Development and psychometric evaluation of Nurses and Midwives’Perceptions of their Roles in Primary Healthcare

Objective:This study aimed to develop Nurses and Midwives’Perceptions of their Roles in Primary Healthcare(NMPR-PHC)and evaluate its psychometric properties.Methods:A cross-sectional survey was performed to recruit a convenient sample of 150 registered nurses and midwives from various primary healthcare settings in Jordan.Reliability was evaluated by examining the internal consistency and split-half reliability of the item.A exploratory factor analysis was performed to assess the factor structure of the NMPR-PHC.Results:The final version of NMPR-PHC contained 18 items.Exploratory factor analysis revealed six factors(care coordination and interprofessional collaboration,workplace facilitators of the primary healthcare,management of care,research,workplace constraints of primary healthcare,and advanced education)for the questionnaire which explained 66.49%of the total variance.The Cronbach’s a of the total scale was 0.834,the subscales Cronbach’s a were ranging between 0.662 and 0.770,and the splithalf reliability of the total scale was 0.734.Conclusion:The overall performance of the questionnaire showed promising sound psychometric properties.The NMPR-PHC can be recommended for use as a tool for the assessment of nurses and midwives’perceptions of their roles in primary healthcare.

Involvement·Development·Make progress-The role of nurses in primary health care

1.Primary health care(PHC)1.1.Purpose of PHC In 1977,the 30th World Health Assembly presented its global health goal of"Health for All by the Year 2000—HFA 2000."In 1978,the International Conference on Primary Health Care adopted the ALMA-ATA Declaration,which clearly stated that the implementation of PHC is the basic strategy and basic approach for achieving the goal of health care.

Prevalence of Menstrual Pain among Saudi Nursing Students and Its Effect on Sickness Absenteeism

Background: Primary menstrual pain is a well-known gynecological disorder among adult females including nursing undergraduate students. Nursing students tend not to seek medical treatment. As a result, this affects their quality of academic life and also absenteeism rate is increased. Objectives: To evaluate the prevalence of menstrual pain and its effect on sickness absenteeism on nursing student. Methods: This is a descriptive survey research design study by means of using a validated and modified questionnaire. Questionnaire information regarding menstrual pain severity, history and absenteeism were included. The research took place in the collage of nursing at the largest University in the world, Princess Nourah Bint Abdelrahman University, Riyadh, Saudi Arabia. A total of 100 single, female, unmarried undergraduate nursing students (Year 1, 2, 3, 4) were recruited by personal invitation during lectures. Result: The prevalence of menstrual pain was 92%. Most of the nursing students 27% had menstrual pain of moderate grade 5 - 6 and 38% of nursing students did not take pain medication for it. Lecture and collage absenteeism due to menstrual pain was present in 9% and 30% respectively. Finally, there was no significant correlation between menstrual pain and age of menarche, age and height. Conclusion: Menstrual pain is widely common prevalent among nursing undergraduates. As a result, it affects the quality of students’ day-to-day life routine. The majority of nursing students’ rarely seeks medical treatment. Providing health and patient education to improve awareness on managing menstrual period might help in avoiding students’ absence from classes.

Challenges for Nurses in Providing Patient-Centered Care in Rural Primary Health Care Clinics in Nigeria

Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.

Factors Influencing Patient-Centered Care in the Primary Health Care Settings: The Impact of the Pandemic Crisis and Nurses’ Experience

Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.

Prenatal of Pregnant Adolescents Performed by Nurses in Primary Health Care

This study aims to identify the actions performed by nurses of the Family Health Strategy with the pregnancy cycle of adolescents and analyze if the actions developed by these nurses are focused on risk prevention in pregnancy and childbirth. It is a qualitative and exploratory research in basic health units with 12 nurses. A semi-structured interview technique was applied, and the speeches were analyzed using content analysis. In the analysis of the results, it was identified two thematic categories in which it was noted that nurses during the prenatal make the reception of pregnant adolescents differently and conduct guidelines on examination, signs and symptoms of possible complications during the pregnancy and still emphasize the importance of educational activities as groups of pregnant women to be a chance of coexistence and exchange of experiences, doubts, and anxieties among themselves. It is concluded that the care provided by nurses is fundamental for the pregnant adolescents having prenatal with more quality.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

