目的 探讨早产儿出生后24～72h且医学评估稳定后,接种卡介苗的安全性和效果.方法 选取2021年12月至2022年6月北京协和医院国际医疗部产科病房出生的接种0.1 ml卡介苗的早产儿35例(病例组),另选取同时期出生的体质量N 2 500 g的接种0.1 ml卡介苗的足月新生儿35例(对照组),比较2组接种卡介苗后的卡痕率、卡痕均值和不良反应.结果 病例组胎龄为34～36+6周,平均胎龄低于对照组[(35.5±0.6)w比(38.8±0.9)w],接种卡介苗时日龄高于对照组[(1.5±0.7)d1比(1.3±0.6)d],出生时体质量低于对照组[(2 276.3±140.7)g比(3 125.0±384.1)g],差异均有统计学意义(P＜0.05).病例组和对照组的卡痕率(57.1％比68.6％)和卡痕均值[(4.4±1.3)mm比(4.6±1.2)mm]比较,差异均无统计学意义(P＞0.05).两组在1、3个月查体时,均未发现接种部位直径＞10 mm的局部脓肿或溃疡、同侧腋下局部淋巴结肿大＞10 mm或发生脓疡破溃、骨髓炎、全身播散性卡介苗感染和寻常狼疮等不良反应.结论 34～36+6周的早产儿在出生24～72 h且医学评估稳定后,接种卡介苗是安全、有效的,可在临床中推广实行.

目的 评价五维音乐呼吸法对初产妇分娩控制感和分娩恐惧的效果.方法 选取2020年6-9月北京协和医院自然分娩的初产妇100例,偶数日期临产的产妇为对照组,奇数日期临产的产妇为试验组,每组50例.试验组临产后予以五维音乐呼吸法指导,在音乐的陪伴下进行自我催眠暗示;对照组采用常规分娩指导.比较两组产妇的分娩控制感和恐惧感的评分,以及第1产程的疼痛评分.结果 两组第1产程宫口开2～3 cm时的视觉模拟评分(visual analogue scale,VAS)比较,差异无统计学意义(P＞0.05);试验组第1产程宫口开9～10cm时的VAS为(5.5±1.6)分,明显低于对照组的(6.9±1.4)分,差异有统计学意义(P＜0.05).试验组分娩时内在控制得分、外在控制得分及控制感总分均显著高于对照组[(36.06±3.74)分比(28.3±5.43)分、(42.48±2.99)分比(29.22±4.16)分、(78.54±4.49)分比(57.52±6.03)分],分娩恐惧中的对分娩时失去控制的恐惧得分、对疼痛伤害的恐惧得分及分娩恐惧总分均显著低于对照组[(8.98±2.21)分比(11.10±2.98)分、(6.96±2.77)分比(9.12±4.12)分、(32.62±6.05)分比(37.50±7.96)分],差异有统计学意义(P＜0.05).结论 五维音乐呼吸法能有效提升初产妇在分娩过程中自我控制感的积极心理,减轻分娩恐惧感的消极心理,值得临床推广应用.

Objective:To investigate the status quo of patient privacy protection behavior of clinical nurses and analyze its influencing factors.Methods:Using the convenient sampling method, clinical nurses from tertiary hospitals in China were selected to conduct a questionnaire survey on from March to April 2018. The Chinese version of Patient Privacy Scale (PPS) were used to conduct an investigation through Questionnaire Star electronic questionnaire. A total of 1, 043 valid questionnaires were collected, and the effective response rate was 100%.Results:The PPS total score of 1 043 clinical nurses was (124.86±12.16) . The item with the highest score was "You would use screens, curtains and sheets to protect patients' privacy when necessary" (4.89±0.39) , while the item with the lowest score was "You would knock on the door before entering the patient's room and enter after asking for the patient's consent" (4.11±1.14) . The results of multiple regression analysis showed that education level and department had effects on patients' privacy protection behavior ( P<0.05) . Conclusions:The patient privacy protection behavior of clinical nurses is generally at a good level, but there is still room for improvement in individual behaviors. Teaching hospitals should strengthen education related to patient privacy protection for nurses with higher education degree who undertake teaching tasks and nurses in surgical monitoring departments and formulate specific relevant teaching procedures and detailed rules.

