总结在承担北京冬奥会医疗保障工作期间综合诊所急诊科筹建及护理管理经验,包括:诊治区域筹建、护理人员组织构架、闭环管理模式、急诊科诊疗制度、消毒管理、医疗物资及废物处理等.在疫情防控背景下,为未来举办类似大型国际体育赛事的医疗保障工作提供借鉴与参考.

目的 构建适用于急诊主管层护士的客观结构化多站式考核体系,并评价其应用效果.方法 通过文献分析和德尔菲专家咨询构建考核体系,实施考核并评价各项目得分情况,问卷调查考核内容和形式.结果 考核体系由8个考核站点、17个考核项目组成.考核结果显示,急诊主管层护士在问诊思路、急救处理、心电图识别、专科查体、转运前准备、沟通及组织协调能力上存在不足.100％的急诊主管层护士认为考核站点及内容全面,考核形式贴近临床,有利于发现自身不足,但亦增加了自身压力和焦虑.结论 构建的考核体系涉及知识面全面,评判标准量化、统一,能够有效提升急诊主管层护士的综合能力.

目的 探讨约束患者快速核查单在预防患者非计划性拔管中的应用效果.方法 通过查找约束患者发生非计划拔管的原因,结合文献分析和专家论证编制约束患者快速核查单,比较核查单应用前后身体约束患者非计划拔管发生率并记录护士在应用核查单过程中核查出的风险及不足之处.结果 核查单应用后,约束患者非计划拔管发生率由5.63％(36/639)降至0.72％(2/278),差异有统计学意义(x2=4.315,P<0.05),同时核查出一系列风险及不足之处.结论 约束患者核查单的应用有助于护士快速识别风险环节及不足之处,降低非计划拔管发生率,提高管路安全性,提升护理质量.

总结1例甲亢危象致心搏骤停患者亚低温治疗的护理.护理要点:通过热交换导管联合冰毯和冰帽降低患者体温,从而减少对脑神经的损伤;通过激素疗法与对症治疗控制甲亢危象.经过10 d的治疗和护理,患者意识恢复且脑功能未受损伤,甲亢危象得到了有效的控制,后转至普通病房继续治疗.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:对酒精依赖患者配偶的应对方式进行调查分析,探索应对方式的相关因素。方法:选取符合国际疾病分类（ICD-10）酒精依赖诊断标准的患者配偶118名（女性114名,男性4名）。采用一般资料问卷和应对方式问卷（CSQ）测查其人口学资料和应对方式得分。采用单样本t检验比较酒精依赖患者配偶应对方式各因子分与常模之间应对方式的差异,广义线性回归模型进行多因素分析。结果:酒精依赖患者配偶6种应对方式除解决问题外,其他应对方式得分高于常模（P&lt;0.01）。患者配偶教育程度与解决问题得分正向关联（β=1.44,P&lt;0.05）,收入与合理化因子粗分负向关联（β=-0.91,P&lt;0.05）。结论:酒精依赖患者配偶使用的应对方式均较普通人群多。教育程度较高的配偶更多的采取解决问题的应对方式;家庭收入较低的配偶更多的采取合理化的应对方式。</span>

总结1例重症新型冠状病毒肺炎患者的护理经验.该患者病情危重、进展迅速、威胁生命且具有传染性,需多种生命支持,该患者护理重点为:重症新型冠状病毒肺炎患者的安置,护理人员的自身防护,抢救时护理人员气管插管的配合,机械通气采取密闭式吸痰的护理,床旁血液滤过的护理.该患者经过一系列治疗及护理后,病情基本稳定,未进一步恶化.

目的 总结急诊科应对新型冠状病毒肺炎疫情防控期间的护理管理工作,为护理管理者今后更好地应对突发疫情提供决策依据.方法 根据急诊科工作特点,结合新型冠状病毒肺炎的诊疗及防控方案、医用防护用品使用指引、环境清洁消毒建议等制订一系列急诊科护理管理工作内容,包括诊治区域管理、就诊流程管理、疑似病例管理、环境消毒管理、工作人员和防护物资管理.结果 疫情防控期间,我科平均每日收治抢救患者33例、流水245例、留观45例,急诊病房、监护室有患者32例,医护人员210例,均无感染发生.结论 疫情防控期间,在完成常规危急重症患者救治的基础上,围绕疫情防控做好急诊科的护理管理工作,对保证医务人员、患者及家属的健康安全至关重要.