When Information Does Not Translate into Knowledge. Ebola and Hemorrhagic Fevers Knowledge among Primary Care Physicians and Nurses

After the first secondarily-transmitted ebola case in Spain, a wave of divergent opinions flooded mass and sanitary media. Very few of these opinions, however, came from experts on epidemiology or hemorrhagic fevers. This observational study aimed to assess the specific knowledge of Primary Care physicians and nurses about ebola and hemorrhagic fevers by means of analyzing the results obtained from a 5-item self-reported questionnaire dealing on hemorrhagic fevers basic knowledge. Validity and reliability of questionnaire were confirmed by a pilot study. The participants were 138 family doctors and nurses from the 64 public Primary Care centers sited in the North Metropolitan Area of Barcelona (1,400,000 inhab;Catalonia, Spain) taking part in training-the-trainers ebola workshops. Overall, there were 117 (84.8%) respondents out from 138 workshop participants;of them were physicians 61 (51.2%). The main age was 46.7 (8.8) years;stating previous specific knowledge on hemorrhagic fevers 39 (33.3%). On the whole, up to 92 (78.6%) of respondents shown a poor knowledge. Previous specific formation was significantly and independently associated with having proper knowledge (p < 0.001);OR = 8.6 (CI 95%: 3.199 - 23.623). In summary, confusion that accompanied the single secondary-transmitted ebola case in Spain could probably be explained by the existence of a serious gap on hemorrhagic fevers knowledge. More accurate, scientific and formally-presented information should be provided to Primary Care physicians and nurses.

The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare profes-sionals’mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong.A total of 61(20%)school health nurses(frontline primary healthcare professionals)participated in a cross-sec-tional online survey from March to June 2020.Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form(14-item scale with three subscales related to emotional,social and psychological wellbeing);the Perceived Stress Scale(10-item scale with two subscales related to perceived help-lessness and lack of self-efficacy);and the Coping Orientation to Problems Experienced Inventory(Brief COPE),a 28-item inventory with two subscales related to adaptive and maladaptive strategies.Almost half(42.6%)of par-ticipants experienced mental health problems.Those employed in government subsidized schools had signifi-cantly lower scores in mental health wellbeing than those who worked in private schools.Factors relating to increased mental health problems included lack of emotional support,inadequate training relating to infection prevention and control measures,disengagement and self-blame.A variety of factors influencing school health nurses’social,emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported.The mental-emotional wellbeing of school nurses may relate to their subjective feeling of lone-liness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic.Studyfindings provide relevant evidence for management teams to build a cul-ture of psychological and social support into workplace policies and procedures.Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare pro-fessionals in school communities as they play a significant role in safeguarding resources during pandemics.

超声联合影像学调整双腔耐高压PICC原发性异位的临床实践效果

目的:探讨双腔耐高压注射型经外周静脉穿刺中心静脉置管术(PICC)导管原发性异位借助超声引导+影像学资料复位的临床实践效果。方法:选取2020年3月—2023年3月我院724例双腔耐高压PICC置管病人,51例病人置管完成后24 h内通过胸部影像学检查确诊导管发生原发性异位,发生率为7.04%。异位后分析其原因,结合胸部影像学资料,通过实时B超影像、腔内心电图P波形态,多种手法及体位综合复位的处理措施。结果:41例病人成功复位,成功率为80.3%。10例病人多因病人血管因素或错过调管时机导致导管复位失败。结论:置管护士要有扎实的理论基础以及丰富的实践经验,在临床实际操作过程中,应该灵活应用,多方法结合,具体问题具体分析,尽可能保证PICC导管尖端处于最佳位置,减少并发症的发生。

