目的:探讨护士人文关怀护理模式对护士人文执业能力、护士职业获益感和护士工作满意度的影响,以期为护理管理者对护士实施人文关怀提供参考.方法:对无锡市某三甲医院814名临床护士进行护士人文关怀护理模式的干预,采用护士人文执业能力测评量表、护士职业获益感问卷和护士工作满意度调查表对814名护士进行调查.结果:干预前,护士人文执业能力得分为32(26～52)分,干预后,护士人文执业能力得分为41(27～52)分,两者比较差异有统计学意义(Z值=4.85,P＜0.001);干预前,护士职业获益感得分为44(29～58)分,干预后,护士职业获益感得分为57(31.75～61)分,两者比较差异有统计学意义(Z值=5.96,P＜0.001);干预前,护士工作满意度得分为71.5(48～79)分,干预后,护士工作满意度得分为75(56～82)分,两者比较差异有统计学意义(Z值=4.88,P＜0.001).结论:实施护士人文关怀护理模式有助于提高护士的人文执业能力、护士职业获益感及护士工作满意度,从而提升护士工作积极性,增强护士职业发展信心,稳定护理队伍.

目的:调查某三级甲等医院护士工作满意度、人文执业能力及职业获益感现状,分析其影响因素,以期为护理管理者提供政策依据.方法:采用整群抽样,抽取无锡市某三级甲等医院护士814人,采用一般资料问卷、护士工作满意度评定量表、护士人文执业能力测评问卷及护士职业获益感问卷进行问卷星调查.结果:护士工作满意度评定量表得分(83.37±19.47)分,护士人文执业能力测评问卷得分(42.41±15.16)分,护士职业获益感问卷得分(61.54±17.99)分;多元线性回归分析结果显示,护士职业获益感、护士工作环境、护士人文执业能力、所在科室是护士工作满意度的主要影响因素,职务、平均收入、所在科室是护士人文执业能力的主要影响因素,所在科室、职务、学历、护龄是护士职业获益感的主要影响因素(P<0.01);护士工作满意度量表总分与职业获益感量表总分及各维度得分均呈正相关(P<0.01).结论:该院护理人员的工作满意度、人文执业能力及职业获益感处于中等水平,护理管理者应重视医院人文环境的营造和护理人员支持系统的建设,以提升护士人文执业能力,进而提高护士工作满意度和职业获益感,从而提升护理工作质量.

Background: Peritoneal dialysis (PD) is an ideal method for the treatment of chronic kidney disease. Its survival rate and quality of life depend on the quality of dialysis. The quality of dialysis depends on the compliance of patients with drugs and dialysis treatment, the choice of diet, the detection of complications and the monitoring and management of the disease. Therefore, the self-management of PD patients is particularly important. This study explored the role of peer support in improving the self-management ability of PD patients.Methods: A total of 105 PD patients in a Chinese tertiary hospital were enrolled and divided into a control group (35 cases), a WeChat group (intervention group 1; 35 cases), and a face-to-face group (intervention group 2; 35 cases). During the 6-month follow-up, the control group were given individualized education, and the intervention group was given peer support.Results: After the 6-month intervention, the self-management ability of the intervention group was significantly different from that of the control group (P<0.01). There were significant differences between the WeChat group and the face-to-face group with respect to hemoglobin and blood phosphorus (P<0.05). There were significant differences in prealbumin, hemoglobin, blood phosphorus and calcium levels between the intervention and control groups after 3 months and 6 months of intervention (P<0.01).Conclusions: Peer support can effectively improve the self-management ability and biochemical indicators in PD patients.

目的:探讨移动平台支持下团体心理干预模式对护士职业心理状态的影响.方法:采用整群抽样法在无锡市某三甲医院抽取护士518例,进行移动平台支持下团体心理干预,于干预前后采用马氏职业倦怠问卷(MBI)、中国护士压力源量表(CNSS)、心理韧性量表(CD-RISC)和总体幸福感量表(GWB)进行问卷调查,比较干预前后的差异性,并随机抽取职业倦怠问卷得分三个等级的护士各70人,进行唾液标本中皮质醇和褪黑素检测.结果:经团体心理干预后MBI、CNSS得分低于干预前,CD-RISC和GWB得分高于干预前,差异有统计学意义(P<0.05),皮质醇的水平与职业获益感成负相关,与职业倦怠成正相关;褪黑素水平与职业获益感成正相关,与职业倦怠成负相关.结论:基于移动平台的团体心理干预可提高护士的积极情绪,降低职业倦怠,提高职业获益感,维护身心健康,提高护理队伍的稳定性.

