早临床、勤临床、反复临床是中医人才培养的重要法宝,临床实习是医学生培养的重要途径和手段,也是培养中医临证思维的黄金时期.门诊是发挥中医特色优势的重要阵地,但由于业务量大,带教老师难有充足的时间和精力进行规范的带教,导致实习生中医思维的培养力度削弱或缺失.建立教学门诊实训平台,探讨中医教学的新路径,能够促进中医人才的培养及中医学的传承和发展,根据辨证论治基本方法,制订"八大步骤中医门诊案例式诊疗及带教方案",采用"群师带群徒"的方法,遴选学验俱丰的带教老师,规范带教路径,明确带教要求,使本科生在临床实习阶段能够养成良好的中医临证思维习惯,掌握正确的中医辨证思维模式,从而提高综合运用知识的技能,加强理论与临床过渡阶段的有机衔接.

老年人的生活随着年龄的增大自理能力日益弱化，而中国特有的“421式”家庭结构，使传统的养老模式越来越满足不了老年人的需求〔1〕，采用先进物联网技术为老年人提供良好和健康的护理服务，加快实现健康老龄化，是养老服务与养老产业发展的方向。本文就物联网技术在养老护理领域的应用与展望进行综述。

目的 观察运动康复对老年慢性心衰患者心功能及生活质量的改善效果.方法 选取东南大学退休职工90例老年慢性心衰患者并采用信封法随机分为两组各45例,对照组采用慢性心衰常规治疗与护理,观察组在对照组基础上配合运动康复训练.在两组患者入院、出院及随访1年时测定左心室射血分数(LVEF)、左室舒张末径(LVDEd)、左室收缩末径(LVSEd)、左房内径(LAd)、E/A比值及心肌重量指数(LVMI)等心功能各项指标;并进行运动贮量(METS)和6 min步行试验,记录两组步行距离、步行前后呼吸、血压及心率、临床症状等,采用明尼苏达心衰问卷调查表对生活质量进行评定.结果 观察组在出院及随访1年时NYHA分级改善程度明显优于对照组,观察组出院及随访1年时NYHA Ⅰ级所占比例分别为13.33％和26.67％,而对照组分别为0.00％和2.22％,观察组明显高于对照组(P＜0.05).观察组出院及随访1年时LVDEd、LVSEd、LAd、LV-MI明显低于入院时及对照组出院、随访1年时(P＜0.05),观察组出院及随访1年时LVEF、E/A水平明显高于人院时及对照组出院、随访1年时(P＜0.05).观察组出院及随访1年时METS评分分别为(5.23±0.45)、(5.78±0.42)分,6 min步行距离为(223.56±45.67)、(247.67±43.21)m,生活质量评分分别为(10.98±4.12)、(9.34±3.12)分;对照组分别为(3.65±0.56)、(3.78 ±0.54)分;(105.67--±21.45)、(110.34±20.31)m,(20.31±7.32)、(19.89±6.12)分,观察组METS评分及6 min步行距离显著高于对照组(P＜0.05),生活质量评分显著低于对照组(P＜0 05).结论 运动康复应用于老年慢性心衰患者的辅助治疗,可明显改善患者心功能,提高运动耐量和生活质量.

<正>我国人口老龄化的快速发展,"4-2-1"家庭结构的形成和"空巢家庭"的增多,催生了新型战略性产业(养老产业)的发展〔1〕,各种高级福利院、老年护理院应运而生,面对广阔的、迅速发展的养老产业及用人市场,老年护理人才培养和专业教育迫在眉睫。现行的通科护理专业如何改革向专科护理如老年护理专业渗透,老年护理专业如何在市场中准确定位,课程如

<正>腹部手术后患者胃肠运动从完全抑制到完全恢复需要一定的时间,术后发生腹胀是临床上常见的症状,也是护理比较棘手的问题之一,若不及时处理,可对肠道吻合口及腹壁切口的愈合产生严重的不良影响〔1〕。老年人各项生理机能均减退,腹部手术后,腹胀的发生率高,而且也较严重。本文旨在观察早期锻炼对患者术后胃肠功能的影响。

[目的]确定养老护理员认证培训实训项目与模块,为养老护理员认证培训进一步完善提供科学依据。[方法]由6名老年护理专家应用头脑风暴法初步拟订42项养老护理员认证培训实训项目,采用德尔斐法对15名有丰富经验的老年护理教学、临床、管理专家进行2轮函询,对项目的重要性进行评价,并初步形成4个一级模块、13个二级模块。再次进行2轮专家咨询,对拟订的模块进行可行性和重要性评价。[结果]前2轮函询中专家最终确认养老护理员认证培训实训项目为41项,重要性评分为7.0分～9.8分。后2轮函询中专家最终确认养老护理员认证培训实训模块为4个一级模块、12个二级模块。专家权威程度Ca=0.772±0.072。[结论]养老护理员认证培训实训项目和模块构建具有可靠性和权威性高的特点,能满足科学性与可行性的双重要求,使养老护理员认证培训的内涵具体化和规范化,为我国养老护理员认证培训进一步完善提供科学依据。

