目的 实施目标管理方案降低导尿管相关性尿路感染发生率,通过制订目标、实施目标、完成目标,推进质量改善.方法 对某三级甲等综合医院2020年4月—9月留置导尿管的住院患者,应用目标管理方案,依次制订质量改善目标、质量改善计划,实施计划并对过程进行质量评价,通过评估结果的反馈改进行动,实现质量改善.设定1个月为1个质量周期,首个周期的质量为基线,之后各周期质量与之比较,同时与前1周期质量比较.结果 12个过程指标与基线质量比较,6个指标在第2个周期得以改善(P<0.05),此后凡优于第2周期和基线质量的指标,较基线质量比较,差异均具有统计学意义(均P<0.001).5个过程指标基线完成率已达到较高水平,与后续测量数据持平.结果 指标导尿管相关性尿路感染发生率项目末期较基线显著降低(P<0.05).过程指标10项措施执行完成率≥95％,2项措施执行率≥91％,达成目标.结论 应用目标管理方案进行质量改善,实现目标导向指标具体化管理,对护理质量进行客观测量,科学比较,切实降低了留置导尿管住院患者的导尿管相关性尿路感染发生率,促进护理质量提升.

Objective:To construct a pressure injury risk prediction model for critical patients and verify its prediction effect.Methods:A cohort study was conducted to collect relevant data of critical patients hospitalized in the Intensive Care Unit from February 2019 to September 2019. The occurrence of pressure injuries was used as a dependent variable to conduct a single factor and multiple factor analyses of relevant data and establish predictive models. The risk stratification and predictive effect tests were also performed.Results:There were 329 critical patients and 48 cases of pressure injuries. The single factor analysis of 11 factors showed that blood lactate, body temperature, ICU hospitalization days, Braden score, consciousness state, age and booster drug treatment were the suspicious factors of stress injury, and the difference was statistically significant ( Z value was 2.575-3.694, χ 2 values were 6.800, 30.510, 6.344, P<0.05 or 0.01); The results of the binary Logistic regression analysis showed that the independent influencing factors for the occurrence of pressure injuries included the patient′s body temperature within 24 hours after entering the ICU, the Braden score, state of consciousness, age and ICU hospitalization duration ( P<0.05 or 0.01). A prediction model was established. The likelihood ratio chi-square proved that the model was statistically significant and fitted well. The sensitivity was 66.7% and the specificity was 72.2%. The risk stratification of the model was performed. The difference between the high-risk group and the low-risk group was statistically significant ( t value was -33.371, P<0.01); the validation set was used to test the prediction effect, and the area under the ROC curve was 0.758. Conclusions:The constructed prediction model is a scientific combination of objective indicators of the clinical characteristics of critical patients, which is statistically significant; the model can predict critical patients’ risks of pressure injuries; it also has a good degree of discrimination, which can provide a theoretical basis for the risk management of critical patients with great clinical application value.

为了提高援湖北医疗团队的救治能力,使新冠肺炎防控工作能够有序、高效地开展,援湖北医疗队就整建制接管重症病区救治工作中遇到的问题及对策进行阐述,以期为医疗救援团队整建制接管病区工作的顺利开展提供参考.

目的 遴选并获取预防医疗器械相关压力性损伤的临床实践依据,并对相关证据进行总结.方法 针对医疗器械相关压力性损伤提出问题,检索国内外数据库相关文献,检索时限为建库至2019年10月.由2名研究者依据JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行文献质量评价及证据级别评定,纳入符合质量标准的文献,并提取证据.结果 共纳入证据8篇,包括指南6篇、专家共识1篇、系统评价1篇.最终形成包括皮肤评估、皮肤清洁、医疗器械的安置与移动、合理使用敷料和教育培训5个方面的最佳证据.结论 本研究总结了预防医疗器械相关压力性损伤的临床实践依据,在临床应用证据时,建议评估相关医疗机构的就医环境、设备条件及医护人员应用证据时的促进及阻碍因素、患者意愿等因素,筛选调适后,进行有针对性的证据使用,以促进证据有效地向临床转化,为临床护理实践提供更多科学依据,从而提升护理质量.

