目的:探讨护士执业资格考试成绩与护士第一年执业能力的相关性.方法:采用整群抽样法选取2017年—2019年入职某三级甲等综合医院的267名护士为研究对象.依据新入职护士培训大纲开展新入职护士岗前培训和第一年轮转培训,培训结束后进行考核,分析护士执业资格考试成绩与护士第一年执业能力的相关性.结果:护士执业资格考试总分为(174.85±5.98)分(每科成绩转换为百分制后),岗前培训考核总分为(173.60±11.94)分,转正考核总分为(171.70±9.85)分.护士执业资格考试总分与转正考核总分呈正相关(r=0.415,P<0.01),护士执业资格考试专业实务得分与转正理论考核得分呈正相关(r=0.049,P<0.01),护士执业资格考试实践能力得分与岗前培训操作考核得分(r=0.121,P<0.05)及转正操作考核得分(r=0.140,P<0.01)呈正相关.结论:护士执业资格考试成绩与护士第一年执业能力具有相关性,建议管理者注重新入职护士自主学习能力和动作迁移能力的培养,促进不同基础的新入职护士快速提升执业能力.

Objective:To investigate and analyze the gap between the current clinical practice and guidelines of infant safe sleep protection strategies in China, and to provide a basis for further construction of evidence-based practice programs and evidence-based transformation of infant safe sleep protection strategies that conform to the actual situation in China.Methods:From March to May 2021, a total of 50 medical staff and 100 caregivers from the Obstetrics Ward, Neonatal Ward and Child Health Clinic in Peking University First Hospital were selected by the convenient sampling method. The survey was carried out at the organizational, the medical staff level and the caregiver. At the organizational level, the Maternity Ward, Neonatal Ward and Child Health Care Clinic of the hospital were investigated, and relevant support systems and supporting documents were reviewed. On-site observation was adopted at the medical staff level. At the caregiver level, the self-designed Infant Safe Sleep Protection Strategy Behavior Questionnaire was used to conduct the survey and the results were statistically analyzed.Results:There were 15 items with an execution rate of 0, 6 items with an execution rate of 1% to 50%, 6 items with an execution rate of 51% to 99% and 4 items with an execution rate of 100%. Multiple linear regression analysis shows that the influencing factor of caregivers' practice of infant safe sleep protection strategy was their educational level ( P<0.05) , and there was a positive correlation between them ( r=0.238, P<0.05) . Conclusions:There is still a big gap between clinical practice and guidelines of infant safe sleep protection strategies, and relevant training should be strengthened to narrow the gap between clinical practice and guidelines.

医疗救治是大型国际体育赛事工作的重要组成部分,北京大学第一医院多次承担大型体育赛事医疗保障任务.为了做好2022北京冬奥医疗保障工作,该院借鉴集体培训理论模型,针对冬奥运会医疗救治能力需求,选编培训课程内容和教学方法,以适应本次赛事对医疗救治能力建设的要求.

Objective:To explore design of an intelligent teaching platform based on the training path of medical education and its application in clinical nursing teaching and management.Methods:Starting from three stages of medical education in colleges and universities, post-graduation education, continuing education and teacher development and training, combining the whole process of nursing teaching, relying on the nursing management information platform, the intelligent nursing teaching platform was designed and developed by using the front and rear separation design framework and the whole station HTTPS encrypted connection. The platform included teaching plans, teaching training, exam management, teaching feedback, teaching resources and system management modules. Among them, the teaching training module was divided into six sub-modules, such as college education, post-graduation education, continuing education, teacher development, advanced training and base training. The intelligent teaching platform was applied to clinical nursing teaching and management.Results:The use of the platform improved the quality of nursing teaching, provided independent learning environment for nurses and helped the hospital save time and labor costs.Conclusions:The application of intelligent nursing teaching platform effectively saves nursing labor cost and teaching management cost and promotes the development of nursing teaching training assessment and management towards the direction of informatization, which is a training management platform worthy of wide application by nursing teaching managers.

