目的 分析归纳我国医护人员安宁疗护服务实践体验的质性研究,为完善安宁疗护临床服务、解决临床实践困境提供参考.方法 系统检索PubMed,Ovid,Web of Science,CINAHL,ProQuest,中国生物医学文献数据库、中国知网、万方数据库和维普数据库中从建库至 2022 年 10 月收录的关于医护人员安宁疗护服务实践体验的质性研究.采用澳大利亚JBI(Joanna Briggs Innstitute)循证卫生保健中心质性研究质量评价标准(2017)评价文献及汇集性Meta整合方法整合研究结果.结果 共纳入文献 16 篇,提炼出 52 个结果,形成 8 个类别,汇总成 3 个整合结果:患者和家属安宁疗护服务需求,医护人员安宁疗护服务胜任力,阻碍安宁疗护服务临床实践的因素.结论 临床医护人员安宁疗护服务面临诸多困扰,需增强服务核心能力并合理调适负面影响,以准确识别与满足患者及家属个体化需求.同时政策与医疗卫生机构需从多方面加强支持,促进安宁疗护服务临床实践的发展.

AIM:The aim of this study is to construct a quality evaluation system for fever clinic nursing management.BACKGROUND:Fever clinic is the first line of defence against the epidemic during COVID-19 in China.METHODS:Our study combines the Delphi method and the analytic hierarchy process. Delphi method was used to carry out two rounds of consultation for 18 experts, to select and revise indicators at all levels. Analytic hierarchy process was used to calculate the weight of indicators at all levels.RESULTS:A quality evaluation system of nursing management for fever clinics is built using Delphi method. It includes five first-level indexes, 14 second-level indexes and 82 third-level indexes. A two-round expert consultation is used to build the indicators. The recovery rates of expert questionnaires in the two rounds were, respectively, 100% and 94%, and expert authority coefficients were 0.925. The Kendall coefficients in the two rounds were, respectively, 0.205 and 0.162 (P < .001). The weight analysis shows that health management of nursing staff (0.2803) and disinfection isolation and treatment of medical waste (0.2803) are most important, followed by nursing post management and personnel training (0.1889), configuration and management of equipment (0.1427) and patient consultation management and nursing (0.1078).CONCLUSION:The quality evaluation system of nursing management in the constructed fever clinic is used to put forward a specific, objective and quantifiable evaluation criteria of nursing quality for fever clinic management, which can better meet the needs of epidemic prevention and control, and has a certain application and promotion value.IMPLICATIONS FOR NURSING MANAGEMENT:The establishment and improvement of a quality system for fever clinic care management will help to respond to outbreaks such as COVID-19.

Objective:To study the feasibility of using bedside ultrasound in evaluating gastric residual volume in critical ill patients with enteral nutrition support.Methods:From May 2019 to August 2019, 60 patients were selected to receive enteral nutrition via gastric tube in ICU of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. Patients were divided into the experimental group and the control group according to the odd and even number of beds, 30 patients in the experimental group with odd number of beds and 30 patients in the control group with even number of beds. Gastric residual volume was evaluated at 0, 4, 8, 12, 16, 20, 24 h of enteral nutrition. In the experimental group, the gastric residual volume was evaluated by bedside ultrasound and syringe suction at each time point. In the control group, only bedside ultrasound was used to evaluate gastric residual volume. The results of operation time, monitoring results at different time points, diarrhea and the utilization rate of gastrointestinal motility drugs target feeding time, vomiting, were compared between the two groups.Results:There was no statistical difference between the gastric residual amount monitored by ultrasound and the gastric residual amount monitored by suction ( P>0.05). The operating time of bedside ultrasound monitoring was (62.40 ± 4.00) s, the operating time of suction monitoring was (78.39 ± 12.15) s, and the operating time of bedside ultrasound monitoring was less than that of suction ( t value was 6.633, P<0.01). There was no significant difference in the rate of vomiting, diarrhea and gastrointestinal motility drugs between the two groups( P>0.05). The time to reach the target feeding amount in the control group was (3.04 ± 0.31) d, and the time to reach the target feeding amount in the experimental group was (4.19 ± 0.33) d. The time to reach the target feeding amount in the control group was less than that in the experimental group ( t value was 13.42, P<0.01). Conclusions:Bedside ultrasound can be used to evaluate the residual gastric volume of enteral nutrition support patients, guide the implementation of enteral nutrition, shorten the operation time, reduce the workload of nurses, and avoid the contamination of enteral nutrition preparation.

总结新型冠状病毒肺炎疫情期间发热门诊咽拭子的风险防控措施.重点是优化咽拭子采样区的布局和流程,实施不同人群的分类分时段采样,强化采样人员的岗前培训和考核,关注采样人员心理健康,制定采样期间标准操作流程和采样后实施全面的人、环境和物品集束化处理.发热门诊共采集咽试子样本12 933例次,采样区护理人员未发生新型冠状病毒感染.

