The Development of the “Monitoring Application for Inappropriate Expressions in Nursing Records”for PsyNACS©

Lengthening periods of hospitalization, increasing numbers of patients with age-related complications, and a shortage of nursing staff have been of great concern in medical psychiatry in Japan. Under these circumstances, countries such as Japan that face a super-aging society and a decline in the working-age population, have been recommended for use of advanced information and communications technology (ICT) to improve the efficiency of medical treatment and care. This study aims to develop the “Monitoring Application for Inappropriate Expressions in Nursing Records” for using PsyNACS©, which will enable psychiatric nursing plans to harness the advantages of ICT. The functions considered necessary are as follows: 1) identification of users who enter information;2) a necessary database for lists of inappropriate expressions;3) development of a matching function to recommend proper writing input and a warning function;and 4) a management function for an inappropriate expression list database. A demonstration experiment for developing the application in this study was conducted at a specialized psychiatric hospital. To introduce them to the application, nurses and nurse managers were informed about the system developed in this study, and a survey regarding their opinions on the functions of the application was conducted with ten nurse managers. The results were evaluated in terms of usefulness for nursing care, documentation, and the education of nurses from an ethical perspective. This study suggests that matching their input with an inappropriate expression database will allow nurses to record more appropriate expressions. From an ethical perspective, the ability to use appropriate expressions makes records more likely to withstand disclosure requests from patients and their families.

Underlying Beliefs Influencing Vietnamese Nurses and Doctors in Screening for Victims of Domestic Violence: An Exploratory Study

Many health professionals in Vietnam have limited knowledge and experience in coordinating care for victims of Domestic Violence (DV). This qualitative study aimed to elicit the beliefs of nurses and doctors that are influencing the care of victims of DV. Data were collected by semi-structured interviews with nineteen nurses and doctors. Data were analyzed by content analysis and organized by three main themes;behavioral beliefs, normative beliefs and control beliefs. The outcomes of this study will inform the development of intervention strategies that will enable health professionals to better respond to and manage care for women who experience domestic violence in Vietnam.

Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records

The objective of the present study was to discuss patients with disturbances in consciousness by analyzing nursing records. Observations from clinical nurses as well as patients’ responses about their care were selected from nursing records. Nursing records from one week of patient care were examined for patients who were unable to speak during hospitalization within a neuro-surgery ward of the hospital. Selected records were classified into the following eight categories: results from monitoring;results from observation;opening and moving the eyes to stimulus;movement of the limbs to stimulus;vocalization to stimulus;facial expression to stimulus;patient’s response to care;and miscellaneous. Patients comprised two groups. One group encompassed eight patients with Japan Coma Scale (JCS) II and the other was a group of eight patients with JCS III. When nurses use the JCS to assess patients with disturbances in consciousness, patients who awaken to stimulus are classified as JCS II, while those who do not are JCS III. The total nursing records selected for JCS II were 1551 and 1160 for JCS III. The category of “results from monitoring” was the most selected category within nursing records and accounted for 42.8% of the JCS III group, while “results from observation” accounted for 38.4% of the JCS II group. Furthermore, results indicated that the categories of “results from monitoring”, “results from observation”, and “movement of the limbs for stimulus” had peaked after two to three days, and then abruptly decreased. There were only a few records for the categories of “vocalization to stimulus” and “facial expression to stimulus”, both for the JCS II and the JCS III groups. Even though patients could not verbally indicate their intentions due to problems with consciousness, it is essential for nurses to pay careful attention to the details of patients’ reactions.

Opportunities for nurses in the era of electronic health records

Nursing leaders are currently faced with opportunities to advance nursing’s role in the use of electronic health records (EHRs). Nurse leaders can advance the design of EHRs with nurse informaticists to improve health outcomes of individual and populations of patients.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

目的:遵循叙事循证医学理念,抽提医患共建式循证病历的理论,建立医患共建式循证病历的范本.方法:检索Pubmed等重要医学数据库,参照叙事医学的理念,咨询中西医消化内科及循证医学专家,初步达成共识.结果:本研究是一次叙事循证医学指导下医患共建式循证病历建立的有益尝试.思考与展望:医患共建式病历有可能成为叙事医学指导下的中西医合作治疗脾胃病相关疗效评价方法学体系的内容.