目的 探讨新生儿尿布疹评估量表汉化后的信效度.方法 经原量表作者同意,对国外已形成的新生儿尿布疹评估量表进行引进和汉化.对2019年7～11月北京市某三级甲等医院产科病房112例新生儿进行评估,通过内部一致性信度、评定者间一致性信度进行量表信度的检验,通过内容效度进行量表效度的检验.结果 新生儿尿布疹评估量表的信效度检验结果:Cronbach'sα系数为0.744,评定者间信度为0.939,内容效度为0.925.结论 中文版新生儿尿布疹评估量表具有较好的信度和效度,可用于国内新生儿尿布疹严重程度的评估,为临床干预和动态评估提供依据.

目的 构建产科护士核心能力评价指标,为产科护士核心能力评价提供有效的测评工具.方法 通过文献分析、参考相关量表基础上,应用Delphi法等构建产科专科护士核心能力评价指标体系,并以构建的指标体系为依据,编制自评问卷;采用该问卷对北京市5所三级甲等医院238名产科护士进行自评调查,以检验该指标体系的信效度.结果 最终确立了包含一级指标5个(专业实践能力、专业发展能力、沟通协调能力、批判性思维能力、管理能力)、二级指标13个、三级指标68个的产科护士核心能力评价指标体系.指标体系的总体Cronbach'sα系数为0.896,内容效指数S-CVI为0.950,一级指标与总体相关系数为0.744～0.958(P<0.05).结论 产科核心能力评价指标体系可靠、信度较高,具有一定的区分度,可以作为后续产科护士培训和考核准入的有效测量工具.

目的 调查不同层级护士培训需求,为规范化护士培训体系建立提供参考依据.方法 采用护士培训需求量表对160名在岗护士进行调查.结果 不同层级护士在科研、交流与团队协作、临床实践技能、电子设备的应用与事务管理方面均有不同程度的需求(P＜0.01或P＜0.05).N1级护士对交流与团队协作、临床实践技能培训需求显著;N2级护士在护理管理及电子设备应用与事务管理培训需求显著,N3级护士对科研培训需求显著.结论 医院管理者应针对不同能级护士采取针对性和满足个人需求的培训,以提高不同能级护士专业素质和技能水平,建设护理人才梯队.

Objective To understand obstetrical nurses′awareness and attitude to breastfeeding in patients with hepatitis B in level three class A hospitals in Beijing,so as to provide references for scientific guidance and increase of breastfeeding rate in this special population in the future.Methods Using convenience sampling method,questionnaires were delivered in 1 86 obstetrical nurses from 7 level three class A hospitals in Beijing,in order to investigate their awareness on whether patients with hepatitis B could feed infants with breast milk,and their attitude toward breastfeeding of patients with hepatitis B.Results A total of 1 86 obstetrical nurses were surveyed,of whom only 64.6% could correctly answer breastfeeding-related problems about patients with hepatitis B.82.3% of the surveyed obstetrical nurses falsely thought that level of HBV DNA titer in breast milk would affect breastfeeding.Only 29.6% of the surveyed nurses were aware of Clinical Guideline on Prevention of Mother-to-child Transmission.When surveying about their willingness,only 45.2% of the nurses supported the breastfeeding of patients with hepatitis B.Differences were statistically significant among nurses on their awareness and attitude toward whether newborn infants could be fed by breast milk from patients with hepatitis B after receiving immune block,and on whether the nurses would encourage puerperas with hypatitis B to feed their infants by breast milk when they were consulted by these puerperas.Conclusions Hospital and department managers should pay increasing attention to learning and awareness of new knowledge and new technologies of obstetrical nursing staff,by implementing continuing education,enhancing their acceptance of self-worth and their confidence in self knowledge level,so as to provide more scientific,accurate and effective health education for maternal and child safety.

Objective:To evaluate the reliability and validity of Chinese version of fistula self nursing ability eval-uation form.Methods:Susanne developing fistula patients self care ability evaluation form was introduced,a to-tal of 70 fistula patients were evaluated by researchers using fistula self care ability evaluation form,and to ana-lyze the validity and reliability of the scale.Results:The CVI of all items index of Chinese version fistula self care ability evaluation form ranged from 0.80 to 1,average 0.92,rater reliability was 0.92,with good discrimi-nation.Conclusion:Chinese version of fistula self care ability evaluation form has good reliability and validity. The introduction of the scale will be conducive to the continuous dynamic monitoring of self care ability of co-lostomy patients by medical staff,and provided evaluation tools.for new intervention effect.

