PDCA循环在提高肿瘤患者输液港护理依从性的应用

目的探讨PDCA循环在提高肿瘤患者输液港护理依从性的应用效果。方法选取2018年2~8月我院收治的504例输液港置管的肿瘤患者按随机分配原则分为对照组240例和观察组264例,对照组给予一般治疗和常规管理,观察组在对照组基础上实施PDCA循环管理,观察两组患者的并发症发生情况、输液港护理依从性,并进行统计分析。结果观察组的并发症发生率明显低于对照组,差异有统计学意义(P<0.05);观察组的输液港护理依从性明显高于对照组,差异有统计学意义(P<0.05)。结论运用PDCA循环能优化维护流程,降低并发症,提高患者输液港护理依从性,值得临床应用。     

Being black,foreign and woman: African immigrant identities in the United States

This paper contextualizes racial and ethnic identities in shaping African women’s work lives in the USA. While the literature on black immigrant groups has posited that ethnic identities are often deployed to shield black immigrants from racism, my findings indicate that for a group of African women, their racial and ethnic identities are viewed as potential sources of discrimination. As black immigrant women from middle-class backgrounds in their home countries, they also articulate experiences with racism and downward social and occupational mobility. Accounting for how race and ethnicity intersect in the lives of black immigrant groups can nuance our understanding of racial identities and highlight diversity in experiences among national and regional groups. Focusing on particular health-care settings further suggests the importance of professional contexts in shaping the identity formations of recent black immigrants.     

The Silence of the Unblown Whistle: The Nevada Hepatitis C Public Health Crisis

In 2008, one of the worst public health crises occurred in the state of Nevada, where authorities discovered up to 63,000 patients were potentially exposed to hepatitis C infection, largely due to substandard infection control and other negligent practices at two endoscopy clinics in Las Vegas. In the subsequent grand jury proceedings that followed, it was discovered that several clinic employees not only participated in these egregious practices, but doctors, nurses, and other health care professionals witnessed yet failed to report these incidents, largely due to fears of whistleblower retaliation. In response, the Nevada state legislature attempted to strengthen whistleblower protection laws, but it remains unclear if such laws actually protect employees who attempt to report patient safety concerns. As the push for quality patient outcomes becomes more prominent with health care reform, whistleblower concerns must be effectively addressed to ensure that health care professionals can report patient safety concerns without fear of retaliation.     

The Challenge of Antibiotic-Resistant Staphylococcus: Lessons from Hospital Nurseries in the mid-20th Century

In the late 1940s, epidemics of antibiotic-resistant strains of Staphylococcus aureus began to plague postpartum nurseries in hospitals across the United States. Exacerbated by overcrowding and nursing shortages, resistant S. aureus outbreaks posed a novel challenge to physicians and nurses heavily reliant on antibiotics as both prophylaxis and treatment. This paper explores the investigation of the reservoir, mode of transmission, and virulence of S. aureus during major hospital outbreaks and the subsequent implementation of novel infection control measures from the late 1940s through the early 1960s. The exploration of these measures reveals a shift in infection control policy as hospitals, faced with the failure of antibiotics to slow S. aureus outbreaks, implemented laboratory culture routines, modified nursery structure and layout, and altered nursing staff procedures to counter various forms of S. aureus transmission. Showcasing the need for widespread epidemiologic surveillance, ultimately manifesting itself in specialized “hospital epidemiology” training promoted in the 1970s, the challenges faced by hospital nurses in the 1950s prove highly relevant to the continued struggle with methicillin-resistant Staphylococcus aureus (MRSA) and other resistant nosocomial infections.     

某大型综合医院护理人力资源配置研究

?????? 目的 从目前护理人员承担的工作量出发,探讨临床科室护理人员配置理想床护比,为医院护理人力配置提供依据。方法 以工作量测算法作为核心研究方法,采用工现场观察法对西安市某大型综合医院42个临床科室护士的工作量进行测算,并使用Excel、SPSS17.0统计软件进行公式运算和统计分析。结果 （1）临床科室护理人员的工作时间超过标准工作时间6小时;（2）所调研科室现有床护比仅为1: 0.46,缺编41.50%;（3）依据目前的工作量需要,内科病房的床护比应为1:0.62,外科病房床护比应为1:0.63,监护科室为1:2.08,平均床护比1:0.78。结论 临床科室医师人员配备亟待补充,医院应根据实际工作量进行合理测算后配置护理人员,通过工时测定提出了的理想床护比可为其他医院提供参考。     

重症医学科护理质量与效率平衡的研究

??????? 目的 探索在保证护理安全的基础上提升护理工作效率的方法。 方法 按实施不同制度的时间段将患者分为A组和B组,A组实行三级责任护理管理制度;B组在实行三级责任护理管理制度并对现有病区进行合理分区的基础上,依据患者危重分级和护理人员分层来分配每个床单位的责任护士(双向分层管理制度),两组进行护理总时数、所护理的患者人数、不同危重分级患者的平均护理时数、同一患者不同危重分级平均天数等比较。 结果 B组中不同分层护理人员所护理的患者危重分级与护理时数成正比,但总护理时数相近,所护理人数随危重分级提高而减少,危重分级1级患者平均住院天数明显下降。 结论 双向分层管理组相对于三级责任护理管理组更能保证护理安全、提升护理工作效率。     

