公立医院分级护理标准探索与研究

目的 探索一种基于病情和自理能力的病人分级护理标准。方法 调查2015年5—12月江苏省某三级教学医院内科、外科共10个普通成人病房的住院病人,采用Barthel指数评定量表和急性生理功能和慢性健康状况评估系统Ⅱ（APACHEⅡ）评价病人自理能力及疾病严重程度,采用自行设计的直接护理工时测量表记录病人24 h所需直接护理时间,根据不同病情及自理能力病人24 h直接护理时间的不同进行护理等级的划分。结果 共调查病人570例,有效问卷551份（96.67%）,不同疾病严重度和病人自理能力病人24 h所需直接护理时间不同,共形成4个新的护理等级。结论 以Barthel指数评定量表和急性生理功能和慢性健康状况评估系统Ⅱ（APACHEⅡ）作为分级护理标准,依据不同病情、自理能力病人所需直接护理时间的差异可将病人划分等级,新的分级方法较原有护理等级划分方法更加客观、方便,有利于满足病人需求,指导人力资源配备和成本核算。     

Cross-generational impact of a male murine pheromone 2-sec-butyl-4,5-dihydrothiazole in female mice

The current understanding of the activity of mammalian pheromones is that endocrine and behavioural effects are limited to the exposed individuals. Here, we demonstrate that the nasal exposure of female mice to a male murine pheromone stimulates expansion of mammary glands, leading to prolonged nursing of pups. Subsequent behavioural testing of the pups from pheromone-exposed dams exhibited enhanced learning. Sialic acid components in the milk are known to be involved in brain development. We hypothesized that the offspring might have received more of this key nutrient that promotes brain development. The mRNA for polysialyltransferase, which produces polysialylated neural cell adhesion molecules related to brain development, was increased in the brain of offspring of pheromone-exposed dams at post-natal day 10, while it was not different at embryonic stages, indicating possible differential brain development during early post-natal life.     

Development of an index to measure oral health care priority among nursing staff

Objective: To develop an index to measure oral health care priority among nursing staff. Background: Nursing staff, working on hospital wards, at nursing homes and at other facilities, have to deal with oral health care and there are many reports about the low priority that is given to oral health care by nursing staff. It is difficult to measure oral health care priority among nursing staff. A Dental Coping Beliefs Scale (DCBS) index was used in an intervention study and was found to be easy to handle but did not have the ability to reveal significant differences in small study samples. A development process consisting of added items and item numbering by chance was carried out. During this process, different nursing staff test groups were used. The aim was to develop an oral health care priority index that can be used both on hospital wards and at special facilities to measure oral health care priority among nursing staff over time and between groups. Material and methods: Nursing staff at both special facilities and hospital wards and nursing students. Results: It was found that the index, the nursing DCBS, was more stable compared with the version that was used in the initial intervention study. It was also noted that its ability to discriminate between the items was improved. Conclusion: The nursing DCBS index is a suitable tool for use in further studies where the aim is to measure how different nursing staff groups give priority to and allocate responsibility for oral health care, even where study samples are small.     

Maternal behaviors of gray whales (Eschrichtius robustus) on a summer foraging site

The weaning period for gray whale (Eschrichtius robustus) calves is important for maternal instruction and learning. We examined observational and acoustic data from a foraging site for evidence of calf development and mother-young information transfer. Site survey data demonstrated an initial prioritization of calf protection by using shallow shoreline areas. Foraging in more open water was only noted in late summer, perhaps an indicator of the maturation of the calf. Other indicators of development were found in acoustic recordings made over two summers. Motherese call types have been reported from recordings made in breeding lagoons, but have not before been described outside of calving regions. They were present in recordings from this study site, predominantly in the early summer and not heard past late July. We suggest vocal repertoire may evolve as the calf ages, and more adult calling behaviors eventually replace motherese. Long-term mark-recapture analyses demonstrated a high return of calves to the area to forage in summers subsequent to weaning, suggesting maternally inherited prey preference and site use behaviors. From our findings we suggest a calf's first summer is a highly critical period for development and may be formative in shaping future behaviors and habitat use patterns.     

