实习护生发生锐器伤的原因分析及预防对策

目的探讨实习护生发生锐器伤的有效预防措施。方法分析实习护生发生锐器伤的主要原因,并提出相应对策。结果缺乏职业防护知识、防护意识薄弱、护理操作行为不规范、锐器废弃物的处理不当是实习护生发生锐器伤的主要原因。结论加强护生自我防护意识,掌握安全技能,完善安全管理制度,推广应用安全产品,能有效预防锐器伤的发生。     

高职护生实习期间锐器伤的现状及防护对策

目的:探讨我校高职护生实习期间锐器伤的现状、原因及对策。方法:采用自行设计的问卷进行问卷调查。结果:我校高职护生实习期间职业防护意识薄弱、锐器伤发生率高、处理情况差、上报率低。结论:学校和医院要采用有效措施,提高护生职业防护的意识,并将安全防护的知识技能融入护理操作流程,建立疫苗接种制度,不断改善护生工作环境,同时加强护生职业暴露的监测,从而有效降低锐器伤的发生率。     

临床护理教学中护生职业能力的培养

目的探讨在传统带教方法的基础上注重加强护生职业能力培养的护理教学效果。方法将2015年7月~2016年3月在我科实习的56名护生随机分为对照组和观察组,对照组按传统带教方法教学,观察组在传统带教方法的基础上注重加强护生的职业能力培养,护生实习结束时由带教老师采用自行设计的调查表对护生进行考核,同时调查护生对带教老师的满意度情况。结果观察组护生职业能力考核成绩优于对照组(P0.05),对带教老师的满意度高于对照组(P0.05)。结论在传统带教方法的基础上注重加强护生职业能力培养,可适应社会发展需要,提高护生的职业胜任力。     

医护人员对抗肿瘤药物的职业暴露及防护措施

配置和输入化疗药物是护士的主要工作之一,故对护理人员的健康造成了很大的威胁。职业防护已成我们近年来高度关注的话题。虽很多医院现已改为中心配液,但在工作中仍有很多临时化疗医嘱需要临床护士,接触抗肿瘤药物可能导致个人健康风险。本文综述了抗肿瘤治疗过程中常见的职业暴露途径,并提出了针对性的防护措施,以期为医护人员提供安全保障信息。     

不同学历实习护生对带教老师素质能力期望现状调查

目的调查护生对临床带教老师素质能力期望现状,有针对性地加强护理临床带教教师队伍建设。方法采用吕岩编制的《护理本科生临床实习情况调查问卷》对龙岩市三甲医院实习的不同学历实习护生165名进行问卷调查,并对不同学历实习护生对带教老师素质能力期望现状调查的结果进行统计分析,从教学计划、带教教学能力、学生参与实践、带教监督管理、护生评价体系五个维度评价实习护生对带教老师的期望现状。结果不同学历实习护生在带教老师的教学能力、学生参与实践、带教监督管理、护生评价体系得分比较,差异具有统计学意义(均P0.05);教学计划得分比较差异无统计学意义(P0.05)。结论不同学历实习护生对带教老师素质能力期望具有差异性,护生实习管理体系尚未健全,需要进一步提升。     

胸外科不同层次实习护生护患沟通能力分析

??????目的 探讨合理管理并提高不同层次实习护生沟通能力的有效方法。方法 采用护生护患沟通能力评价量表,对每位实习护生的临床操作技能及与患者的沟通能力分别打分,同时请患者及其家属根据自身的感受对各实习护生进行打分。结果 本科、专科和中专3个不同层次实习护生,与患者及其家属的沟通能力有明显统计学差异（P<0.01）。中专实习护生被投诉的比率明显比本科和专科实习护生高（P<0.01）。结论 应采取有效的措施管理实习护生,提高实习护生的沟通能力。     

中职检验学生临床环境评价及困扰因素对实习的影响

目的调查中职检验学生临床环境评价对实习效果的影响,分析其存在的问题,为改善临床学习环境,提高临床学习效果提供客观依据。方法采取调查问卷对实习护生临床环境和实习困扰因素进行调查。结果检验学生实习对临床实习环境较满意(临床实习环境评价得分136.51±12.68),其临床实习满意度受多重临床实习困扰因素影响,学院与实习医院可采取措施提高护生实习满意度。     

护生对护士社会地位认知度调查与分析

目的了解不同年级护生对护士社会地位的认知度,以及其与护生年级和学习成绩的关系。方法对2007级至2010级4个年级共189名护生进行有关护生对护士社会地位认知度的问卷调查。结果 1)各年级统一对以下4项因子打分偏低:1护士职业升职容易程度;2职业自由度;3职业本身所具有的权力;4职业收入。2)各项因子的评分呈现由低年级向高年级递减的现象。3)各年级护生对护士社会地位总体认知程度与学习成绩有一定相关性。结论随着年级增加,护生对护士社会地位认知度也表现的更消极,护生对临床工作了解的越多,对职业社会声望越悲观,因此,在教学中应该注重和加强护生对本职业的价值观培养,帮助护生树立积极的职业态度。     

