目的:调查儿科护士对 2020 年发布的《儿童动脉血气分析临床操作实践标准》的临床实践现状,为提升儿童动脉血气标本采集护理质量提供依据.方法:于2022 年 8月—9月,采用便利抽样法,抽取全国范围内32所医疗机构的 838 名儿科护士为研究对象,采用自行编制的调查问卷进行儿童动脉血气分析临床操作实践现况调查.结果:调查中仅有 28.64%的护士知晓患儿体温对于血气分析结果的影响;67.78%的护士知晓应在动脉血气操作前安抚患儿情绪,68.97%的护士知晓在桡动脉采血前应进行Allen试验/改良版Allen试验结果判定方法,80.31%的护士选择专业动脉采血器,90.69%的护士首选桡动脉进行动脉采血,6.44%的护士因动脉采血操作而发生至少1次针刺伤,80.67%的护士表示科室针对动脉采血操作进行培训或考核.结论:儿科护士对《儿童动脉血气分析临床操作实践标准》的整体掌握较好,大多数儿科护士对动脉血气分析相关知识掌握和临床实践水平有待提升,需要进一步培训与临床实践督导.

目的 探讨全程护士的参与对儿童恶性实体瘤围手术期护理质量的影响.方法 2020年我院肿瘤外科设置3名全程护士,全程护士由病房系统护士遴选,完成手术室相关技术培训后同时担任病房责任护士与手术室器械护士.结果 全程护士参与恶性实体瘤患儿护理后,医护配合更加融洽,术后并发症发生率由18.6％降低到4.3％;平均住院天数由的12.97d降到11.52d.护理满意度由98.1％提高到99.4％.结论 全程护士岗位的设立使恶性实体瘤患儿围手术期护理方法更精准、个性化、整体化,为全面提升小儿肿瘤外科护理质量提供了新思路.

目的:探讨肛周皮肤保护措施在先天性巨结肠患儿术后失禁相关性皮炎的应用效果.方法:将2020年6月至2021年9月于我院普外科行Soave手术治疗的116例先天性巨结肠患儿随机分为对照组和实验组.对照组患儿肛周皮肤给予常规护理,实验组根据肠段类型给予不同的肛周皮肤护理措施,比较两组患儿术后失禁相关性皮炎的发生率以及严重程度.结果:实验组患儿术后失禁相关性皮炎的发生率低于对照组(P<0.05);两组患儿失禁相关性皮炎的严重程度差异有统计学意义(P<0.05).结论:对于不同肠段类型的先天性巨结肠患儿在术后给予不同的肛周皮肤护理措施,可以有效预防失禁相关性皮炎的发生,值得在临床护理中推广该措施.

目的 调查儿童综合医院重症医学科护理工作量及护理人力资源配置现状.方法 采用护理活动评分量表,于2019年3月1日至31日连续31 d,每天3个时间点,即每班次下班时的16:00、00:00、8:00,共93个时点对当班所有患儿进行数据采集,评估住院所有患儿所有班次的护理工作量及护理人力资源配置情况.结果 共采集了2703份护理工作量及护理人力资源配置相关数据.儿童综合医院重症医学科患儿护理活动评分量表得分平均为(58.63±10.81)分;儿童综合医院重症医学科护士总体配置上,每例患儿每班次实际配置的护士数小于理论应配置护士数,两者比较差异具有统计学意义(P<0.01).各班次每例患儿实际配置的护士数与理论应配置护士数相比,差异具有统计学意义(P<0.01).结论 儿童综合医院重症医学科护理人力资源配置应该与成人ICU持平或高于成人ICU.儿童综合医院重症医学科护理人力资源总体配置和各班次配置均不足,夜班护士工作负荷尤其过重.护理管理者应努力提高护理人力资源的总体配置水平和各班次配置水平,并根据白夜班护理工作量的差异,进行护理人力资源的精确配置.

This paper reviews the research progress of arterial puncture related pain management in children,intervention methods include pharmacological interventions such as the use of local anesthetics; non-pharmaceutical interventions such as cryotherapy, distraction, non-nutritional sucking and using sweeteners, kangaroo care, massage, and other techniques, as well as innovations in puncture technology such as ultrasound-guided puncture, summarizes the existing problems of children artery puncture related pain management, puts forward the future research direction and trend, to provide a reference for standardizing the pain management practice of arterial puncture in children.

目的 构建儿科护理质量指标,为我国儿科护理质量评价提供依据.方法 基于文献回顾、小组讨论、专家咨询、国家护理专业质控中心儿科专科质控组审议等确定儿科护理质量指标.于2019年在全国8家儿童专科医院及综合医院儿科进行试应用.结果 构建的儿科护理质量指标包括结构指标6项、过程指标2项、结果 指标7项.8家医院每名住院患儿24 h平均护理时数、护士离职率、住院患儿身体约束率、新生儿院内尿布皮炎发生率、住院患儿外周静脉输液外渗/渗出发生率等总体呈下降趋势,6月龄内患儿母乳喂养维持率明显提升,但床护比和护患比有所下降.结论 儿科护理质量指标具有实用性,体现了儿科特色,可用于住院患儿护理质量评价.