Nursing decision support system:application in electronic health records

The clinical decision support system makes electronic health records(EHRs)structured,intelligent,and knowledgeable.The nursing decision support system(NDSS)is based on clinical nursing guidelines and nursing process to provide intelligent suggestions and reminders.The impact on nurses’work is mainly in shortening the recording time,improving the quality of nursing diagnosis,reducing the incidence of nursing risk events,and so on.However,there is no authoritative standard for the NDSS at home and abroad.This review introduces development and challenges of EHRs and recommends the application of the NDSS in EHRs,namely the nursing assessment decision support system,the nursing diagnostic decision support system,and the nursing care planning decision support system(including nursing intervene),hoping to provide a new thought and method to structure impeccable EHRs.

Reviewing the trends of nursing doctoral thesis research in Hong Kong

This review aimed to analyze the trends and contributions of nursing doctoral theses produced in Hong Kong. A total of 56 nursing doctoral theses were included in this review. The most often studied topic was cardiovascular rehabilitation care (n = 9, 16%). More recently, the most often studied topics has been health technology advancements in nursing care (n = 6, 10.7%). The common trend of study methods was to be quantitative in nature. Of the total, 35 out of 56 were quantitative studies. Half were experimental/ quasi-experimental research studies (n = 28, 50%). For theoretical foundations or applications, the majority (n = 21, 36%) of doctoral theses had no specific theoretical/conceptual models as study frameworks. This trend indicates that there is space for improving the theoretical and philosophical foundation of nursing research in Hong Kong. For the contributions of doctoral thesis research, Hong Kong nursing scholars place more emphasis on direct enhancement of clinical practice or the improvement of patient outcomes. This review provides concrete evidence of the status of nursing research and knowledge development in Hong Kong nursing.

Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

The development of an interdisciplinary nurse educator doctoral program: Issues for consideration and goals for success

The nursing shortage is exacerbated by the faculty shortage, as faculty approach retirement age and too few faculty exist to replace them. Masters-prepared nurse with limited preparation for teaching may be unable to attend traditional educational programs because of work and family commitments. Without further academic preparation, these nurses are illprepared for the faculty role. The College of Nursing partnered with the College of Education to develop a nurse educator degree program to prepare nurses for the faculty role. Blended and online courses are provided by the Colleges of Nursing. The EdD. in Instructional Leadership for Nurse Educators degree can be completed in three years of coursework followed by dissertation research.

Awareness and Practice of Proper Health Seeking Behaviour and Determinant of Self-Medication among Physicians and Nurses in a Tertiary Hospital in Southwest Nigeria

