目的:突发公共卫生事件对护士造成明显的心理负担,影响护士心理健康.新型冠状病毒肺炎疫情暴发之后,护士的心理健康备受重视.本研究通过调查常态化疫情时期护士的焦虑、抑郁、失眠现状及影响因素,并进一步比较不同级别医院护士、一线抗疫护士和其他护士的焦虑、抑郁及失眠的风险,旨在为医院心理健康工作、管理工作和相关研究提供理论依据.方法:2020年12月选取湖南省内各级医院护士共4237名,采用一般资料调查表、7项广泛性焦虑障碍问卷(Generalized Anxiety Disorder-7 items,GAD-7)、9项患者健康问卷(Patient Health Questionnaire-9 items,PHQ-9)、失眠严重指数(Insomnia Severity Index,ISI)对护士进行问卷调查.采用描述性统计分析了解护士焦虑、抑郁、失眠的情况;采用t检验、方差分析、多元线性逐步回归分析等方法分析护士焦虑、抑郁、失眠的影响因素.结果:4237名护士GAD-7总分为4.44±4.20,中重度焦虑者占10.3％;PHQ-9总分为6.03±4.76,中重度抑郁者占17.5％;ISI总分为8.37±5.42,中重度失眠者占12.3％.不同医院级别、性别、职称、职务、文化程度、最近1年轮晚夜班个数、家庭月收入组的GAD-7、PHQ-9、ISI得分差异有统计学意义(均P<0.05),不同婚姻状况、是否参加一线抗疫、是否参加心理健康知识培训组的GAD-7、PHQ-9、ISI得分差异无统计学意义(均P>0.05).性别、医院级别、职称、学历、最近1年轮晚夜班个数、家庭月收入是GAD-7、PHQ-9得分的影响因素.性别、工龄、职务、医院级别、学历、最近1年轮晚夜班个数、家庭月收入是ISI得分的影响因素.结论:参加抗疫与没有参加抗疫的护士GAD-7、PHQ-9、ISI得分无差别,说明中国对于抗疫医护人员的一系列举措有效;常态化疫情时期,部分护士存在焦虑、抑郁及失眠问题,应着重注意女性、无职务、轮晚夜班个数较多、地市级医院及家庭月收入低的护士的心理健康.建议通过给予政策、提供心理支持及人力资源保障等措施缓解护士的压力,维护其心理健康;同时,建议在应对突发公共卫生事件时,将心理健康知识培训作为上岗前的常规培训内容.

OBJECTIVES Public health emergencies have caused significant psychological burden on nurse and affect their mental health. After the coronavirus disease 2019 pandemic, the nurse's mental health has been paid much attention. This study aims to investigate status and influencing factors for anxiety, depression, and insomnia in nurses during the normalized epidemic period, and to further compare the risk of anxiety, depression, and insomnia among nurses at different levels of hospitals between front-line epidemic nurses and other nurses so as to provide a basis for mental health work, nursing management, and relevant study in hospital. METHODS A total of 4 237 nurses from all levels of hospitals in Hunan Province participated in the survey in December 2020. A self-designed anonymous questionnaire was used in this study. Anxiety, depression, and insomnia were assessed using Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire-9 items (PHQ-9), and Insomnia Severity Index (ISI), respectively. Descriptive statistical analysis was used to evaluate nurses' anxiety, depression, and insomnia; t-test, analysis of variance, and multiple linear stepwise regression analysis were used to analyze the influencing factors of nurses' anxiety, depression, and insomnia. RESULTS The scores of GAD-7 among 4 237 nurses were 4.44±4.20, with 10.3% of them experienced moderate to severe level anxiety. The scores of PHQ-9 were 6.03±4.76, with 17.5% of them experienced moderate to severe level depressive symptom. The scores of ISI were 8.37±5.42, with 12.3% of them experienced moderate to severe insomnia. There were significant differences in GAD-7, PHQ-9, and ISI scores among different groups of hospital levels, gender, professional title, position, education level, night shifts, and family monthly income (all P<0.05). Marital status, whether to participate in the front-line, and whether to participate in psychology training groups were not associated with anxiety, depression, and insomnia (all P>0.05). Gender, hospital level, professional title, educational background, more night shifts, and family monthly income were the influencing factors for the GAD-7 and PHQ-9 scores. Gender, length of service, position, hospital level, educational background, night shifts in the last year, and family monthly income were the influencing factors for ISI score. CONCLUSIONS There is no difference in the scores of the GAD-7, PHQ-9, and ISI between nurses whether to participate in the front-line, indicating that series of measures for front-line medical staff are effective in China.Meanwhile, some nurses experienced anxiety, depression, and insomnia, and attention should be paid to nurses with low position, more night shifts, lower-level hospitals, and families with low income. It is recommended that management policies, psychological support, and human resource protection should be given to relieve the pressure and maintain the mental health of nurses. At the same time, it is necessary to make mental health knowledge training as a routine training when responding to public health emergencies.

