Analysis of the Influence of Operating Room Nursing Care Management on the Incidence Rate of Nosocomial Infection in Orthopedic Surgery Patients

Objective:To analysis the influence of operating room nursing care management on the incidence rate of nosocomial infection in orthopedic surgery patients.Methodology:Fifty six orthopedic surgery patients who admitted into the hospital between January to December 2018 were enrolled into this study and randomly divided into two groups,which were the control group(under general management)and the observation group(under the operating room nursing care management).Further,the incidence rate of nosocomial infections,the incidence rate of irregular nursing care phenomena,the satisfaction score of nursing care management,and the quality of life score were observed and recorded.Result:The incidence rate of nosocomial infection,the incidence rate of irregular nursing care management,the satisfaction score of nursing care management,and the quality of life score of the observation group were compared to that of the control group,and the result showed P<0.05,indicates the statistical significance between the data indicators.Conclusion:The use of operating room nursing care management in patients with orthopedic surgery has shown a significant effect.

Application of Whole-Process Management in Day Surgery for Endometrial Polyp

Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 were selected for this study,and they were separated into an observation group(131 patients)and a control group(135 patients);the clinical data of the two groups were compared.Results:After intervention,the scores of Hamilton Anxiety Scale(HAM-A)of the patients in the observation group were lower than those in the control group(P<0.05).The rate of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the satisfaction degree of the patients in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the whole-course management model in endometrial polyp day surgery can alleviate patients’anxiety,ensure the quality and safety of day surgery nursing,and improve patients’satisfaction.

Practice of the construction and management of TCM nursing outpatient service--takes a breast specialty in a third-grade hospital in Beijing as an example

Through the phased construction,the breast specialty traditional Chinese medicine(TCM)nursing clinic of our hospital has achieved good results.From 2017 to 2019,the number of patients increased by 7.6%,and the clinical cure rate increased by 9.4%.Take the breast specialty TCM nursing clinic of our hospital as an example,introduce the registration method of TCM nursing clinic,the TCM nurse home call qualification,service mode,and the clinical diagnosis and treatment effect of specialty TCM nursing.It is pointed out that the construction of TCM nursing clinic needs to be guided by clinical efficacy,and to provide patients with professional TCM care through clear positioning,disease refinement,medical division of labor,and highlighting the technical characteristics of TCM nursing.By reviewing the construction and development of breast specialty TCM nursing clinic in our hospital,we introduced the experience in detail,in order to provide ideas and guidance for the construction of other clinical specialty TCM nursing clinic.

Developing an evidence-based and theory informed intervention to involve families in patients care after surgery: A quality improvement project

Objectives: In the post-surgical setting,active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care.This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.Methods: We used a quality improvement project following a multi-phase design.In Phase 1,an iterative method was used to combine evidence from a narrative review and professionals' preferences.In Phase 2,the logic model underlying the program was developed guided by four steps: (1) confirm situation,intervention aim,and target population;(2) documented expected outcomes,and outputs of the intervention;(3) identify and describe assumptions,external factors and inputs;and (4) confirm intervention components.Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review.In Phase 2,the logic model was developed and includes (1) the inputs (e.g.educational-and environmental support),(2) the ultimate outcomes (e.g.reduction of postoperative complications),(3) the intermediate outcomes (e.g.behavioural changes),and (4) immediate outcomes (e.g.improved knowledge,skills and attitude).Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards,and how we took different factors into account.The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.

Value Based Purchasing and Nursing Case Management

The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.

思维导图联合Mini-CEX在胸外科健康评估教学中的应用

目的探讨思维导图联合迷你临床演练评估在胸外科实习护生健康评估教学中的应用效果。方法方便取样法选取在胸外科实习的大专护生59人,按时间段分为对照组30人、观察组29人。对照组按常规实施临床带教;观察组采取思维导图联合迷你临床演练评估教学法实施临床带教。连续6周后评价效果。结果观察组批判性思维能力、健康评估能力及学习效果自我评价得分显著优于对照组(均P<0.05)。结论思维导图联合迷你临床演练评估教学法用于胸外科大专实习护生健康评估能力教学,可培养护生的批判性思维能力,提高健康评估的教学效果。