层级护理管理模式在临床护理中的应用

科室层级护理管理模式是护理质量控制的重要组成部分,对科室和全院的护理质量建设起到极大的推动作用。在立足医院科室层级管理模式的基础上,简单介绍临床层级护理模式,并探讨相应的管理对策和建议。     

Oral care training in the basic education of care professionals

doi:10.1111/j.1741‐2358.2009.00304.x
Oral care training in the basic education of care professionals Objective: To investigate the quantity and quality of oral care training in the basic education of future long‐term care (LTC) professionals in Norway. Background: The level of oral hygiene has often proved inadequate in LTC facilities. It has been maintained that this could be due to insufficient knowledge of oral care among care professionals. Materials and methods: A self‐administered questionnaire was sent to all 270 schools in Norway which offered basic education of LTC personnel in 2004/05. Information on theoretical and practical oral care training, scope of oral care in teaching material and curriculum, educational background of the teaching staff and schools opinion regarding adequacy of their training programme was collected. Results: Of the 203 respondents (75% response rate), 188 (participants) included oral care in their educational programme. Approximately two‐thirds of the participating schools provided 3 h or more of oral care training and many of the important themes were presented in the textbooks that were recommended. Moreover, the practical exercises performed in practice placement supplemented the knowledge. Conclusion: The results could not confirm that LTC professional’s basic education concerning oral care was inadequate. There may therefore be other explanations for the poor oral hygiene in many LTC facilities.     

Tactics of care for young infants by forest-living ruffed lemurs (Varecia variegata variegata): Ground nests,parking, and biparental guarding

Over a 4 month period, systematic and ad libitum observations were conducted on two adult female black-and-white ruffed lemurs (Varecia variegata variegata) and their infants in a 3.5 ha forest enclosure. The females were mother and daughter, members of a family group that had been semifree-ranging for 2 years and 3 months at the time of the births. One to two weeks before parturition, the females independently constructed nests, in which they kept their infants during the first few weeks following parturition. The older mother, cage-reared herself, prepared at least one nest. Her daughter, who has lived in the forest since late juvenescence, prepared at least four. Two to three weeks after parturition, the mothers moved their infants high into trees. During periods of maternal absence, the infants were often alone, and they rarely or never moved, vocalized, or groomed themselves. The mothers often kept their infants together after nests were no longer used. Each infant nursed freely from both lactating females. The infants were carried orally only by their mothers and were never transported by clinging to the pelage of any group members. Previously, researchers suggested that ruffed lemurs build nests for care of infants high up in trees. The present observations, however, suggest that two major modes of neonate care in Varecia exist: serial use of multiple ground nests and “parking” of infants high in trees. Advance preparation of several nest sites, relative lack of large predators, alternate maternal and paternal guarding of infants, infant immobility during absence of mother, and rapid infant development make this tactic of care for neonates plausible.     

Observations of maternal-infant interactions in a captive herd of sable antelope (Hippotragus niger)

The New York Zoological Society's captive-breeding program on St Catherine's Island, Georgia, includes a herd of sable antelope (Hippotragus niger). Two aspects of mother-infant interactions, nursing and hiding, are described herein. Three younger calves, up to 6 d of age, and three older calves, 8 to 50 d of age, were the subjects of focal-animal and continuous observations and instantaneous time-point samples. Two of the younger calves were born to multiparous cows. One cow was primiparous. Between the three calves, quantitative differences in nursing episodes were found in the mean duration (1.7–3.6 min), mean number per d (1.0–8.6 episodes), and mean total time per d (2.6–14.6 min). Despite these differences, all calves thrived. The multiparous cows exhibited a pattern described in captive and wild ungulates: approaching their calves prior to nursing before the calves emitted any response; and nursing their calves early and late in the day. The cows also exhibited nursing-time synchrony. Three instances of calves suckling younger calves' mothers are also described. Two new interpretations of the function of hiding behavior are offered: (1) If older calves exploit the inexperience of newborn calves by nursing from their mothers, then younger calves may benefit by hiding out of the view of other herd members. Hiding behavior may result from intercalf competition; and (2) if newborns vacillate between arousal-increasing and arousal-reducing activities, then “hider” species may hide to attain arousal-reduction.     

Oxytocin receptor is not required for social attachment in prairie voles

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