Objective: To systematically review and summarize the relevant evidence of safe sleep protection strategies for infants at home and abroad, to provide a reference for clinical evidence-based decision-making and guideline formulation. Methods: "Infant Death/Sudden Unexpected Infant Death/Sudden Infant Death Syndrome" and "Sleep protecting program/Sleep safety/Sleeping environment" were used as search keywords. The literature retrieval for all the Chinese and English evidence on safe sleep protection strategies for infants published before March 2020 was conducted by using the National Guideline Clearinghouse (NGC), Registered Nurse' Association of Ontario (RNAO), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), JBI, Clinical Evidence, China Evidence-based Medicine Center, PubMed, Embase, CINAHL, Wanfang Data, CNKI and other databases. Inclusion criteria were guidelines, evidence summary and systematic reviews on infant safe sleep protection strategies for infants aged 0 to 1 years. The full text was available. Exclusion criteria include duplicates, directly translated documents as well as guide abstracts, discussion drafts, draft guides, interpretations, excerpts. The Appraisal of Guideline for research & Evaluation Instrument (AGREE Ⅱ) and A Measure Tool to Assess Systematic Reviews (AMSTAR 2) were used to compare and evaluate the selected literature, and extracted evidence from the literature that meets the quality standards. Results: A total of 12 articles were incorporated into study, including 1 Summary of evidence from UptoDate, 3 guidelines, and 8 systematic reviews. The results of the AGREE II quality evaluation showed that the overall quality of 3 guidelines was high. Among them, there was 1 with a recommendation level of "A", and 2 with a rating of "B". The AMSTAR 2 quality evaluation showed that the contents of the systematic reviews were relatively complete except for one literature. In the end, totally 39 terms of evidences were summarized, including 6 aspects of assessment, planning, implementation, health education (pregnant women, parents and other infant caregivers), evaluation, organization and policy. Conclusion: The evidence summary of infant safe sleep protection provides evidence support for formulating infant safe sleep care standards and carrying out scientific and high-quality clinical nursing practices.

Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

Objective To explore the attitude of new nurses on department rotation frequency and their mental status as well as pressure before rotation during standardized training so as to provide related recommendations for nursing management. Methods From February to May 2019, we selected 115 new nurses hired in 2017 and 2018 with standardized training in a Class Ⅲ Grade A hospital of Beijing as subjects by convenience sampling. Finally, a total of 115 valid questionnaires were collected. SPSS 20.0 was used to statistical analysis. Results In the total of 115 new nurses, there were 53(46.1％) and 40(34.8％) of new nurses thought a rotation every year and every half a year was appropriate respectively; 15(13.0％) of new nurses did not support the rotation. In mental status before rotation, 113(98.3％) of new nurses were tense and 99(87.6％) of them with scores of self-evaluation tense >5; 108(93.9％) of new nurses had great expectations for departments and 87.0％ of them with scores of self-evaluation expectation >5. Before rotation of new nurses, the common stressors involved that they felt they lacked specialty knowledge, they worried about that they were unable to process rescue because of insufficient emergency competence, errors in their work, they were unable to finish their work independently, they were not adapted to the rhythm of work in new departments. Conclusions Department rotation frequency is needed to be explored further in new nurses during standardized. Tension and expectation are the common mental status of new nurses before rotation. New nurses have great pressure before rotation and are with many stressors. Nursing managers should pay more attention to mental status of new nurses and provide support for them.

目的 探讨基于最佳证据的产妇正常分娩第二、三产程的护理方案,并评价其应用效果.方法 应用循证的方法系统检索产妇正常分娩第二、三产程护理方案的国内外指南,评价并汇总最佳证据,制订审查指标,进行基线审查,基于审查结果分析促进和障碍因素.比较证据应用前后产妇的分娩结局,助产士对产妇正常分娩第二、三产程护理措施的认知水平及审查指标的执行情况.结果 最佳证据应用后,产妇会阴完整率从7.9％提升到13.4％;助产士对产妇正常分娩第二、三产程护理措施的认知得分从培训前的25～85(54.9±14.3)分提升至50～100(77.1±13.8)分;除指标14、15外,证据应用前执行率＜50％指标的执行率均上升到70％以上.结论 本研究基于最佳证据,结合科室临床情境、患者意愿,并通过分析促进和障碍因素,制订产妇正常分娩第二、三产程的护理方案,证据应用后,产妇会阴完整率、助产士相关护理措施认知水平得到提高,助产士工作行为得到规范.

