目的 调查首次经皮冠脉介入(PCI)术后患者的电子健康素养现状,并分析其影响因素.方法 2021年10月-2022年2月,便利抽取河南省某三级甲等医院心内科住院的272例首次PCI术后患者作为研究对象,采用一般资料调查表、电子健康素养量表进行调查,并采用单因素分析和多重线性回归分析首次PCI术后患者电子健康素养的影响因素.结果 首次PCI术后患者的电子健康素养得分为(24.06±3.67)分.多重线性回归分析结果显示,年龄、是否愿意使用网络查找相关健康信息、获取健康信息的途径、网络健康信息自我感知可信度、获取网络健康信息的重要性是电子健康素养的影响因素(P＜0.05),共解释变异率的38.6％.结论 首次PCI术后患者的电子健康素养水平有待提高,医护人员应采取电子健康素养技能培训及专业健康网站使用培训等针对性干预措施,以提高首次PCI术后患者的电子健康素养水平.

目的:调查急诊科护士的职业悲伤现状并分析其影响因素.方法:采用便利抽样法2022年8月—2022年10月选取河南省6所三级甲等医院的366名急诊科护士为研究对象,采用一般资料调查表、修订版悲伤体验量表、中文修订版死亡态度描述量表、临终关怀态度量表、心理脱离量表、社会支持评定量表进行调查.结果:急诊科护士职业悲伤总分为(44.60±5.05)分;多元线性回归分析结果显示,宗教信仰、接触死亡形式、接受死亡教育培训情况、接受临终关怀教育情况、接触死亡频率、自然接受、死亡逃避、临终关怀态度、心理脱离、社会支持是急诊科护士职业悲伤的影响因素(P<0.05),共解释总变异的40.7％.结论:急诊科护士职业悲伤处于轻度水平,提示护理管理者应及时关注急诊科护士的心理健康,采取针对性措施,帮助其降低职业悲伤水平,以促进其悲伤成长.

Objective: To investigate the humanistic care consciousness and ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City. Methods: In June 2021, a total of 345 outpatient and emergency nurses from 6 tertiary Grade A hospitals in Zhengzhou City were selected as the survey objects by random number table method. The humanistic care ability of outpatient and emergency nurses was investigated. Multiple linear regression analysis was used to analyze the related factors influencing the humanistic care ability of outpatient and emergency nurses. Results: The total score of humanistic care ability of outpatient and emergency nurses in Zhengzhou tertiary Grade A hospital was (194.18±30.53). The scores of humanistic care ability of outpatient and emergency nurses with different gender, age, educational background, professional title, length of service, night shift frequency, marital status, children's status, employment patterns and average monthly household income were significantly different (P<0.05). Regression analysis showed that education background, length of service, professional title and night shift frequency were independent influencing factors for outpatient and emergency nurses' humanistic care ability (β=0.243, 0.139, 0.163, -0.126, P<0.05) . Conclusion: At present, the humanistic care ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City is still low. Education, length of service, professional title and night shift frequency are independent influencing factors affecting the humanistic care ability of nurses.

Objective:To explore the effect of nursing intervention based on nursing outcomes classification in patients with acute myocardial infarction after percutaneous coronary intervention (PCI) .Methods:From September to November 2021, a total of 86 patients with acute myocardial infarction after PCI admitted to Henan Provincial People's Hospital were selected as research subjects using convenience sampling method, and were divided into the observation group and the control group using the random number table method, with 43 patients in each group. The control group received routine nursing intervention, while the observation group received nursing intervention based on nursing outcomes classification. The incidence of complications, the scores of self-management ability, anxiety, depression, and quality of life were compared between the two groups.Results:After intervention, the incidence of complications of the observation group was lower than that of the control group, and the difference was statistically significant ( P<0.05). After intervention, the total score and dimension scores of self-management ability of the two groups were higher than those before intervention, and the scores of the observation group were higher those of the control group, with statistically significant differences ( P<0.05). After intervention, the scores of anxiety and depression of two groups were lower than those before intervention, and the scores of the observation group were lower than those of the control group, with statistically significant differences ( P<0.05). After intervention, the scores of physical function, physical pain, energy, emotional function, physical role, health status, and mental health scores of the observation group were higher than those of the control group, with statistically significant differences ( P<0.05) . Conclusions:Nursing intervention based on nursing outcomes classification can reduce the incidence of complications in patients with acute myocardial infarction after PCI, alleviate their anxiety and depression, improve their self-management ability and quality of life, which is worthy of clinical promotion and practice.