目的 探讨PDCA循环和精益管理在小儿心外手术护理质量控制中的应用效果.方法 2017年7月至2018年3月接收患儿611例,采用常规护理控制管理;2018年4月至2019年1月接收患儿632例,在小儿心外手术室质量控制中采用PDCA循环和精益管理理念进行管理.比较实施PDCA循环和精益管理前后的护理质量(护理文书、仪器设备、房间规范评分和手术室空间布局摆放时间)、患儿家属及医生满意度和护理技术操作满意度评分.结果 实施后护理文书、仪器设备和房间规范评分均高于实施前,手术室空间布局摆放时间短于实施前(P＜0.01);实施后各项护理技术操作满意度评分均高于实施前(P＜0.05,P＜0.01);实施后患儿家属满意度、手术医生满意度高于实施前(P＜0.05).结论 在小儿心外手术护理质量控制中应用PDCA循环和精益管理,可取得较高的患儿家属及手术医生满意度,并显著提升护理人员技术操作水平.

This article summarizes the necessity of professional team cooperation in the field of pediatric critical care, the status of domestic and foreign child critical care team cooperation, the role of nurses in team cooperation, team cooperation evaluation tools and so on. This article aims to provide new methods and ideas for the development and cooperation of nursing team building and cooperation in the field of critically ill children in our country, and to improve the team's ability to treat critically ill children.

总结6例集体重度氯气中毒患儿的多学科救治与护理经验.包括成立多学科救护小组,实施肺通气保护策略,做好气道管理、眼部护理及有针对性的心理护理.通过专业的护理措施保证了重度氯气中毒患儿的治疗效果,6例患儿均痊愈出院.

Objective:To explore the current situation of psychological resilience and emergency rescue knowledge, attitudes and practice of pediatric nurses during public health emergencies, and analyze the influencing factors of psychological resilience, aiming at providing a basis for nursing managers to formulate strategies to improve psychological resilience, so as to further improve nursing staff's response to public health emergencies level.Methods:This study was a cross-sectional study. From February to April 2020, convenience sampling was adopted to select the pediatric nurses of the national children's hospitals or general hospitals as the research object. The General Information Questionnaire, the Connor-Davidson Resilience Scale (CD-RISC) and the Knowledge, Attitude and Practice Questionnaire for Medical Practitioners about Emergency Rescue of Public Health Events were used for investigation. A total of 13 091 questionnaires were distributed, and 12 750 valid questionnaires were returned with the valid response rate of 97.4%.Results:Among 12 750 nurses, the total score of CD-RISC was (65.53±15.55) . Multiple stepwise regression analysis showed that age, fertility, position, title, years of pediatric work, economic zone of the hospital, basic knowledge, psychological knowledge, other knowledge, emergency rescue attitude and emergency rescue practice were the main influencing factors of the psychological resilience of pediatric nurses during public health emergencies ( P<0.05) . Conclusions:The psychological resilience level of pediatric nurses in my country during public health emergencies needs to be improved. We should pay attention to nurses ≤40 years old, have no child, junior professional title, no positions, 6-10 years of pediatric work, and in the western region, and strengthen emergency rescue basic knowledge, psychological knowledge and other knowledge training, and improve their emergency rescue attitudes and behaviors, so as to improve the psychological resilience of pediatric nurses during public health events.

目的:调查护士儿童动脉血气分析临床操作实践现状,为开展规范化临床操作实践提供参考.方法:采用便利抽样方法,于2019年7月2日至8月31日,采用自行设计的调查问卷对全国范围内17家三级甲等医疗机构内的儿科护士进行动脉血气分析操作实践现况调查.结果:共回收有效问卷1518份,其中67.7％的护士使用专业采血器进行采血;桡动脉为首选穿刺部位,占74.4％.不同科室动脉血气分析采血工具选择、采血工具使用方法不同.近一年在动脉血气分析操作中发生针刺伤的护士为127名,发生率为8.4％.结论:儿童动脉血气分析采血流程规范化、管理标准化十分必要,尚须加强动脉血气分析操作知识和技能培训,以提高动脉采血的成功率,保证检测结果的准确性.

