Objective:To establish the norm of clinical nursing teachers' competency in tertiary first-class hospitals in northwest China.Methods:From August 2019 to February 2020, 1 077 clinical nursing teachers were selected from 12 tertiary first-class hospitals in northwest China by stratified, random and proportional sampling, and were investigated with the Clinical Nursing Teacher Competency Evaluation Scale. Descriptive statistics were carried out on the sample data, and univariate variance analysis and pairwise comparison were carried out on the multi-classification variables of age, nursing age, professional title, teaching years and the number of teachers per year. The verified data were exported to SPSS 26.0 for statistical analysis, variance analysis was used for multi-group comparison, and LSD test was used for pairwise comparison between groups.Results:①The corresponding mean norm was established by grouping the total score and the first-class index; the percentile norm was made with 5% spacing; P10, P30, P70 and P90 were selected as the grading demarcation points, and the demarcation norm was constructed. ②Factor analysis showed that there were statistical differences in personality characteristics among different ages, nursing ages and professional titles ( P<0.05), and also in professional attitudes among different nursing ages and professional titles ( P<0.05). Conclusion:The establishment of norm provides references for individuals or units to evaluate teachers' competence.

目的 为探索灭菌注射用水对膀胱血块填塞患者的效果,研究比较灭菌注射用水和0.9％氯化钠溶液对老年患者体外血块的冲洗效果.方法 选取55例老年患者,自肘静脉抽取血标本,每例患者血标本平均分成2份,制备血凝块,将血凝块分为0.9％氯化钠溶液组和灭菌注射用水组,分别浸泡于0.9％氯化钠溶液和灭菌注射用水中,于5 min、10 min、15 min、20 min、30 min使用20 ml一次性注射器对血块模拟冲洗,记录血凝块破碎例数,进行统计学分析.结果 灭菌注射用水组血凝块在5 min、10 min、15 min、20 min、30 min的破碎率明显高于0.9％氯化钠溶液组(P<0.05);对于血浆D-二聚体正常患者的血凝块,灭菌注射用水与0.9％氯化钠溶液对体外血块的冲洗效果差异无统计学意义(P>0.05);对于血浆D-二聚体0.5～2μg/ml患者的血凝块,当浸泡时间≤10 min时,灭菌注射用水对体外血块的冲洗效果优于0.9％氯化钠溶液,当浸泡时间≥15 min时,2组对体外血块的冲洗效果相同;对于血浆D-二聚体>2μg/ml患者的血块,除浸泡时间为10 min外,其他时间点灭菌注射用水对体外血块的冲洗效果均优于0.9％氯化钠溶液(P<0.05).结论 灭菌注射用水对体外血块的冲洗效果优于0.9％氯化钠溶液,尤其是当血浆D-二聚体增高时,灭菌注射用水组效果更显著.

脓肿分枝杆菌(mycobacterium abscess)是存在于环境中的一类条件致病菌,是非结核分枝杆菌(non-tuberculous mycobacteria,NTM)的一个亚群,可导致肺部、淋巴结、皮肤软组织、骨关节和全身播散性病变.近年来,NTM病呈快速增多趋势,已成为威胁人类健康的重要公共卫生问题之一,但目前此感染尚未被广大临床医护人员认识[1-3].此前病例报道多集中于脓肿分枝杆菌引起的肺部疾病[4],而引起的关节感染相对较少.由于该类感染有诊断难、病情重、治疗时间长、医疗费用高等特点,如感染发现不及时,处理不恰当,患者经常会出现感染反复,难以治愈且有截肢的风险.近期我科收治一例双膝关节置换术后合并脓肿分枝杆菌感染患者,先后 5 次行手术治疗,经2 次关节液培养确诊为脓肿分枝杆菌,通过严密的病情监测及护理,目前患者病情平稳,现将护理体会报道如下.

Objective:To construct a training program based on competency evaluation of clinical nursing teachers.Methods:From August 2019 to July 2020, based on Competency Evaluation Scale, through literature review and expert group discussion, the competency training program for clinical nursing teachers was constructed through expert consultation.Results:The effective recovery rates of the three rounds of expert inquiry were all 100%, the expert authority coefficient was 0.935 and the Kendall coordination coefficients of expert opinions were respectively 0.21, 0.27 and 0.35. The final training program included basic ability training module and advanced ability training module, including 3 modules, 14 projects, 25 courses and 3 modules, 8 projects and 8 courses, respectively.Conclusions:The clinical nursing teacher training program based on the competency evaluation scale is comprehensive and specific in content and it has good practicality, which provides a reference for the training of clinical nursing teachers.

1病例介绍 病人,女,28岁,因“停经36+5周下腹部疼痛4小时”于2010年5月29日入院.患者有剖宫产手术史,停经5月出现胎动,未在我院行产前检查.检查:血压159/102mmHg.

目的:对于髋部骨折患者的手术后的自我体位护理配合协助体位护理的模式进行分析与研究,同时进行不断地优化护理,以提高髋部骨折患者手术后的生活质量.方法:对我院所收治的22例髋部骨折患者平均分为实验组以及对照组两组,分别进行协助体位护理并且同时配合患者的自我体位护理以及单一的协助体位护理,观察其手术前以及手术后的身体状况以及生活质量.结果:22例髋部骨折患者全部得到了良好的体位护理,没有出现并发症以及其他意外情况,其中实验组11例患者恢复情况更为良好,实验组患者舒适度为100％(11/11),相较对照组的63.64％(7/11)差异有统计学意义(P＜0.01).结论:自我体位护理配合协助体位护理的模式,对于髋部骨折的患者有着非常重要的意义,可以在一定程度上提高髋部骨折患者的生活上自理的能力,并且对于病患的疼痛有一定的缓解作用.