ObjectiveTo construct the Admittance Standard System of COPD Case Manager.MethodsAdmittance Standard System of COPD Case Manager was formed through literature analysis and group discussion and Delphi method.The weight of each indicator were determined by using the analytic hierarchy process.ResultsTwo rounds of expert consultations were conducted.The positive coefficients of experts in the two rounds of consultations were all 100.00%.The authority coefficients of experts were 0.882 and 0.890，respectively.The values of Kendall's W were 0.462 and 0.435，respectively（all P<0.01）.The final Admittance Standard System of COPD Case Manager included 4 first⁃level indicators，14 second⁃level indicators and 43 third⁃level indicators.ConclusionThe established Admittance Standard System of COPD Case Manager was systematic and comprehensive，which could provide a scientific basis for the selection of COPD case managers.

肺移植是治疗终末期肺部疾病的有效手段[1],受者术后的护理过程及康复方案很大程度上关系到治疗的有效性及患者的生活质量[2].近年来,加速康复外科(accelerated rehabilitation surgery,ERAS)的理念逐渐被引入其他器官移植中,旨在基于循征医学基础上,优化围术期干预措施,鼓励患者早期活动,减少应激、减少术后并发症,促进患者快速康复,缩短住院时间[3-4].术后早期进行康复锻炼有助于提高患者活动耐力,改善患者肺功能状态,降低肺移植术后并发症对患者造成的影响[5].ERAS需要更精准治疗,不仅仅包括肺康复训练方案的精准性,还包括术后症状管理的精准性及ERAS临床标准评价的精准性,从而达到控制症状和改善患者生活质量的目的[6].鉴于缺乏标准化、系统化的肺移植围术期ERAS管理模式,笔者对肺移植受者实施了量化ERAS康复护理模式,并探讨了该模式对受者骨骼肌功能及康复效果的影响.

总结了61例行肺移植术患者置入PICC管的护理体会.主要包括置管前进行充分的病情及心理评估,置管中做好感染的预防、体位的安置及异位的处理,置管后做好预防导管堵塞、CRBSI及血栓的护理.61例患者中有2例患者在PICC使用过程中发生房颤,将导管拔出2 cm后症状缓解,1例患者由于输液过程中液体走空发生回血,导管堵塞经回抽后再通.认为对于行肺移植术患者置入PICC,只要给予充分的评估和护理,可以满足患者治疗的需求,并不增加感染及血栓的风险,值得推广.

目的 调查医院护士心理状态,分析相关因素,以期为护理管理者提供依据.方法 采用一般资料问卷、中文版心理韧性量表、总体幸福感量表和职业倦怠量表对某三甲医院1 193名护士进行调查.结果 1 193名护士心理韧性总均分为(57.42 ±15.77)分、总体幸福感总均分为(73.12±12.03)分、职业倦怠感总均分为(35.03±15.17)分.护龄、职称、职务、学历、睡眠质量(睡眠时间和是否使用睡眠辅助药物)、离职意愿,奖金透明度、进修次数、夜班频次是影响护理人员心理状态的主要因素.结论 护理管理者应关注护士心理健康,重视提高薪酬待遇、增加学习机会,提供适当支持满足护龄较短护士心理需要,提高护士人员整体心理水平.

目的 探讨急诊流程优化策略在急性ST段抬高型心肌梗死患者救治中的应用价值.方法 以2018年1—3月急诊抢救室接诊的急性ST段抬高型心肌梗死患者中进行PCI急诊手术的35例患者作为对照组,其中男32例,女3例,年龄38～82岁,平均(63.3±10.6)岁;以实施急诊流程优化策略后2018年9—11月急诊抢救室接诊的急性ST段抬高型心肌梗死患者中进行PCI急诊手术的45例患者作为观察组,其中男41例,女4例,年龄42～79岁,平均(60.5±9.4)岁.对照两组救治效果.结果 对照组和观察组院内首份心电图时间、检验报告时间、进门-球囊扩张(D-to-B)时间比较,差异均有统计学意义(P<0.05).结论 实施急诊流程优化策略后,缩短了急性ST段抬高型心肌梗死患者D-to-B的时间,提高了胸痛中心救治团队的工作效率,同时提高了与院前急救和社区医疗机构衔接效率,改善了救治效果,提高了救治质量.