目的 调查全国三级综合医院落实《新入职护士培训大纲(试行)》的现状,以及新护士对培训的感受和意见,为进一步完善培训方案提供参考.方法 采用方便抽样法,于2018年8月-9月抽取全国31个省、自治区、直辖市的1421所三级综合医院以及62 031名新护士为调查对象.采用自行设计的调查问卷,以问卷星的形式进行调查.结果 91.6％的医院开展了新护士规范化培训项目.基础培训时长为4.0(2.0,6.0)周,专业培训时长为11.0(3.0,23.8)个月.基本理论知识培训落实率为88.8％～98.6％,常见临床护理操作技术培训落实率为81.6％～97.7％;临床科室轮转落实情况为内科(91.0％)、外科(91.8％)、重症监护病房(85.8％)、急诊(85.1％)、妇产科(72.7％)、手术室(71.3％)、儿科(70.6％).培训方法主要为操作示教(96.8％)、课堂讲授(95.5％)、临床查房(91.5％)及个案护理(82.0％);临床实践能力考核方式为标准化病人(76.7％)、高仿真情景模拟(63.4％).78.0％的新护士认为培训内容符合大纲要求,55.8％的新护士认为规范化培训的时长合适,52.0％的新护士认为临床科室的轮转频率合适.新护士对规范化培训的认可程度较高(84.2％),其中对带教教师的满意度最高;影响新护士感受的主要因素由高到低依次为集体归属感(65.2％)、工作强度(65.0％)、带教规范性(58.3％)、薪酬分配(56.5％)、病房人际关系(45.4％)和个人发展(45.2％).结论 《新入职护士培训大纲(试行)》发布以来,我国三级综合医院的新护士规范化培训开展率较高,但在培训时长、培训内容、考核方式等方面需要进一步贴近临床需求,以提高全国新护士规范化培训的效果,同时,建议医院在培训中重视新护士的个体感受,促进新护士的职业发展.

This article reviewed the intension and current status of knowledge translation in health care and analyzed the existing problems including a lack of nursing evidence summary, low quality of nursing evidence, nurses with low ability in evidence-based and insufficient evidence-based atmosphere. It is recommended that knowledge translation researchers of the institutions and clinical knowledge translation practitioners should work closely together to carry out integrated knowledge translation research, and should produce more best evidence summary and knowledge translation tools close to clinical needs, accelerate the cultivation of evidence-based nursing talents at all levels, and use a variety of incentives to support evidence-based practice,apply the concepts and methods of knowledge translation to improve the quality of nursing and promote the development of nursing science.

Objective To explore the effects of application and management of the standardized training system for newly graduated registered nurses. Methods A total of 238 newly graduated nurses in Peking University First Hospital were selected by purposive sampling method. The 138 nurses who were enrolled in August 2015 were assigned into control group, adopting the traditional training program for new nurses. The 100 newly enrolled nurses in August 2016 were assigned into observation group, adopting the new standardized training program for new nurses. After training, the nurses of both groups were evaluated with the Transition Shock of Newly Graduated Nurses Scale (TSNGNS), the New Nurse Standardized Training Satisfaction Questionnaire, and the comprehensive examination paper. Results The total scores of TSNGNS, physical dimension, psychological dimension, social culture and development of nurses in the observation group were lower than those in the control group after training, and the differences were statistically significant (P＜0.01). After training, the total score and each dimension score of nurse satisfaction questionnaire in the observation group were higher than those in the control group, and the differences were statistically significant (P＜0.05). After the training, the comprehensive examination score of the nurses in the observation group was higher than that in the control group, and the difference was statistically significant (P＜ 0.01). Conclusions The implementation of the new training scheme can effectively relieve the new nurses' transition shock and improve their satisfaction and comprehensive evaluation score during training.