Effect analysis of applying high-quality service model to surgical nursing

BACKGROUND Surgical care of the hand plays a crucial role in the medical field,as problems with the hand can profoundly affect a patient's quality of life and function.In order to meet the needs of patients,improve patient satisfaction and improve treatment outcomes,high-quality service models have been introduced in the field of nursing.AIM To explore the effect analysis of applying high-quality service model to surgical nursing.METHODS We conducted a retrospective study of patients who underwent hand surgery at our hospital between 2019 and 2022,using a quality service model that included improved patient education,pain management,care team collaboration,and effective communication.Another group of patients received traditional care as a control group.We compared postoperative recovery,satisfaction,complication rate,and length of hospital stay between the two groups.Inferential statistics were used to compare the difference between the two groups by independent sample t test,Chi-square test and other methods to evaluate the effect of intervention measures.RESULTS Postoperative recovery time decreased from 17.8±2.3 d to 14.5±2.1 d,pain score decreased from 4.7±1.9 to 3.2±1.4,and hand function score increased from 78.4±7.1 to 88.5±6.2.In terms of patient satisfaction,the quality service model group scored 87.3±5.6 points,which was significantly higher than that of the traditional care group(74.6±6.3 points).At the same time,patients'understanding of medical information also improved from 6.9±1.4 to 8.6±1.2.In terms of postoperative complications,the application of the quality service model reduced the incidence of postoperative complications from 26%to 10%,the incidence of infection from 12%to 5%,and the incidence of bleeding from 10%to 3%.The reduction in these data indicates that the quality service model plays a positive role in reducing the risk of complications.In addition,the average hospital stay of patients in the quality service model group was shortened from 6.8±1.5 d to 5.2±1.3 d,and the hospitalization cost was also reduced from 2800±600 yuan to 2500±500 yuan.CONCLUSION Applying a quality service model to hand surgery care can significantly improve patient clinical outcomes,including faster recovery,less pain,greater satisfaction,and reduced complication rates.

护理主导多部门协作管理提升血培养标本质量的效果研究

目的 :评价护理主导的多部门协作管理模式对血培养标本质量提升的效果,为护理临床实践和质量改进提供参考。方法 :成立护理主导多部门协作管理团队,开展质量改进,比较措施实施前后血培养标本送检率、合格率、污染率,以及护士血培养知识、态度、行为的变化。结果 :2023年5月—6月血培养标本送检率、送检方式为双瓶双侧的比例分别为19.1%、61.3%,高于2022年同期的4.7%、35.6%,差异有统计学意义(P<0.05);2023年5月—6月和2022年同期污染率分别为2.9%和3.8%,呈下降趋势;2023年护士血培养相关知识、态度、行为得分分别为(12.69±2.81)、(5.89±0.44)、(36.73±3.40)分,高于2018年的(7.89±2.79)、(5.82±0.52)、(30.81±4.35)分,差异有统计学意义(P<0.05)。结论 :护理主导多部门协作管理模式下的质量改进策略,提高了血培养标本送检率和合格率,降低了血培养标本污染率,提高了护士血培养的知识、态度、行为水平,体现了护士在院感防控工作中的价值。

我国三级医院急诊病人激增应对方式调查

目的:了解我国三级医院急诊病人激增应对方式。方法:于2023年1月—3月选取我国54所三级医院急诊科作为研究对象,其中,东部地区26所(48.1%),中部地区10所(18.5%),西部地区18所(33.3%)。采用自行编制的中国不同地区医院急诊病人激增应对方式调查问卷进行调查。结果:三级医院急诊病人激增后日均急诊量增幅达87.5%,急诊日均候诊时间整体延长(Z=-5.560,P<0.001),东部地区三级医院急诊病人激增后72 h出抢救室病人比例较激增前下降(P<0.05)。面对急诊病人激增,各三级医院采取的应对措施包括增加急诊床位数和出诊医生诊位、增设专门收治新型冠状病毒感染病人的病房、增加重点设备投入、调配医护人员支援急诊等。东部地区三级医院急诊候诊时间变化率与医患比变化率(r=-0.418,P=0.034)、护患比变化率(r=-0.469,P=0.016)、互联网诊疗变化率(r=-0.684,P=0.020)均呈负相关,东部地区三级医院抢救室滞留时间变化率与护患比变化率呈负相关(r=-0.422,P=0.032),中西部地区三级医院抢救室滞留时间变化率与留观室床位变化率呈正相关(r=0.405,P=0.036)。结论:急诊科应不断优化人力、床位、仪器设备等医疗资源配置,探索急危重症病人“互联网+”新模式,进一步提升重大传染病的应对能力。

