过专家咨询,最终确定了含有3个一级指标,12个二级指标的手术室护理安全管理评价体系.通过现况调查可知手术室护士对护理安全相关知识掌握程度得分均＞4分;手术室护士普遍对手术中的安全护理相关知识掌握度较高;影响手术室护士护理安全相关知识掌握的主要因素为工作的年限、技术职称以及从事的工作.结论 构建的手术室护理安全管理评价指标体系在临床上具有良好的可操作性和实用性,较为贴合手术室护士的临床需求并突出了手术室的工作特点,值得临床手术室进行推广.     

手术室护理管理与医院感染水平控制的相关性研究

目的探讨手术室护理管理与医院感染水平控制的相关性。方法回顾性分析外科手术治疗发生院感的300例患者的临床资料,根据管理方法不同分为观察组和对照组各150例,观察组严格实行手术室护理管理,对照组进行普通护理,对影响患者术后医院感染的可能因素进行分析。结果单因素分析结果显示,切口类型、接台手术、手术时间、侵入性操作、术前使用抗生素、参观人员是手术室术后患者医院感染的主要影响因素;多因素分析显示手术切口、手术时间、预防性抗生素使用、接台手术是手术室患者术后医院感染的主要影响因素。结论在手术室护理工作中,通过严格的手术室护理管理,可降低医院感染的发生率。