Objective To explore the effects of two kinds preoperative fasting and liquid-fasting time before caesarean section on blood glucose of puerperae with GDM before and after the operation,intra-operative complications and on blood glucose of neonates.Methods With prospective study method,162 puerperae with GDM admitted to obstetrical department of Peking University First Hospital and received cesarean section under combined spinal-epidural anesthesia between April 1st and Sep. 30th in 2015,were selected as the research object,and were divided into the control group (admitted on odd-numbered days) and the observation group (admitted on even-numbered days). Puerperae in the control group were forbidden to eat solid food for 8 h and drink transparent liquid for 6 h before the operation,while those in the observation group were forbidden to eat solid food for 6 h and drink transparent liquid for 2 h before the operation. Puererae in two groups were compared about their preoperative blood glucose,incidence of intraoperative nausea and vomiting or aspiration,intra-operative quality of bleeding,postoperative exsufflation time and blood glucose half an hour after the operation, meanwhile,neonates in two groups were compared about their Apgar scores 1 min and 5 min after birth,and their blood glucose half an hour after birth. Statistical analysis was done by independent-samplest test,Mann-WhitneyU test and χ2 test.Results Difference of preoperative blood glucose of puererae in two groups was statistically significant (P<0.01). Differences of intraoperative bleeding of puererae in two groups and blood glucose of neonates half an hour after birth in two groups were statistically significant (P<0.05). There was no statistic difference in the incidence of intraoperative nausea and vomiting or aspiration,postoperative exsufflation time of puererae,or Apgar scores 1 min and 5 min after birth of neonates in two groups(P>0.05).Conclusions The scheme of forbidding puererae from eating solid food for 6 h and drinking transparent liquid for 2 h before cesarean section can reduce the incidence of preoperative hypoglycemia,maintain a smooth post-operative blood glucose, reduce intraoperative bleeding without increasing the incidence of intraoperative complications like nausea,vomiting or aspiration,or hypoglycemia of the neonates. The new fasting and liquid-fasting scheme is safe and feasible,which makes it worth promoting in clinic.

ObjectiveTo explore the practice effect of "disease-characteristics nursing quality improvement" program (DNQIP) in patients with gestational diabetes mellitus (GDM).Methods Totally 841 GDM patients were selected by convenience sampling method and were divided into two groups based on whether they were nursed by the "DNQIP" program. Totally 236 GDM patients diagnosed between July 1st,2011 and June 30th,2012 were selected as the control group,while 605 GDM patients diagnosed from July 1st,2012 to April 30th,2015 were selected as the intervention group. Patients in the intervention group were cared with the "DNQIP" mode,which meant "looking for optimal evidence,relying on optimal processes and displaying optimal care". Finally,maternal and fetal outcomes,patient satisfaction and nursing quality ratings for various nursing units in two groups were compared.Results The differences in the incidence of macrosomia and hypertensive disorder complicating pregnancy between two groups were of no statistical significance (P>0.05);the incidence of premature delivery in the intervention group (7.2%) was significantly lower than that in the control group (16.0%) (χ2=15.04,P<0.01). In terms of patient satisfaction,the intervention group obtained higher scores than the control group in all items except for "nurses′ operation" (P<0.01). Composite score of special inspection for nursing quality of various nursing units after the implementation was higher than that before the implementation (P<0.05).Conclusions The DNQIP can reduce the incidence of premature delivery among GDM patients, improve the satisfaction of patients and optimize the quality of nursing service.

Objective With methods of literature review, item test, reliability and validity test, etc., to develop a fall risk assessment scale specific to the obstetrical department, which, after reliability and validity test, can be used for women health care before, at and after delivery.Methods Items in the fall risk assessment scale for pregnant and maternal women were determined and weights were assigned by reviewing relative risk factors in literature, referring to items in other fall risk assessment tools from home and aboard. After a preliminary scale was formed, 154 pregnant and maternal women hospitalized from May to December 2016 were assessed, so that reliability and validity of the scale were tested.Results In this fall risk assessment scale for the obstetrical department, test-retest reliability was 0.822, interrater reliability was 0.926, content validity of expertise was 0.927, and area under the curve (ROC) was 0.750 (P<0.05). When the dividing value was 3.5, sum of sensitivity (0.714) and specificity (0.714) reached the max.Conclusions The new fall risk scale, with favorable reliability and validity, can filter patients with high risk of fall, yet, it is still to be testified and perfected in future application.