目的:检索、评价和整合儿童血流感染患儿血培养采集的最佳实践证据.方法:按照6S模型,检索BMJ best practice,UpToDate、英国国家卫生与临床优化研究所指南网(NICE Guidance)、苏格兰院际指南网(SIGN)、安大略注册护士协会(RNAO)、国际指南协作网(GIN)、美国国立指南库(NGC)、医脉通、美国临床和实验室标准协会(CLSI)、世界卫生组织官网(WHO)、PubMed、CINAHL、Cochrane Library英文数据库、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Data)、Sinomed中关于血培养标本采集管理的相关指南、标准、临床决策,补充检索最新指南发表时间之后发表的系统评价.由2名研究者对纳入的文献进行质量评价,对符合质量标准的文献进行证据提取和汇总.结果:共纳入文献7篇,包括临床决策1篇、指南4篇、系统评价2篇,最终从采血时机、采集前消毒、采集工具、采血途径、采血量、管理策略6个方面总结证据22条.结论:所总结的关于儿童血培养采集的证据可用于临床实践,促进儿童血培养采集的规范化管理,提升检出率.

Objective:To investigate the clinical practice status of neonatal arterial blood gas collection in Class Ⅲ Grade A children's hospitals in China, so as to provide a reference for further standardizing neonatal arterial blood gas collection operating standards.Methods:From July to September 2020, convenience sampling and self-designed Neonatal Arterial Blood Gas Collection Technology Practice Questionnaire were adopted to conduct a cross-sectional survey on the technical operation of 824 nurses of Neonatology Department in 15 ClassⅢ children's hospitals, general hospitals, and maternal and child health hospitals across the country. A total of 824 questionnaires were distributed, 791 were retrieved, and 747 valid questionnaires were collected.Results:The most common site for neonatal arterial blood gas collection was the radial artery, accounting for 98.80% (738/747) , followed by the brachial artery 47.79% (357/747) . The radial artery was often selected below the place where the pulsation was strongest (46.86%, 350/747) , and the most needles were inserted at an angle of 15° to 30°. The brachial artery was often selected below the place where the pulsation was strongest (58.77%, 439/747) , and the most needles were inserted at an angle of 30° to 45°. The more common complications after arterial blood gas collection were bruising, bleeding, and hematoma. A total of 390 (52.21%) nurses received uniform training in arterial blood gas collection in the past year. There was a statistically significant difference in the incidence of needle stick injuries in the collection of nurses of Neonatology Department who received uniform training or not ( P<0.05) . Conclusions:The operating standards for neonatal arterial blood gas collection are not uniform, and it is necessary to standardize the collection process and management. Although the training for nurses has been carried out in clinical practice, the incidence of needle stick injuries among nurses still needs to be further reduced, especially the targeted training of arterial blood gas collection and operation skills. The collection tools should be improved to increase the success rate of arterial blood collection, reduce the occurrence of complications, and ensure the safety of nurses.

目的 基于德尔菲法构建儿科护士健康教育素养评价指标体系,为护理管理者对儿科护士健康教育素养的测评工具和培训考核提供参考标准.方法 通过查阅国内外文献、半结构式访谈初步构建儿科护士健康教育素养评价指标体系的各级指标;对15名国内专家进行2轮德尔菲专家函询,并对函询结果进行汇总,完成指标的修改,最终形成评价指标体系.结果 通过2轮德尔菲专家函询,构建的儿科护士健康教育素养评价指标体系包含5个一级指标,52个二级指标;2轮专家函询问卷回收率分别为100％、100％,专家函询权威系数分别为0.885、0.890,专家函询的意见协调系数分别为0.152、0.195,显著性检验均为P<0.001.结论 基于德尔菲法构建的儿科护士健康教育素养量表科学、合理、可靠性好,突出了儿科健康教育的特色;函询专家的积极性和权威程度高,协调性较好,可作为评价儿科护士健康教育素养的测评工具.

本文对2020年发布的《儿童动脉血气分析临床操作实践标准》进行解读,主要包括对动脉血标本采集准备、采集操作及并发症的防治等关键环节进行了规范,以保证动脉血气分析结果的准确性,为临床操作提供指导.

目的 探讨张金哲院士提出的"八字诀"在小儿外科护理中的应用效果.方法 采用回顾性研究,比较2018年我院肿瘤外科治疗的常规护理组558例患儿和2019年采用"八字诀(多哄少碰,多讲少替)"护理的531例患儿的观察指标.结果 与常规护理组相比,八字诀组基础护理质量增高(t=6.847,P = 0.000),术后患儿卡氏功能状态评分增高(t = 2.228,P = 0.034),患儿照护者的满意度提高(x2 =9.154,P =0.002);术后患儿护理并发症的发生减少(x2 =4.604,P=0.026).结论 八字诀的应用,不仅提高了护理质量,减少了患儿术后护理并发症的发生,提高了患儿家长的满意度;而且使患儿照护者在全程参与护理患儿的过程中学会基本护理方法,有效提高了患儿术后的生活质量;密切了患儿、患儿照护者和护理人员之间的关系;为促进家庭参与式护理模式下的延续性护理奠定了基础.