Objective To construct post capacities and core competencies for nurses working in primary healthcare institutions under the background of China′s new cooperative medical scheme.Methods The questionnaire containing items of capacities was designed,then 280 nurses and nursing superintendents working in primary healthcare institutions in Yueyang city of China were surveyed,and 20 chief head nurses were consulted.Results The post capacities of professional quality were composed of 15 items,and the top 5 core competencies were interpersonal communication,written communication,psychological bearing,computer application,innovation and development;The professional capacities contained 14 items,the top 5 core competencies were holistic nursing,problem-solving,fundamental skills for operating,health assessment,and emergency treatment and cooperation.Conclusion Post capacities for nurses working under the background of China′s new cooperative medical scheme include professional quality and professional capacities.The framework can be used to guide the training for nurses,so as to provide high-quality nursing care in rural healthcare institutions.

With the rapid progress of population aging and diversified nursing need of elderly people,aged care presented differentiation as well as diversification,which was mainly performed by elderly people or people with different backgrounds.Differential aged care was confronted with great challenge.Diversified and systematic vocational education including health education,vocational education for nursing workers,training for clinical nurses,cultivation of college students was in urgent need.The strengthening of cognition of aged care,together with qualified aged care workers can push the development of aged care.

目的 探讨高职院校与卫生服务中心(站)社区护理对接的方法.方法 将岳阳职业技术学院与岳阳市50家社区卫生服务中心(站)进行社区护理对接,人才对接采用两地专家座谈、专家咨询,教师在卫生服务中心(站)开展讲座或指导,学生实习、寒暑假学生实践活动等;内涵对接采用在理论指导下构建社区护理操作模块和具体的操作项目;与社区居民对接采用学生深入社区宣教,深入家庭护理等.结果 高职院校与社区卫生服务中心(站)在社区护理人才、内涵和社区居民3个接口上开展7条对接途径,构建社区卫生服务中心(站)社区护理操作的3大模块、45个操作项目,其中健康评估与指导模块社区护理实践操作13项.结论 高职院校与卫生服务中心(站)社区护理对接能缓解我市社区护理人才缺乏,拓展社区卫生服务中心(站)社区护理的内涵.

[目的]探讨高等职业院校与卫生服务中心(站)护学结合的途径和方法,提高社区卫生服务中心(站)社区护理的效果.[方法]收集国内外社区护理相关资料,考查国内外社区护理机构社区护理现状,通过专家座谈、专家咨询、老师指导、学生实习、寒暑假学生实践活动开展高等职业院校与卫生服务中心(站)社区护理护学结合的实践.[结果]在人才对接、内涵对接、居民对接3个接口上开展7条有效途径的护学结合实践,促进了社区卫生服务中心(站)在3个社区护理一级模块、46个社区护理操作项目的开展.[结论]高等职业院校与卫生服务中心(站)护学结合实践,在一定程度上解决目前我国社区护理中存在的理论与实践脱离、人才人力缺乏、资金短缺、内容局限等问题,促进社区护理内涵建设,提高社区护理效果.

<正>差异化养老是指不同老年人群对养老服务需求不同而在服务形式、内容和机构选择上出现的差别。老年护理是针对老年人生理功能减退、疾病增多的特点进行的生活照顾与健康促进的护理。我国人口的快速老龄化和养老模式的差异化使目前发展滞后的老年护理成为和谐社区发展的突出问题〔1〕。而老年护理职业教育又是制约老年护理发展的瓶颈。我院是国内最早开设老年护理课程和招收护理专业(老年护理方向)学

It introduced the status quo of community nursing in developed and developing countries.It found that community nursing in developed countries has systematic and strict requirements in aspects of organization setup,management mode,service connotation and personnel admission.Although developing countries were relatively falling behind due to economic strength and people's ideas,it developed quickly due to government's thinking highly of and in the development of economy.Hope to take reference experiences from developed countries as mirror,to promote and enhance the overall level of community nursing in China.

随着我国社会经济的发展,党和国家高度重视社区及社区服务的建设,而作为社区服务的主要内容之一,社区卫生服务更成为政府和广大社区居民关注的首要内容.社区卫生服务中心(站)是我国卫生服务体系中最基层的机构,承担着我国社区居民集预防、医疗、护理、康复、保健和健康教育"六位一体"的功能[1],而执行这一功能的主体是社区护士.