Background: There is generally a lack of good health-seeking practices among health professionals due to a variety of factors, including the intensity of the medical practice itself. Doctors and nurses are perceived to have a good knowledge of ideal health-seeking behaviors and as such, it is important to determine the level of their awareness and estimate whether this knowledge is put into practice. This study, therefore, aimed to determine the level of awareness and practices of proper health-seeking behavior and to identify the factors responsible for self-medication among doctors and nurses in a tertiary hospital in Nigeria. Methodology: A cross-sectional descriptive study was conducted between April and may 2018 among 106 doctors and 164 nurses in a tertiary health facility in Ido-Ekiti, Ekiti State, Southwestern Nigeria. A simple random sampling technique by balloting was performed from the list of doctors and nurses in the hospital to select doctors and nurses that participated in the study. A pretested semi-structured self-administered questionnaire was designed and used to collect data. The data were entered into the computer software and analyzed using SPSS version 20. P ≤ 0.05 was taken as significant. Result: Out of 106 doctors and 164 nurses recruited, only 102 doctors and 143 nurses filled the questionnaire completely and returned for analysis. One hundred and four respondents (42.4%) fall within the ages of 31 - 40 years with a male to female ratio of 1:1.23. Awareness of proper health seeking behavior among both doctors and nurses was high among the two groups with no statistically significant difference between them. Twenty-nine (28.0%) doctors compared with thirty-four (23.8%) nurses go for a regular medical check-up with no statistically significant difference between the two groups (p = 0.411). Out of these, 5 (17.2%) doctors and 7 (23.8%) nurses visit at an interval of less than 6 month (p = 0.736). There is a statistically significant difference in the number of doctors (60.8%) compared with nurses (41.3%) that have consulted a doctor in the last one year (p = 0.003). More than half (51.6%) of this consultation among doctors was over the phone whereas 64.4% of such among nurses were via clinic appointment (p = 0.008). More doctors (90.2%) comply with their treatment prescription from physicians compared with nurses (77.6%) (p = 0.010). More nurses compared with doctors self-medicate when ill [Doctor 61.8% (63), Nurses 78.3% (112)] (p = 0.005) and had also self-medicated in the last one year [Doctor 34.3% (35), Nurses 42.7% (61)] (p = 0.187). Decreasing age, decreasing years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services are factors that significantly increased the likelihood of self-medication among doctors and nurses within the last one year. Conclusion: Awareness of proper health seeking behavior was high but this did not translate into proper health-seeking practices among doctors and nurses. There is apathy for regular medical check-up and self-medication was also high among this group of health workers. Decreasing age and years of experience, increasing working hours, lack of health insurance, fear of confidentiality and lack of satisfaction with health services were factors were identified to significantly increase the likelihood of self-medication.

Enhancers and hindrances to doctor-nurse interdisciplinary collaborative practice in Nigeria

The purpose of this study was to identify factors that enhance and hinder interdisciplinary collaborative practice (ICP) among doctors and nurses at the Nnamdi Azikiwe teaching hospital, Nnewi, southeast Nigeria. The study was a cross-sectional descriptive survey and the quantitative method of data collection was employed. The population was all doctors irrespective of area of specialty and all nurses employed and working in the hospital as at the time of study. Proportionate stratified and convenience sampling methods were used to select study participants according to their categories. Using validated structured questionnaire, data were collected from 110 doctors and 95 nurses in the teaching hospital on their perception on ICP and factors that enhance/hinder ICP. Data were analyzed using both descriptive and inferential statistics. Specifically, frequencies, percentages, standard deviation and graphic presentation were used for descriptive analysis of scores while the unpaired t test of mean score using Graph Pad Prism, Version 5.30 was used to determine the influence of profession, gender, and years of experience on perception of ICP at 0.05 level of significance. The study found that both doctors and nurses have positive perception on ICP. Their years of experience have significant influence on their perception. Clear individual roles and good working relationships enhance ICP while giving priority to professional status rather than expertise was seen as a prominent hindrance to ICP. The study recommends collaborative continuing education for doctors and nurses to enhance ICP in patient care. In addition, the inclusion of interdisciplinary collaborative practice programmme into the curriculum of medical and nursing students (where it does not exist) would go a long way to strengthen ICP and decrease hindrances when they graduate.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

家庭医生服务能力自我评估调查问卷的开发与应用

目的:开发并应用家庭医生服务能力自我评估调查问卷。方法:选取我国8469名已经或即将从事家庭医生工作的基层卫生机构医生为研究对象,采用自行开发的家庭医生服务能力自我评估调查问卷对其进行调查。结果:基本医疗服务能力7项职责中,家庭医生具备承担常见病、多发病诊治职责能力的比例最高,为94.69%,社区康复服务和合理用药、用械职责能力的比例相对较高,分别为90.94%和90.75%。基层医生具备承担危急重症应急处置、医疗服务协同等职责能力的比例较低,分别为53.74%和56.68%。73.27%的家庭医生基本医疗服务能力得分≥4分,东、中、西部地区的家庭医生基本医疗服务能力得分≥4分者分别占73.72%、77.03%、67.49%。农村地区的家庭医生基本医疗服务能力得分≥4分者占74.62%,高于城市地区(70.63%)。全科医生基本医疗服务能力得分为7分者占比最高(27.48%),执业医师占比为19.99%。结论:本研究构建的家庭医生服务能力自我评估调查问卷可行性和可靠性较高,家庭医生服务能力自我评估调查问卷的应用有利于识别基层医生服务能力短板,能够反映家庭医生实际能力水平,符合基层工作实际情况,城乡家庭医生和不同类别的家庭医生基本医疗服务能力存在差别。

