Nursing emergency management practice of COVID-19 in a traditional Chinese medicine hospital

Nursing work is an integral part of hospital work.Under the challenge of the COVID-19 epidemic,it is particularly important to establish a timely and efficient nursing management system.The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills.The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions,rational allocation of human resources,and strengthening personnel training,so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

Strategic management in the establishment of a magnet hospital: A nursing staff perspective

Magnet hospital certification has a reputation for being one solution to nurse recruitment and retention. It is a matter of priority for hospitals to identify and enhance the basic organizational social structures which promote the development and maintenance of magnetism. A total of 436 valid self-administered questionnaires were collected from nurses. Paired sample t-tests, importance-performance gap analysis andANO-VAwere applied. The aims of this study were to investigate the key factors in and the gaps between nurses’ perceptions and hospital performance in areas contributing to magnetism. The results showed that Salary structure, welfare, and manpower deployment were the key forces of magnetism influencing nursing practice. Public and private hospitals showed significant differences in manpower deployment and nurse-patient relationships. Nurses who rotated shifts were more dissatisfied with their hospital scheduling system. Therefore, personnel policies and program are the primary forces in the development of a magnet hospital. Considering the demand for flexible scheduling of nurses, providing a supportive work environment, and keeping pace with today’s changing health care environment could achieve better outcomes for nurses, patients, and hospitals. These findings provide a reference to help set priorities for the implementation and development of effective strategies with limited resources. Public hospitals should take the lead in promoting magnet hospitals and set up reasonable salary systems, nursing workforce standards, and administrative support in order to attract and effectively retain nurses.

Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic

Objective:To introduce the emergency management of nursing human resources and supplies of a large general hospital when facing the outbreak of coronavirus disease 2019(COVID-19).Method:The Nursing Department of the hospital fully executed its functional authority to establish a three-level echelon of sustainable support,allocate human recourses dynamically,organize pre-service training,supervise the key working steps,formulate positive incentive methods,and deploy medical supplies scientifically.Result:By taking these strategies,the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19.Conclusion:The emergency management of nursing human resources and material resources for COVID-19 of the hospital is successful.But several deficiencies were identified as well,which indicated that the hospital needs to establish an efficient emergency management system,and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.

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.

Application of refined management in prevention and control of the coronavirus disease 2019 epidemic in non-isolated areas of a general hospital

Objective:This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19)epidemic in non-isolated areas in a general hospital.Methods:Based on refined management theory,we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas,systematically implemented various prevention and control measures,performed gridding audits,effectively communicated among teams and between medical staff and patients assisted by information techniques,and reported results for quality improvement.Results:There was no hospital-acquired COVID-19 infections among staff in the hospital.The rates of mask-wearing,epidemiological history screening,and the medical supplies disinfection were all 100%in the hospital.The accuracy rate of mask-wearing of patients and their families was 73.79%and the compliance rate of their hand hygiene was 40.78%.Conclusion:Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective.The accuracy rate of mask-wearing and hand hygiene compliance of patients and their families need to be further improved.

Management of work place bullying in hospital:A review of the use of cognitive rehearsal as an alternative management strategy

Lateral violence is not uncommon in workplaces.Unfortunately,nursing,a profession that builds its practice on compassion and code of ethics while caring for their patients is not spared from this phenomenon of lateral violence.Studies have reported cases of lateral violence among nurses to occur frequently worldwide.The impact of lateral violence has serious repercussions not only on the health of bullied victims but also on the structure and financial spending of the organisation.More importantly,the potential latent impacts on the patients'safety and health is of great concern.This literature review suggests that the contributing factors towards lateral violence are mainly due to characteristics of perpetrators,victims'reaction to bullying and organisation's characteristic.To mitigate the impact of lateral violence among young and inexperienced nurses,a cognitive rehearsal scripted response is proposed to prevent harassment and bullying incidents from becoming a feature at the workplace for nurses.

