新形势下整体护理在护生临床带教中的应用

在新形势下，随着社会的发展，人民生活水平的日益提高，健康保健意识的逐渐增强，社会医疗保健需求不断增加，护理模式已由单纯对生物的人进行护理转变为对生物、心理、社会整体的人提供身心系统化的整体护理，以满足患者的需要，解决患者的健康问题为原则。     

PDCA整体护理带教模式的探讨

将PDCA程序与整体护理相融合,并且运用于教育,使护生能运用护理程序进行护理诊断,同时还要培养护生的现代思维方式,充分发挥护生潜在的才能,激发护生的主动性、积极性和创造性,培养出合格的临床实用型护理人才。     

改进临床护理带教模式提高护生实习质量

培养高素质护理人才,对提高护理质量具有重要意义。护理是一门以实践为主的学科,临床教学是护理教育的重要组成部分。如何适应医学发展要求,培养合格的高素质护理人才是医院护理管理者及临床带教老师值得深思的一个问题。因此,改革教学方法、提高临床护理带教质量,对培养实用型护理人才有重要意义。     

浅谈护理程序的工作方法在护生带教中的应用

目的探讨护理程序的工作方法在实习护生带教中的应用。方法将整体护理的思想运用于护生的带教工作中,以护生为中心采用评估、诊断、计划、实施、评价的程序,实施“因人施教、因材施教”的个案化带教。结果在该带教方案实施的几年中护生的考核成绩呈现上升趋势,实习质量得到了提高,护生及校方对该方法表示认同。结论护理程序的工作方法在护生的带教工作中是可取的。     

整体护理在临床带教中的应用体会

为了适应护理模式的改变,培养具有综合素质的人才,护理教育观念随之改变,在临床带教中针对护生的特点把整体护理观念融入其中,在教学中通过融新的护理观念于教学中;强化基本技能的训练;注重沟通技能;加强护生素质教育一系列的有效举措,经长期的临床实践,取得一定的效果,能得到护生的欢迎.     

论临床护理带教中的协同作用对护生综合能力的影响

随着医疗护理水平的不断提高，医院对于护理实习生的综合能力要求也越来也高。作为临床带教的主体，带教老师，实习护生之间有多种层面的关系需要重新梳理，如教与学的关系，知识与能力的关系，带教内容和形式的关系，个体与团体的关系，知识理论与实践操作的关系，带教和育人的关系。只有这些关系相互作用，相互协调（称之为协同），才能实现临床护理带教工作的顺利进行，为提高护生综合能力打下基础。     

论临床护理带教中的协同作用对护生综合能力的影响

随着医疗护理水平的不断提高,医院对于护理实习生的综合能力要求也越来也高。作为临床带教的主体,带教老师,实习护生之间有多种层面的关系需要重新梳理,如教与学的关系,知识与能力的关系,带教内容和形式的关系,个体与团体的关系,知识理论与实践操作的关系,带教和育人的关系。只有这些关系相互作用,相互协调(称之为协同),才能实现临床护理带教工作的顺利进行,为提高护生综合能力打下基础。     

探索优质护理带教模式在儿科实习护生带教中的应用效果

目的探索优质护理带教模式在儿科实习护生带教中的应用效果。方法选取2017年9月-2018年9月该院儿科实习护生84名,随机分为传统带教模式的对照组(42名)与优质护理带教模式的观察组(42名),观察护生考核成绩、综合能力、护生满意度、带教质量。结果与对照组相比,观察组理论成绩、操作成绩及综合能力评分高,护生满意度高,带教质量高,差异有统计学意义(P<0.05)。结论在儿科实习护生带教中应用优质护理带教模式,能提高护生考核成绩,提升综合能力,有利于带教质量的提高,这种带教模式得到了护生认可,值得借鉴。     

加强手术室护生的带教工作 提高实习护士的综合能力

本文就做好带教老师的选拔工作，重视护生良好医德的培养、加强护生实践能力的培养及加强出科考核工作等方面进行了探讨．为全面提高实习护生的综合能力起到了抛砖引玉的作用。     

做好急诊护生临床带教的体会

我院是一所综合性医院,每年承担着卫校部分护理专业学生(护生)的实习带教任务,急症科是临床实习的重要科室。针对他们实习时间短,而急诊护理工作涉及面广、病人发病急、病情变化快等特点,为使他们在较短的时间内迅速把课堂上学到的理论知识应用到实践中去,了解并掌握急症科常见病急救知识和技术操作,我们     

Comprehensive Literature Review of Factors Influencing Medication Safety in Nursing Homes: Using a Systems Model

Objectives

The objectives of this review were to identify the work system factors influencing medication safety measures [adverse drug events (ADEs), adverse drug reactions, or medication errors (MEs)], to determine the incidence of ADEs, and describe the most common ADEs in nursing homes (NHs).