大动脉炎是一种原因不明累及主动脉及其主要分支和肺动脉非特异性慢性炎性血管病,以相应血管狭窄或闭塞为主,造成一系列缺血及高血压的临床症状和体征[13]。疾病主要累及大、中血管,经典表现为外周脉搏搏动的不对称,即“无脉症”,其临床症状和体征取决于病变累及的部位。临床常分为4型：①头臂动脉型,症状为头晕、视力障碍、偏瘫、一侧或双侧上肢血压降低或未测出；②主、肾动脉型,症状为下肢无力、高血压、心力衰竭、上肢血压增高而下肢脉搏减弱或消失；③混合型,具有前两型的特点；④肺动脉型,大多症状不明显。妊娠合并大动脉炎在临床上比较少见。妊娠期,孕妇血容量增加,心搏出量也随之增加,同时由于妊娠子宫压迫下腔静脉,使回流血量减少,致使大动脉供血不足,大动脉炎的病情可能进一步加重。病人妊娠时发生充血性心力衰竭、脑血管意外、肾功能不全及子痫前期的发生率增高,尤其是孕前脏器受累的病人,易发生自然流产、早产、胎儿发育迟缓,甚至胎死官内[4,5]。大动脉炎合并妊娠为高危妊娠,妊娠并发症和不良妊娠结局的风险明显增加,密切监测病情变化,早期识别和正确的处理对于产妇预后及胎儿的妊娠结局非常重要。北京协和医院1991年—2014年共收治妊娠合并大动脉炎病人7例,现将其临床特点及护理重点报道如下。

报道12例妊娠合并卵巢癌患者行剖宫产联合卵巢癌切除术的护理经验。由于卵巢癌病情复杂、复发率高，加之怀孕的特殊阶段，担心自身和胎儿健康及安全，需做好心理护理。患者行剖宫产联合卵巢癌切除术，术前做好腹胀、营养不良的护理，预防先兆早产；术后密切观察有无发生出血，同时预防感染及血栓形成，术后做好化疗护理，指导患者定期复查。本组12例行剖宫产联合卵巢癌切除术患者，经手术治疗及积极护理，11例患者顺利出院，1例产妇因癌症晚期和复发死亡。分娩出12名新生儿，其中1名早产儿因呼吸衰竭脑出血经治疗后存活，其他新生儿均健康存活。

锁骨下动脉盗血综合征（subclavian steal syndrome,SSS）是由于无名动脉或锁骨下动脉分出椎动脉之前的近心段发生部分或完全闭塞时,在虹吸作用下,患侧椎动脉血液逆流,同时对侧椎动脉血液也部分被盗取,进入患侧锁骨下动脉供应患侧上肢,而产生椎-基底动脉缺血和患侧上肢缺血症状[1]。病人常有间歇性眩晕、头痛、严重时可出现晕厥、患肢坏死,因此早期的识别和正确的处理对于病人的预后非常重要。支架置入治疗已成为

[目的]评定中文版医护合作量表(NPCS)的信度和效度。[方法]使用 NPCS对120名护士进行测试,应用探索性因子分析量表的信度和效度。[结果]NPCS所有条目的内容效度(CVI)为0.80~1.00,所有条目CVI均值为0.92。整个量表的 Cronbach’sα系数为0.96,因子分析后3个维度Cronbach’sα系数分别为0.92,0.93,0.89。因子分析累积解释变异量为63.36%。[结论]中文版 NPCS的效度和信度良好,设置条目适于评价临床工作中医护合作行为的程度。

目的 探讨呼吸功能训练仪在老年肺癌患者围手术期的应用方法及效果.方法 将2011年8月至2012年8月行肺叶切除手术的老年肺癌患者60例设为对照组,接受围手术期常规呼吸功能锻炼;2012年12月至2013年12月的60例设为观察组,常规呼吸功能锻炼基础上采用LEVENTON 1200040型呼吸功能锻炼仪进行锻炼.结果 术后第2天观察组肺复张良好率显著高于对照组,术后胸腔闭式引流管留置时间和术后住院时间显著短于对照组(均P＜0.01).结论 老年患者在肺叶切除围手术期使用呼吸功能训练仪可有效地改善呼吸功能,促进术后肺复张.

[目的]评定DASH简式评分表中文版在乳腺癌病人上肢功能障碍评估中的信度和效度。[方法]由研究者使用DASH简式评分表对110例乳腺癌病人进行评价。[结果]DASH简式评分表所有条目的内容效度（CVI）值为0.80~1.00,所有条目CVI均值为0.92。肩关节活动度得分与DASH值的Pearson相关系数为r=-0.812（P＜0.05）。整个量表的Cronbach’sα系数为0.911,各条目的Cronbach’sα系数为0.721~0.914。量表的组内相关系数（ICC）为0.882,各条目的ICC值为0.745~0.939。[结论]DASH简式评分表的效度和信度良好,设置条目适于评价乳腺癌病人上肢功能障碍的程度。