遗传性凝血因子Ⅴ缺乏症即副血友病，是一种罕见的常染色体隐性遗传的出血性疾病。人群中纯合子发病率约为1/100万，男女均可罹患，少数患者的父母为近亲婚配[1]。对于患有纯合性凝血因子V缺乏症的患者而言，妊娠和分娩意味着危险的挑战，多数患者在分娩或产后表现出不同程度的出血，因为出血增多可能随时出现休克、多脏器功能衰竭、弥散性血管内凝血等严重情况[2]。因此，对患有凝血因子Ⅴ缺乏症的产妇一旦发生出血可能危及产妇生命。我院2012年11月收治1例凝血因子Ⅴ缺乏症的足月产妇，经过充分的评估及精心的治疗和护理，患者顺利自然分娩且未发生产后出血，现报道如下。

Objective To explore the effects evaluation of extended care after “one-day care” for delivery women with gestational diabetes mellitus ( GDM ) . Methods From May to September 2013 in Department of Gynaecology and Obstetrics Peking University First Hospital, a total of 354 GDM pregnant women participated “one-day care” and then they were divided into experimental group (171 cases) and control group (183 cases) according to whether attended the extended care. Using repeated variance analysis measurement, the fasting blood glucose and postprandial 2h blood glucose values were compared whether the values had statistical significance between two groups at different visit time. Results The uterine-incision rates were 48. 55%(83/171) and 49. 7%(91/183) in the experimental group and control group respectively, and the incidence of giant babies were 9. 4%(16/171) and 12. 0%(22/183) respectively in the experimental group and control group (P>0. 05). The time point of before visit, during visit and last visit in the experimental group, the fasting blood glucose and postprandial 2 h blood glucose were lower than that of the control group (P<0. 05). Conclusions “One-day care” for GDM can reduce the blood glucose level of GDM delivery women, but it has not significant effects on the control of gestation′s body weight and to decline the uterine-incision rate and incidence of giant babies.

This paper introduces the nursing care of a case of 20-day delayed delivery in twin pregnancy complicated with gestational diabetes.Before the delivery,nursing care focused on basic nursing,psychological nursing,prevention of infections,control of uterine contraction,monitoring of blood sugar and fetus situation.During the delivery,monitoring of birth process and preparations for rescuing the neonate were emphasized.After the delivery,the key points in nursing were prevention of postpartum hemorrhage and infection,as well as health education.The patient was discharged 7 days after the labor and the second twin was discharged 59 days after the delivery.

对腹腔镜术后肩部疼痛的发生机制及处理方法进行综述,多因素的综合作用导致了术后肩痛的发生,这些因素包括残余CO2对膈神经的直接刺激、气腹张力对膈肌纤维的牵拉、头低臀高位所致膈下积液刺激膈肌及膈神经。有效的处理方法有氧疗法、降低气腹压力、水排气法、膝胸卧位、放置引流管或排气管等。

Objective To investigate the comfort status of advanced lung cancer patients receiving chemotherapy and analyze the relation between comfort and social support and also between comfort and coping style.Methods A total of 149 cases of advanced lung cancer patients receiving chemotherapy were sampled from 5 hospitals and surveyed by questionnaires which including Chemotherapy Patient Comfort Scale(CPCS),Perceived Social Support Scale and Medical Coping Modes Questionnaire.Results The mean of CPCS was(71.72±10.10).The social support had a positive effect on comfort(P0.01) and resignation had a negative effect on comfort(P0.01).Conclusion Improving social support and guiding the patients to take positive attitude are the keys to increase the level of comfort.

受北京市卫生局医政处委托,护理院试点工作项目组于2009年开始,承担了"北京市康复院、护理院试点工作"项目.根据项目的要求,北京市西城区一家公立二级医院的一个病区和北京市丰台区一家民营护养型养老院作为护理院试点单位,纳入了试点项目.