目的 编制适合于我国急诊环境下使用的危重患者院内转运前核查单.方法 通过文献研究进行证据整合,运用德尔菲法对36名专家进行2轮函询并进行评定者间一致性及内容效度测评.结果 2轮函询问卷的有效回收率均为100％,专家权威系数均为0.96,协调系数分别为0.197和0.204(P<0.001).最终形成的核查单包括一级指标8项,二级指标35项.各条目Kappa值为0.727～1.000,平均为0.880;内容效度指数为0.912,各条目内容效度指数为0.806～1.000.结论 本研究基于文献研究和专家论证所编制的核查单科学、可靠,内容全面、细致,具有较强的可操作性及实用性.

报告了1例急性曼陀罗中毒患者的护理.主要包括:入院时快速准确的系统评估,建立静脉输液通路,及时应用新斯的明改善患者中毒症状,以及在住院期间对患者进行密切的病情观察、用药护理、健康教育.经3天积极的治疗及护理,患者康复出院.

目的:探讨新冠肺炎疫情期间急诊科接收患者优化管理方案,以期为综合医院的急诊科和其他科室应对类似新型冠状肺炎等重大传染病疫情提供经验和参考依据.方法:2020.1.24-2020.3.16,我科出现了2例因"发热、肺部影像学有典型新冠肺炎表现的疑似病例",其中1例最终确诊,1例排除,总结2例患者的临床特点及对主要采取的应对措施等进行梳理.结果:由于急诊科应对和处理及时,防止了新型冠状肺炎在我科乃至院内大面积感染.结论:疫情期间有效地防控措施可防止新冠病毒在急诊的传播.

ObjectiveTo analyze the incidence rate，types and risk factors of adverse events during intra⁃hospital transfer of critically ill patients in emergency department，so as to provide a basis for reducing the occurrence of adverse events.MethodsA total of 461 adult patients，who were in the emergency room and emergency intensive care unit and received intra⁃hospital transfer in a tertiary grade A hospital in Beijing from May to September 2018，were selected.The self⁃designed "Adverse Events Record Form During Intra⁃Hospital Transport of Critically Ill Patients in Emergency Department" was used to record the transfer events.Then according to whether adverse events occurred，subjects were grouped.And single factor analysis and logistic regression analysis were used to screen out the risk factors causing adverse events.ResultA total of 90 patients （19.5%） had adverse events，among which the incidence of adverse events that were unrelated to disease changes was higher.Infusion of catecholamines，carrying oxygen bag and total transfer time were major risk factors causing adverse events.ConclusionsThe adverse events during intra⁃hospital transfer of critically ill patients in the emergency department are mainly concentrated in five aspects：transfer equipment，organization coordination，catheter/pipelines，liquid medicine and disease changes.The nurse should fully evaluate the transfer risks before transshipment，and check the key links that are prone to cause adverse events in the transshipment process.Thereby，to reduce and avoid the occurence of adverse events.

目的 调查北京市护理人员对心脏骤停患者目标体温管理的现状.方法 采用便利抽样法,采用自行设计的调查问卷调查2017年9月-12月北京市22所医院的急诊科和ICU的护理人员,调查内容包括调查科室和护理人员的一般特征、护理人员对心脏骤停患者目标体温管理的认知及实践.结果 共发放900份问卷,791名(87.9％)护理人员完成调查.其中87.1％的护士不知道目标体温管理的概念,84.8％的护士不知道亚低温治疗的概念.仅有6.4％的护理人员表示会对心脏骤停患者进行目标体温管理,32个科室中只有4个科室以及5.7％的护理人员表示对心脏骤停患者实施过亚低温治疗,未实施的主要原因是科室未开展亚低温治疗、对相关知识了解较少.而执行过目标体温管理的护理人员表示,在实施亚低温治疗过程中会更频繁地使用静脉滴注冰盐水和冰袋、冰帽、冰毯来诱导和维持目标体温,而很少使用先进的自粘式体表降温毯和血管内降温技术.结论 心脏骤停患者的目标体温管理在中国仍处于应用早期阶段,北京市护理人员对目标体温管理的认知和实践尚不足,需要进一步提升.

目的:评价编制的急诊科危重患者院内转运前核查单(以下简称核查单)应用效果和可行性.方法:通过证据汇总和Delphi专家咨询编制核查单,比较核查单应用前后院内转运中各类不良事件及患者病情异常变化的发生率;同时在使用核查单第1、3个月时,记录20名不同年资护士填写核查单时间.结果:核查单应用后,实验组各类不良事件总发生率低于对照组(4.0％vs 28.6％,χ2=77.183,P<0.001),且转运设备、组织管理、导管/管路及液体/药物类不良事件和病情异常变化的发生率均有降低;护士在使用核查单第1、3个月时填写时间分别为(2.85±1.05)min、(1.12±0.42)min,且不同年资护士填写时间无统计学差异(P>0.05).结论:编制的核查单能够降低转运中各类不良事件的发生率,填写时间在可接受范围,可供急诊科不同年资护士进行危重患者院内转运前核查使用.

