自2022年3月以来,因新型冠状病毒(新冠)奥密克戎毒株传播快、潜伏期短、隐匿性强致上海市短时间内多点出现疫情,感染人数显著增加.我院作为上海市新冠肺炎后备定点医院承担特殊时期新冠感染患者的救治任务.本研究基于全面质量管理理论"4M1E"法制定的整建制转化方案,使医院在接到上级指令后,迅速、高效完成整体转化,有序收治患者.现将整建制转化方案及实践经验报道以供参考.

采用精益六西格玛[界定(Define)、测量(Measure)、分析(Analyze)、改进(Improve)、控制(Contro1)DMAIC],对发热门诊管理进行流程优化探讨.选取2021年3月至2022年3月在我院发热门诊就诊的患者为研究对象,其中2021年3月至8月间就诊的患者为对照组;2021年9月至2022年3月间就诊的患者为实验组,采用DMAIC流程优化门诊管理.流程优化后,实验组患者的平均就诊时间为(88±17.89)min,较对照组平均就诊时间[(138±24.57)min]明显降低.实验组患者就诊满意度为(95.14±7.26)分,较对照组就诊满意度[(92.37±9.87)分]明显提高,差异均有统计学意义(t值分别为33.67,4.62,P均＜0.05).基于DMAIC模型优化发热门诊管理流程,能有效降低患者就诊时间及现场等候时间,充分提高发热门诊运行效能,避免人群聚集,降低交叉传染风险.

作为新型冠状病毒肺炎(新冠)定点治疗医院,迅速、安全、高效的护理人力管理是保障救治效能的关键因素.作为新冠定点医院,整体转化时间紧,感染控制任务重.因此,短时间内,迅速、安全、高效的调配护理人力是护理人力资源管理工作的重点与难点.护理管理者应根据医院整体患者收治管理策略,统筹规划护理人力资源部署.本院在护理人力资源调配过程中,通过护理人力资源梯队建设、严格各级病房准入标准、系统培训提升新冠护理能力、把控关键环节,确保了护理质量与防护安全,保障了新冠疫情救治工作的顺利有序开展.

目的:了解先天性垂体发育不良患儿父母疾病相关的负担体验及护理服务需求,以期为后续制订相应的护理干预方案提供依据.方法:2019年6月1日～2019年8月30日,采用目的抽样法抽取上海市某医院内分泌科就诊的10名先天性垂体发育不良患儿父母为研究对象,采用现场象学研究方法对其进行半结构式访谈,现场录音,根据Colaizzi 7步分析法对访谈资料进行分析,提炼主题.结果:本研究共提取3个主题,即患儿父母心理负担重,表现为无处诉说的压力,对患儿未来的担忧,对患儿的愧疚及对治疗信心不足;消极的应对方式,表现为隐瞒和逃避及治疗依从性不佳;多样化的需求,具体为心理支持、就医及疾病知识方面的需求.结论:先天性垂体发育不良患儿父母心理负担重,负性情绪复杂,应对方式消极,医护人员应及时给予有效的心理干预、适当的疾病知识指导,帮助其正确认识疾病,树立治疗信心,缓解心理压力,减轻其疾病相关照护负担体验,提高治疗依从性与生活质量.

Objective:To understand the real experience of standardized training nurses on the two-way selection mode in postion management.Methods:From march to April 2018, semi-structured interviews were conducted among 20 standardized training nurses and the data were analyzed by Colaizzi′s method.Results:Three categories and 12 themes were extracted from data. Category one: subjective feelings, including fairness, sense of ritual, humanization, and hasty decision making. Category two: objective influence,including competitive pressure, enthusiasm of study and work, good work habits, strong sense of belonging, and stereotype. Category three: personal advice,including protection of personal privacy, the structure and homogeneity evaluation index, high decision efficiency.Conclusions:Two-way selection model can build a fair environment and stimulate the standardized training nurses′ enthusiasm of learning and practicing. but managers also should explore effective intervention strategies to improve the post selection decision efficiency actively.