Using Evidence to Improve Evaluation: A Comprehensive Psychometric Assessment of a SP-Based OSCE Licensing Examination

Background: Bridging the theory of psychometric assessment to an evaluation instrument is a challenging and continuous task. Such a task was completed for the SP-based OSCE licensing examination used in Quebec since 1990.Purpose: To review the comprehensive series of psychometric studies undertaken on the examination based on the theory of psychometric assessment. Methods: The examination is a 5.5 hour-long OSCE composed of 26 clinical cases of7, 10 or 15 minutes' duration. Candidates' total scores and case scores are used for licensing decisions. Reliability coefficients were obtained as well as generalizability studies to assess the impact of examination sites (4), tracks (14) and languages(French and English) on candidates' results. Its content validity was assessed by experts as well as by practicing family physicians, examiners and exam coordinators. Concurrent validity was assessed. Through differential item functioning (DIF)statistical approach, possible gender biases were analyzed. The predictive validity of the examination scores on selected aspects of practice was analyzed as well as the impact of the examination on the teaching and learning process.Results: These studies confirmed the validity, reliability and generalizability of the examination scores. No biases were demonstrated. Examination scores predicted elements of practice. Educational impact was present.Conclusion: This study confirmed the quality of the examination, ensured its continuous improvement and supported the inferences made from the examination results. This revised version was published online in June 2006 with corrections to the Cover Date.     

Using Criteria-Based Audit to Improve the Management of Postpartum Haemorrhage in Resource Limited Countries: A Case Study of Malawi

Objective The goal of this study was to assess and improve the management of postpartum haemorrhage (PPH) in maternity units in Malawi. The main objective was to determine whether criteria-based audit can improve adherence to standards for the management of PPH. Methods We used a before-and-after design and univariate statistics for data analysis. A retrospective review of 40 consecutive cases of PPH was conducted in eight hospitals and the results compared with standards for PPH, established based on World Health Organisation manuals. Results of the audit were presented to healthcare providers who made and implemented recommendations for improvement. A re-audit (45 cases) was conducted 3 months later. Results There was a significant improvement in adherence to three standards: typing and cross-match carried out (65.0% vs. 84.4%; P = 0.034), patient’s hematocrit or haemoglobin established (67.5% vs. 86.7%; P = 0.029), and fluid intake/output chart maintained (0.0% vs 33.3%; P < 0.001). There was no significant change in close monitoring of vital signs (32.5% vs. 53.3%, P = 0.065) and case fatality rate (10.0% vs. 6.7%, P = 0.702), intravenous access achieved and intravenous fluids administered (100.0% vs. 97.8%; P = 0.735), and oxytocic drugs administered (100.0% vs. 95.6%; P = 0.357). Conclusion Introduction of criteria-based audit can improve the management of postpartum haemorrhage in countries with limited resources. Future studies should consider using larger sample size to evaluate the effect of criteria-based audit on mortality.     

Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment,United States

Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke’s classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler–related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.     

Applicability of Aspecific Noninvasive Methods for Biomonitoring of Occupational Exposure to Deltamethrin: Preliminary Study Using an Animal Model

Deltamethrin (CAS registry No. 52918-63-5), a synthetic dibromo-pyrethroid insecticide is highly effective against a broad spectrum of insects, and is widely used on crops and in public health programs. Data on the genotoxicity and carcinogenicity of deltamethrin are rather controversial, depending on the genetic system or the assay used. The aim of the present study was to analyze previously demonstrated metabolic changes using aspecific noninvasive methods in rats which are potentially applicable for monitoring occupational exposure. Since human exposure to pesticides occurs not only to active principles but to all chemicals present in a commercial formulation, we tested both the pure compound and a deltamethrin-based commercial formulation. Groups of rats were treated, i.p., consecutively for 7 days. The daily doses tested were 5 and 10 mg/kg body weight for pure deltamethrin, corresponding to volumes of 178.57 and 377.14 μl/kg body weight for the commercial formulation (containing 2.8% deltamethrin). Urine was analyzed for mutagenic metabolites, thioethers, and D-glucaric acid content. Faeces extracts were tested for mutagenicity. Results show that DGA urinary excretion values did not mirror the phase I enzyme induction capability of the insecticide. Results obtained for urinary thioethers do not agree completely with those obtained on the influence of deltamethrin on glutathione S-transferase activity in rat liver. In fact, after administration of the deltamethrin commercial formulation, highest thioether excretion values were obtained during the treatment time for treated animals, as compared to controls. The mean values (±SEM) of thioether excretion were 0.033 ± 0.002 μmole -SH/24 h for control animals, 0.122 ± 0.004 and 0.185 ± 0.025 for the two treatment groups. Thence, thioether determination in urine samples seems to be a suitable aspecific noninvasive method for assessing exposure to deltamethrin-based formulations, particularly those containing xylene and mesitylene as solvents, as in the tested formulation. Negative or toxic results obtained in the urinary and faecal mutagenicity test seem to exclude the formation and excretion of mutagenic metabolites following treatment with deltamethrin. Received: 19 July 1996/Accepted: 27 March 1997     

