Skin damage due to personal protective equipment among nursing staff in a dedicated coronavirus disease-2019 hospital of tribal India

Background:Nursing staff are at much greater risk of infection(Ebola virus diseases and severe acute respiratory syndrome)due to their exposure to highly infectious bodily fluids and droplet nuclei and the need for personal protective equipment(PPE)to reduce the transmission risk.Aim:The present study was conducted to estimate the prevalence of skin injuries and their types due to PPE usage among nursing staff in tribal India.Materials and Methods:This descriptive cross-sectional study was conducted in the dedicated coronavirus disease-2019(COVID-19)hospital for a period of 4 months among 144 nursing staff wearing Grade 2 and 3 PPE kits.Study subjects were approached through social networking websites and survey questionnaires(Google forms)according to relevant guides,and research literature was used to collect the details regarding baseline,duty,and skin injury characterization.Chi-square test was used to find the association between skin injury and baseline or duty characteristics,and the association was significant at a P<0.05.Results:It was observed that 54.7%of nursing staff were working for 6 or more hours and 16.5%of subjects were wearing the PPE kit for 5 or more hours per day.Skin injury was reported by 86.3%of the subjects after using PPE.Skin injuries among nurses were statistically significant with their current place of stay and daily duty hours(P<0.05).Conclusion:In this study,it was found that 86.3%of subjects had suffered from skin injuries by using PPE while caring for COVID-19 patients during duty hours,so an effective preventive measure should be adopted.

An investigation into the occupational protection status of clinical nursing staff exposed to anti-tumor drugs

Objective:To investigate the occupational protection status of clinical nursing staff vocationally exposed to anti-tumor drugs.Methods:A self-designed questionnaire was used to survey 180 clinical nursing staff vocationally exposed to anti-tumor drugs.Results:Recognition of the need for protection and dependent occupational protection behaviors were very poor in clinical nursing staff vocationally exposed to anti-tumor drugs.The management of the occupational protection of clinical nursing staff vocationally exposed to anti-tumor drugs was also seriously underdeveloped.Conclusion:There is deficiency in the understanding and related protection practices of clinical nursing staff vocationally exposed to anti-tumor drugs in our hospital.The protection measures currently employed in medical practice are inadequate in virtually every aspect considered.It is recommended that all clinical nursing staff should receive full occupational protection training in these matters.The training must raise nursing staff's awareness of the need for occupational protection and standardize their occupational protection behaviors to conform to "best practice" models.These "best practice" models should be quickly established and all staff made cognizant of them forthwith.In addition,where occupational protection systems are already in place,they should be improved to come into line with the new "best practice" models instigated.

Research Progress on the Occupational Hazards and Protective Measures of Emergency Department Nurses

The emergency department is a department that is crucial for medical institutions.It is mainly responsible for rescuing critically ill patients and dealing with all kinds of public health emergencies.There are significant differences in the working environment and working mode between the nurses in emergency departments and those of other departments.They tend to come into contact with various occupational risk factors,resulting in high incidence of occupational hazards and accidental injuries.Therefore,it is necessary to analyze the common occupational risk factors of nurses in the emergency department and propose protective measures to ensure that these nurses are able to provide nursing services safely and effectively.

Study on the Value of the Theory of Protection Motivation in the Nursing of Spinal Fracture to the Quality of Life

Objective:To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture.Methods:From August 2019 to September 2020,72 patients with spinal fracture were selected and randomly divided into two groups.The routine nursing group was the routine nursing group,and the combined nursing with the theory of protective motivation was the dynamic nursing group.Results:The hospitalization time,detumescence time,healing time and muscle strength recovery time of group A were shorter than those of group B(P<0.05).The VAS score and Barthel index score of the dynamic group were better than those of the conventional group(P<0.05);The score of SF-36 in the group A was higher than that in the group B(P<0.05).Conclusions:The application of protection motivation theory in the nursing of patients with spinal fracture can shorten the healing time of fracture,promote the recovery of muscle strength,relieve the pain of fracture,and then improve the ability of daily life and quality of life of patients.