Time Management of the Clinical Nurses at Public Hospital in Bangladesh

Nursing is a very intense and focused career, so picking the right time and its proper management can help to relieve personal stress, manage tasks properly and achieve patients and organizational outcome. Objective: This study aimed to explore perceived time management skill of the clinical nurses. Methods: This was a descriptive correlational study design using simple random sampling. A total of 77 clinical nurses working in Mugda Medical College Hospital, Dhaka, Bangladesh were selected as study participants. The data were collected through structure questionnaire which consisted of demographic questionnaire and five dimensions of Time Management Skill Questionnaire (TMSQ). Results: The overall mean score of time management skill was 2.63 (SD = 0.28) reflecting a medium level of nurses perceived time management skill. The results also revealed that nurses age (r = 0.39, p = 0.000), monthly income (r = 0.294, p = 0.017) and service experience (r = 0.248, p = 0.030) were statistically significant correlated with nurses’ perceived time management skill. Conclusion: The outcome of this research would add to develop a strategy for nurse administrators to take an initiative for how nurses could improve the time management and utilize their limited time effectively. It specifies that proper time management can influence to provide quality care and achieving organizational goal.

Conflict management and perceived team cohesion of nurses in university hospitals

Objective Team cohesion is an essential component in a multidisciplinary team and can inspire the team to perform creative and complex works.This descriptive correlational study aimed to determine the styles of conflict management,levels of team cohesion,and the relationship between each style of conflict management and perceived team cohesion among nurses at affiliated hospitals of Dali University.Methods The sample consisted of 336 nurses from two university hospitals in Yunnan province,selected using the proportionate sampling method.Research instruments included demographic data form,Dutch Test for Conflict Handling(DUTCH)and Group Cohesion Scale.The Cronbach’s alpha coefficient for the five subscales of DUTCH were the following:forcing(0.83),yielding(0.81),avoiding(0.88),problem-solving(0.85),and compromising(0.84).The Cronbach’s alpha coefficient of Group Cohesion Scale was 0.83.Data were analyzed using descriptive statistics and Spearman’s rank-order correlations.Results The results of this study revealed that nurses were most likely to use avoiding conflict management style to deal with conflict situations,followed in rank order by problem-solving,compromising,forcing and yielding conflict management style.Nurses perceived team cohesion at a moderate level(x=4.43,SD=2.01).Additionally,conflict management associated with team cohesion.Conclusion The study findings revealed that avoiding was the conflict management style most frequently utilized by nurses,and nurses perceived team cohesion was at a moderate level.It is required to identify various strategies to improve team cohesion in multidisciplinary teams and develop a support system for nurses.

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。

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。

基于医联体的基层医院护士培训方案的设计与应用

目的设计基于医联体的基层医院护士培训方案,评价其应用效果。方法选取2022年6—12月在漯河医学高等专科学校第二附属医院培训学习的26名基层医院护士为研究对象,对比培训前后参训护士各项考核成绩及对培训效果的评价。结果培训后护士的理论考核成绩[(74.96±6.88)分]与操作技能考核成绩[(93.15±1.22)分]均高于培训前[(58.42±6.33)、(88.35±4.20)分],差异有统计学意义(P<0.001)。培训后,参训护士病情观察评估能力[(16.08±0.25)分]临床思维能力[(21.77±2.18)分]、临床护理操作技能[(26.11±0.20)分]、沟通协调能力[(8.08±0.12)分]、应急处理能力考核得分[(7.85±0.15)分]均高于培训前[(14.15±0.29)分、(16.31±0.36)分、(25.19±0.25)分、(7.50±0.14)分、(6.31±0.16)分],差异有统计学意义(P<0.05)。培训后,参训护士对培训效果综合评价满意率为92.3%。结论基于医联体的基层医院护士培训方案具有实用性和可操作性,可有效提升基层医院护士基本理论水平和临床实践能力,并得到学员的普遍认可,可为医联体成员医院开展护士培训提供借鉴。