目的 分析肺移植受者术后第1年的健康相关生活质量(health-related quality of life,HRQOL),探讨肺移植受者HRQOL相关的影响因素.方法 肺移植术前及术后第3、6、9、12个月共调查132例患者,采用人口统计学特征、临床特征、与健康有关的生活质量SF-36(中文版)对肺移植术后门诊随访患者进行纵向调查,以确定对HRQOL的结果.结果 通过肺移植术前与术后临床特征分析:FEV1％、6MWD和mMRC与术后时间均呈负相关(均P<0.001),均有统计学意义(P<0.001).HRQOL随时间变化分析:不同时间点的生理功能、生理职能、躯体疼痛、总体健康、精力、社会功能、精神健康和总分均存在差异,差异具有统计学意义(P<0.05),而不同时间点情感职能的差异无统计学意义(P=0.709),并且对组间差异有统计学意义的维度进行两两比较,差异有统计学意义;生理方面生活质量的影响因素为移植类型、内分泌系统和呼吸系统并发症;心理方面生活质量的影响因素为文化程度、原始疾病、血液系统、消化系统和呼吸系统并发症.结论 肺移植患者术后生活质量受多因素影响,导致生活质量较低.因此,应重点关注影响患者生活质量的因素,并做好针对性干预及护理.

Objective? To explore the effects of enteral nutrition program based on intensive ultrasound monitoring gastric residual on patients receiving lung transplantation. Methods? Totally 100 patients who received lung transplantation in a Class Ⅲ Grade A hospital between January and December 2016 were selected and divided into the treatment group (n=50) and the control group (n=50) according to the random number table. Patients in the treatment group received enteral nutrition based on intensive ultrasound monitoring gastric residual, while patients in the control group received conventional enteral nutrition. The indicators of enteral nutrition application and complications were observed in both groups. Results? The gastric residual of the treatment group was (130.32±40.44) ml; the nutrition interruption rate was 6%; the time for achieving the target feed volume was (3.47±0.62) d, lower than those of the control group (t/χ2=-2.341, 8.575, 2.193;P＜ 0.05), which were (198.13±40.25) ml, 28% and (5.59±0.71) d. The dripping speed of the treatment group was (87.00±10.59) ml/h, higher than that of the control group (t=6.121, P＜0.05). The incidence rate of aspiration of the treatment group was 4%, and there was no statistically significant difference compared with that of the control group (χ2=0.298; P＞0.05), which was 6%. The incidence rates of enteral nutrition reflux, diarrhea and reintubation rates of the treatment group were 10%, 10% and 8%, respectively, lower than those of the control group (33%,26%,24%) (χ2=6.250, 4.336, 4.762; P＜ 0.05) . Conclusions? The enteral nutrition program based on intensive ultrasound monitoring gastric residual conforms to target-oriented nursing care for patients receiving lung transplantation, which helps to achieve the target feed volume more quickly and ameliorate enteral nutrition-related complications.

目的:了解无锡市基层医疗机构护士长的管理能力培训需求,为基层医疗机构护士长的培训提供依据.方法:以罗伯特·卡茨的管理者基本能力与素质为理论框架,自制问卷调查表,对89家基层医疗卫生机构112名护士长进行问卷调查.结果:52.68％的护士长注重护理工作中安全观念;78.5％的护士长注重沟通合作与关怀能力;56.25％的护士长注重计划与组织能力.结论:基层医疗机构护士长的培训应建立在其需求之上,应特别注重安全观念、沟通合作与关怀能力以及计划与组织能力的大力培养.

目的 提高手术室工作效率.方法 成立多部门协作的手术室效率管理小组,实施精益管理,包括改进硬件设施,优化工作职责及流程,确保首台手术准时开始,充分利用信息化手段,优化奖惩机制,建立“3个1”响应机制.比较管理前(2016年1～12月)与管理后(2017年4月至2018年3月)平均接台间隔时间、准点开台率、延迟手术率、患者及手术医生满意度.结果 与管理前比较,管理后平均接台手术时间缩短,准点开台率提高,延迟手术率降低,患者及手术医生对护理工作的满意度提高(P＜0.05,P＜0.01).结论 多部门协作实施精益化管理可加快手术运转,提高手术室整体效率、手术医生和患者满意度.

Objective? To investigate the effect and safety of high-flow nasal cannula (HFNC) oxygen therapy for patients after extubation in lung transplantation. Methods? A retrospective study was conducted on 60 hospitalized patients with lung transplant during January 2017 to December 2017 in Wuxi People＇s Hospital. According to the different methods of respiratory support prescribed after extubation, the patients were divided into two groups: observation group (n=28, via HFNC) and control group (n=32, via nasal oxygen tube) . The two groups were compared in terms of the clinical indicators including their blood gas analysis(oxygenation index, lactic acid, partial pressure of carbon dioxide) , viscosity of sputum and comfort, etc. Results? Six hours after extubation and before transferring to other departments, the observation group＇s oxygenation index was(263.70±48.97)and(273.22±43.26)mmHg, which were statistically different from those of the control group with (217.83±77.30)and(229.08±68.64)mmHg respectively (P＜ 0.05). Before transferring to other departments, the partial pressure of carbon dioxide in the observation group was (37.04±8.56)mmHg, lower than the control group with (42.43±6.14)mmHg with a statistical difference (P＜0.05); the viscosity of sputum in the obseration group was lower than the control group with statistical difference (P＜0.05); the patients＇ comfort in the observation group achieved (7.72±1.06)points, higher than the control group＇s (4.39±0.82)points with statistical difference (P＜ 0.05). Conclusions? HFNC oxygen therapy for the patients after extubation in lung transplantation has good effects, is safe and reliable, and can be widely applied in clinical practice.