[目的]深入了解重症监护室 (ICU) 护士对ICU探视制度的真实体验, 为探索符合我国国情及临床需要的新型探视制度提供参考依据.[方法]采用质性研究中的现象学研究方法, 对ICU内11名护士进行半结构式访谈, 根据Colaizzi的七步分析法分析资料.[结果]ICU探视制度对ICU护士心理真实体验提炼出4个主题:ICU探视制度的影响、完善相关ICU探视制度的辅助设施、不支持实行开放性探视、实行灵活多变的限制性探视制度.[结论]ICU探视制度有利有弊, 限制性探视制度被广泛接受, 但不支持实行开放性探视制度.需构建更完善的社会支持系统, 符合我国国情, 逐步建立由病人、家属和医护人员共同满意的探视制度.

目的 设计新型动静脉压力传感器固定装置,并检测其在动静脉测压患者中的临床应用效果.方法 将2017年6月—2017年12月选取我院重症监护室收治的50例使用动静脉测压患者,按照随机数字法分为实验组和对照组,每组各25例.实验组使用新型动静脉压力传感器固定装置固定动静脉压力传感器,对照组使用传统方法用胶布将压力传感器固定于患者手臂或胸前平心脏位置.评价两组测量准确性、患者舒适度、护士满意度.结果 实验组在测量准确性上明显高于对照组(P<0.01),患者舒适度评分高于对照组(P<0.01),护士使用新型压力传感器后满意度明显高于使用前,差异存在统计学意义(P<0.01).结论 使用新型动静脉压力传感器固定装置固定压力传感器能够提高测量准确度,增加患者舒适度,提高护士满意度.

目的 探讨应用清单式磁性软白贴在整合ICU患者各种信息中的效果,为患者的信息管理提供参考.方法 在应用清单式磁性软白贴前后,分别采用护士交接班评估量表对ICU护士交接班效果进行调查.结果 应用磁性软白贴整合ICU患者的信息前后,护士对交接班效果的总体评分分别为58.5±9.62、69.36±5.94(P<0.001),应用后总评分高于实施前.结论 清单式磁性软白贴应用在ICU患者的信息整合中,能提高交接班质量、保证患者安全及提高患者的参与度.

Objective To explore the intervention effect of ICU nurses' scientific research behavior and psychological contract based on psychological contract theory.Methods Totally 48 ICU nurses' willingness of nursing research was investigated based on psychological contract theory,then the goals of hierarchical personal nursing research were set according to the investigation result,which was combined with the nursing scientific research target of the department,and the contract interventions were provided at the same time,such as training support,diversified incentive and communication preventing contract breach.Results After the intervention,the number of ICU nurses'publications and patents were significantly more than those before the intervention,more nurses involved in scientific research.The nurses' perceived degree of psychological contract performance was improved gradually (P＜0.05 P＜0.01).Conclusion The intervention based on psychological contract can promote nurses to carry out nursing research activities actively,increase scientific research output,and improve the level of nursing scientific research in department.

目的 制作可自加液式胸腔闭式引流瓶并探讨其临床应用价值.方法 选取胸部肿瘤手术患者320例,随机分为对照组和观察组各160例.对照组采用传统胸腔闭式引流瓶,观察组采用可自加液式胸腔闭式引流瓶.结果 观察组护士为患者准备胸腔闭式引流瓶时锐器伤发生率为0,显著低于对照组;准备耗时显著短于对照组(均P＜0.01).结论 可自加液式胸腔闭式引流瓶使用方便,可提高护士工作效率,避免护士锐器伤的发生.

[目的]探讨神经语言程序(NLP)培训对肿瘤科护士情绪管理能力的影响。[方法]选取肿瘤科护士70人，按随机数字表分为观察组和对照组各35人，选择合适的 NLP导师对观察组护理人员进行 NLP课程培训，对照组给予一般支持性心理护理，运用症状自评量表(SCL 90)对两组护士进行心理测评。[结果]3个月后，观察组护士 SCL 90测评因子中强迫症状、人际关系敏感、抑郁、焦虑、敌对5个因子的评分及总均分低于对照组，差异有统计学意义(P<0.05或P<0.01)。[结论]NLP 能帮助肿瘤科护士掌握自我调节负面情绪的方法，正确认识自我，增强心理调节能力和承受能力，能有效管理情绪，营造更良好的心理环境，从而更好地服务于临床。

疼痛是继呼吸、脉搏、血压、体温后的第五大生命体征.目前,护士已经作为医院疼痛管理的重要组成部分,国际医疗卫生机构认证联合委员会(JCI)疼痛管理标准要求护士必须接受相关培训以明确在疼痛评估和管理中其所承担的角色;护士必须对所有患者进行疼痛评估和记录;护士必须评估并记录每次疼痛干预的效果[1].疼痛是骨科患者的主要临床表现,患者由于疼痛会产生焦虑、烦躁、血压上升、免疫功能下降等一系列生理和心理改变,对术前、术后功能锻炼的恢复都将产生严重影响.

