新护士规范化培训初期职业认同及留职意愿调查分析

目的了解新护士规范化培训初期的职业认同感、留职意愿及影响因素。方法采用护士职业认同量表及留职意愿量表对179名规范化培训初期的新护士进行问卷调查。结果新护士规范化培训初期的职业认同总分114.56±13.25,留职意愿总分23.30±3.28。规范化培训科室与意向科室是否一致、专业选择方式、意向职业方向、职业自我反思、职业社交技能是新护士留职意愿的主要影响因素(P0.05,P0.01)。结论新护士规范化培训初期职业认同有待提高,并在一定程度影响留职意愿。护理管理者应加强新护士对自身职业的肯定,以增强其留职意愿,稳定护理队伍。     

临床护士留职意愿与职业疲溃感的相关性研究

目的了解临床护士留职意愿和职业疲溃感相关性,为护理管理者制定留职策略提供参考。方法采用护士留职意愿问卷和职业疲溃感量表对大连市3所综合性医院的458名临床护士进行问卷调查。结果临床护士留职意愿总分22.12±4.41;情感耗竭、去人格化、个人成就感得分分别为27.80±11.44、8.05±6.40和35.81±8.24;临床护士留职意愿与情感耗竭、去人格化呈显著负相关(P0.01),与个人成就感呈显著正相关(P0.01);职务、情感耗竭、去人格化以及个人成就感是护士留职意愿的主要预测因素(P0.05,P0.01)。结论临床护士留职意愿受职业疲溃感的影响,管理人员应通过降低护士职业疲溃感来强化其留职意愿,以促进护理团队的稳健发展。     

80后护士工作嵌入与留职意愿的相关性分析

目的了解80后护士工作嵌入、留职意愿现状,探讨两者之间的关系,为管理者形成护士留职意愿干预策略提供参考。方法抽取哈尔滨市4所三级甲等医院的332名护士,采用护士一般情况调查表、工作嵌入量表、护士留职意愿量表进行问卷调查。结果80后护士工作嵌入得分(22.74±4.17)分,留职意愿得分(13.72±3.87)分;护士工作嵌入与留职意愿呈正相关(P0.01);年龄、婚姻、工作嵌入为影响护士留职意愿的主要因素(均P0.01)。结论护士工作嵌入对其留职意愿有正向预测作用,护理管理者应制定针对性的护士留职政策与措施,以稳定护理队伍。     

护士长诚信领导行为与团队关系冲突对护士留职意愿的影响

目的探讨护士长诚信领导行为与团队关系冲突对护士留职意愿的影响。方法采用方便抽样法抽取哈尔滨市3所三级甲等综合性医院629名护士,应用诚信领导量表、团队关系冲突量表和护士留职意愿量表进行调查。结果护士感知护士长诚信领导行为得分40.64±9.85,团队关系冲突得分19.08±4.83,留职意愿得分19.32±4.25;团队关系冲突及护士长诚信领导行为的关系透明、内化道德观为护士留职意愿的主要影响因素(均P0.01)。结论护士留职意愿有待提高,可通过提高护士长的诚信领导行为,营造和谐的护理团队氛围,以提高护士的留职意愿。     

上海三甲医院护士留职意愿及影响因素研究

目的 了解上海市三甲医院住院部临床护士留职意愿的现况、探究影响护士留职意愿的因素,为优化护理人力资源管理提供依据。 方法 采用护士工作压力源量表、工作场所暴力频度测定量表、心理弹性量表和留职意愿量表,对上海5所三甲医院的1 035名护士进行调查。 结果 护士的留职意愿量表得分为（16.98±4.02）分,仅有63.19%护士愿意留在原单位。不同科室、工作年限、技术职称、临床护理角色、工作压力、工作场所暴力和心理弹性护士留职意愿得分比较,差异有统计学意义（P＜0.05,P＜0.01）。Logistic回归分析结果显示,工作年限、护士角色、工作压力、工作场所暴力及心理弹性是护士留职意愿的主要影响因素（P＜0.05,P＜0.01）。 结论 上海三甲医院住院部护士留职意愿不高,工作5~16年、承担普通护士角色、承受较大工作压力、经历工作场所暴力和低心理弹性护士应成为关注的重点人群。     