专业化清洗、消毒流程对手术器械清洗质量的影响

目的:探讨专业化清洗、消毒流程对手术器械清洗质量的影响。方法:以我院2020年11月—2021年10月需要灭菌的手术器械984件为对照组,2021年11月—2022年10月需要灭菌的手术器械1026件为观察组;对照组采用常规流程,观察组采用专业化清洗、消毒流程;比较两组器械外观、清洗合格率、质量控制评分。结果:两组器械目测外观血渍、污垢、锈斑、外观光亮、清洗合格率及器械拆装、清洗质量、消毒质量、包装质量、环境管理评分比较,差异均有统计学意义(P<0.001)。结论:专业化清洗、消毒流程可提高器械清洗合格率及器械质量控制水平。

精细化护理管理模式在控制医院感染中的效果

目的探讨将精细化护理管理模式运用于医院感染控制中的效果。方法选取吉林省前卫医院医院感染率较高的重点科室(重症医学科、普通外科、心内科、综合内科)的住院患者及护理人员作为研究对象,其中2023年1月至3月为干预前阶段设为对照组(住院患者1850例,护理人员74人),4月至6月实施精细化护理管理模式为干预后阶段设为观察组(住院患者1880例,护理人员74人),分析比较实施精细化护理前后医院感染监测指标、医院感染知识掌握及院感措施落实情况。结果观察组的院内感染发生率低于对照组,住院患者治疗前病原学送检率高于对照组,差异有统计学意义(P<0.05);两组的多重耐药菌检出率比较,差异无统计学意义(P>0.05);观察组护士的感控知识知晓率、环境清洁消毒合格率、消毒物品管理合格率、无菌物品的管理合格率高于对照组,差异有统计学意义(P<0.05);两组的医疗废物管理情况比较,差异无统计学意义(P>0.05)。结论在医院感染管理中实施有针对性的精细化护理管理模式,能够显著提高护理质量,有效控制医院感染。

原发性肝癌病人健康素养管理移动护理辅助应用程序的构建及应用分析

目的:构建原发性肝癌(primary liver cancer, PLC)病人健康素养管理移动护理辅助应用程序,并对其使用效果进行验证分析。方法:构建由病人使用端、医护使用端及处理器组成的PLC病人健康素养管理移动护理辅助应用程序,将2021年2月-2022年10月于菏泽市立医院住院的100例PLC病人按随机数字表法分为干预组和对照组各50例。对照组采用常规护理管理,干预组在对照组基础上实施基于移动护理辅助应用程序的健康素养管理。采用慢性病病人健康素养调查量表及肝癌病人生活质量量表对两组病人干预前及干预1个月和3个月的健康素养和生活质量进行评估,验证程序的应用效果。结果:两组病人健康素养和生活质量的时间效应、组间效应及交互效应均有统计学意义(P<0.05),两组除干预前各项评分比较差异无统计学意义外,其余时间点各维度评分比较,干预组均高于对照组(P<0.05)。结论:构建PLC病人健康素养管理移动护理辅助应用程序是一种科学有效的医疗护理管理辅助手段,可有效提升病人健康素养水平,改善病人生活质量。

分层次教学培训对护士医院感染防控知识掌握水平及管理质量的影响

目的探讨和分析分层次教学培训对护士医院感染防控知识掌握水平及管理质量的影响和改善效果。方法选择安徽医科大学第二附属医院402名护士作为研究对象,于2023年3月1日—7月31日开展分层次教学培训,采用回顾性分析,对是否担任过医院感染管控护士的护士知识掌握程度、培训前后护士医院感染防控知识掌握水平和医院感染管理质量进行比较与分析。结果担任过医院感染管控护士的护士医院感染防控知识掌握评分高于未担任过的护士,差异有统计学意义(P<0.05)。培训后,护士在医院感染管理规范、诊疗器械处理程序、医院感染概念、空气消毒方面的知识掌握评分高于培训前,差异有统计学意义(P<0.05);护士在操作技能、应急能力、理论知识以及消毒管理方面的医院感染管理质量评分高于培训前,差异有统计学意义(P<0.05)。结论分层次教学培训的实施,显著提升了护士的医院感染防控知识掌握水平,同时也改善了医院感染管理质量。