目的 降低麻醉复苏期间动脉血气分析采血时的疼痛.方法 将150例全麻术后麻醉复苏期血气待查患者按入室时间分为对照组(74例)和观察组(76例),两组均使用一次性血气针进行动脉采血,对照组按常规方法进行采集,观察组在遵循常规操作的基础上进行疼痛护理干预,包括局部加温、涂抹0.1％丁卡因胶浆、细化操作等.比较两组患者的穿刺成功率、疼痛程度和患者的满意度.结果 观察组穿刺成功率显著高于对照组(P＜0.05),疼痛程度显著低于对照组,患者对血气分析的满意度显著高于对照组(均P＜0.01).结论 对麻醉复苏期间动脉采血实施有效的护理干预能提高穿刺成功率,减轻患者的疼痛程度,提升动脉血气分析的依从性和对护理工作的满意度.

[目的]探讨认知盈余在新护理团队建设中的作用。[方法]建立新护理团队的认知盈余小组，应用现代化网络手段搭建快捷的沟通方式，发布即时信息，利用非工作时间在网络平台进行话题探讨，利用晨会和每月1次科室例会与护士进行沟通、点评及总结。[结果]100%的护士认为将认知盈余观念引入到工作中是有效的；95%的护士认为认知盈余活动的开展对提高自身职业素养起到了积极的作用。[结论]利用发达的网络和通讯工具，能充分发挥每位护士的主观能动性，挖掘每位护士的认知盈余，促进新护理团队的凝聚力，提高新护理团队的业务水平和能力，同时保证护士业余学习的时效性。

[目的]探索萨提亚模式教学对提高护理人员自我价值感和护患沟通能力的作用。[方法]选择合适的萨提亚模式指导者，对被培训者进行萨提亚模式课程培训，通过自制调查表了解被培训者学习后自我价值感和护患沟通能力的改变。[结果]通过系统培训，护理人员的自我价值感和护患沟通能力均有所提高。[结论]萨提亚模式教学可以提高护理人员自我价值感和沟通能力。

<正>目前,我国已进入老年化社会,随之而来的如高血压、糖尿病、冠心病等需要长期药物治疗的老年慢性病发病率也越来越高。但老年患者普遍存在用药依从性差的问题,使治疗难以达到满意疗效,甚至造成患者病情加重、医疗资源浪费,这使老年患者护理工作面临新的挑战[1]。现代医学模式已从

Objective To reduce fluctuations of blood glucose during continuous total parenteral nutrition(TPN) treatment.Methods Sixty critical multi-trauma patients without diabetes mellitus receiving continuous TPN treatment more than 7 days were randomly divided into two groups of 30.The observation group was given two-lumen central venous catheter for infusion of medicines and nutrition solutions,one lumen was used to infuse drugs,the other was applied for 24-hour infusion of nutrition solutions,while in the control group,nutritional solutions were infused after infusion of agents.Results The values of blood glucose in the observation group were significantly lower than those in the control group at different time points(P<0.01);the frequency of injecting insulin in the observation group was significantly reduced(P<0.01).Conclusion Using bi-lumen central venous catheter in continuous TPN treatment can reduce fluctuation of blood glucose.

Embeded system has weak computer power and small storage.In order to reduce control information and scheduling time,this paper presents a scheduling algorithm based on Coolstreaming scheduling policy,analyzes data scheduling policy using new exchange mechanism and heuristic algorithm.The new algorithm is properly designed according to the characteristic of STB and application environment of IPTV.The test result shows that the scheduling algorithm used in embedded system can reduce the overhead of peers efficiently and provide high quality live streaming service to vast number of STB users.

硝基苯是一种无色或微黄色、苦杏仁味的油性液体,多用于生产染料、香料、炸药等有机合成工业,近年来,在装饰材料中用途广泛.其蒸气能经肺吸收,液体易经皮肤吸收,若不慎口服,将导致多器官功能损伤[1].病人主要表现为高铁血红蛋白血症、溶血、肝肾损害等,病死率高.2007年我科收治1例硝基苯中毒病人,经积极救治病人痊愈.现报告如下.

ICU重症病人因病情重、镇静等原因,活动量少,卧床时间长,加之营养状况相对低下,所以各种预防性的措施对防治压疮尤为重要.医用透明敷贴现在在临床上主要应用于留置针的固定.2005年1月起,我科在常规护理的基础上,对50例病人应用医用透明敷贴(美国3M公司生产)来预防压疮,效果良好.现介绍如下.

Objective To explore which method is more effective and easily accepted by patients through contrasting the method of pressing blood vessel with four fingers and the meihod of pressing blood vessel with four fingers holding the hand.Methods In this study,to learn which method is better accepted by patients,194 cases were observed by seff-control stuay after withdrawing the needle.The Occurrence of bleeding and petechia Was evaluated.Results In the method of pressing blood vessel with four fingers and the method of pressing blood vessel with four fingers holding the hand,the occurrence rates of bleeding were 10.3 1%and 0.52%.and tlle occurrence rates of petechia were 9.28%and 0.52%,respectively.There wag a significant differenee between the occurrences of bleeding and petechia(P<0.01).The patients preferred to the method of pressing blood vessel with four fingers holding the hand.Conclusions Adopting the method of pressing blood vessel with four fingers after withdrawing the needle could reduce the occurrence of bleeding and petechia more effectively and is better accepted by patients.