中国医院临床科主任、护士长胜任力研究现状的循证分析

目的循证分析我国临床科主任和护士长胜任力研究进展与管理现状,为促进临床科主任、护士长管理研究进一步发展和完善我国医院人力资源管理提供可靠参考。方法利用VIP、CNKI、WANFANG中文数据库、网络资源及相关官方网站检索我国临床科主任和护士长胜任力相关文献,并运用文献计量学方法、循证科学的原理和方法,对检索文献进行描述性分析。结果共纳入文献82篇,主要涉及临床科主任、护士长相关概念理论的阐述、胜任力模型的构建、应用研究等内容;我国科主任、护士长胜任力的研究起步较晚且呈先增长后下降的趋势,期刊分布较分散;文献主要来源于各级高校院所和医疗机构;发展停滞于实证研究阶段,未发展向评价研究阶段。结论我国临床科主任和护士长胜任力研究处于应用实践阶段,缺乏系统化研究,主要以高等院所、医疗机构为主导,国家、政府在医院临床科主任、护士长胜任力方面的的关注有待加强。

骨科患者术中下肢深静脉血栓风险增高的血流变化及影响因素

目的探讨骨科患者术中下肢深静脉血栓(DVT)风险增高的血流变化特点并分析其影响因素,为手术室护理干预提供临床指导。方法选取151例骨科择期手术患者为研究对象,术中使用多普勒超声诊断仪观察下肢血流改变特征,并收集患者基本资料、手术相关资料、术前实验室检查指标等,患者手术结束24 h内采血行D-二聚体凝血功能检测。结果D-二聚体检测结果显示,DVT高风险患者70例(46.36%),低风险81例(53.64%)。手术结束后DVT高风险患者下肢平均血流速度、血管内径显著低于或小于低风险患者(均P<0.05)。logistic回归分析显示,手术时间>120 min、凝血酶原时间(PT)>13.1 s、术中发生低体温和术中失血量>100 mL是骨科患者术中DVT风险增高的独立危险因素(均P<0.05)。结论骨科手术患者术中DVT发生风险较高,存在明显血流动力学改变。手术室护理人员需针对性地开展手术效率管理、术中低体温监测和预防、维持术中血容量稳定,有效降低骨科手术患者术中DVT发生风险。

强化儿科护理人员风险防范意识的管理策略分析

目的探讨强化儿科护理人员风险防范意识的管理策略及效果。方法将2021年1—12月、2022年3月—2023年2月这2个阶段在山东大学附属儿童医院小儿呼吸内科从事护理工作的30名护士作为研究对象,分别设为对照组、研究组。对照组阶段实施常规护理管理,研究组阶段在护理管理中实施风险管理。对2组护士的职业暴露伤害发生率进行统计和对比,调查并对比2组护士对于自身安全防护的满意度,并对于2组护士的自我防护知信行评分、疲劳评分、工作压力评分、职场正念评分、职业满意度评分作比较。结果研究组护士的职业暴露伤害总发生率为6.67%,低于对照组的26.67%(P<0.05)。研究组护士对于自身安全防护的总满意度高于对照组(P<0.05)。研究组护士的自我防护知信行评分、职场正念评分、职业满意度评分均高于对照组(P<0.05);研究组护士的疲劳评分、工作压力评分均低于对照组(P<0.05)。结论在小儿呼吸内科护理管理中实施风险管理,可提高护士的自我防护认知、信念,有利于减少护士在护理工作中的职业暴露伤害风险,使其对于自身安全防护更加满意,还可减轻护士的疲劳感、压力,增强其职场正念和职业满意度。

分级护理管理模式在肝胆外科护理中的价值

目的研讨分级护理管理模式在肝胆外科护理中的价值。方法选择200例在我院肝胆外科接受治疗的患者,入院时间为2022年1月至2023年12月,采用双盲法将其分成对照组与试验组,每组100例,两组患者分别采用常规护理管理以及分级护理管理,对比试验组与对照组护理质量(宣教评分、护理记录评分、病房评分及护理操作评分)、护理满意度、不良反应发生率。结果试验组患者宣教评分、护理记录评分、病房评分及护理操作评分数值比对照组数值更高(P<0.05);试验组总满意度数值比对照组数值更高,97.50%vs.80.00%(P<0.05);不良反应发生率比较,试验组数值比对照组数值更低,2.50%vs.15.00%(P<0.05)。结论将分级护理管理模式运用于肝胆外科护理,可改善护理质量及护理满意度,降低患者不良反应的发生率。

