ICU护士严重感染和感染性休克治疗指南的培训效果

目的了解ICU护士对《严重感染和感染性休克治疗指南》相关知识的掌握程度,评价集中专题知识培训的效果。方法以指南内容为基础对我院ICU护士进行集中培训,并采用问卷调查了解培训前后护理人员对感染性休克复苏治疗相关知识的掌握程度。结果本组ICU护士对指南内容的知晓率培训后较培训前提高28．5％;培训前后总分及4个方面得分的比较,培训前总分为（14．50±3．53）分,培训后为（16．08±4．29）分,差异有统计学意义（P〈0．05）。结论ICU护士对严重感染和感染性休克治疗相关知识的掌握程度不够,进行相关知识的培训可提高护理人员对知识的掌握程度。     

参与手术医务人员深静脉血栓认知的调查

目的调查参与手术的医务人员对深静脉血栓（DVT）相关知识的掌握程度、术中预防意识及预防措施落实情况。方法采用调查问卷方法调查195名参与手术的医务人员对下肢DVT相关知汉的掌握程度、术中预防意识及措施落实情况。结果共发放问卷195份,回收有效问卷192份,回收有效率为98％。参与手术的医务人员DVT知识平均得分为（14．00±3．26）分,其中DVT发病机制、术中DVT危险因素分项的得分较高,分别为（0．72±0．20）,（0．67±0．23）分,DVT临床表现和术中有效预防措施得分较低,分别为（0．56±0．21）,（0．62±0．23）分;不同科室、职称、年龄的调查对象DVT知识得分不同,差异均有统计学意义（F分别为5．090,5．113,3．493;P〈0．05）;不同学历的调查对象DVT知识得分不同,差异有统计学意义（t=2．613,P〈0．05）;192名医务人员DVT知识的来源分别为工作经验、自学理论、专业培训,分别为59．9％,35．4％,27．6％的医务人员希望通过课堂讲授、病例讨论、实战训练的方式得到DVT知识。结论应在继续教育中加强手术医务人员DVT知识培训,制定出统一的预防方案和指南,进一步完善预防措施。     

实习护生骨质疏松症知识的调查与分析

目的了解实习护生骨质疏松症知识现状，分析影响骨质疏松症知识水平的相关因素。方法采用便利抽样的方法，抽取北京市某三级甲等医院的164名实习护生作为研究对象，运用自行设计的骨质疏松症知识问卷调查。结果实习护生骨质疏松症知识得分（14．71±3．66）分，属于中等水平，其中运动知识答对率最低（49．86％），危险因素知识答对率最高（61．55％）；不同学历实习护生骨质疏松症知识得分差异具有统计学意义（F=4．394，P=0．014）；临床实习时间与骨质疏松症知识得分呈正相关。结论实习护生骨质疏松症知识不足，提示护理管理人员和教育者在学校应积极开展有关骨质疏松症的教育，使护生能够掌握相关知识，并能在实习期间加以强化，从而更好地进行自身预防，为患者提供相关的健康教育。     

对临床护士糖尿病知识认知误区的调查

目的探讨临床护士对糖尿病知识的认知误区,为更好地实施有针对性的培训对策提供依据,以提高临床护士对糖尿病患者的护理及教育的能力。方法采用自行设计的糖尿病知识问卷对60名临床护士进行问卷调查,统计不同情况护士的糖尿病知识认知情况。结果60名护士问卷总答对率82．7％,平均答对14．07题;不同护龄及学历问卷得分差异无统计学意义（P〉0．05）;随着职称升高,得分逐渐降低,差异具有统计学意义（F=32．59,P〈0．01）;100．0％的护士能答对“严格控制血糖可以预防或延缓糖尿病并发症的发生”、“糖尿病饮食治疗的原则是合理控制总热量”等题,但只有58．3％的护士答对“糖尿病的治疗主要是控制血糖”及56．7％答对“运动持续时间”。结论临床护士对糖尿病知识存在认知误区,在进行糖尿病健康知识培训时应有针对性的解决普遍存在的问题,提高临床护士健康教育的正确率。     