Objective To evaluate the effect of multidisciplinary cooperative intervention on the rehabilitation outcome of lumbar surgery patients with kinesiophobia.Methods A total of 172 postoperative kinesiophobia patients after lumbar fusion surgery in the department of spine surgery were divided into an observation group and a control group chronologicall, with 86 patients in each group. The control group received routine nursing and follow up, while the observation group additionally received the intervention formulated by spinal surgeons, anesthesiologists, rehabilitators, psychological counselors, nurses, and others. Patients′ kinesiophobia, lumbar spine rehabilitation and quality of life were evaluated at 24 hours after surgery, 1 month, 3 months, and 6 months after discharge respectively.Results At 1 month, 3 months and 6 months after discharge, the TSK score of the observation group were significantly lower than those of the control group, and the score of JOA were significantly higher than those of the control group (P<0.01 for all);at 3 months and 6 months after discharge, the quality of life score of the observation group were significantly higher than those of the control group (P<0.01 for both).Conclusion The multidisciplinary cooperative intervention could reduce the degree of postoperative phobia for patients after lumbar surgery, improve their rehabilitation outcome and quality of life.

文章概括了慢性下腰痛患者恐动症的测量工具、研究现状和主要影响因素(疼痛和自我效能感),并提出包括缓解疼痛、认知行为疗法、多学科合作综合干预、虚拟步行训练等干预措施,旨在为恐动症的进一步研究提供借鉴与参考.

Objective To explore the application and effects of risk management in umbilical artery catheterization of extremely pre?term infant.Method The risk management team was established,then retrospectively analyzed the risk factors of umbilical artery catheteriza?tion and maintenance,formulated and implemented umbilical artery catheterization and maintenance of standard operating procedure in ex?tremely preterm infant,strengthened their training in theory and pratical,and intervent before,in and after cathetering.Results The achieve?ment ratio of umbilical artery catheterization increased(P<0.01),the incidence of umbilica errhysis,catheter blockage,catheter displacement and catheter infection were reduced(P< 0.01 or P<0.05).Conclusion Implementation of risk management of umbilical artery catheteriza?tion and maintenance in extremely preterm infant can raise achievement of umbilical artery catheterization,reduce risk factors of cathetering and maintenance,which can provide safe nursing service for extremely preterm infant.

This paper analyzes the advantages and disadvantages of the medical journals integration under the internal conditions as well as the opportunity and threat in the external environment to resist academic misconduct by SWOT analysis.The SWOT matrix analysis chart is constructed in order to gradually integrate the resources of medical journals,to promote the academic behavior management,to overall plan academic supervision and management,and to continuously improve the scientific research integrity system.

Objective To explore the effect of continuous nursing model in the growth and development of preterm infants.Methods Totally,122 patients were divided into control group (n =60) and experimental group (n =62) according to the time of admission.The control group recieved routine nursing.The experimental group was based on the continuous nursing model of Ahmadi to construct the continuous nursing program of premature children from admission to hospital.The physical development status,hospitalization rate and neuropsychological development assessment score of premature infants were collected at 2 months olds,3 months old,4 months old,5 months old and 6 months old.Results The body length,head circumference and body weight of the experimental group were higher than those of the control group (P ＜ 0.01 or P ＜ 0.05).The readmission rate was lower than the control group (P ＜ 0.05),neuropsychological development of the energy and the total development of the experimental were higher than those of the control group (P ＜ 0.01 or P ＜ 0.05).Conclusion Continuous nursing model of premature infants with Ahmadi continuous nursing model can effectively promote the growth and development of preterm infants and reduce the readmission rate.