Prevention of violence risk and interventions of Chinese and western medicine nursing on emotion

Accumulation of bad emotion with patients and their relations added violence risk.Workplace violence of nursing is an acute injury to nurse,and long-term threats and challenges to their physical and mental health and professional values. It also has an potential problem on parties negotiate the settlement of medical disputes,as well as boosting reform of national health system.Identifying and managing patients' emotion has positive impact on doubts and resentments elimination,anger escalation avoidance,violence prevention. This study proposed emotional intervention program in terms of traditional Chinese medicine and modern nursing care,which based on introducing the research status on nursing workplace violence. The purpose is to culture the ability of patients' self-identification and emotions regulation,take effective protective measure. The research provides the reference on perfecting the medical security system and related policy research.

The Effect of Evidence-based Management on Occupational Protection of Nurses Who Perform Chemotherapy

Objective:The study was to explore the effect of evidence-based management in occupational protection for nurses who perform chemotherapy.Methods:40 chemotherapy nurses were selected,20 of them were included in the experimental group for evidence-based management,and the other 20 were included in the control group for routine management.Results:Compared with the control group,there were significantly fewer adverse nursing events in the experimental group,and P<0.05.Conclusion:The effect of evidence-based management in occupational protection of nurses who perform chemotherapy is significant.

精神科护士使用保护性约束的知信行量表编制及信效度检验

背景当前,我国关于精神科护士使用保护性约束知信行的测量工具未充分考虑精神科专科特点,且测评条目繁冗,不利于推广应用,亟需更为科学的测量工具对精神科护士使用保护性约束的知信行水平进行评定。目的构建精神科护士使用保护性约束的知信行量表,并验证其信效度,为评估精神科护士使用保护性约束的知信行水平提供工具。方法基于知信行理论,通过查阅文献、访谈以及德尔菲法形成初版量表。采用分层抽样法,于2021年7月—12月,选取广东省内三级、二级和一级(含未评定等级和基层医院)各2家、共729名精神科护士为研究对象。通过项目分析、探索性因子分析、验证性因子分析形成正式量表,并采用内容效度、结构效度评价量表的效度,采用Cronbach’sα系数、重测信度、折半信度评价量表的信度。结果精神科护士使用保护性约束的知信行量表共12个条目,分为知识、信念、行为三个维度。量表水平的内容效度指数(S-CVI)为0.941,各条目的内容效度指数(I-CVI)为0.812~1.000。探索性因子分析共提取3个公因子,累计方差贡献率为62.948%。验证性因子分析结果显示模型拟合良好。量表的Cronbach’sα系数为0.887,其中知识、信念和行为维度的Cronbach’sα系数分别为0.819、0.842和0.831,量表的折半信度为0.712,重测信度为0.922。结论精神科护士使用保护性约束的知信行量表具有良好的信效度,可用于临床工作中对护理人员保护性约束知识、态度及行为的测评。

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。

甲醛加液台对减少手术室医护人员甲醛暴露的效果研究

目的探讨自行设计的甲醛加液台对改善手术室标本间护士甲醛暴露的效果。方法采用自身前后对照试验,将江西省某三级甲等医院2022年6月工作日手术标本室内空气质量设为对照组,2022年7月空气质量设为实验组。对照组采用传统加仑桶取液,实验组采用自主研制的电动甲醛加液装置进行取液。比较2组标本间内甲醛浓度、总挥发性有机物(total volatile organic compounds,TVOC)及空气质量指数(air quality index,AQI)及操作中鼻眼刺激程度,护士标本处理所用时间。结果实验组甲醛值、AQI、TVOC均低于对照组;标本室内甲醛值、TVOC值、AQI值在不同甲醛存储工具下不同时间的变化趋势不同(P<0.01)。实验组中护士重度鼻眼刺激次数均小于对照组(P<0.01),且标本处理所用时间也少于对照组(P<0.01)。结论采用医用甲醛加液台进行手术室标本间的甲醛溶液存储及取用,密闭性强,同时提供了便捷式的液体用量选择,缩短了护士操作时间,减少了标本室内甲醛暴露风险,效果良好。

护理实习生职业防护意向与行为量表的研制及信效度检验

目的研制适用于护理实习生调查的职业防护意向与行为量表,并进行信效度检验。方法基于计划行为理论,依据职业防护行业相关规范、文献及访谈结果,构建量表条目池;采用Delphi专家咨询法、条目分析法、条目与维度相关系数法等筛选量表条目,并进行信效度检验。结果职业防护意向与行为量表共37个条目,意向分量表和行为分量表均通过探索性因子分析提取了3个公因子;各目标分布与维度间的联系符合理论构想。结论护理实习生职业防护意向与行为量表具有良好的信效度,符合问卷的心理学测量要求,可用于评估护理实习生职业防护意向和行为。