儿科护士疼痛知识掌握情况的调查及分析

目的：了解儿科护士对疼痛知识的掌握情况，探讨提高儿科护士疼痛知识的方法。方法：采用Margo McCaffery的“疼痛知识与态度调查表”及自行设计的5题有关小儿疼痛知识题，对98名儿科护士进行了有效调查。结果：20题总答对率仅为33．88％，但在学历上本科护士得分较其他组护士高，平均答对率85％；在职称上主管护师以上得分较其他组护士高，平均答对率为81．07％；在科室分组上，儿外科护士得分较其他组高，平均答对率73．21％。MargoMcCaffery设计项目15题的总答对率仅为：38．09％．自行设计项目5题的总答对率仅为：21．23％。结论：大部分儿科护士对疼痛知识缺乏，尤其是对小儿疼痛知识更为缺乏，应当多种途径加强对儿科护士进行疼痛知识的培训，提高儿科护士疼痛知识水平，使其能胜任小儿疼痛管理，积极参与小儿疼痛的处理。     

长春市社区老年人糖尿病相关知识及影响因素调查

目的了解长春市社区老年人对糖尿病（diabetes mellitus,DM）相关知识的认知状况及其影响因素,为制订针对性的健康教育对策提供依据。方法采用问卷调查法对长春市385名社区老年人DM相关知识认知水平及其影响因素进行调查。了解社区老年人DM相关知识认知状况及其影响因素。结果社区老年人对DM典型症状、饮食及治疗知晓率较高,分别为74．0％、80．8％、75．8％,对DM的高危行为及并发症知晓率较低,分别为52．7％、25．7％;文化程度、经济收入以及疾病状态是老年人认知糖尿病相关知识主要影响因素,呈现文化水平越高、经济收入越高、疾病状态的老年人其相关知识回答正确率越高的趋势。结论社区老年人缺乏全面的DM知识,对于疾病的预防及控制极为不利,应加强老年人DM相关知识宣教,达到有效预防和减缓老年人DM及其并发症的发生。     

临床护士对深静脉血栓形成的认识及预防护理现状调查

[目的]调查临床护士对下肢深静脉血栓形成（DVT）相关知识的掌握程度及措施落实情况。[方法]采用问卷调查法评估北京市某三级甲等综合医院122名临床护士对下肢DVT知识掌握及措施落实情况。[结果]临床护士DVT相关知识、基础知识、预防知识、致死性并发症、各危险分度人群相应预防措施知识、药物预防知识,得分率〈60％者分别为41．0％、18．9％、68．9％、87．7o,4、96．7％、78．7％,有23．8％的护士措施落实情况得分率≥80％。经单因素方差分析得出,护理DVT病人例数不同的护士,相关基础知识、预防知识得分不同（F值分别为4．069、8．387）。经一元线性相关与回归分析得出,自变量基础知识与因变量预防知识具有相关性（r=0．422,P〈0．01）;自变量知识总得分与因变量措施落实情况得分具有相关性（r=0．222,P〈0．05）。[结论]临床护士DVT相关知识掌握及措施落实情况均较差,管理者应加强对临床护士DVT相关知识的继续教育。     

上海市郊县基层医生慢性阻塞性肺疾病规范诊疗知晓情况调查

目的调查上海市郊县基层医生对慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）常识及规范化诊疗的知晓情况。方法参照中华医学会呼吸病学分会制定的《COPD诊治指南（2007年修订版）》和2007年《全球COPD防治创议》的内容设计问卷,随机对上海市崇明县1家二级乙等综合性医院和8家社区卫生服务中心内科医生进行问卷调查,调查内容包括COPD概念、诊断标准、病情分级、规范治疗方案等。结果共发放问卷106份,回收106份,回收率100％。结果显示,96．2％的调查对象不知道我国《COPD诊治指南（2007年修订版）》相关内容,对COPD和COPD急性发作概念的知晓率分别为20．8％、15．1％,对COPD诊断标准和严重程度分级的知晓率分别为11．3％、1．0％。在规范化治疗方面,65．1％的医生无指征滥用抗生素,10．4％的医生对喘息患者予吸入β2受体激动剂,无应用吸入抗胆碱能药物的医生。诊疗过程中主动劝吸烟患者戒烟者仅为19．8％。结论基层医院医生对COPD缺乏认识,对COPD患者诊疗存在严重问题,我国基层医生COPD知识及规范化诊疗亟待加强。     