This article reports the significance of the application of intraluminal electrocardiogram (EKG) positioning technology in peripherally inserted central catheterization (PICC) in children. It reviews the the application of EKG in the placement of PICC in children at home and abroad, the selection of EKG positioning tools, the guidance method, and how to decide the position of the tip of catheter by the P wave. It also analyzes the relevant factors affecting the stability of EKG in children. This study looks forward to the application prospects of EKG positioning technology in children's PICC catheterization, and puts forward suggestions to facilitate clinical guidance.

Objective:To explore the knowledge of pediatric nurses about intravenous infusion therapy, find the problems, and provide a reference for managers to provide targeted training.Methods:In this multicenter cross-sectional study, the nurses on duty were selected from 43 hospitals under the medical alliance of Beijing Children's Hospital by convenient sampling from July 24th to 31st, 2018. The self-made questionnaires were used in this study, and data were collected online through wjx.cn. The questionnaires were developed by 4 veteran venous infusion therapists according to the Infusion Therapy Standards of Practice (2016 ) as well as the Technical Standards for Intravenous Therapy Nursing Issued by the National Health Commission of the People's Republic of China in 2014. The questionnaire mainly included three parts. Part I was the basic information of the respondent subjects and hospitals; Part II was the knowledge of the subjects about domestic standards for infusion therapy and Infusion Therapy Standards of Practice; and Part III the knowledge of the subjects about infusion therapy operations and maintenance as well as the current status of infusion therapy in their departments. SPSS 17.0 was used for statistical analysis. Results:A total of 8 405 pediatric nurses were investigated in this study. The average knowledge of infusion therapy was (11.72±2.41), and the pass rate was 54.8%. The survey showed that nurses performed well in selecting infusion tools and puncture sites according to the nature of the drug, evaluating the patient and treatment plan before infusion therapy, the sealing method of peripheral vein indwelling needles, and treatment methods when resistance was encountered or no blood was returned in suction. The univariate analysis revealed that the level of the hospital, whether the hospital had a dosing center and an infusion therapy group, the nurse's education, job title, working years, position, and whether to teach young nurses were the main influencing factors to nurses' knowledge about infusion therapy ( P<0.05) . The results of Logistic regression analysis showed that whether the hospital had a dosing center and a infusion therapy group, and the nurse's education background, title, working years, position, and teaching were the main influencing factors for the nurse's knowledge of infusion therapy ( P<0.05) . Conclusions:Pediatric nurses have insufficient knowledge about infusion therapy. They need to be further trained in the basics of infusion therapy, especially in the correct use of infusion tools, the proper selection of puncture sites, and catheter maintenance.

本文通过检索近年来儿童危重症护理研究相关文献,综述了儿童危重症护理在护士主导的护理实践、ICU患儿及家长相关研究、ICU物理环境及新技术新方法、多重耐药菌管理方面的研究现状,对比我国儿童危重症护理在此领域的发展与不足,对未来护理研究及儿童危重症护理专业的发展提出展望.

Objective:To evaluate the current status of knowledge and behavior in breast milk collection and storage among nurses in the Neonatal Intensive Care Unit (NICU) , and to explore the factors influencing knowledge and behavior of nurses.Methods:By adopting the convenient sampling method, a total of 175 NICU nurses from ClassⅢ Grade A hospitals in Henan province were selected as the research objects in April 2019. A cross-sectional survey of NICU nurses was conducted using the knowledge and behavior questionnaire on breast milk collection and storage of NICU nurses. A total of 175 questionnaires were issued and 175 were recovered, with a recovery rate of 100%.Results:The total score of knowledge and behavior standards of breast milk collection and storage of 175 NICU nurses was (59.69±8.24) , which was at a low level. Among which, the score of knowledge dimension standard was (43.11±9.74) , and the score of behavior dimension standard was (33.58±5.14) . 85.1% (149/175) NICU nurses had not received special training in breast milk collection and storage, and there were great individual differences in the perception of the working environment of breast milk collection and storage among NICU nurses. The results of multivariate analysis showed that age, working environmentperception score of breast milk collection and storage and training of breast milk collection and storage were the main influencing factors of breast milk collection and storage knowledge behavior of NICU nurses ( P<0.05) . Conclusions:The knowledge and behavior of NICU nurses in breast milk collection and storage need to be improved, especially in breast milk thawing, storage temperature and other issues. Nursing managers should formulate objective and unified breast milk collection and storage systems and procedures and strengthen relevant training for nurses to improve nurses' perception of the working environment of breast milk collection and storage, strengthen relevant knowledge and improve breast milk collection and storage behavior.