BCW理论健康教育联合保护动机理论护理在糖尿病足患者中的应用

目的探讨糖尿病足(diabetic foot,DF)患者应用行为改变模式(behavior change wheel,BCW)理论健康教育联合保护动机理论护理的效果。方法随机选取2021年6月—2023年6月滨州市中心医院收治的80例DF患者为研究对象,按照不同护理方法分成干预组(n=40)和对照组(n=40)。对照组给予常规护理,干预组给予BCW理论健康教育联合保护动机理论护理,比较两组患者遵医依从性、疼痛程度、自我管理能力。结果干预组遵医总依从率[97.50%(39/40)]高于对照组[80.00%(32/40)],差异有统计学意义(χ^(2)=4.507,P<0.05);干预后,两组患者疼痛视觉模拟评分均降低,且干预组低于对照组,差异有统计学意义(P均<0.05);干预后,两组患者糖尿病患者自我管理行为量表评分均升高,且干预组高于对照组,差异有统计学意义(P均<0.05)。结论DF患者应用BCW理论健康教育联合保护动机理论护理,能够提高患者遵医依从性,缓解疼痛问题,提高其自我管理能力。

基于保护动机理论的护理干预对慢性阻塞性肺疾病稳定期患者吸入制剂使用依从性的影响

目的探讨基于保护动机理论(protection motivation theory,PMT)的护理干预对稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者吸入剂使用依从性的影响。方法方便选取2021年1月—2022年1月昆山市第二人民医院收治的108例COPD稳定期患者为研究对象,根据不同护理方法分为干预组(55例)与对照组(53例)。对照组给予常规护理干预,干预组在此基础上实施基于PMT的护理干预。比较两组护理干预3个月后的服药依从性、PMT问卷得分和呼吸道疾病量表(Airways Questionnaire 20,AQ20)得分情况。结果干预后3个月,干预组PMT评分为(47.05±7.76)分,高于对照组的(43.16±6.43)分,差异有统计学意义(t=2.831,P=0.006)。干预后3个月,干预组服药依从率高于对照组,差异有统计学意义(P<0.05)。干预后,干预组AQ20得分低于对照组,差异有统计学意义(P<0.05)。结论基于PMT的护理干预可激发COPD稳定期患者的保护动机,提高吸入制剂使用依从性并提高生活质量。

深圳地区手术室护理人员艾滋病职业防护分析

目的调查深圳地区手术室护理人员艾滋病职业防护知识掌握情况并分析相关影响因素。方法采取调查问卷方式收集2020年8—10月深圳地区60例手术室护理人员艾滋病职业防护知识掌握情况,并分析其影响因素。结果60例护理人员对于艾滋病基础知识掌握相对较好,其各项基础知识完全掌握人数为52例,占比86.67%,而对于艾滋病职业防护知识掌握程度相对薄弱,其各项职业防护知识完全掌握人数为43例,占比71.66%;不同文化程度、职称、工作年限及是否发生过职业暴露的护理人员对于艾滋病职业防护知识掌握情况比较,差异有统计学意义(P<0.05);经多因素分析,较高的文化程度、工作年限、职称及发生过职业暴露是影响艾滋病职业防护知识掌握情况的保护因素(P<0.05)。结论深圳部分地区护理人员艾滋病职业防护掌握情况较差,文化程度、工作年限、职称及是否发生过职业暴露是影响手术室护理人员艾滋病职业防护知识掌握情况的重要因素,应针对性加强其职业防护技能和意识的培训。