糖尿病患者足部护理知识与行为的调查

目的调查糖尿病（DM）患者足部预防护理知识与行为状况,为加强DM足患者的健康教育提供参考。方法采用自设问卷,对50例DM足患者和48例未发生DM足患者进行DM足危险因素、相关知识以及足部护理行为进行调查。结果DM组患者危险因素得分（5．82±2．27）,相关知识得分（5．82±2．27）,足部护理行为得分（5．44±2．56）,与非DM组三项得分（6．23±2．90）,（7．71±2．94）,（8．40±2．88）比较,差异均有统计学意义（t分别为2．49,3．55,5．38;P〈0．05或P〈0．01）;两组患者危险因素情况、DM足相关知识情况及足部护理行为情况比较差异均有统计学意义（P〈0．05或P〈0．01）。结论医护人员应加强对DM患者DM足知识的健康教育,减少相关的危险因素,使其建立健康的足部护理行为,减少DM足的发生。     

护士对静脉采血检验分析前质量控制知识的现状调查

目的了解护士对静脉采血项目检验分析前质量控制知识的掌握程度。方法采用自行设讣的“静脉采血检验分析前质量控制调查问卷”埘116名在岗护士进行问卷调查。结果静脉采血知识得分为（40．25±4．70）分;不同学历、职称、是否参加过静脉采血相关知识培训的护士得分比较差异无统计学意义（P〉0．05）,但不同年龄、护龄、科室的护士得分比较差异具有统计学意义（P〈0．01或P〈0．05）。结论护士缺乏足够的静脉采血相关知识,应加强临床护士静脉采血的继续教育及在校护生的静脉采血知识基础课程的教育。     

Incidental findings: A practical protocol for reporting elevated depressive symptoms in behavioral health research

Intervention studies conducted in caregivers often focus on improving mental health. Consequently, researchers may discover incidental findings like elevated depressive symptoms. Researchers have an ethical obligation to report incidental findings to participants, but no protocols exist for reporting behavioral health symptoms. The purpose of this paper was to describe a protocol for reporting elevated depressive symptoms to participants, based on the protocol used in a national randomized clinical trial of stress-reduction methods for 348 grandmothers raising grandchildren. Each questionnaire included the CES-D scale, and was scored immediately after completion. We established a cut-off score of 30 based on previous research. A registered nurse on the research team called participants with scores over 30 and ascertained whether the participant 1) was aware of the problem and 2) had sought help, and then offered additional resources. Overall, 94 (27%) participants had a CES-D score > 30. The majority (91%) were aware of the problem. About a third of the participants were on medication for their symptoms, and a third were seeing a therapist. Nine participants were not aware they had depressive symptoms. This paper outlines the ethical premise for developing our protocol, details of protocol development, and discussion for how research teams can apply this protocol to their work.     

Evaluation of a training program in breast cancer nursing

A training program in breast cancer nursing was evaluated in terms of its effects on 55 nurse participants and 18 breast cancer patients who were assigned to a control or to a program group. The quasi-experimental evaluation design employed both standard and investigator-developed instruments. Pre- and posttests were used to measure nurse participants' knowledge and attitudes and appraisal of usefulness and satisfaction with the program. Effect on patient outcomes was measured by means of a Perception of Care Questionnaire, a Breast Cancer Knowledge Quiz, and the Multiple Affect Adjective Checklist. In the cognitive and attitude domains, nurse participants improved significantly and appraised the program as highly useful and satisfactory. Program group patients scored significantly higher scores on the Perception of Care and Breast Cancer Knowledge Questionnaires and exhibited significantly less anxiety than control group patients. Results support the use of evaluation as a part of systematic program development. The evaluation of patient outcomes is a challenging but essential component of program evaluation.     