改良正念减压疗法在原发性肝癌切除术患者中的应用

目的探究改良正念减压疗法在原发性肝癌(primary liver cancer,PLC)切除术患者中的应用。方法选取2020年5月至2022年5月北京市和平里医院收治的160例PLC患者作为研究对象,按照随机数字表法分为对照组(n=80)和研究组(n=80)。对照组采用风险管理护理模式,研究组在对照组基础上联合改良正念减压疗法干预,比较两组患者干预前后癌症疲乏量表(cancer fatigue scale,CFS)评分、中文版压力知觉量表(Chinese perceived stress scale,CPSS)评分、心理弹性水平、疼痛程度、心理应激程度和满意度。结果研究组患者干预后躯体疲乏、情感疲乏、认知疲乏CPSS评分均显著低于对照组(均P<0.05),坚韧性、自强、乐观评分和疼痛改善程度均显著优于对照组(均P<0.05)。两组患者干预后焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)评分较干预前均显著降低(均P<0.05),且研究组患者干预后SAS和SDS评分均显著低于对照组(均P<0.05)。两组患者干预后CFS各项评分均较干预前显著降低(均P<0.05),且研究组降低幅度显著大于对照组(均P<0.05)。研究组患者的干预满意度显著高于对照组(P<0.05)。结论采取风险管理护理模式联合改良正念减压疗法干预PLC患者,能显著降低术后并发症发生率,缓解患者疼痛、疲乏感和心理应激反应,减轻患者的知觉压力并有效改善患者的心理弹性,提升生活质量。

系统护理干预对原发性青光眼患者术后并发症及视觉相关生活质量的影响

目的探讨系统护理干预对原发性青光眼患者术后并发症及对视觉相关生活质量的影响。方法将102例原发性青光眼患者随机分为观察组(系统护理干预)与对照组(常规护理),比较两组患者的视力水平、眼压、视觉相关生活质量及并发症。结果干预后,观察组视力水平高于对照组,眼压低于对照组(P<0.05)。干预后,观察组VRQL量表评分高于对照组(P<0.05)。观察组并发症发生率为7.84%,低于对照组的23.53%(P<0.05)。结论系统护理干预可改善原发性青光眼患者术后视力水平及眼压,提高其视觉相关生活质量,降低并发症发生率。

原发性肝癌介入治疗依从性的影响因素及护理对策分析

目的 分析原发性肝癌(PLC)患者介入治疗依从性的影响因素,制定护理对策。方法 选取2019年1月至2023年10月在濮阳市安阳地区医院接受治疗的共计98例PLC患者进行分析,统计介入治疗依从性情况,进行单因素与多因素Logistic回归分析以明确介入治疗依从性的影响因素。结果 98例PLC患者介入治疗不依从29例,不依从率为29.59%;不依从组与依从组相比年龄> 60岁、高中及以下文化程度、个人月收入≤4 000元、疾病认知水平未掌握、肿瘤大小≥5 cm、低社会支持状态、消极应对占比更高,差异有统计学意义(P <0.05);多因素Logistic回归分析发现,年龄> 60岁(OR=2.731)、文化程度高中及以下(OR=3.022)、个人月收入≤4 000元(OR=4.510)、疾病认知水平未掌握(OR=6.074)、肿瘤大小≥5 cm(OR=2.943)、低社会支持状态(OR=5.284)、消极应对(OR=6.224)是影响PLC患者介入治疗依从性的独立危险因素,差异有统计学意义(P <0.05)。结论 PLC患者介入治疗依从性的影响因素包括年龄、个人月收入、文化程度、肿瘤大小、疾病认知水平、社会支持度及应对方式等,临床需要制定相应的护理对策,促进治疗依从性提高。

以肠道出血为首发表现的原发性淀粉样变性1例

总结1例以肠道出血为首发表现的原发性淀粉样变性病人的护理经验,包括消化道出血护理、预防心力衰竭、达雷妥优单抗及糖皮质激素给药及不良反应护理、个体化心理护理、营养支持、个体化出院指导和延伸护理。通过精心的治疗和护理,病人病情好转,消化道出血停止,随访10个月,恢复良好。

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。

互联网+5E康复护理模式在肝硬化主要照护者中的应用

目的分析互联网+5E康复护理模式在肝硬化主要照护者中的应用。方法选取2020年12月至2023年12月于笔者医院收治的120例肝硬化患者为研究对象,采用随机数字表法分为对照组、研究组每组60例,对照组采用常规干预措施,研究组采用互联网+5E康复护理模式,观察两组主要照护者照顾负担、自我效能感,分析患者肝功能、负性情绪、生活质量、自我管理水平、应对方式。结果干预后两组主要照护者照顾负担评分降低,自我效能感评分升高,且研究组低于/高于对照组(P<0.05)。干预后两组患者总胆红素(total bilirubin,TBIL)、天冬氨酸转移酶(aspartate transferase,AST)水平、肝功能Child-Pugh评分、焦虑、抑郁、回避、屈服评分降低,且研究组低于对照组,差异有统计学意义(P<0.05)。干预后两组患者生活质量、自我管理水平评分升高,且研究组高于对照组,差异有统计学意义(P<0.05)。结论肝硬化患者与主要照护者采用基于互联网+5E康复护理模式干预,可改善患者应对方式,使患者自我管理能力、生活质量提高降低主要照护者的负担。