基于需求层次论的护生导学辅导应用与实践

目的分析大型综合性三甲医院教师对护生的合理导学辅导,充分考虑人的生理和心理感知。方法运用马斯洛需求层次理论,从生理、安全、爱与归属、尊重和自我实现五个需求层次指导和教育护生。结果护生树立了正确的职业需求心理和积极健康的实习心态。结论当代医院在护生导学辅导中积极运用马斯洛需求层次理论,强调"以人为本"的教学理念,对护生的职业素养与职业规划具有指导性意义。     

程序化管理在护理实习带教中的应用

护理临床实习是学校教育的延伸,是学生从理论走向实践的一个重要过程,是培养护生综合素质的重要阶段,也是从一名护生到一名合格护士的身份转换的重要过程。因此,护理临床实习过程中每一环节的管理尤显重要。对不同层次实习护生,如何达到实习管理目标要求,是每一位带教老师值得思考的问题。2010年8月以来,我科在护理临床实习     

Vaccines and exposed occupations

The use of safe and efficacious vaccines in occupational settings to protect workers from diseases to which they may be exposed is obvious and has been included in the employment law. Healthcare workers are particular exposed. Immunization has two purposes : protect the worker from contracting a disease, but also prevent him from disseminating the disease to weakened patients. It is important not only to take into account existing recommendations for immunization, but also to envisage their extension to teachers and staff of nurseries and primary schools. Routine vaccination against whooping cough, varicella, measles and hepatitis A is particularly warranted in these categories. Recommendations should also extend to medical students who are too often poorly protected and insufficiently warned against potential occupational exposure to pathogens and dissemination to their patients.     

目标教学法在护理教学查房中的应用价值分析

目的:探讨目标教学法在护理教学查房中的临床应用价值,以培养护生的临床思维能力,并且提高实践工作能力。方法:选取我院2014年5月~2014年9月在急诊科实习的护生120人为研究对象,在实习之初,按照随机的原则将其分为观察组与对照组,每组60人。在查房中,观察组实施目标教学法,对照组实施常规护理教学法。实习结束后,调查两组护生对查房时教学与课堂效果的满意程度,记录两组护生病历书写的质量以及在实习结束后,通过考核,统计两组护生的在理论成绩、基础护理成绩、专科护理成绩以及护理综合技能方面的成绩,然后对所得到的数据进行统计,以探讨目标教学法在护理教学查房中的临床应用价值。结果:从查房时教学的满意程度及对课堂效果的满意程度来看,观察组都高于对照组,差异具有统计学意义(P0.05);观察组病历书写优良的人数为48,优良率为80%,高于对照组,差异具有统计学意义(P0.05);观察组护生的理论成绩、基础护理成绩、专科护理成绩及护理综合技能的成绩均高于对照组,差异具有统计学意义(P0.05)。结论:目标教学法是一种科学、合理并且适合时代发展要求的新型教学法,应用于护理教学查房中,能提高护生的主动性,激发护生的学习兴趣,充分发掘其潜能,做到理论与实际的结合,从而提高学习者的自身能力,值得临床推广应用。     

Sister chromatid exchanges in lymphocytes of nuclear medicine physicians

OBJECTIVE: The aim of this study was to assess whether occupational exposure to chronic, low doses of Iodine 131 (I-131) and Technetium 99m (Tc-99m) may lead to genotoxicity. Medical personnel occupied in nuclear medicine departments are occupationally exposed to low doses of I-131 and Tc-99m. The determination of the frequency of sister chromatid exchanges (SCEs) and of cells with a high frequency of SCEs (HFC) is considered to be a sensitive indicator for detecting genotoxic potential of mutagenic and carcinogenic agents. Therefore, we examined peripheral lymphocytes from nuclear medicine physicians for the presence of both SCE and HFC. METHODS: Sixteen exposed nuclear medicine physicians (non-smokers) were compared to 16 physicians (non-smokers) who had not been exposed to chemical or physical mutagens in their usual working environment at the same hospital. RESULTS: A statistically significant difference was found between SCE frequencies and HFC percentages measured in lymphocytes from the exposed and control groups. CONCLUSIONS: The present observation on the effect of chronic low doses of I-131 and Tc-99m indicates the possibility of genotoxic implications of this type of occupational exposure. Hence, the personnel who work in nuclear medicine departments should carefully apply the radiation protection procedures and should minimize, as low as possible, radiation exposure to avoid possible genotoxic effects.     