进入21世纪,党和国家高度重视卫生服务体系的建设,2006年国务院办公厅印发<国务院关于发展城市社区卫生服务的指导意见>,2009年4月6号<中共中央国务院关于深化医药卫生体制改革的意见>提出:加快建设以社区卫生服务中心为主体的城市社区卫生服务网络建设.随着社区卫生服务中心(站)大批的新建或改建,为我国社区护理的纵深发展提供了良好的平台.2009年3月开始我院护理学院与岳阳市50家社区卫生服务中心(站)开展对接研究(以下简称"院-中心对接"),并同当地卫生行政主管部门共同研究并制定"院-中心对接"模式下社区卫生服务中心(站)的软硬件建设标准,从而促进了社区卫生服务中心(站)社区护理的规范运作和内涵拓展.

Objective To confirm the items of community nursing procedures,to construct the modules,and to provide information for development and scientific management of community nursing.Methods The panel of 6 community nursing experts drafted tentatively 43 community nursing procedures by using brain storming.Then 15 experienced experts were consulted twice in terms of the procedures and they were asked to rate the importance of each procedure.Based on the relation among the procedures,4 first-class modules,9 second-class modules were developed,and the above 15 experts were asked to appraise feasibility and importance of the modules twice.Results The importance of the procedures was rated from 4.0 to 10.0 points in the first two rounds of expert consultation.According to the opinions of the experts,5 procedures were deleted and another 7 procedures were added.Therefore,the final version consisted of 45 community nursing procedures.The final version consisted of 3 first-class modules and 9 second-class modules.100.0% of the experts agreed with first-class modules,and feasibility and importance of the modules were rated 8.5-9.6 points and 8.6-9.5 points respectively.86.7%-100.0% of the expert agreed with second-class modules,and feasibility and importance of the modules was rated 7.0-9.6 points and 8.6-9.8 points respectively.The expert authority of the research was 0.825.Conclusion The construction of procedures and modules about community nursing,has high reliability and authority;it works with the development of domestic community nursing and meets the requirement of good feasibility.Researchers should extend the contents of community nursing and standardize the construction process in an effort to improve the quality of nursing service.

目的构建社区护理实习创新模式,评价社区护理实习效果,提高社区护理教学质量。方法抽取我院2004级五年制护理专业学生100名,分为实验组与对照组,各50名,实验组社区护理实习按社区-医院-社区(创新实习模式)进行实习;对照组按原教学计划,即:医院-社区(传统实习模式)进行实习。实习结束时依照已制订的"社区护理实习效果考核评分标准"对学生进行成绩考核,并比较两组学生成绩的差异。结果实验组在社区护理实习考核中,健康调查、健康教育和家庭护理方面的成绩均优于对照组(P<0.01)。结论社区护理实习模式的创新与改革有效地提高了社区护理教学质量,培养了学生社会实践能力,但与之配套的教师组织学生实习的能力、实习基地的建设还有待加强。

Western countries in the development of community nursing emerged in the course of five typical patterns,namely: Nightingale model,Neuman system model,Community as client model,Public health nursing conceptual model,A model of community health promotion.Learning from foreign experience,China also has explored community-based nursing "family bed" model,"College-Community" model,community nursing model of special populations and community health service model.But there is a single mode,the target constraints,service content narrow,poor quality of service.The many issues need to be further innovative research.

目的改革传统的外科护理学学科课程,开发和运用外科护理技术项目课程,为高职院校培养实用型护理人才提供专业教材。方法深入临床进行外科护理岗位调研,同护理行业专家及资深专业教师分析和确定外科护理技术课程的大纲、结构和内容,将课程结构模块化、项目化。并应用于152名三年制护理大专二年级学生,与151名应用传统学科教材教学的学生统一考核比较教学效果。结果本课程共设置外科门诊患者护理(3项)、手术室患者护理(5项)、烧伤外科患者护理(6项)、普外科患者护理(10项)、颅脑胸外科患者护理(6项)、泌尿骨外科患者护理(9项)6大模块39个项目;两班学生实践考核分及实习考评分比较,差异有统计学意义(均P<0.01)。结论外科护理技术项目课程彻底打破了传统学科课程模式,使外科护理工作任务更明确,提高了学生的实践能力。

In teaching,we should expound the curriculum reform,persist on taking professional skill training as the goal,conform curriculum course content according to nursing post demand,improve teaching method to explore educational model of integrated classroom and practice place;through improving teaching condition,training double modeled teacher troop,developing teaching research to solve important and difficult problems in curriculum teaching,the specialized core curriculum Adult Nursing can be made to be a provincial level and even the state-level high-quality curriculum course.

<国务院关于大力发展职业教育的决定>明确提出"坚持'以服务为宗旨、以就业为导向'的职业教育办学方针""职业教育要为提高劳动者素质特别是职业能力服务""改革以学校和课堂为中心的传统人才培养模式" [1],为职业教育的发展指明了方向,也提出了明确的要求.要实现这些要求,课程体系的改革是关键,其中最具代表性的就是项目课程.2003年开始我院率先在护理专业课程教学过程中引入模拟临床护理工作的情境教学,2005在此基础上开展以病人整体护理为项目的项目教学,开发项目课程,积累了一定的经验.现报告如下.