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。

喉乳头状瘤患儿主要照顾者家庭坚韧力及影响因素分析

目的:探讨喉乳头状瘤患儿主要照顾者家庭坚韧力现状并分析其影响因素。方法:采用便利抽样法,选取2020年4月-2023年1月在医院住院的127例喉乳头状瘤患儿主要照顾者为研究对象,采用一般资料调查表、家庭坚韧力量表和亲职压力量表对喉乳头状瘤患儿主要照顾者进行现状调查,采用多元线性回归分析喉乳头状瘤患儿主要照顾者家庭坚韧力的影响因素。结果:喉乳头状瘤患儿主要照顾者家庭坚韧力得分为(38.49±7.02)分,亲职压力得分为(95.94±15.43)分,相关性分析显示喉乳头状瘤患儿主要照顾者的家庭坚韧力与亲职压力呈负相关(r=-0.619,P<0.05)。多元线性回归分析显示文化程度、亲职愁苦、亲子互动失调和困难儿童是喉乳头状瘤患儿主要照顾者家庭坚韧力的影响因素。结论:喉乳头状瘤患儿主要照顾者家庭坚韧力处于较低水平,临床护理人员应该采取积极的措施,缓解患儿照顾者的亲职压力,提高患儿照顾者的家庭坚韧力。

临床决策支持系统在原发性肝癌患者围手术期护理中的应用

目的探讨临床决策支持系统(CDSS)在原发性肝癌患者围手术期护理中的应用价值。方法回顾性分析2022年1月至2023年10月河南省人民医院收治的48例围手术期接受常规护理的原发性肝癌患者资料,纳入对照组;采集同期医院收治的48例围手术期接受基于CDSS的护理管理的原发性肝癌患者资料,纳入观察组。查阅并比较两组护理质量(护理级别符合率、护理诊断正确率、护理处理及时率)、术后1、3、72 d时疼痛程度[采用疼痛数字评分法(NRS)评估]、护理期间并发症发生情况。结果观察组护理级别符合率、护理诊断正确率、护理处理及时率均高于对照组(P<0.05)。两组术后1、3、5 d NRS评分组间、时间、交互效应有统计学意义(P<0.05)。两组术后3、5 d NRS评分均较术后1 d高,术后5 d较术后3 d高(P<0.05)。两组术后1 d NRS评分差异无统计学意义(P>0.05),观察组术后3、5 d时NRS评分均低于对照组(P<0.05)。观察组护理期间并发症总发生率低于对照组(P<0.05)。结论基于CDSS的护理管理可提高原发性肝癌患者围手术期护理质量,减轻患者术后疼痛,降低术后并发症发生风险。

中药穴位贴敷缓解原发性肝癌疼痛的Meta分析

目的:系统评价中药穴位贴敷缓解原发性肝癌疼痛的效果。方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、the Cochrane Library、Web of Science、EMbase,检索时限从建库至2022年5月21日,筛选符合纳入及排除标准的随机对照试验,提取数据并采用RevMan 5.4软件进行数据分析。结果:共纳入14篇中文文献,涉及1 060例研究对象;Meta分析结果显示,与单用西药止痛剂相比,中药穴位贴敷联合西药止痛剂或单用中药穴位贴敷可以提高原发性肝癌病人疼痛缓解有效率[RR=1.19,95%CI(1.09,1.30),P=0.000 1]、减少不良反应发生率[RR=0.30,95%CI(0.20,0.44),P<0.000 01]、缓解气滞血瘀证症状[MD=-0.86,95%CI(-0.98,-0.75),P=0.000 5]、降低疼痛评分[SMD=-2.80,95%CI(-3.58,-2.02),P<0.000 01],但在改善原发性肝癌病人生活质量方面差异无统计学意义[RR=1.16,95%CI(0.97,1.38),P=0.10]。结论:现有证据表明,在常规西药止痛的基础上联合中药穴位贴敷治疗能有效缓解原发性肝癌病人疼痛发生率、降低疼痛程度和不良反应发生率。