综合公立医院“医护管”一体化慢病全程管理模式探索

慢病是导致我国居民死亡的主要原因,老龄化程度的加深以及疾病年轻化趋势加剧慢病防控形势。目前以基层医疗机构为主的慢病防控模式的实际效果并不理想,同时也无法满足慢病患者对优质医疗资源的需求。为帮助解决慢病患者就医随访等问题,推动形成公立医院医防融合服务新模式,四川大学华西医院探索构建了“医护管”一体化团队协同慢病全程管理模式,为加强慢病管理提供一种新的解决方案。

网络实习备案平台联合钉钉教学模式在实习护生带教中应用研究

目的分析网络实习备案平台联合钉钉的教学模式在实习护生带教中的构建与应用价值。方法选取2020年级实习护生200名,将其随机分成对照组与研究组各100名;给予对照组常规带教模式,给予研究组网络实习备案平台联合钉钉带教模式,对两组的带教效果进行观察比较。结果研究组的理论成绩、实验成绩、总成绩均高于对照组,差异有统计学意义(P<0.05)。研究组的不良事件(护理记录不全、用错药物、弄错患者)发生率少于对照组,差异有统计学意义(P<0.05)。研究组的教学满意度(资源共享、合理分配时间、自主学习能力、知识理解、学习兴趣)评分均高于对照组,差异有统计学意义(P<0.05)。结论在实习护生中构建和应用网络实习备案平台联合钉钉的带教模式,不但能提高实习护生的综合成绩及学习效果,减少不良事件,保证护理安全,而且能在一定程度上提升实习护生对带教的满意度,充分激发学习兴趣。

老年慢性心力衰竭住院患者中重度心力衰竭发生风险预测模型的构建

目的基于电子病历的方式,构建慢性心力衰竭(CHF)患者中重度心力衰竭发生风险预测模型,并验证该模型的预测效果。方法2019年1月-2020年12月,选择上海市某三级甲等医院心血管临床医学中心诊断为CHF的299例患者为研究对象,采用Logistic回归建立CHF患者中重度心力衰竭发生风险预测模型,采用Hosmer-Lemeshow和受试者操作特征曲线分别检验模型的拟合优度及预测效果,并纳入100例患者对模型进行验证。结果心超(运动幅度降低)(OR=5.109)、双下肢水肿(OR=3.947)、心房颤动(OR=2.772)、血肌酐升高(OR=1.015)是CHF患者发生中重度心力衰竭的危险因素;血清白蛋白升高(OR=0.939)是保护因素;Hosmer-Lemeshow检验P=0.127,受试者操作特征曲线下面积为0.858,约登指数为0.528,最佳临界值为0.805,灵敏度为0.731,特异度为0.797,实际应用的正确率为77.00%。结论本课题建立的CHF患者中重度心力衰竭发生风险的预测模型效果良好,有利于以后早期识别中重度心力衰竭发生风险电子系统报警提示程序的更新提供依据。

医院信息系统下结构化经外周插管的中心静脉导管专科护理记录单的设计与应用

目的探讨医院信息系统(HIS)下结构化经外周插管的中心静脉导管(PICC)专科护理记录单的设计与应用,为患者提供高层次和专业化服务。方法选取2023年1月至3月九江市第一人民医院的60例门诊患者作为研究对象,根据就诊顺序将其分为对照组(n=30)和观察组(n=30)。基于HIS设计,并采用专科护理门诊的高级护理实践模式,拟设计HIS下结构化PICC专科护理记录单,与传统门诊病历记录模式进行比较。比较两组的记录时间、数据质量、数据统计便捷性等方面。结果观察组PICC护理书写时间和检查时间等记录时间短于对照组,差异有统计学意义(P<0.05);观察组关于完整性、易读性、可溯性得分和数据质量总分高于对照组,差异有统计学意义(P<0.05);观察组关于局部皮肤情况、针眼情况、导管刻度、导管冲封管情况和贴膜敷料情况等PICC护理数据便捷性得分高于对照组,差异有统计学意义(P<0.05)。结论采用HIS下结构化PICC专科护理记录单进行PICC护理记录,有助于提高数据质量、数据统计便捷性,缩短护理记录时间。