2型糖尿病合并高血压患者个性化延续护理研究

为探讨个性化延续护理对2型糖尿病合并高血压患者生活质量及服药依从性影响,本研究选取2015年6月至2017年1月在哈励逊国际和平医院治疗的150例2型糖尿病合并高血压患者,随机分组,对照组患者应用常规护理,试验组患者给予个性化延续护理,观察比较两组患者血糖、血压、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)、自尊量表(self-esteem scale,SES)、依从性差异。结果显示,12个月后试验组患者空腹血糖(7.59±1.26) mmol/L,糖化血红蛋白(glycated hemoglobin, HbAIC)(5.62±1.28)%较对照组明显下降(p<0.05);12个月后试验组患者收缩压(116.08±9.41) mmHg、舒张压(90.35±6.92) mmHg明显低于对照组(p<0.05);试验组患者SAS (35.13±4.27)分、SDS (31.42±2.09)分、SES (25.01±5.85)分同对照组比较明显改善(p<0.05);试验组患者依从性97.33%、不良生活习惯改善94.67%、健康知识掌握98.67%同对照组比较显著升高(p<0.05)。本研究结论初步表明针对2型糖尿病合并高血压患者应用个性化延续护理可改善患者血糖和血压水平,提高患者生活质量和治疗依从性,值得推广应用。     

Effect of crate opening from day 3 postpartum to weaning on nursing and suckling behaviour in domestic pigs

Temporary crating may be a more acceptable housing system for lactating sows than permanent crating and loose-housing because it combines benefits of both systems while reducing some of their limitations. It remains unclear whether nursing and sucking behaviour is influenced after crate opening. The aim of this study was to assess the short- (24 h post-crate opening) and long-term (day 25 postpartum (pp.)) effects of opening the farrowing crate from day 3 pp. to weaning on nursing and suckling behaviour. Sows were crated from 5 days prepartum either to weaning (permanently crated group; n = 14) or 3 days pp. (temporarily crated group; n = 13). Sows and their litters were observed on days 4 and 25. Duration of pre- and post-massages, nursing termination, number of piglets missing milk ejection and number of piglets fighting during pre- and post-massages were scored at 15-s intervals. Nursing success (i.e. with or without milk ejection) was also recorded. Data were analysed using PROC GLM and PROC GENMOD of SAS including housing, litter size and parity as fixed effects. Nursing behaviour did not differ between sows housed in temporary crates and those housed in permanent crates on days 4 and 25 pp., that is, same number of nutritive nursings (NNs), same proportion of non-NNs, same duration of post-massages and same proportion of termination of post-massages. There was only a housing effect on day 25; with sows having longer pre-massages in permanent crates (P < 0.05). Suckling behaviour was overall similar between treatments. There were no differences in the number of piglets attending pre- and post-massages, proportion of piglets fighting during pre-and post-massages and the proportion of piglets missing milk ejection on both days. The only housing effect was found on day 25 during which fewer piglets attended post-massages (P < 0.05) in permanent crates. Sows with larger litters terminated post-massages more often (P < 0.05), allowed shorter post-massages (P < 0.05) on day 4, and had more piglets miss milk ejection on days 4 and 25 (P < 0.05). In conclusion, the results of this study showed that housing had a very limited effect on nursing and suckling behaviour. Sow and piglet behaviours were not altered after crate opening (short-term effect) and nursing was to some extent calmer (shorter pre-massages and more piglets attended post-massages) in temporary crates on day 25. Increased litter size impaired nursing and suckling behaviour of sows and piglets independently of the housing system.     

Evidence for non-genomic transmission of ecological information via maternal behavior in female rats

Maternal behavior is flexible and programs offspring development. Using a novel manipulation, we demonstrate that rat maternal behavior is sensitive to ecologically relevant stimuli. Long-Evans hooded rat dams (F0) and pups were exposed to a predator condition (cat odor) or a control condition (no odor) for 1 h on the day of parturition. Predator-exposed F0 dams displayed significantly more maternal behavior (licking/grooming, arched-back nursing) relative to control-exposed dams across five subsequent observation days. Female offspring (F1) were raised to adulthood, bred and maternal behavior was observed. F1 dams reared by a predator-exposed F0 dam displayed significantly higher maternal behavior relative to F1 dams reared by a control-exposed F0 dam across 5 days of observation. Increased levels of maternal behavior in predator-reared (PR) F1 dams were evident even in F1 females that had been cross-fostered (CF) from a control-exposed F0 dam, suggesting a non-genomic transmission of increased levels of maternal behavior. Lactating PR F1 dams had significantly elevated estrogen receptor alpha and beta mRNA in the medial preoptic area relative to control-reared (CR) F1 dams. Furthermore, among CR F1 dams, there was no significant difference between those dams that had been CF from predator-exposed F0 dams and those that had been sham CF. These results support the hypothesis that flexible rat maternal behavior can shape offspring development according to current environmental conditions. The results also suggest that estrogen signaling may be part of an epigenetic mechanism by which changes in maternal behavior are passed from F0 to F1 dams.