急诊科护士心理韧性、离职意愿与职业倦怠的关系研究

目的探讨心理韧性对急诊科护士职业倦怠、离职意愿的影响并建立结构方程模型,为急诊科护士管理提供依据。方法采用整群抽样,运用职业倦怠量表、心理韧性量表、离职意愿量表,对临床403名护士进行调查,运用SPSS13.0和Amos17.0统计软件包进行统计分析及结构方程模型构建。结果不同护龄的护士情感衰竭维度得分、不同学历的护士个人成就感维度得分存在统计学差异(均P0.01);不同学历的护士心理韧性得分存在统计学差异(P0.01),不同护龄、学历水平、月收入水平护士离职意愿得分存在统计学差异(均P0.01)。结构方程模型显示:心理韧性对离职意愿(λ=-0.71,P0.01)、职业倦怠(λ=-0.54,P0.01)有直接效应;职业倦怠对离职意愿有直接效应(λ=0.42,P0.01);心理韧性通过职业倦怠对离职意愿有间接效应(λ=-0.23,P0.05);心理韧性、职业倦怠共解释急诊科护士离职意愿26.46%的变异量。结论心理韧性因素对急诊科护士离职意愿有较大的影响,应运用适宜的干预措施提高护士心理韧性,从而降低职业倦怠,降低护士离职意愿,保证临床正常的护患比例。     

ICU护士道德韧性状况及影响因素分析

目的 了解ICU护士道德韧性状况并分析其影响因素,为制定针对性培养方案提供参考。 方法 便利抽取郑州市3所三级甲等医院ICU护士322人,采用一般资料调查表、拉什顿道德复原力量表、医院伦理氛围量表、护士自我概念问卷进行调查。 结果 ICU护士道德韧性条目均分为（3.03±0.50）分。ICU护士道德韧性总分与医院伦理氛围总分、专业自我概念总分呈正相关（均P＜0.01）。多元线性逐步回归分析显示,ICU工作年限、接受过道德伦理课程培训、医院伦理氛围、专业自我概念是ICU护士道德韧性的影响因素（均P＜0.05）,共解释总变异的49.6%。 结论 ICU护士道德韧性处于中等偏上水平,护理管理者可多关注ICU工作年限较低的护士,加强医院伦理氛围营造,提升ICU护士专业自我概念水平,针对性制定道德韧性培养方案,从而提升ICU护士道德韧性水平。     

护士留职意愿质性研究的Meta整合

目的 对护士留职意愿的质性研究进行Meta整合，为护士留职策略的制定提供参考。方法 计算机检索PubMed、Medline、Embase、Web of Science、PsycINFO、中国生物医学文献数据库、中国知网、维普和万方数据库，收集从建库至2023年4月期间关于护士留职意愿的质性研究文献。采用JBI循证卫生保健中心的质性研究质量评价标准及混合方法评价工具进行文献质量评价，并使用Meta整合分析。结果 共纳入13项研究，提炼出65个研究结果，归纳为13个新类别，得到4个整合结果，分别是护理专业吸引力(护理专业性、职业发展前景和职业认可度)、护理岗位吸引力(岗位匹配性、岗位稳定性、薪酬水平和家庭工作平衡)、工作环境吸引力(物理环境、与患者和家属的联系、团队合作和氛围、管理)和个人特质(个人特性和内在应对)。结论 护士留职意愿对解决护理人力资源短缺问题有重要意义。管理者需要重视影响护士留在护理行业的因素，从护理专业、护理岗位和工作环境等层面制定针对性的策略，以提升护士的留职意愿。     