Review question / Objective: “Usual care” is changing all the time whether in clinical practice or experimental research, the scope of usual care is constantly updated by adding new contents. However, the composition of usual care is still unclear, and there is no formal description to confirm whether the nursing contents are in line with usual care’ requirements. The goal was to review existing or not published but completed SRs about UC’s elements to gather the evidence about: a What’s the development routine of UC in diverse field. b The similarities and differences of different UC. c The similarities and differences between UC group and experimental group. d What should the nursing routine meet in the interventional study, or the elements that usual care needs to have in researched or clinical experiment within a relatively controllable range.

目的 探讨优化的院前救治流程在急性ST段抬高型心肌梗死患者中的应用效果.方法 对2017年1月至2020年12月在河南省人民医院急救中心接受治疗的66例急性ST段抬高型心肌梗死患者进行回顾性分析,2017年1月至2018年12月院前急救的急性ST段抬高型心肌梗死患者33例为对照组.观察组包括2019年1月至2020年12月在院前急救中接受治疗的33例急性ST段抬高型心肌梗死患者.对照组接受急性ST段抬高型心肌梗死患者的常规治疗程序,观察组接受优化的院前救治流程.比较观察组和对照组的首次医疗接触至急性ST段抬高型心肌梗死患者确诊时间、首次医疗接触到球囊扩张的时间和患者满意度.结果 观察组从FMC到STEMI的确诊时间和FMC-B时间分别为(20.45±3.32)min和(55.12±7.08)min,均短于对照组,差异有统计学意义(P＜0.05);观察组满意度为96.97％,高于对照组,差异有统计学意义(P＜0.05).结论 优化的院前救治流程可以显著提高急性ST段抬高型心肌梗死患者的急诊救治工作的时效性,提高患者满意度.

目的 调查了解新型冠状病毒肺炎(COVID-19)疫情下急诊科一线医务人员心理弹性状况并分析其影响因素.方法 2020年2月10日—28日,采用偶遇抽样法,选取河南省某几所三级甲等综合医院急诊科一线医务人员作为研究对象,开展问卷调查并分析心理弹性的影响因素.结果 共回收146份有效问卷.调查对象心理弹性量表(CD-RISC)得分为(56.25±16.06)分,一般自我效能感量表(GSES)得分为(27.57±5.55)分,领悟社会支持量表(PSSS)中家庭内、家庭外支持维度得分分别为(17.36±4.48)、(38.62±8.52)分,简易应对方式量表(SCSQ)中积极、消极应对维度得分分别为(2.11±0.55)、(1.58±0.64)分.心理弹性与自我效能、家庭内支持、家庭外支持、积极应对方式呈正相关(r值分别为0.850,0.729,0.768,0.745),与消极应对方式呈负相关(r=-0.383).多重线性回归分析结果显示:工种、受教育程度、医院类型(是否为定点医院)、科室、自我效能、家庭外支持、积极应对是心理弹性水平的主要影响因素(P<0.05).结论 COVID-19疫情下,急诊科一线医务人员心理弹性较差,医院应完善各种应急管理措施,加强对急诊科一线医务人员的相关支持及心理疏导,鼓励其积极应对,提高其自我效能,从而提高其心理弹性.

目的 了解首发中青年脑卒中患者家属心理弹性及其影响因素,为提高其心理健康水平提供依据.方法 对216名首发中青年脑卒中患者家属采用心理弹性量表、领悟社会支持量表、简易应对方式量表进行调查分析.结果 本组患者家属心理弹性量表总分(52.16±8.97)分,领悟社会支持量表的家庭内支持维度分为(16.92±4.12)分,家庭外支持维度分为(37.62±6.93)分,简易应对方式量表的消极应对维度分为(1.67±0.34)分,积极应对维度分为(2.01±0.48)分.患者家属心理弹性量表总分及坚韧、自强、乐观维度分与领悟社会支持量表的家庭内支持、家庭外支持维度分及简易应对方式量表的积极应对维度分呈显著正相关(P<0.01),与消极应对维度分呈显著负相关(P<0.05或0.01).多元回归分析显示,年龄、文化程度、有无子女、患者治疗方式、家庭内支持、家庭外支持、积极应对是首发中青年脑卒中患者家属心理弹性的主要影响因素(P<0.05或0.01),可解释因变量的76.9％.结论 首发中青年脑卒中患者家属心理弹性处于中等水平,其影响因素众多,应对其予以有针对性的干预提高其心理健康水平.

[目的]探讨奥马哈问题分类系统在慢性心力衰竭住院病人护理问题评估中的应用.[方法]以奥马哈问题分类系统为护理评估、诊断的框架,对 113 例慢性心力衰竭住院病人的主要护理问题进行分析、归类,找出病人存在的主要护理问题.[结果]113 例慢性心力衰竭病人住院期间共存在问题 838 个,平均每位病人存在 7.42 个;存在的护理问题中生理领域占 37.1%,健康相关行为领域占43.6%,心理社会领域占 14.2%,环境领域占4.8%;发生率超过 50%的护理问题是呼吸、循环、营养、药物治疗方案、健康照顾督导、精神健康.[结论]奥马哈问题分类系统能全面评估慢性心力衰竭病人住院期间存在的护理问题,发现病人的主要护理问题及分布特点.适当修改后,奥马哈问题分类系统可用于慢性心力衰竭病人临床护理评估.

