''I found myself to be a down to earth Dutch girl'': a qualitative study into learning outcomes from international traineeships

OBJECTIVE: To explore learning outcomes from international traineeships for undergraduate medical students. METHODS: In-depth interviews were conducted with 24 undergraduate medical students at Maastricht University Medical School, The Netherlands. The 24 subjects were selected by purposeful sampling. RESULTS: Students reported meaningful learning outcomes in 6 domains: medical knowledge; skills; international health care organisation; international medical education; society and culture, and personal growth. DISCUSSION: International traineeships appear to provide good opportunities for students to meet the requirements of globalisation as well as some of the generic objectives of undergraduate medical education. The tentative findings of this study need to be confirmed by further studies.     

PDCA循环在输液室规范化管理中的应用

目的研究PDCA(计划—实施—检查—处理)循环管理模式在医院输液室规范化管理中的应用效果。方法分析影响输液室护理服务质量的原因,成立护理质量管理小组,提出切实可行的整改措施,并组织落实。每月科会讨论实施情况,每季小结一次,未解决的问题进入下一轮PDCA。结果比较输液室在实施PDCA循环前后,护患纠纷发生率及不良事件发生率比较,差异有高度统计学意义(P<0.01);满意度及护理部对输液室质量评分差异有统计学意义(P<0.05)。结论 PDCA循环是输液室规范化管理中的一项行之有效的管理模式。     

以患者为中心的护患沟通在老年患者胃镜检查中的作用

目的 观察以患者为中心的护患沟通在老年患者胃镜检查中的作用.方法 将2010年6月至2012年10月收治的971例胃镜检查的老年患者分为无沟通需求组（284例）和护患沟通组（687例）.无沟通需求组采用传统方式沟通,护患沟通组进行以患者为中心的护患沟通.记录两组患者体位摆放时间、胃镜检查时间、恶心次数、咽部黏膜损伤情况和胃镜检查成功率,监测患者血压和脉搏;调查两组患者心理状况、胃镜检查满意度和检查后反应.结果 护患沟通组胃镜检查成功率高于无沟通需求组,差异有统计学意义（χ2=4.033,P〈0.05）;体位摆放时间、胃镜检查时间均较无沟通需求组缩短,差异均有统计学意义（t=21.85、60.98,P〈0.01）.与无沟通需求组比较,护患沟通组患者对胃镜检查满意度升高,差异有统计学意义（χ2=59.290,P〈0.01）.胃镜检查时,两组患者血压、脉搏较检查前均明显升高,且护患沟通组检查时血压和脉搏低于无沟通需求组,差异均有统计学意义（P〈0.01）.胃镜检查时,在心理状态Ⅲ、Ⅳ级中,护患沟通组患者的比例均低于无沟通需求组,差异均有统计学意义（χ2=4.280,P=0.039;χ2=4.033,P=0.045）.两组患者不良反应发生率比较,差异无统计学意义（χ2=0.047,P=0.828）.结论 以患者为中心的护患沟通是一种促进老年患者胃镜检查顺利进行的有效方式.     

优质儿科护理对改善护患关系的实践研究

目的探讨优质护理服务对儿科工作中护患关系的作用。方法选取2012年6月～2013年6月我院收治的患儿380例,随机分为对照组和实验组,每组各190例,对照组实施常规性护理服务,实验组实施优质护理服务,比较两组患者及家属对护理工作满意度调查。结果实验组和对照组患儿及家属平均满意度分别为161例（84．7％）和96例（50．5％）,两组比较差异均具有统计学意义（P〈0．05）,观察组和对照组护理质量考核平均成绩分别为（94．1±1．7）分和（86．4±2．3）分,两组比较,差异具有统计学意义（P〈0．05）。结论儿科护理中开展优质护理服务可明显提高患儿及家长对护理工作的满意度,并且同时提升护理服务质量,值得临床进一步推广使用。     

急诊科护患纠纷的相关因素及预防措施

目的：通过对急诊科护患纠纷现存及潜在因素的分析,以减少急诊科护患纠纷的发生。方法对成都大学附属医院急诊科5年来发生的护患纠纷记录进行回顾研究。结果患者对医院期望过高,护士的技术水平及服务质量不足,护士本身工作压力过大,法律意识不强是急诊科护患纠纷的主要原因所在。医院应通过加强护士道德、技术和法律素质,促进护患沟通,以减少纠纷的发生。     

Exploring historical conflicts between midwives and nurses: a perspective from Chile

Abstract

This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives’ nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.     

Culture and communication in Thai nursing: a report of an ethnographic study

Most nurses live and work in multicultural settings. Given the need for all nurses and health-care workers to communicate--with patients, with families and with other health-care professionals--the study of the relationship between culture and communication can help to inform practice. This paper offers the findings from an ethnographic study of culture and communication, carried out in Thailand. The aim of the study was to address the question: 'in what, if any, ways do Thai cultural issues influence interpersonal communication patterns in Thai nursing and Thai nursing education?'. Data were collected from a variety of sources, including direct and indirect observation, interviews and discussions and the literature on the topic. For the interviews, the sample was a convenience and purposive one made up of clinical nurses and nurse educators (n = 14). Those data were analysed with the aid of a computerised, qualitative data analysis program. Findings reported in this paper include those relating to 'Thainess', Buddhism, the nursing profession and nurse--patient/doctor--patient relationships. The report ends with a 'portrait' of Thai nursing communication. It is suggested that understanding the cultural aspects of nursing in various contexts can help nurses, internationally.     

How international is Medical Education?

AIMS: To consider Medical Education's claim to international status in terms of the extent of international authorship within published articles, the degree to which authors draw on the international literature to support their work, and its self-citation rates and publication decisions. METHOD: We examined 6 journals' citation rates for the period 1997-2001 to see if there was evidence of national publication bias; we calculated their self-citation rates to see if this had any influence on impact factor, and we examined Medical Education's management files for trends which might indicate publication bias due to country of origin of authors. RESULTS: All 6 journals exhibited a bias in favour of citing journals from their own countries. The US journals were more likely to cite journals from their own country. Medical Education was most likely to cite journals from non-UK countries. Self-citation rates did not appear to affect impact factors. The ratio of UK to non-UK papers published in Medical Education has not changed significantly over the period studied although non-UK submissions increased sharply in 2002 and the number of North American submissions has doubled since 1998. CONCLUSION: Medical Education is justified in calling itself an international journal to the extent that the majority of papers it publishes are from countries other than the UK, and it is more likely than other journals in the field to publish papers which cite work in journals published outside the UK. Nevertheless, there is some evidence of publication bias in the journal and more work is needed to discover why this is the case. Various strategies to address the issue of national bias in Medical Education are discussed.     

Early Intervention: Some Issues in Co-operative Team Work

Working in teams appears to be the currently acceptable way of providing early intervention services for children and families with special needs. Different approaches to teamwork have been identified and a sizeable amount of literature has developed around potential sources of disruption to team work. An area often overlooked is the role played by the individual, both as a person and in the position they occupy in the team. In this article ways in which individual team membership can be reviewed and the team as a whole can be considered are presented.