Objective To explore the application of continuing nursing model in life of puerperae with preterm infants and evaluate its effects.Methods Based on continuous nursing model of Ahmadi,puerperae's continuing nursing program was constructed.Randomized controlled trail design was used,and totally 110 puerperae in a hospital in Beijing were recruited from August 2016 to March 2017.The experimental group received continuing nursing intervention model,and the control group received routine nursing care.Parenting knowledge and psychological evaluation of the two groups were collected 3 days before discharge,1 month,3 months and 6 months after discharge.Results Ninety-eight puerperae completed the study.In the experimental group,the score of parenting knowledge was higher than that of the control group(P＜0.01),and the total score of mental health assessment and scores of depression and anxiety were lower than those in the control group (P＜0.05).Conclusion Puerperae's continuing nursing program based on the continuous nursing model of Ahmadi improved maternal ability and positive emotion,and promoted quality of life.

The paper reviewed the status of remote intervention in chronic disease continuous nursing,including the intervention models and group,and analyzed the intervention effect of remote intervention in chronic disease continuous nursing,then the paper put forward the envision improvements,so as to provide suggestions and references for developing the chronic disease continuous nursing remote intervention.

文章综述了国外早产儿连续护理社会支持系统、实践形式及内容和测评工具,国外早产儿连续护理实践形式包括多学科团队连续护理模式、医护-家长合作模式、居家护理模式、远程医疗管理模式、高危儿门诊随访模式,并针对我国现状提出了相应建议,包括完善相关制度和法规、完善早产儿连续护理内容与工作模式、组建多学科连续护理团队、构造开放式的NICU环境、完善早产儿连续护理相关测评工具,以期为我国开展早产儿连续护理的实践提供指导和帮助.

Obejective To investigate the current situation of nursing work enviroment in China.Methods By using the Bicomb bibliographic co-occurrence analysis system to extract the data from CNKI database,Wanfang database and Weipu database,SPSS 20.0 software was used to carry out cluster analysis,and the literature was analyzed by means of metrological analysis.Results Totally,340 articles related to nursing work envimment were recruited and the number of publications increased in recent years.The results showed that the number of documents increased the most in 2016.There were 4 core authors who had 17 papers.The cooperation degree was 2.69.Key words clustering results could be divided into 3 categories,which is more extensive.Conclusion There are more attentions paid to nursing work environment by the nursing profession,but the relevant research groups still need further development,and research hotspots are not significant and should to be further strengthened.

It reviews the definition of health management,the managers,management,management contents,management effects and related assessment tools of health management for premature infants,and the development trend of health management for premature infants in China is expounded,which provide the theoretical basis and behavior guidance for the domestic health management of premature infants.

Objective At present , there is only a small amount of survey scale of caregivers′cognitive level on continuous nursing care for premature infants , which had not been subject to stringent testing of reliability and validity .This paper aims at developing a suitable survey scale of caregivers′cognitive level oncontinuous nursing care for 0-1 year premature infants , and testing its reliability and validity. Methods Convenience sampling method was used and totally 495 caregivers of premature infants of Army General Hospi-tal affiliated BaYi Children hospital from April to August 2016 has been investigated .After we had preliminary content of the question-naire, two-round Delphi consultations were used to identify the draft of the scale , and the reliability and validity were tested . Results Totally 419 valid questionnaires from 495.Questionnaires effective recovery was 84.65%.Critical ratio for each entry was 9.355-23.179 ( P<0.05) , which suggested that entries had good distinction .Coeffi-cient of correlation between scale items and total score was 0.500-0.775(P<0.05), whichindicated highly homogeneity between entries and table.By exploratory factor analysis , 5 entries were removed and 77 entries remained .The final scale of caregivers′cognitive level on continuous nursing care for premature infants included 4 indicators in&nbsp;level one , 15 indicators in level two and 77 indicators in level three .The Cronbach′s alpha was 0.985 for overall questionnaire and 0.848-0.939 for each dimension .The split-half reliability was 0.895 for overall questionnaire and 0.814-0.939 for each dimension .The content validity index was 0.963.The cumulative contribution rate of each dimension was 64.645%-83.236%. Conclusion The scale content was scientific and comprehensive .It can be used to investigate the caregivers′cognitive level on continuous nursing care for 0-1 year pre-mature infants, direct nurses to provide continuous care for premature infants , and evaluate the continuous nursing effect .