蜂蛰伤,即为分泌毒液的蜂腹部末端一堆毒螯、一根毒针刺入人体皮肤,蜂毒毒素进入人体血液循环后通过直接作用和抗原抗体免疫反应作用于多系统,迅速出现全身严重中毒症状,易并发急性肾功能衰竭及多器官功能衰竭,一般对症治疗效果不佳,病死率在90％以上[1 ].体外膜肺氧合(extracorporeal mem-brane oxygenation,ECMO),又称体外生命支持系统,是指将患者的静脉血引流至体外,经氧合器进行气体交换将含氧的血液加温后,再送回患者的动脉或静脉,暂时替代患者的心、肺功能,是一种抢救重度多器官功能衰竭(ARDS )患者的治疗手段,为心、肺功能的恢复赢得时间[2,3].ECMO 联合床旁肾脏替代疗法(CRRT)治疗重症ARDS,血流动力学稳定,可以清除炎性介质,纠正低氧血症,是治疗 ARDS 和急性肾损伤(AKI )的有效方法 [4].本院于2018年10月收治了1 例蜂蛰伤合并多器官功能衰竭的患者,通过ECMO联合CRRT等综合治疗与精心护理后,患者的病情明显好转,预后良好.现将护理经验报道如下.

目的 应用标准化航空医疗救援接诊流程,缩短航空医疗救援反应时间,提高救援效率.方法 选取某航空医疗救援中心2017年1月—2019年11月接到拨打服务平台/公共平台电话需要航空医疗救援的81例案例进行研究.其中,2018年7月1日—2019年11月30日的40例为试验组,应用标准化航空医疗救援接诊流程;2017年1月1日—2018年5月31的41例为对照组,应用常规航空医疗救援接诊流程.比较两组航空医疗救援的反应时间、安全转运成功率、转运前医生评估病情正确率、护士准备救援物资完整率的差异.结果 在实施标准化流程后,医生评估病情时间、救援物品准备时间、医护人员到达停机坪时间、救援平均反应时间均显著短于对照组,差异有统计学意义(P<0.05);试验组的航空医疗安全转运成功率、转运前医生评估病情正确率和护士准备救援物资完整率均显著高于对照组,差异有统计学意义(P<0.05).结论 航空医疗救援标准化流程的实施可有效缩短救援反应时间,从而提高救援效率,提高抢救成功率.

[目的]探讨生命教育对卒中后病人抑郁的影响.[方法]将120例神经内科住院的脑卒中合并抑郁病人按入院顺序分为观察组、对照组,每组60例,观察组病人采用生命教育相关内容实施健康教育,对照组病人实施常规健康教育,2周后对两组病人使用汉密尔顿抑郁量表(HAMD)进行评价.[结果]干预后观察组病人HAMD得分为9.12分±1.52分,明显低于对照组的14.23分±1.41分(P＜0.05).[结论]对卒中后病人采用生命教育可缓解病人的抑郁情绪.

对伤残病人的伤残接受度等概念进行阐述,并对相关研究测评工具及国内外研究现状进行综述,分析现阶段伤残病人伤残接受度影响因素的研究及干预措施中的不完善之处,为提高伤残病人生活质量及促进早日康复提供参考.

This article defined the definitions and evaluation of disease uncertainty,and reviewed the research progress of disease uncertainty among family members of hospitalized patients.It pointed out that the research contents of disease uncertainty among family members of patients in other countries included the influencing factors,intervention programs and the impact on the quality of life.In China,the relevant research were on the preliminary exploratory stage.In the future,the research could be improved in these aspects: expand the research object,enrich the research methods,improve the research contents,and conduct a deeper study from the controversy.

随着我国逐渐步入老龄化社会，医疗卫生服务事业的挑战将不断增加.目前，我国医疗环境存在医疗资源不足、卫生保健费用逐年增加、护理人员缺乏等问题.因此，如何合理有效地利用现有的资源，提高护理质量、改善健康结局成为护理界关注和急需解决的问题.1992年Lott初次提出的协同护理模式(collaborative care　model,CCM)是随着这些问题呈现的.目前，该模式已在国内外护理领域中得到了广泛应用，并取得显著效果.本文将总结协同护理模式在国内外的应用现状和研究经验，为国内协同护理的发展提供参考.