[目的]了解中青年糖尿病病人自我病耻感水平及其影响因素,为制订干预措施提供参考依据.[方法]采用一般资料调查问卷、糖尿病病人自我病耻感量表、简易疾病认知量表、社会支持量表对上海、常州两地3家医院便利抽取的中青年糖尿病病人进行横断面调查.[结果]中青年糖尿病病人病耻感得分为(68.14±10.70)分,多元线性回归分析结果显示,社会支持、疾病认知、并发症、胰岛素治疗、性别、收入水平及糖尿病类型进入回归方程,调整R2=0.628.[结论]中青年糖尿病病人自我病耻感水平较高,医务人员应积极探索有效的干预措施,缓解其自我病耻感,促进身心健康.

[目的]系统评价新入职护士工作体验的质性研究,为其顺利过渡到合格临床护士提供干预依据.[方法]检索PubMed、EMbase、the Cochrane Library、JBI图书馆、知网、万方、维普数据资源系统中有关新入职护士工作体验、心理压力、情绪体验等的质性研究,检索时限从建库至2018年10月31日.将纳入文献按照澳大利亚JBI循证卫生保健中心质性研究的质量评价(2016)标准进行评价,采用汇集Meta整合的方法将研究结果进行整合.[结果]共纳入11篇质性研究文献,提取17个研究结果,归纳形成6个类别,整合形成2个结果.整合结果1:新护士规培初期角色适应不良,身心俱疲,渴望有效支持.整合结果2:规培后期新护士专业能力全面提升,职业认同感提高,逐渐适应护士角色.[结论]新护士在规范化培训阶段均经历从初期的焦虑、缺乏自信、角色适应不良到后期专业能力迅速提升,逐渐适应岗位的过程.护理管理人员应针对规培护士不同阶段出现的共性问题制定适宜的干预计划与规培方案,促进新护士到专业护士角色的顺利过渡.

目的 深入了解中青年糖尿病患者的病耻感体验及其来源与应对方式,以期为制订针对性的干预措施提供参考依据.方法 2017年1-5月,采用目的抽样法,选择某三级甲等院内分泌科收治的15例中青年糖尿病患者为研究对象,采用现象学研究方法对其进行半结构式访谈,现场录音,借助NVivo 7.0软件,根据Colaizzi的7步分析法对资料进行分析,提炼主题.结果 中青年糖尿病患者的病耻感体验可归纳为3个类属10个主题.类属一:病耻感体验,即悔恨与愧疚、对刻板印象的认可、自卑感、被歧视的经历、遭受异样的眼光;类属二:病耻感来源,即亲友和同事、医护人员、公众;类属三:病耻感的应对,即隐瞒、回避.结论 糖尿病患者存在较强烈的病耻感,医护人员应为其提供相应的心理支持,指导其采取正确的应对方式;同时社会媒体及各界人士,应积极正确地宣传糖尿病的相关知识,并为糖尿病患者创造宽松的社会环境.

Objective To investigate the therapeutic and protective effects of Tongxinluo (TXL) on cerebral ischemia reperfusion injury in rats. Methods Ninety-nine SD rats were divided into three groups:①the normal group;②the TXL-treated group and ③the TXL preventive group. Reversible occlusion of the right middle cerebral artery for 2 h was carried out using a intraluminal-suture method of Longa. The analyses were performed at 1, 24 and 120 hours after re-circulation in the three groups. The infarct volume was assessed by TTC staining and the cerebral water content was measured by dry weight method. The activities of SOD, GSH-Px and Na+-K+-ATPase and the contents of NO and MDA were measured in the cortical tissues of ischemic hemisphere. Activated microglial cells were detected by immunofluorescence labeling. Results TXL significantly reduced the volume of cerebral infarct and water content (P<0.05). In TXL treated rats, the activities of SOD, GSH-Px and Na+-K+-ATPase in the cortex of ischemic hemisphere were elevated (P<0.05), while the MDA and NO content was significantly decreased (P<0.05) compared with the sham-operated group. The overactivation of microglial cells was inhibited. ConclusionTXL has neuroprotective effect on cerebral ischemia reperfusion injury in rats by reducing the overproduction of free radicals, blocking the intracellular calcium overload and inhibiting the inflammation.