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income,Predominantly Latino Urban Residents: An Agent-Based Model

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)–(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.     

Reaiming RE-AIM: Using the Model to Plan, Implement, and Evaluate the Effects of Environmental Change Approaches to Enhancing Population Health

The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, which provides a practical means of evaluating health interventions, has primarily been used in studies focused on changing individual behaviors. Given the importance of the built environment in promoting health, using RE-AIM to evaluate environmental approaches is logical. We discussed the benefits and challenges of applying RE-AIM to evaluate built environment strategies and recommended modest adaptations to the model. We then applied the revised model to 2 prototypical built environment strategies aimed at promoting healthful eating and active living. We offered recommendations for using RE-AIM to plan and implement strategies that maximize reach and sustainability, and provided summary measures that public health professionals, communities, and researchers can use in evaluating built environment interventions.The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework¹ was developed to enhance the impact of health promotion interventions by evaluating the dimensions considered most relevant to real-world implementation, such as the capacity to reach underserved populations and to be adopted within diverse settings.^2,3 Briefly, the reach dimension of the framework refers to the percentage and characteristics of individuals receiving the intervention; effectiveness refers to the impact of the intervention, including anticipated as well as unanticipated outcomes; adoption concerns the percentage and representativeness of settings that adopt the intervention; implementation refers to the consistency and cost of delivering the intervention; and maintenance refers to long-term sustainability at both the setting and individual levels (see http://www.re-aim.org for more information about the framework.).^1,4,5The RE-AIM model was intended to guide planning and evaluation of evidence-based interventions^6,7 that address the different levels of the socioecological model, such as those that target individual health behavior change by increasing intrapersonal, organizational, and community resource support.⁸ It has been used to evaluate programmatic and policy⁹ interventions addressing a wide range of health conditions (e.g., diabetes, obesity, and hypertension)^10–12 and health behaviors (e.g., physical activity, dietary behaviors, and smoking).^13–15Despite RE-AIM''s efficacy as a public health planning and evaluation framework, it has not been formally applied to interventions targeting the social or built (i.e., manmade features of the environment that provide the settings for human activity)^16,17 environment. As public health continues to expand its focus beyond surveillance and epidemiology to address root factors affecting community health, we need models that help frame the planning and implementation of multilevel health interventions and guide comprehensive evaluations of the processes, effects, and outcomes¹⁸ associated with such interventions. Holistic evaluations of changes in public spaces (e.g., changes in transportation and land use) are critical given the complexity of such changes and their strong potential to positively affect social capital and cohesion or to exacerbate social and health inequities.Here we focus on applying RE-AIM to built environment interventions, although many of the issues and recommendations are also applicable to social environment interventions, and intended or unintended social consequences of interventions are included within the RE-AIM model. Our specific goals are to provide a rationale for using RE-AIM to plan and evaluate built environment changes that promote health behavior, discuss definitions and measures of the dimensions of RE-AIM and propose adaptations to them, illustrate applications of the dimensions through examples of built environment changes, and establish practical RE-AIM summary measures for built environment interventions.     

利用综合指数测评期刊的核心著者 —— 以《中国科技期刊研究》为例

以《中国科技期刊研究》为例,依据发文量和被引量2个计量指标,利用综合指数测评其1998～2006年的核心著者。通过计算,确定出54位核心著者,70％的核心著者分布在北京、上海、陕西、河南和辽宁5个地区,杂志社（期刊编辑部）是该刊最重要的核心著者来源机构。     

A Case Study Using a Patient Satisfaction Survey to Improve the Delivery and Effectiveness of Drug Addiction Treatment Services: Marketing Implications and Organizational Impact

Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services.