目的 探讨心理授权对护士职业倦怠的影响,为采取针对性措施预防护士职业倦怠提供参考.方法 采用便利抽样法于2012年3月选取北京市某三级甲等医院国际医疗部的73名护士进行问卷调查,内容包括护士职业倦怠量表、心理授权量表以及一般人口学资料.结果 被调查护士存在着中度的职业倦怠,对心理授权的认知处于中等水平;护士职业倦怠与心理授权呈负相关(P<0.01),且心理授权是护士职业倦怠的独立保护性因素.建立的多元回归方程为:护士职业倦怠=0.25×工作环境+0.79×人格特征-0.18×心理授权-0.59.结论 护理管理者在为护士营造良好的工作环境、优化员工特征与岗位匹配的前提下,应给予护士更多的自主决策权,增强护士的自我效能感、工作意义感及自主性,从而减轻职业倦怠的发生.

目的探讨工作授能对护理人员患者安全文化态度的影响,为更好制定患者安全相关政策和措施提供参考。方法便利选取200名护士进行问卷调查,包括护理人员患者安全文化测评问卷的安全态度评分、工作效能条件量表以及一般基本人口学资料,并对调查结果进行分析。结果护理人员对患者安全文化感受为正向,其工作授能处于中等水平。护士患者安全文化态度与工作授能呈显著正相关(P<0.05,P<0.01)。结论护理管理者应为护理人员建立良好的授权职业实践环境,从而实现患者安全文化的改进。

<正>护理不良事件是指在护理过程中发生的、不在计划中的、未预计到的或通常不希望发生的事件,包括病人在住院期间发生跌倒、用药错误、走失、误吸或窒息、烫伤及其他与病人安全相关的、非正常的护理意外事件[1]。护理不良事件的发生可能影响病人的诊疗结果,增加病人痛苦和负担,并可能引发护理纠纷或事故[2]。近年来,随着现代护理管理的发展,人们医疗健康知识

Objective To determine the effect of an exercise-dietary intervention on exercise-dietary self-efficacy and behavior among migrant children aged 9-12 with obesity and overweight in Beijing.Methods Thirty migrant obesity and overweight children in two schools aged 9-12 were recruited by convenience sampling method.They completed the study by the method of self-control before and after the treatment.The self-efficacy and behavior of diet and exercise are measured by self designed questionnaire.Data were obtained at five time points: baseline,one week,two months,three months and six months after the intervention.Results(1)Self-efficacy in taking healthy food and exercising improved significantly one week after the intervention(P<0.01),but there was a significant decrease two months after intervention compared with the data of one week after intervention(P<0.005);(2)Healthy diet and exercise behavior scores increased one week and three months after the intervention compared with the baseline(P<0.005),but there was a significant decrease two months and six months after intervention compared with the data of one week after intervention(P<0.005).Conclusion This study found an effect of positive changes in self-efficacy in taking healthy food and exercising,healthy diet and exercise behavior of participants who undertook an exercise and dietary intervention program,but the long term effects needed to be verified in future studies.The findings of the study show that the behavior maintaining is a long term process which needs the cooperation and supervision of the parents and their family.

Objective: To investigate current clinical nurses' ethical behaviors, in order to provide theoretical basis for further interventions in regulating nurses' behaviors and improving the quality of nursing. Methods: Peer assessment was used in this survey. By convenient sampling, we chose 56 nursing departments where nursing students had their internship in. All of the 180 nursing students practiced in those departments were asked to complete a questionnaire about clinical nurses' ethical behaviors based on their recalling of nurses' behaviors they have seen during their internship in the hospital. Results: The average score of clinical nurses' ethical behaviors was 3.64±0.35. Dimension of Cautious scored highest, but Dimensions of Affiliation and Prudence scored lowest in this investigation. Conclusion: Clinical nurses' ethical behaviors are on a high level in all, but there are differences in some dimensions. Clinical nurses' ethical behaviors still need to be improved, especially the behaviors related to affiliation and prudence.

Objective To describe body mass index (BMI) changes in migrant children with overweight and obesity in Beijing treated by the exercise and dietary intervention programme.Methods BMI was assessed at before and after the intervention in 30 migrant obesity and overweight children aged 9 ～ 12 in two schools from March,2010.Results BMI reduced significantly one week after the intervention ( P ＜ 0.05 ),but from two months to six months after the intervention BMI increased again to the pretreatment level( P ＜ 0.05 ).Conclusion The intervention was successful in decreasing BMI,however maintenance of BMI after treatment was not easy.The controlling of obesity and overweight is a long term process which needs the cooperation and supervision of their parents.