精神科保护性约束的规范执行现况调查

目的:调查精神科保护性约束的规范执行情况。方法:采用整群抽样的方法于2020年8月—9月选取湖南省某两所医院的3个精神科病房103例住院病人为研究对象,采用保护性约束病人一般情况调查表、精神科保护性约束规范落实查检表进行调查。结果:103例保护性约束病人中,精神分裂症(64.08%)、非自愿住院(64.08%)、病程≤5年(72.82%)、住院次数≤3次(83.50%)的病人比例较高,在233例次约束操作中,约束时长为0.33~306.50 h,约束时长>24 h有40例次(17.17%),主要约束部位为四肢约束[189例次(81.12%)],约束时间主要为白班(08:01~16:00)[134例次(57.51%)]。保护性约束的评估维度平均规范执行率为84.46%,保护性约束的决策维度平均规范执行率为43.92%,保护性约束的实施维度平均规范执行率为82.89%,保护性约束后的护理维度平均规范执行率为51.31%,保护性约束的不良影响维度平均规范执行率为96.57%。考察医护患三方合作决策、替代措施的使用、约束部位的选择、与病人的沟通、心理护理、约束告知、定时护理、约束工具清洁等条目规范执行率较低。结论:精神科保护性约束的规范执行情况不容乐观,需采取措施保证保护性约束的规范落实。

临床护士乳腺癌筛查保护动机现状及影响因素分析

目的调查安徽省临床护士乳腺癌筛查保护动机现状,并分析其影响因素。方法于2022年9-10月采用便利抽样法选取安徽省864名临床护士作为研究对象,采用一般资料调查表、乳腺癌意识量表、健康信念量表、护士组织支持感量表和乳腺癌筛查保护动机量表进行调查,并对数据进行分析。结果864名临床护士乳腺癌筛查保护动机总分为(53.51±6.87)分,条目均分为(3.15±0.40)分。乳腺癌意识得分、健康信念得分、护士组织支持感得分与乳腺癌筛查保护动机得分均呈正相关(r分别为0.264、0.362、0.178,均P<0.01)。多元回归分析结果显示,亲属是否患乳腺癌、乳腺癌意识、健康信念和护士组织支持感是乳腺癌筛查保护动机的影响因素,共解释乳腺癌筛查保护动机总变异的19.8%。结论临床护士乳腺癌筛查保护动机处于中等水平,有待进一步提升。医院管理者应注重提高临床护士乳腺癌预防意识,改善健康信念水平,给予临床护士充足的组织支持,进而提高其乳腺癌筛查保护动机水平。

3D打印婴幼儿拇指畸形矫正术后护具的设计研究

目的探索3D打印护具在婴幼儿拇指畸形矫正术后患肢固定中的应用效果及前景。方法以婴幼儿拇指畸形术后固定需求为切入点,借助3D打印技术打印护具,并进行临床应用及反馈。选取2021年9月至2022年2月在我科行多指畸形矫正的患儿,将2021年9月至11月的患者设为对照组(n=15),2021年12月至2022年2月患者设为观察组(n=12)。对照组术后采用常规外敷料包扎及石膏托固定,观察组使用外敷料及3D打印护具进行固定。比较两组患儿的术后伤口愈合情况、舒适度及患儿家长的满意度。结果两组患儿术后愈合及功能恢复良好,观察组患儿患肢固定舒适度及患儿家长满意度均高于对照组(P<0.05)。结论3D打印婴幼儿拇指多指畸形矫正术后护具使用方便、自重轻,有助于在良好固定患肢的同时,提升患儿术后患肢固定舒适度及家长满意度,此3D打印护具值得在临床中进行实践和推广。

高甘油三酯血症性急性胰腺炎患者健康教育方案的构建

目的:构建高甘油三酯血症性急性胰腺炎(Hypertriglyceridemia Acute Pancreatitis,HTG-AP)患者的健康教育方案,为HTG-AP患者健康教育工作的开展提供借鉴。方法:通过文献回顾,并基于保护动机理论构建HTG-AP患者的健康教育方案初稿。2022年1月,邀请相关领域专家进行德尔菲专家咨询,对各级指标进行筛选和修改。结果:共对18名专家进行了2轮德尔菲专家咨询,2轮咨询专家积极性分别为94.7%和100.0%,专家权威系数为0.905,肯德尔和谐系数分别为0.297和0.115,所有条目的变异系数均<0.25。最终形成的HTG-AP患者健康教育方案包括威胁评估和应对评估2个一级指标,易感性、严重性、内部奖励、外部奖励、自我效能、反应效能、反应代价7个二级指标,以及19个三级指标。结论:该方案在构建过程中从动机角度出发,分析环境和人际关系对HTG-AP患者健康行为可能产生的影响,判断威胁HTGAP患者应对和避免不良行为的能力,能够为开展HTG-AP患者健康教育提供借鉴和指导。