指南临床适用性评价实证研究:以肾移植指南临床适用性评价为例

目的通过实证研究评价《中国肾移植排斥反应临床诊疗指南》(以下简称"肾移植指南")的适用性,建立指南临床适用性评价的数据分析和结果报告模型,为指南的临床适用性评价和更新提供参考依据。方法采用横断面调查方法,调查国内已开展肾移植工作的医疗机构16家,每家医疗机构抽取肾移植科或相关科室医生6~8人填写指南适用性评价问卷。描述性分析调查对象基本特征、各维度评分、指南获取途径等。采用Kruskal-Wallis秩和检验和Nemenyi检验进行多组比较和两两比较,采用多重线性回归方法并结合逐步回归模型筛选出各评分的影响因素。结果本次调查发放了128份问卷,共收集有效问卷105份,有效回收率82.03%。本次调查对象均为公立三级医院从事肾移植专业的医生,平均工作年限为10.95年。评分结果显示,该指南可获得性评分最低,可接受性评分最高。多组比较和多重线性回归分析结果显示,专科医生对指南熟悉程度是各评分的影响因素(P<0.05)。专科医生指南获取途径主要为生物医学文献数据库(73.3%),专业学术期刊(55.2%),学术会议(55.2%)。认为指南存在实施障碍的专科医生有44名(41.9%),认为实施障碍为环境因素的有40名(38.1%)。结论肾移植指南整体适用性评价结果较好,但该指南在宣传和推广方面仍有待提高。建议指南更新时可考虑在指南中加入获取指南的途径,增加免费公共信息推广,通过指南培训项目,使临床医生熟悉指南内容,从而促进指南的普及、推广和应用。     

Knowledge of inter-facility transport among emergency nurses in Hong Kong: a questionnaire survey

INTRODUCTION: Inter-facility transport (IFT) is a dynamic process and its quality largely depends on pre-transport preparation, emergency equipment support and recognition of possible en route adverse events. This study aims to evaluate knowledge of IFT among emergency nurses of three Accident and Emergency Departments in Hong Kong. METHODS: Questionnaires were distributed to registered nurses of the three departments. Data was sought on participants' characteristics, knowledge on equipment preparation and management of en route adverse events. Four clinical IFT scenarios were set for participants and answers were scored. Measured outcomes were defined as (1) relationships between clinical experience and relevant training in IFT with questionnaire results, (2) staff knowledge of the equipment carried routinely in ambulances and (3) the en route adverse events encountered according to the participants' past experience. RESULTS: Participants' test scores ranged from 24 to 37 (out of 40) with a mean of 30.6 (95% confidence interval 29.7-31.5). Participants with more clinical experience demonstrated significantly better test scores (p<0.05). Most participants were familiar with the monitoring devices carried in ambulances but were less familiar with the pharmacologic agents and airway devices available routinely in Hong Kong ambulances. Thirty participants (59%) had encountered en route adverse events in the past. CONCLUSION: Nurses in emergency departments in Hong Kong have good knowledge of IFT. Extensive clinical experience is related to better IFT knowledge. IFT training for nurses should emphasize available ambulance service resources and capabilities.     

Knowledge and attitudes of primary care nurses and midwives towards health promotion in rural South Africa

This study was designed to study knowledge, attitudes and views about health promotion among nurse clinicians in rural South Africa. The sample included 90 nurse clinicians (73 primary health care nurses and 17 midwives) in the age range of 24 to 59 years (M age 38.4 yr., SD = 9.3) in the Northern Province. Results indicate that nurses (66.6%) had an inadequate knowledge score on health promotion in this sample. Higher knowledge scores on health promotion were not associated with age and years of experience. However, male nurses had significantly higher knowledge scores on health promotion than female nurses. The majority strongly supported the centrality of their role in health promotion acknowledging the time constraints involved. Better knowledge on health promotion was associated with more positive views on health promotion. More nurses had a satisfactory positive attitude towards health promotion (63.3%) than knowledge about health promotion (33.3%). Finally, the study found that compliance with health promotion was seen as a problem but health counselling was nevertheless seen as cost effective.     