太原市三甲医院临床护士主观幸福感与自我概念的相关性研究

目的探讨三甲综合性医院临床护士总体幸福感与自我概念之间的相关性。方法采用总体主观幸福感量表(GWB)和田纳西自我概念量表(TSCS)对太原市2所三甲综合性医院193名临床护士进行随机抽样调查。结果三甲综合性医院临床护士主观幸福感评分为(106.33±13.49)分,自我概念总分为(252.59±20.01)分,两者呈显著正相关(P<0.01);自我概念是临床护士主观幸福感的主要预测因素(P<0.01)。结论自我概念是影响临床护士主观幸福感的重要因素,可以通过增强临床护士的自我概念而提高临床护士的主观幸福感,进而促进临床护士的身心健康,利于提高临床护理工作质量。     

血液净化专科护士职业认同与离职意愿的相关性

目的探讨血液净化专科护士职业认同与离职意愿的现状及相关性。方法采用职业认同量表和离职意愿量表对102名血液净化专科护士进行调查。结果血液净化专科护士职业认同得分为(39.73±7.63)分。离职意愿得分为(13.16±3.44)分,得分率为54.83%;离职意愿Ⅲ维度得分最高(得分率为71.75%);53.92%的护士离职意愿处于较高及以上水平。职业认同与离职意愿总分、离职意愿Ⅰ和离职意愿Ⅱ呈负相关(均P0.01)。结论血液净化专科护士职业认同处于中等偏上水平,离职意愿处于中等水平,其职业认同与离职意愿呈负相关。应提高护士职业认同感,降低其离职意愿,稳定护理队伍。     

Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy

Purpose

The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy.

Methods

Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability.

Results

No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis.

Conclusions

Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Level of evidence

IV.     

When to start: as soon as possible

Debate regarding “When to start” antiretroviral (ARV) therapy has raged since the introduction of zidovudine in 1987. Based on the entry criteria for the original Burroughs Wellcome (002) study, the field has been anchored to “CD4 counts” as the prime metric to indicate ARV treatment initiation for asymptomatic HIV‐positive individuals. The pendulum has swung back and forth, based mostly on the efficacy and toxicity of available regimens. In today's world, several factors have converged that compel us to initiate therapy as soon as possible: (i) The biology of viral replication (1 to 10 billion viruses/day) screams that we should be starting early. (ii) Resultant inflammation from unchecked replication is associated with earlier onset of multiple co‐morbid conditions. (iii) The medications available today are more efficacious and less toxic than in years past. (iv) Clinical trials have demonstrated benefit for all but the highest CD4 strata (>450 to 500 cells/µL). (v) Some cohort studies have demonstrated clear benefit of ARV therapy at any CD4 count, and almost all cohort studies have demonstrated no detrimental effects of early treatment. (vi) In addition to the demonstrated and inferred benefits to the individual patient, we now have a public health benefit of earlier intervention: treatment is prevention. Finally, from a practical/common sense perspective, we are talking about life‐long therapy. Whether we start at a CD4 count of 732 or 493/µL, the patient will be on therapy for over 40 to 50 years! There does not seem to be much benefit in waiting, and there is likely to be significant long‐term harm. Treat early!     

Percutaneous dilatational tracheostomy is as safe as open tracheostomy

Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. OT was performed in the operating room whereas PDT was performed in intensive care units (ICUs). PDT was performed by surgeons and medical intensivists under a strict institutional policy and procedure governing patient selection and conduct of the procedure. Complications were defined as bleeding, loss of airway, hypotension, hypoxia, tracheostomy tube malposition, subcutaneous emphysema, infection, and conversion of PDT to OT. All patients survived the operation. PDT and OT had similar complication rates: 2.1 per cent for PDT versus 2.8 per cent for OT (P = not significant). Postoperative bleeding, which was the most frequent complication, occurred in one PDT patient and four OT patients. One PDT patient required conversion to OT as a result of extensive tracheal fibrosis. Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.