中医护理技术临床实践保障管理模式探讨

目的探索保障中医护理技术临床实践的有效管理模式。方法在护理部、质控办及护士长三级管理模式下,实施护士分层次培训,完善25项中医护理技术项目及其实践制度,动态督导,以保障中医护理技术的实施。连续实施6个月后评价效果。结果中医护理操作项目服务由实施第1个月的12 996例次上升到第6个月的17 329例次,经济收入从195 938元上升到262 798元,实施前后患者对中医护理技术的接受程度及护士的认可度比较,差异有统计学意义(均P0.01)。结论本保障管理模式有利于中医护理技术在临床规范性的推广应用。     

Clinical Application of Low Vision Rehabilitation Strategies After Completion of a Computer-Based Training Module

This study evaluated changes in occupational therapists’ practice behaviors after completion of an online continuing education (CE) program delivered over a hospital Intranet system. The setting was a large rural medical system covering parts of two southeastern states. A convenience sample of 28 occupational therapists and occupational therapy assistants was recruited from the facility therapy staff. A CE module on low vision assessment and treatment was delivered using the hospital Intranet and a follow-up survey assessing practice change was carried out 8 weeks later. Most participants reported an increase in their comfort level when treating clients with low vision after course completion. Fifty percent of participants reported screening for vision impairments, increased use of environmental modifications, and more referrals to other vision specialists. Outcomes suggest that Internet-delivered CE programs can improve knowledge and affect practice.     

Considering intellectual,in addition to financial,conflicts of interest proved important in a clinical practice guideline: a descriptive study

ObjectivesThe American College of Chest Physicians Antithrombotic Guidelines ninth iteration placed restrictions on panelists with recommendations on which they disclosed a primary conflict of interest (COI). We aimed to describe panelists' financial and intellectual COI and evaluate to what extent, beyond assessing financial COI, assessing intellectual COI affected COI management.Study Design and SettingWe classified financial and intellectual COI into primary (causes voting restriction) and secondary (no restrictions). We analyzed disclosures respectively with panelists and recommendations as units of analysis.ResultsOne hundred two panelists made 4,030 disclosures for 431 recommendations. The median number (and range) of panelists per recommendation who disclosed the various categories of COI was 0 (0–5) for primary financial COI, 0 (0–4) for secondary financial COI, 0 (0–7) for primary intellectual COI, and 1 (0–6) for secondary intellectual COI. Of the 431 recommendations, 63 (15%) had at least one panelist with a primary intellectual COI but no primary financial COI.ConclusionCOI had a relatively low prevalence and a skewed distribution, many panelists with none and some with many disclosures. A substantial number of disclosures should have resulted in restrictions based on intellectual COI in the absence of financial COI.     

Voices of care for adults with disabilities and/or mental health issues in Western Canada: what do families and agencies need from each other?

Our purpose in this paper is to report on the frustrations and unmet needs of paid, formal caregivers and unpaid, family caregivers who together provide care to adults with disabilities and/or mental health issues. We conducted eight focus group interviews between November 2010 and June 2011 in two large, urban centres and one smaller centre in Western Canada. Four of our focus groups were with family members including adults with disabilities and/or mental health issues, their parents and their siblings, and four were with representatives from agencies providing support and services to adults with disabilities and/or mental health issues and their families. Data were collected from 23 family members and 24 agency representatives who responded to questions about successes and struggles in meeting, and collaborating to meet, care needs of adults with disabilities and/or mental health issues. Each focus group session was digitally recorded and transcribed; field notes were also taken and we thematically analysed data according to family versus agency perspectives of their successes and barriers in care provision and care collaboration. We found that family members desire greater and more effective support in enriching the lives of adults with disabilities and/or mental health issues and in preparing for age‐related changes. Agency representatives are keenly aware of the needs and challenges faced by families, yet grapple with being effective collaborators with families of widely varying priorities and styles of care and collaboration.     

Self-management support activities in primary care: A qualitative study to compare provision across common health problems

ObjectiveTo explore the views of primary care teams about the provision of self-management support to patients with common health problems.MethodsSemi-structured interviews were conducted with twenty-one members of the primary care team from thirteen general practices. Interviews were transcribed verbatim, and analysed using the ‘Framework’ approach.ResultsThree categories and six sub-categories illustrating different self-management support activities across common health problems were identified from the analysis of interviews, and contributed to one major theme and one cross-cutting theme. Referral and signposting were frequently used to facilitate patient engagement with external services and resources. Practitioners faced some challenges in balancing medical management and psychosocial support and motivating patients to engage with self-management.ConclusionsPrimary care teams described providing a wide range of self-management support activities, but the pattern of use varied for different types of health problem. These patterns may have been influenced, in part, by general practices focusing upon achieving financially incentivised quality improvement goals.Practice implicationsTo improve self-management support, practitioners need a digital repository of services/resources, motivational interviewing skills, an understanding of the optimum duration and pattern of consultations, and incentivised targets that match a biopsychosocial model of care.     

Therapist training in evidence‐based interventions for mental health: A systematic review of training approaches and outcomes

A lack of effective therapist training is a major barrier to evidence‐based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train‐the‐trainer, and intensive training) affect therapists’ knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.     

Secrets on both sides of the couch

This paper considers omissions and lies in the consulting room, discussing what is known about the nature, extent, and underlying causes of therapists’ deceptions and secrets. The author offers clinical vignettes to illustrate common omissions and deceptions, considers potential ramifications thereof, and concludes with recommendations for clinical practice.