Occupational exposure to anticancer drug--potential and real hazards

Many anticancer agents have been shown to be mutagenic, teratogenic and carcinogenic in experimental systems and second malignancies are known to be associated with several specific therapeutic treatments. Anticancer agents thus represent a class of occupational carcinogens, the handling of which should involve no unnecessary exposure. The available methodologies to detect possible exposures from ambient air and from biological samples are discussed, and the published data on results are reviewed. Analytical methods are available for the detection of most frequently used anticancer drugs from all groups, i.e., alkylating agents, mitotic inhibitors, antimetabolites and antibiotics. The ambient samples taken from sites of admixture of cytostatics have often shown detectable, but low concentrations of anticancer agents. Urine samples from patients under chemotherapy as well as from personnel handling the drugs occupationally in hospitals have been analyzed both chemically and for excreted mutagenicity. Both cisplatin and cyclophosphamide have been detected in the urine of patients; furthermore, cyclophosphamide was observed in the urine of nurses who formulate and deliver this drug. Urinary mutagenicity assays have given both positive and negative results in various groups of nursing and pharmacy personnel. Cytogenetic methods have, likewise, been applied for monitoring purposes. Most of the available data concerns chromosome aberrations (CA) or sister-chromatid exchanges (SCE) induced in peripheral blood lymphocytes of patients under chemotherapy. A few studies on groups occupationally exposed to anticancer drugs have given positive results, but also negative reports have appeared for these same cytogenetic parameters. No studies are as yet available on the possible carcinogenic effects of occupational handling of anticancer drugs. Two recent case-referent studies among hospital personnel have pointed to slightly increased risks of disorders in pregnancy outcome; one of the studies has shown an excess of spontaneous abortions and other malformations in children of females with a history of work with anticancer agents.     

实习护生学历与心理健康状况相关性研究

目的：了解不同学历实习护生心理健康状况及存在的心理健康问题,分析其与学历之间的关系,为实施干预提供依据。方法：采用症状自评量表（SCL-90）,对100名不同学历实习护生进行问卷调查。结果：不同学历实习护生SCL-90量表测试所得强迫症状、抑郁、焦虑、恐惧等因子分均高于常模组具体得分,不同学历SCL-90量表测试所得抑郁、焦虑、敌对、恐惧精神病性等因子分有差异。结论：强迫症状、抑郁、焦虑、敌对是不同学历实习护生最主要的心理问题,研究生、本科学历实习护生更为严重,不同学历心理问题的严重程度不同。     

回顾性分析与评价麻醉性镇痛药的应用情况和发展趋势

目的:神经系统药物是各治疗领域中增长最快的领域,其增速与心脑血管领域和抗肿瘤领域相当,麻醉镇痛类药物则是其中的首类药物。本文主要分析本院麻醉性镇痛药(narcotic analgesics,NALG)应用的现状及趋势,并行客观评价。方法:回顾性分析2010年~2012年第三军医大学第二附属医院麻醉性镇痛药品的种类、用量、金额、用药频度等,并进行归类统计、比较和分析。结果:经过数据统计分析,结果表明注射剂型药物多为住院患者使用,其他口服或透皮贴剂的门诊用量较大。其中,临床应用以芬太尼类居首。羟考酮缓释片的用量排名有明显的上升趋势。结论:当前麻醉性镇痛药的应用情况基本合理,但为创建无痛医院仍需进一步完善科学用药管理与监督,并提高合理用药水平。医院麻醉性镇痛药应注重以改善患者健康为目的,建立以患者为中心的用药指标,最大限度地减轻患者的痛苦。     

Caring for older people. Community services: health.

Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.     

A note on comparing exposure data to a regulatory limit in the presence of unexposed and a limit of detection

In some occupational health studies, observations occur in both exposed and unexposed individuals. If the levels of all exposed individuals have been detected, a two-part zero-inflated log-normal model is usually recommended, which assumes that the data has a probability mass at zero for unexposed individuals and a continuous response for values greater than zero for exposed individuals. However, many quantitative exposure measurements are subject to left censoring due to values falling below assay detection limits. A zero-inflated log-normal mixture model is suggested in this situation since unexposed zeros are not distinguishable from those exposed with values below detection limits. In the context of this mixture distribution, the information contributed by values falling below a fixed detection limit is used only to estimate the probability of unexposed. We consider sample size and statistical power calculation when comparing the median of exposed measurements to a regulatory limit. We calculate the required sample size for the data presented in a recent paper comparing the benzene TWA exposure data to a regulatory occupational exposure limit. A simulation study is conducted to investigate the performance of the proposed sample size calculation methods.     

护理专业学生专业价值观的调查研究

目的:本研究旨在全面了解护理专业学生专业价值观的现状,分析学生在专业价值观上存在的问题,为开展高素质、高职业精神的护理专业提供依据。方法:采用整群抽样法,使用《护理专业价值观量表》对我院四个年级、两个层次的600名护生进行问卷调查。结果:护生专业价值观的总体水平较高(总得分为121.4±19.24);护生对"关怀照顾"(均值为4.03±0.87)和"利他主义"(均值为4.03±0.87)关注度最高,对"行动主义"(均值为3.74±0.89)的关注度最低;护生的学历、年级、自身对护理专业的选择意愿及对护理的喜爱程度影响其专业价值观水平(P0.01)。护生的性别对专业价值观无显著影响(P0.05)。结论:护理教育者应多方式、多渠道、分层次的加强护生的职业情感教育,帮助护生建立并发展稳定的职业价值观,从而为临床培养高质量的护理人才。