This paper summarized the current types of community-based rehabilitation service mode for mental illness patients including day centers, clubhouse model, transitional rehabilitation services, day hospital and other rehabilitation services such as case management, peer support, extended services, assertive community treatment and crisis intervention team, ect. It introduced the definition, development, clients, service mode, service contents of various community rehabilitation services, aiming to provide suggestions for establishing a perfect community mental health rehabilitation service system in mainland China.

医院人工成本是医院总成本中的核心组成部分,建立医院人工成本指标体系,以量化的形式对人工成本进行对比、分析,有利于医院与同行业对比,发现优势,找出差距,提高经济效益,对医院实现战略目标和可持续健康发展有非常重要的作用.

Objective To understand the current situation of knowledge and attitude on depression in nurses in psychiatric and general hospitals of partial regions nationwide so as to provide targeted training on relevant knowledge for nurses.Methods A totals of 5497 nurses (2902 in psychiatric hospitals, 2595 in general hospitals) from 8 provinces were investigated with the adapted questionnaire of knowledge and attitude on depression.Results The scores of knowledge and attitude of nurses in psychiatric hospitals were (13.55±3.58) and (95.34±12.69), which were higher than those [(10.81±2.97), (89.02±15.31)] of nurses in general hospitals with significant differences (t=30.636, 16.824;P<0.01). The single factor analysis showed that there were statistically significant differences in the score of knowledge on depression of nurses between different departments, ages, marriages, educational background and working years (t=30.952, 23.217, 23.266, 40.065, 23.266, 40.065;P<0.05). Besides, there were statistically significant differences in the score of attitude on depression of nurses between different departments, ages, marriages, positional titles, educational background and working life (t=16.656,19.127,17.228,17.894,10.713,17.894;P<0.05). The regression analysis revealed that the influencial factors on knowledge were the property of department, educational background, positional titles and working years; the influencing factors for attitude were the property of department, educational background.Conclusions Clinical nurses are with low awareness of knowledge on depression along with negative attitudes with patients. Managers should draw up a training plan based on the property of department, educational background, positional titles, working years and so on for the nurses to strengthen the training on knowledge of disease and humanities, thus improving their service ability for patients with depression.

It has been a focus on occupational stressors of nurses and ways in which they may be reduced. This article summarized the main stressors and preventive interventions and puted forward some suggestions and prospects for nurse stress management.

It reviewed the application progress on vascular internal heat exchange technology from low tempera-ture principle and technical operation,temperature control and caring,clinical research and caring points of com-plications and its prognosis.

本文通过对阿尔茨海默病患者精神行为症状的临床观察与有效护理,以期阐明相应护理干预方法,为家庭干预策略提供指导.

Objective To evaluate the effect of a nurse-lead rehabilitation training on quality of life and psychotic symptoms of schizophrenia inpatients. Methods Totally 190 schizophrenia inpatients were divided into the intervention group (96 cases) and the control group (94 cases). In addition to rehabilitation activities which can be chosen freely, the schizophrenia in the intervention group received rehabilitation training including medication training, life skills training, social skill training and physical training, while the schizophrenia in the control group could only chose rehabilitation activities freely. The quality of life and the psychotic symptoms of the schizophrenia while enrolled and discharged were evaluated. Results No significant difference was found in the score of Schizophrenia Quality of Life Scale (SQLS) and Brief Psychiatric Rating Scale (BPRS) between the two groups(P>0.05)while enrolled. The scores of SQLS, psychosocial and motivation/energy in the control group were 30.22 ± 17.21, 30.22 ± 17.21 and 18.28± 9.33, while 21.41±14.63,19.76± 18.85 and 15.95± 8.80 in the intervention group one month after intervention, the difference was significant (t=-2.14,-2.19,-1.99,P<0.05). The scores of BPRS and hostile suspiciousness in the control group were 26.39 ± 6.37 and 4.11 ± 1.87 , while 23.67 ± 6.37 and 3.44± 1.26 in the intervention group one month after intervention, the difference was significant (t=-2.33,-2.54, P<0.05). Conclusions The nurse-lead rehabilitation training can improve the quality of life and psychotic symptoms of schizophrenia inpatients.