目的 针对护理专业特点,改革解剖学感官部分教学内容.方法 经与护理专家探讨,制定调查表,对三甲医院临床一线护士展开调查.结果 临床实际工作对解剖学感官部分知识要求与现行教学大纲有较大差距.眼外肌、鼓膜、鼓室、乳突小房结构由要求学生“掌握”改为“熟悉”,内耳各部分的结构由要求学生“掌握”改为“了解”,皮肤的基本结构由要求学生“掌握”改为“熟悉”.结论 护理专业学生需重点掌握解剖学感官部分的组成、功能,主要结构的位置、形态；内耳的结构知识要精简.

目的 建立护理专业内脏解剖学教学内容的专业特点.方法 经与护理专家商讨,制定调查内容,深入临床护理一线调查研究.结果 内脏解剖学教学内容的要求比以前有了较大的改动:口腔的形态结构由了解改为掌握,牙的形态构造、排列、牙周组织,口腔腺的形态、导管开口,肝外胆道由掌握改为熟悉；鼻旁窦及其导管开口部位由掌握改为熟悉;肾的被膜与冠状切面的结构由掌握改为熟悉;前列腺的位置形态由掌握改为熟悉,附睾的形态结构、输精管的分部位置由掌握改为了解；卵巢的位置与形态由掌握改为熟悉；内脏部分各器官的微细构由掌握改为了解;增加护理应用解剖学教学内容.结论 内脏解剖学知识对于护理专业是广而不精,器官的微细结构要精简.

长期以来,我国大多数医学院校护理专业解剖学教学从内容、计划、教学方法等方面与医疗专业一致[1],没有突出护理专业特点.为此,许多解剖学工作者在此方面进行了不断的研究探索.有些对系统解剖学内容进行综合和删减,精选教学内容;有些增加了与现代护理操作相关的解剖学知识[2];有些则对技能性要求很强的高职护理专业,增加了护理应用解剖学方面知识[3].他们的研究成果,一些以论文的方式发表,一些则编写了护理专业实用的解剖学教材,如《护理应用解剖学》[4]、《临床护理应用解剖学》[5]等.但对解剖学各系统专门研究的文章很少,目前只有《护理专业解剖学运动系统的教学改革初探》[6]一文,所以,有些学者削减的解剖学教学内容不太切合临床实际,有些学者只是在系统解剖学基础上增加了护理应用解剖学教学内容,等等.本研究是解剖学者与护理专家一起共同制定临床调查标准,在临床护理一线调查研究的结果,并且将解剖学分为运动系统、内脏系统、脉管系统、神经系统等,进行全面的、系统的、护理一线的调查研究.首先,将运动系统的调查研究情况报告如下.

Objective:To optimize the nursing quality by problem management pathway.Methods:According to the classification standard of the nursing defects,the qualitative mechanism of the nursing defects classifiation was established,and the method for the problem management was employed and improved.Results:The problem management was superior to the traditional method in terms of prospective and timely prevention and correction of the nursing defects.Conclusion:Establishment of the systematic and scienctific problem mangement mechanism can enhance the quality of nursing.

目的总结鼻内窥镜下慢性鼻窦炎手术患者控制区出血的护理经验。方法采用充分的术前准备,术中严密观察和正确的鼻腔护理及健康教育等方法。结果全组198例患者均顺利完成慢性鼻窦鼻内镜手术,平均出血量<50ml,无并发症发生;出院后随诊2～6mo,患者临床症状改善,鼻腔通气功能良好。结论科学全面的护理,有利于保证手术视野的清晰,减少手术出血的发生。

Objective:To investigate the effect of nursing interventions on lifestyle and blood pressure in hypertension patients.Methods:A total of 378 hypertension patients were randomly divided into the interventional group(n=190) and control group(n=188).The control group was delivered to a piece of hypertension prevention and cure handbook,while the interventional group received comprehensive nursing interventions including disease related knowledge education,psychological,diet,activity,cigarette smoking,alcohol consumption intervention.After 6 months follow-up,a comparison was conducted in terms of lifestyle and blood pressure control between both two groups.Results:Seven items of the lifestyle indices such as emotion,activity,salt restriction,weight,cigarette smoking,alcohol consumption and periodic re-visit were markedly improved in the interventional group as compared to those of the control group,and the blood pressure control was also considerably improved,all P0.01.Conclusion:Nursing interventions can facilitate the formation of the better lifestyle and blood pressure control in hypertension patients.

目的探讨联合碘伏鞣酸软膏治疗新生儿红臀的临床效果,为治疗新生儿红臀提供可靠方法。方法109例住院新生儿红臀中随机分为治疗组及对照组,对照组和治疗组常规护理分别采用蘸鱼肝油滴剂及联合碘伏鞣酸软膏涂药,观察对新生儿红臀的治疗效果。结果治疗组总有效53例,无效2例,对照组总有效40例,无效14例。结论联合碘伏鞣酸软膏治疗新生儿红臀疗效确切、简单方便,值得推广。

本文通过对我院1990年1月～1997年12月收治的38例糖尿病足病变患者资料进行分析,以探讨预防和治疗对策.