Registered nurses' knowledge about diabetes mellitus

Level of knowledge was tested in 137 volunteer registered nurses in three hospitals in the Midwest. A 34-item multiple choice Diabetes Knowledge Test (DKT) was developed by the first author (S.D.S.) working with a panel of expert nurse diabetes educators. Reliability using coefficient alpha was 0.61. Staff nurses obtained a mean score of 25.3, or 74% correct. Thirty-four nurses (25%) scored above 80% correct; 62 (45%) scored between 70% and 79% correct; and 41 (30%) scored below 70% correct. Higher-scoring nurses did well on items requiring use of exchange lists, but they missed items on physiologic actions of insulin, side effects of sulfonylureas, where insulin should be stored, and areas of the body suitable for injections of insulin. Nurses who scored below 60% on the test consistently missed items requiring use of exchange lists, effects of regular exercise and illness on blood glucose, and symptoms and causes of hypoglycemia and hyperglycemia. A strong trend (P = 0.055) was found for surgical nurses to score lower than medical unit nurses, and significant differences (P less than 0.05) were found among scores between hospitals. Staff nurses employed in a hospital where clinical specialists also were employed to teach diabetic patients had the lowest scores of the three hospitals. Test content subareas should be developed in the future to test knowledge reliably about urine testing, use of oral medications, home blood glucose monitoring, effects of exercise, and Somogyi phenomenon. A curriculum for regular inservice should be developed for nurses to assure a high level of knowledge for patient teaching with diabetes patients.     

Thromboprophylaxis in ENT patients: A national survey

The aim of this survey was to establish whether ENT departments in England follow British Medical Journal guidelines on thromboprophylaxis. A telephone survey of doctors in 80 ENT departments was used to present six clinical scenarios. The participants were asked what their local department routinely did. They were also asked whether they were aware of a local or national thromboprophylaxis policy. For patients undergoing procedures other than major head and neck procedures, compliance was poor and ranged between 7.5% and 37.5%. For laryngectomy, the rate was 82.6%. There was no statistical difference in answers given by doctors of different levels of seniority. Where local thromboprophylaxis guidelines exist, compliance is found to be statistically better. These results suggest that most ENT departments do not follow national or local guidelines on thromboprophylaxis. Greater awareness of existing guidelines is required.     

集束化管理策略在患者安全集体转运中的应用

目的探索科学有效的患者安全转运管理方法,保证患者集体转运的安全。方法采用集束化管理策略,组织16个科室共277例患者集体转运,成立集束化安全转运组,制订转运风险预案,相关部门间紧密合作,转运前做好设施保障准备及人员准备;转运中做到一站式服务;转运后及时收集反馈意见进行总结。结果顺利完成16个科室277例患者新病房安全转运任务,未发生医疗护理差错事故,保证了患者安全;患者满意度达96.75%。结论集束化管理策略可以将多项措施整合以发挥最大效应,填补了指南与临床实践的间隙,在患者安全转运管理中具有优势,是保障患者安全的有效方法。     

Multidimensional problems among advanced cancer patients in Cuba: awareness of diagnosis is associated with better patient status

Cancer is one of the major causes of death in Cuba, and in current practice, patients are not usually informed of their diagnosis. Palliative care is an emerging discipline in this country. Cuban cancer patients with advanced disease completed the Palliative Outcome Scale (POS), and the researcher elicited patients' knowledge of their condition and prognosis. The POS consists of 12 items that address the clinical, psychosocial, spiritual, family, and service delivery elements considered relevant to patients with advanced disease. Ten items are scored 0 (no problem) to 4 (worst problem), with one open-response question about the main problems experienced and one question about whether the questionnaire was completed with help or alone. Mann-Whitney tests were used to compare POS item scores by patient awareness. Of the 91 patients who participated in the study, 41% knew they had cancer and 9% were believed to be aware that they were dying. The most burdensome problems recorded on the POS were wasted time on appointments (70% of patients scored 3 or 4), pain (42%), patient anxiety (39%), and family anxiety (37%). Those patients who were aware of their diagnosis had statistically significantly better scores with respect to symptoms, patient anxiety, receiving information, and receiving support from family and friends. This study adds to knowledge about characteristics of terminal cancer patients in Cuba and the factors contributing to patient burden. It is the first study to explore the palliative care needs of Cuban patients with advanced cancer. An association has been demonstrated between patient knowledge and quality of life in Cuba, a setting where disclosure is contrary to current clinical practice.