广东省二、三级医疗机构延续护理部门设立及运作现况调查

目的:了解广东省二、三级医疗机构延续护理部门的设立及运作情况,为医疗机构建设延续护理部门、开展延续护理提供参考和借鉴。方法:采用便利抽样法于2023年5月4日—19日选取广东省110所二、三级医疗机构的护理管理人员进行调查,调查其所在医疗机构延续护理部门的建立情况、运作情况、阻滞因素及相关建议。结果:110所医疗机构中有35所(31.82%)设立了延续护理部门,58所(52.73%)拟计划开展延续护理服务,17所(15.45%)暂无设立延续护理部门及开展延续护理的计划。已开展延续护理的35所医疗机构中,2010年前设立延续护理部门的有3所(8.57%),2010—2018年有9所(25.71%),2019年至今有23所(65.71%)。35所医疗机构延续护理运作情况良好,但在医疗收费、医院-社区联动及延续护理质量指标设置方面需进一步加强和完善。51所(46.36%)医疗机构认为设立延续护理部门开展延续护理服务无障碍,59所(53.64%)认为存在障碍,障碍因素主要包括人力资源短缺(79.66%)、经济效益受限(76.27%)、实施场地缺乏(54.24%)、不知如何开展(32.20%)、院领导不支持(23.73%)等。结论:因缺乏统一、规范的标准及指南,广东省二、三级医疗机构延续护理部门的设立及运作情况参差不齐且存在多方面争议、困惑及不足。建议从“相关政策制度、部门组织架构、信息共享与协调机制、服务收费与支付机制、延续护理质量评价指标、工作人员绩效”等方面完善延续护理部门的设立及运作,从而推进延续护理的发展,助力实施健康中国战略。

手术沙滩椅体位摆置标准作业程序的建立及应用

目的研究手术沙滩椅体位(beach chair position,BCP)摆置标准作业程序(standard operation procedure,SOP)的建立及应用。方法采用方便抽样的方法,选取2020年10—12月厦门大学附属第一医院收治的16例肩关节镜手术患者为对照组,以对等原则选取2021年1—3月收治的16例患者为观察组。对照组按常规手术体位摆置;观察组按BCP摆置SOP实施摆置。比较2组摆置时间、团队协作熟悉度及医生满意度,并就对手术BCP摆置SOP进行评价。结果观察组手术体位摆置时间为(471.81±52.41)s,短于对照组的(719.13±66.94)s(P<0.05);观察组手术医生的满意度高于对照组,手术团队协作熟悉度评分高于对照组,差异有统计学意义(P<0.05)。2组麻醉医生满意度比较,差异无统计学意义(P>0.05)。团队成员对手术BCP摆置SOP评价认可度均较高。结论手术BCP摆置SOP的建立及应用使手术体位护理规范化、标准化、同质化,有效提高手术室护理质量和工作效率。

湖北省医疗机构日间手术开展与管理现状调查

目的:调查湖北省医疗机构日间手术的开展与管理现状,为进一步推进日间手术的发展、建立日间手术规范化管理策略提供指导。方法:采用方便抽样法,于2023年6月对湖北省24所医疗机构使用编制的问卷进行调查。调查内容包括医疗机构基本信息、日间手术开展现状、日间手术管理制度与规范实施情况、日间手术管理的模式、日间手术的组织管理、限制日间手术开展过程中的难点等。结果:17所医院开展了日间手术,各医疗机构开展日间手术量排名前三的专科分别为骨科(58.8%)、泌尿外科(52.9%)、普外科或眼科(47.1%);各机构在14项有关管理制度与规范指标的实施情况不均衡,部分管理体系建设欠完善;日间手术管理的模式以集中管理为主(52.9%);13所(76.5%)医疗机构设置了专门运行管理团队,而担任日间手术管理决策者的主要是外科医师(88.2%)与医务处(76.5%);限制日间手术发展的难点主要集中在日间手术安全风险(70.6%)和信息系统缺乏支持(58.8%)。结论:各医疗机构日间手术需健全管理建设,完善医疗机构日间手术管理体系,优化日间手术管理制度,以促进日间手术管理水平向科学精细化和规范化发展,提高日间手术护理管理同质化,推动日间手术医疗服务质量提升。