护士职业暴露和防护情况调查研究

目的 分析护士职业暴露和防护情况。方法 选取2021年1月至2023年12月晋江市医院182名有职业暴露经历护士开展研究,其中2021年80名,2022年39名,2023年63名,开展回顾性问卷调查,分析职业暴露原因、自我防护情况、针刺伤情况和知晓防护知识情况。结果 182名护士中有142名为针刺伤,占比78.02%,有40名为其他,占比21.98%,年人均刺伤次数为1.52次,针总刺伤名数为216次,出现刺伤后有92.00%报告,低于100%报告率;182名护士总暴露次数为284次,常见职业暴露原因有90人次操作不规范/个人疏忽,占比31.69%,有64人次从橡皮或其他阻体中拔出针头,占比22.54%,有29人次在输液、采血时被刺伤,占比10.21%;实施标准预防措施情况:实施率较高的标准预防护措施有用锐器盒存放废弃针头、锐器利器刺伤后从远心端向近心端边挤血边流动水冲洗5 min后彻底消毒和采取消毒剂消毒处理被患者体液/血液污染的物品等;标准化防范策略实施后的职业暴露比率低于标准化防范策略实施前(P <0.05);防护知识来源:182名护士中93名为外出培训班学习交流,占比51.10%,37名为学校教育,占比20.33%,121名为院内学习培训,占比66.92%,84名为同事间交流,占比46.15%,93名为工作经验,占比51.10%。结论 护士工作时可能出现职业暴露,原因较多,应加强自我防护意识,采取适宜预防措施,维护自身安全。

ICU护士对体外循环心血管术后成年患者机械通气管理的现况调查

目的:调查国内ICU护士对体外循环(CPB)心血管术后成年患者机械通气管理的临床实践现况。方法:采用横断面问卷调查方法,2023年4月1日~6月1日向全国15个省、自治区、直辖市36家医疗机构的心脏外科重症监护病房(CSICU)护士发送电子调查问卷,并对调查结果进行分析。结果:共回收有效问卷132份,有效回收率99.25%。心脏外科术后初始机械通气模式中容量触发通气模式占60.61%,压力触发通气模式占19.70%,选择兼容2种触发优势的新型通气模式占15.91%。心脏外科术后潮气量初始设置中81名(61.36%)采用标准体重核算潮气量;有关PEEP的设定,60名(45.45%)护士选择5cm H_(2)O。机械通气管理权属44.70%医生负责、41.66%医生/护士协同调整,9.09%呼吸治疗师主导,4.55%护士主导。患者脱机时使用呼吸机通气模式CPAP为42.42%、SIMV为37.12%、PSV为8.33%、SPONT及其他12.12%。脱机拔管标准化流程,脱机前100.00%行自主呼吸实验,71.97%行气管插管气囊上分泌物清除,35.61%选择行气囊漏气实验,33.33%行最大吸气压监测,30.30%行咳嗽峰流速检测。结论:大多数CSICU护士对CPB心血管术后成人患者机械通气管理具备一定专业知识,但临床实践存在较大差异,亟需出台相关指南/专家共识等指导性文件。

患者隐私保护在实习护生伦理敏感与亲社会行为间的中介效应

目的探讨实习护生的患者隐私保护在伦理敏感性和亲社会行为间的中介作用,为采取针对性措施提高实习护生亲社会行为提供参考。方法以方便抽样方法,选取湖南省6所三甲医院的实习护生543人为调查对象,采用中文版护生伦理敏感性量表、患者隐私保护量表和亲社会倾向测量问卷进行调查。结果实习护生的患者隐私保护能力、伦理敏感性和亲社会行为得分分别为(111.58±13.18)分、(39.75±6.88)分、(95.79±15.69)分;伦理敏感性与患者隐私保护能力、亲社会行为呈正相关,患者隐私保护能力与亲社会行为呈正相关(均P<0.05);患者隐私保护能力在伦理敏感性与亲社会行为之间起部分中介作用,中介效应占总效应的41.89%。结论实习护生的患者隐私保护能力、伦理敏感性、亲社会行为均处于中等偏上水平,患者隐私保护在实习护生伦理敏感性与亲社会行为间起部分中介作用。建议学校与医院采取针对性措施提高实习护生的患者隐私保护能力和伦理敏感性,帮助提升其亲社会行为,进而提升护理服务质量。