曾庆琪教授运用经方治疗失眠合并生殖系统疾病经验

[目的]总结曾庆琪教授运用经方诊治失眠合并生殖系统疾病的学术经验。[方法]通过跟诊学习,阅读古籍,整理相关临床医案,从失眠的经方治疗、生殖系统疾病的经方治疗、失眠合并生殖系统疾病的中医异病同治思路等方面,分析曾师治疗失眠合并生殖系统疾病的临床经验,并佐医案以论证。[结果]曾师治疗失眠合并生殖系统疾病遵循中医异病同治理念,主张运用基于大中医观的辨体-辨病-辨证-辨局部-辨微观的“五辨”诊疗模式,用药重视因势利导、温清并用、通补兼施,认为经方治疗失眠合并生殖系统疾病取效的关键在于处理好“抑亢”与“释放”的问题,重视心(脑)、心肾之间关系的调和,既要疏通以治其标,亦要培补以治其本。所举两则医案中,案一患者失眠合并阳痿,辨为肝郁气滞、脾肾两虚证,治以四逆散合肾气丸化裁;案二患者失眠合并月经病,辨为心肾不交、冲任虚寒、瘀阻胞宫证,治以黄连阿胶汤合栀子豉汤合温经汤化裁,悉用经方,皆获良效。[结论]曾师擅用经方治疗失眠合并生殖系统疾病,辨证灵活,用方精当,疗效确切,其丰富的临床经验值得临床学习和进一步推广。

基于医护患一体化护理模式在急性淋巴细胞白血病患儿化疗期间的应用效果

目的:探讨医护患一体化护理模式在急性淋巴细胞白血病(ALL)患儿中的应用效果。方法:选择2022年1月—2023年7月在南京医科大学附属淮安第一医院收治的80例ALL患儿作为研究对象。随机将其分为对照组(常规健康教育)及观察组(在对照组基础上给予医护患一体化护理模式),各40例。比较两组护理效果、治疗依从性及家属满意度。结果:观察组护理总有效率为95.00%,高于对照组的77.50%,差异有统计学意义(P<0.05)。观察组总依从率为92.50%,高于对照组的75.00%,差异有统计学意义(P<0.05)。观察组家属满意度为95.00%,高于对照组的77.50%,差异有统计学意义(P<0.05)。结论:医护一体化护理模式在ALL患儿化疗期间,可进一步提升临床疗效及依从性,提高家属满意度。

MDT联合Mini-CEX模式在肿瘤学专培生护理教学中的应用价值

目的 探讨多学科会诊联合迷你临床演练评估(multiple disciplinary team+mini-clinical evaluation exercise,MDT+Mini-CEX)模式在肿瘤学专培生护理教学中的应用价值。方法 2019级9月—2021级9月,选择四川大学华西医院60名2019级—2021级肿瘤学专科医生规范化培训(简称“专培”)护理生,使用随机数字表法分为对照组和观察组,各30名。对照组使用传统教学方法,观察组使用MDT联合Mini-CEX模式。课程结束后对2组学生进行实践操作考核、理论知识考核和问卷调查,调查教学效果。结果 观察组实践操作考核成绩高于对照组,差异有统计学意义(P <0.05)。观察组理论知识考核成绩高于对照组,差异有统计学意义(P <0.05)。问卷调查中观察组“是”选项比例高于对照组,差异有统计学意义(P <0.05)。结论 将MDT联合Mini-CEX模式应用于肿瘤学专培生护理教学中,可以增强学生的临床实践能力,提高理论成绩,提升综合素质。