肺移植手术是治疗终末期肺疾病的最佳手段,但患者术后面临各种疼痛问题.对肺移植受者疼痛的发生情况、疼痛对机体的影响、疼痛管理团队的组建、疼痛教育、疼痛评估、多模式镇痛和预防性镇痛等方面进行综述,以期为肺移植患者进行规范化疼痛管理提供借鉴.

目的 探讨营养支持联合早期运动对肺移植术患者肺康复的作用.方法 将肺移植术患者90例按照随机数字表法分为观察组和对照组各45例, 对照组术后进行常规护理、营养支持和康复运动.观察组在常规护理基础上实施营养支持联合早期运动方案, 即结合相关指南推荐制定营养支持及早期运动方案并应用于肺移植术后患者.结果 观察组氧合指数和呼出潮气量、血清白蛋白和总蛋白显著高于对照组, 二氧化碳分压显著低于对照组, 胃管留置时间、机械通气时间和ICU住院天数显著短于对照组, 谵妄发生率显著低于对照组 (P<0.05, P<0.01) .结论 对肺移植术后患者进行营养支持联合早期运动是安全、可行和有效的, 可促进肺康复及营养水平, 提高手术效果.

[目的]探讨依托信息化平台进行护理岗位管理的实践与成效.[方法]将护理岗位管理模型导入信息化平台,采用前后对照试验,比较应用信息化护理岗位管理前后护理队伍的稳定性、护士核心能力、病人满意度和护士自身满意度的差异性.[结果]实施信息化护理岗位管理后,护士离职率逐年下降,病人满意度和护士满意度均升高,护士核心能力总分和各维度得分均高于应用前,且护士对岗位管理模式有较高的认同度.[结论]依托信息化管理平台进行护理岗位管理,使护理人员配置更加系统化,培训方法科学化,绩效考核标准化,促进了科学管理水平的提高.

通过构建由护理部、医务处、保卫处、信息处多部门组成的患者走失多维立体综合防控体系,对患者擅自离院走失现象有效起到了“事前预防”、“事中控制”的作用,使患者走失事件减少,走失后的风险降低.

目的 总结2例危重患者PICC置管心电定位判别特殊案例处理的护理经验.方法 针对案例进行根因分析,探索新方法预防和处理危重患者心电定位辅助下的导管打折.结果 经多学科协作调管成功,并改进了心电定位判别规则的流程、制定了危重患者心电定位下导管打折多学科协作应急处理流程.结论 制定和改进的流程对吁有效早期识别和处理PICC心电定位辅助下的导管打折、减少X线下的反复调管损伤、缩短定位时间、预防导管位置异常和反复调管弓起的相关并发症有重要临床意义.

Objective To investigate the effects of analgesia and sedation scheme on ICU delirium among patients with cardiac surgery. Methods A total of 235 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January to December,2016, and divided into the experimental group(117 cases)and the control group(118 cases).The experimental group received analgesia and sedation scheme designed by our department,and the control group received routine sedation protocol. The incidence of ICU delirium, the dosages of drugs, duration of mechanical ventilation, length of ICU stay were recorded. Results The compliance rate of shallow sedation in the experimental group was 87.17% (102/117), which was lower than 57.62% (68/118) in the control group with statistical difference(χ2=25.642,P<0.05).The incidence of ICU delirium in the experimental group was 17.09% (20/117), which was lower than 34.75% (41/118) in the control group with statistical difference (χ2=9.524, P<0.05). The dosages of sedation drugs were: dexmedetomidine, (269.46 ± 32.47) μg,disoprofol,(286.84±81.96)mg,the duration of mechanical ventilation was(14.31±1.43)h,the length of ICU stay was(16.02±1.25)h.Those data were all lower than those of the control group[(507.29±58.27) μg,(575.63±95.74)mg,(20.45±2.29)h,(22.82±2.45)h]with statistical difference(t=-5.529--4.371, P<0.05). Conclusion Analgesia and sedation scheme was worthy of popularization and application.