目的 了解新入职护士参加CCU规范化培训的现状及影响因素.方法 2015年7月至2016年7月对109名新入职临床护士进行问卷调查.结果 新入职护士参加CCU规范化培训现状总分为(70.36±9.48)分,年龄、学历为主要影响因素.结论 新入职护士参加CCU规范化培训现状处于中等水平,建议依据影响因素分析进行干预,制订一套科学的新护士规范化培训体系,提高新入职护士的满意度与稳定性,提升护理质量.

目的 探索适合血液透析患者的系统饮食教育,改善透析患者的钙磷水平,提高患者的营养状况.方法 组建健康饮食教育团队,筛选40例高磷血症维持性血液透析患者,采取责任护士分组管理,通过集体教育、个体化教育的系统饮食教育,干预3个月后,采取自身前后对照研究的方法评估患者营养状况及钙磷代谢变化.结果 3个月后,患者血磷由(2.12±0.31) mmol/L下降到(1.68 ±0.49) mmol/L(P＜0.01),全段甲状旁腺激素由(824.52±588.07) ng/ml下降到(567.61±526.59) ng/ml(P＜0.05).结论 通过集体教育、个体化教育的系统饮食教育,可以提高患者健康饮食知识水平和依从性,改善饮食习惯,减少磷的摄入,血磷水平下降,改善患者的钙磷代谢.

目的:探讨压力梯度长袜(graduated compression stocking,GCS)在预防老年重症患者深静脉血栓形成(deep vein thrombosis,DVT)及体位性低血压(orthostatic hypotension,OH)中的应用效果.方法:分析125例老年危重患者的病例资料,其中应用压力梯度长袜者61例(GCS组).64例仅做常规处理,未应用压力梯度弹力袜(对照组).观察两组患者下肢深静脉血栓形成及体位性低血压的发生情况.采用x2检验对两组患者下肢深静脉血栓形成和体位性低血压的发生率进行比较分析.结果:GCS组患者下肢DVT发生率为3.3％(2/61),体位性低血压发生率为13.1％(8/61).64例对照组患者的下肢静脉率为15.6％(10/64),OH发生率为29.7％(19/64).组间下肢DVT发生率(X2=5.486,P=0.030)及OH发生率(X2=5.065,P=0.030)比较,差异均有统计学意义.结论:压力梯度长袜可以有效预防老年重症患者下肢深静脉血栓的形成并减少体位性低血压的发生.

[目的]研究三级甲等医院科室分类模型在医院临床科室的实际应用。[方法]选择1所三级甲等医院9个不同类别的临床科室，利用1个月的时间记录每个住院病人24 h 所做护理项目，通过数据计算分析得出各科室的分类及床护比范围。[结果]9个科室按照实际护理耗时分别属于4类科室，床护比为1∶0.30~1∶0.72。[结论]科室的严重程度分类取决于该科室不同严重程度病人的数量，科室分类模型应用于护理人力配置基本能够实现最优化配置。

目的 探讨绩效考核法在神经外科临床护理管理中的应用.方法 设立绩效指标与权重,包括基础绩效、工作量绩效和工作质量与奖惩绩效3部分,占比分别为20.00％、40.00％、40.00％;建立绩效奖金计算公式;设计绩效软件;成立绩效考评小组,制订绩效考核实施办法.结果 实施绩效考核法后,护士流失率下降,护士对护理职业认同感、工作待遇优劳优酬、个人成长发展机会方面的满意度提高(P＜0.01或P＜0.05);患者对护理工作的满意度也得到显著提升(P＜0.01);医院考核的护理质量指标检查得分提高(P＜0.01或P＜0.05);护士听课参训率提高、理论成绩和操作成绩明显提升(P＜0.01).结论 实施科学的绩效考核,优绩优酬,能够提高护士满意度,减低护士流失率,提升患者满意度,改善护理质量,并促进护士个人成长.