体外膜肺氧合病人院际转运管理的最佳证据总结

目的:评价并总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)病人院际转运管理的相关证据。方法:系统检索国内外数据库及相关官网中关于ECMO病人院际转运管理的文献,根据文献评价标准进行文献质量评价并提取证据。结果:共纳入15篇文献,包括临床指南4篇,系统评价3篇,队列研究3篇,横断面研究1篇,专家共识4篇,总结出包含转运决策、转运团队建设、装备耗材管理、转运实施、转运不良事件及转运质量控制与培训6个方面的28条ECMO病人院际转运管理的最佳证据。结论:医护人员根据实际情况将证据转化为ECMO病人院际转运规范化管理方案,有利于提升转运质量,保障病人安全。

专科护士参与的住院患者脑卒中风险筛查及随访管理

目的探讨专科护士参与的住院患者脑卒中风险筛查及随访管理效果,为全面落实脑卒中一级预防提供借鉴。方法构建住院患者脑卒中风险筛查模式,对内外科≥40岁的住院患者进行脑卒中风险筛查。由病区责任护士对患者进行初筛、专科护士对高危风险患者进行卒中一级预防管理,进行1年的随访。结果2021年9月从内外科36个病区中筛查出脑卒中风险患者3416例,其中高危513例(15.02%),中危1926例(56.38%),低危977例(28.60%);对3类患者实施分级管理,其中高危患者由神经内科进一步诊疗;完成1年随访的197例高危患者,随访后血压、血脂、运动等达标率显著高于随访前(均P<0.05),健康自我管理能力得分显著提高(均P<0.05)。结论专科护士参与的住院患者脑卒中风险筛查模式有利于早期发现脑卒中风险患者,落实一级预防,从而降低脑卒中发生率。

围手术期患者院内转运护理质量评价指标的构建

目的构建围手术期患者院内转运护理质量评价指标,为评价与监测围手术期患者院内转运护理质量提供评价工具。方法基于结构-过程-结果三维结构质量模型,通过文献回顾法、半结构式访谈法形成指标初稿,采用德尔菲专家函询法和层次分析法,筛选指标并确定各级指标的权重。结果2轮专家函询问卷有效回收率为88.89%、100%,专家权威程度系数为0.928、0.931,专家意见的肯德尔和谐系数分别为0.275、0.314(均P<0.05)。形成的评价指标包括3项一级指标,11项二级指标和57项三级指标。结论构建的围手术期患者院内转运护理质量评价指标内容全面、具备可靠性和实用性,经验证后可作为围手术期患者院内转运护理质量的评价工具。

我国37家公立医院护理人力资源管理现状与绩效评估

护理人力资源是卫生人力资源的重要组成部分,是保证护理质量的基础,有效的护理绩效管理可以调动护士主观能动性,提高工作效率,提升护理人力资源管理水平。目前我国公立医院对护理绩效管理的探索处于起步阶段,管理方式仍参照企业人力资源管理模式,未充分考虑医疗工作的特殊性,导致当前护理绩效薪酬管理工作存在诸多问题。文章通过问卷调查方式,了解全国不同地区综合公立医院护理人力资源的现状以及绩效管理方式,分析了护理绩效管理中存在的问题及其原因,提出合理化的改革方向建议,以期为公立医院护理绩效管理改革提供参考,使护理绩效分配更加公平合理,发挥绩效导向作用,提高护理服务质量,构建护理管理工作发展良性循环。

山西省某医院冠心病病人住院费用分析

目的:探究山西省某三级甲等医院冠心病病人住院费用疾病诊断相关组(DRGs)分组方案和费用标准,为医院推行DRGs付费改革提供参考。方法:选取2019年该院冠心病住院病人为研究对象,通过Logistic回归分析得到住院费用影响因素并作为节点构建决策树模型,进行冠心病住院病人分组。结果:冠心病住院病人住院天数、是否手术和性别作为分类节点创建了8个病例组合,各组合病人住院费用比较差异均有统计学意义(P<0.05),计算得出各组合病人住院的标准费用和上限费用。结论:创建的冠心病病人DRGs分组比较合理,实施DRGs付费可以有效控制医疗费用,逐步实现医保患三方共赢,DRGs实施为护理管理提供了新方向。