急诊重症脑卒中病人应用加强急救护理管理的效果观察

目的 分析研究急诊重症脑卒中病人应用加强急救护理管理的效果。方法 随机抽选急诊重症脑卒中患者(90例)为研究观察对象,入院时间段:2020年11月—2022年11月。将患者划分为对照组(人员数量45例)、观察组(人员数量45例),两组均配合常规管理,观察组联合应用加强急救护理管理。以管理满意度、并发症发生率、管理质量、生活质量、血流动力学指标、临床指标作为观察指标开展细致对比分析。结果 观察组管理方式满意度高于对照组,组间差异有统计学意义(P<0.05)。观察组临床指标低于对照组,组间差异有统计学意义(P<0.05)。观察组管理质量指标高于对照组,组间差异有统计学意义(P<0.05)。观察组血流动力学指标优于对照组,组间差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,组间差异有统计学意义(P<0.05)。观察组生活质量水平高于对照组,组间差异有统计学意义(P<0.05)。结论 在急诊重症脑卒中患者护理管理期间通过予以加强急救护理管理方式具有明显优势,具有改善血流动力学、减少并发症、缩短急救时间的效果,且患者生活质量和管理方式满意度显著升高,很大程度上提高了护理管理质量。

自主教学模式在普外科护生肠造口护理中的教学效果评估分析

为评估与分析自主教学模式在普外科护生肠造口护理教学中的应用效果,选择于2022年10月到2023年3月在中国医科大学附属盛京医院普外科实习的92名护生作为研究对象,分为对照组和研究组,对照组采用传统教学模式,研究组采用自主教学模式,两组教学时间为3个月。教学实践表明,自主教学模式在普外科护生肠造口护理教学中应用能提高护生的学习成绩和批判性思维能力,促进其职业发展,并提高教学满意度。

精细化管理对全科医学科护理管理质量的提升评价

目的评价精细化管理对提升全科医学科护理管理质量的影响。方法选取2022年10月—2023年10月郴州市第一人民医院全科医学科工作的护士26名为研究对象,采用随机数表法分为常规组和研究组,每组13名。常规组采用常规管理干预,研究组采用精细化管理干预,比较两组管理满意度、护理管理质量、工作效果以及考核成绩等指标。结果两组管理满意度比较,差异无统计学意义(P>0.05)。研究组各项护理质量评分高于常规组,差异有统计学意义(P均<0.05)。研究组工作效果评分优于常规组,差异有统计学意义(P<0.05)。研究组考核成绩高于常规组,差异有统计学意义(P<0.05)。结论全科医学科的护士实施精细化管理干预,对提升护理管理质量具有积极影响。

前列腺癌根治术患者日间手术全程护理管理方案的构建与应用

目的:构建前列腺癌根治术患者日间手术全程护理管理方案并分析其应用效果,以期促进患者快速、优质康复,为临床提供参考。方法:采用便利抽样法,选取2021年1月—12月入院的患者作为对照组,选取2022年1月—12月入院的患者作为实验组。实验组采用全程护理管理方案,对照组采用常规围手术期加速康复外科护理方案。比较两组患者48 h内出院占比、术后首次下床活动时间、术后直立不耐受发生率、手术并发症发生率、出院后30 d内非计划再入院率及术后1个月中重度尿失禁发生率的差异。结果:实验组共纳入62例患者,对照组共纳入64例患者,实验组患者术后首次下床活动时间早于对照组(P<0.05),且实验组患者48 h内出院占比及术后直立不耐受发生率优于对照组(P<0.05),实验组患者术后1个月中重度尿失禁发生率低于对照组(P<0.05),实验组出院30 d内非计划再入院率低于对照组(P<0.05),两组手术并发症差异无统计学意义(P>0.05)。结论:前列腺癌根治术患者日间手术全程护理管理方案可促进患者快速、优质康复,保证日间手术治疗顺利进行,并且能够降低患者术后1个月中重度尿失禁的发生率,实现前列腺癌根治术患者日间手术的高质量管理。