The effect of high-fidelity simulation in medical nursing based on the healthcare simulation standards of best practice

Background:High-fidelity simulation has been demonstrated to make great progress in learning.However,there is still ongoing exploration on how to fully harness the advantages of this teaching method and enhance its effectiveness.This study conducted high-fidelity simulation in medical nursing based on the Healthcare Simulation Standards of Best Practice and evaluated its effect.Methods:The study was conducted from September 2019 to June 2020.A total of 82 undergraduate nursing students from a university in Shanghai participated in the high-fidelity simulation in medical nursing.The simulation design scale,educational practices in simulation scale,and students’satisfaction and self-confidence were used to evaluate the effect.Results:The mean score of simulation design scale was 4.06±0.63 with the mean scores of all dimensions being over 3.0.The mean score of educational practices in simulation scale was 4.14±0.56 with the mean scores of all dimensions being over 4.0.The mean scores of students’satisfaction and self-confidence were 4.07±0.72 and 3.89±0.58,respectively.Conclusion:Students reported high levels of simulation design and educational practices in simulation.They were also satisfied with learning and reported high levels of self-confidence.Some key points need to be considered so that the learning effects might be optimized.

Analysis of the Application and Effect of Homemade Medical Scrotal Support Shorts

Objective:To design and manufacture medical scrotal support shorts for patients with enlarged scrotum and observe its application and effect.Methods:40 patients with enlarged scrotum admitted to the basic surgery department from February 2021 to March 2023 were selected and divided into a test group and a control group according to their time of admission,with the test group using scrotal support shorts and the control group using ordinary shorts without scrotal support pockets or diapers.Results:The complication rate of skin injury in the scrotum and the surrounding inguinal area of the patients in the test group was significantly lower than that of the control group(P<0.01).The medical cost covered by patients in the test group was significantly lower than that of the control group(P<0.01)and the hospitalization satisfaction of the patients in the test group was significantly higher than that of the control group(P<0.01).The difference in the therapeutic effect of the test groups was statistically significant when compared with the control group(P<0.05).Conclusion:Homemade medical scrotal support shorts reduced the local enlargement of the scrotum and bleeding,but also protected the scrotum and the surrounding skin to prevent secondary injuries.The process of patient care was simple and promoted their recovery.The length of hospitalization was also decreased,the burden of health care costs was reduced,and the overall comfort and satisfaction of the patient was improved.

Application of Flipped Classroom Combined with PBL Teaching Method in the Teaching of Respiratory Intensive Care Unit Nursing

Objective:The aim is to investigate the application effect of flipped classroom combined with problem-based learning(PBL)teaching method in the teaching of respiratory intensive care unit nursing.Methods:100 fresh nursing students who were interned in the respiratory intensive care unit of our hospital from June 2020 to May 2022 were selected and randomly divided into 50 students in the control group and 50 students in the experimental group.The students in the control group were taught by PBL teaching method,and the students in the experimental group were taught by flipped classroom combined with PBL teaching method.After the completion of the teaching,the teachers combined the performance of the two groups of students,and scored them comprehensively in terms of their professional theoretical knowledge,clinical operation skills,independent learning ability,and teamwork ability,and carried out a survey of the experimental group’s students in terms of their satisfaction with the understanding of theoretical knowledge,clinical operation,independent learning ability,teamwork ability,and other dimensions.Results:There was no statistical significance in the specialized theoretical knowledge scores of the two groups of students(P>0.05).The scores of clinical operation,independent learning ability,and teamwork ability of the two groups of students were statistically significant(P<0.05),and all the scores of the students in the experimental group were higher than that of the control group.More than 90%of the students believed that the flipped classroom combined with PBL teaching method could assist in the comprehension of theoretical knowledge,improve the clinical operation skills,enhance the ability of independent learning and teamwork;there were 92%of the students supported the use of flipped classroom combined with PBL teaching in respiratory intensive care unit nursing teaching.Conclusion:In the teaching of respiratory intensive care unit nursing,the use of flipped classroom combined with PBL teaching method can improve the learning effect of students,and has certain value in teaching.

Establishment and application of medication error classification standards in nursing care based on the International Classification of Patient Safety

Objective:To standardize the classification,reporting and analysis of medication errors in nursing in order to improve patient safety management by achieving real-time monitoring and systemic analysis.Methods:A system of classifying nurse-related adverse drug effects into four category grades was developed based on the framework provided by the International Classification of Patient Safety.Three investigators used the system to classify 1343 nursing-related drug adverse events reported between January 2006 and December 2010 at 15 tertiary medical institutions in Shanghai.Results:The classification standard incorporated all relevant information provided in the reporting system and revealed that the greatest frequency of drug adverse events resulted from staff-related factors.In particular,the largest number of events resulted from routine violations,followed by technology type errors of negligence and fault.Conclusion:Application of this classification system will help nursing administrators to accurately detect system-and process-related defects leading to medication errors,and enable the factors to be targeted to improve the level of patient safety management.

Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors

BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group(n=51)and a combined group(n=51)according to the nursing plan.The routine group adopted routine nursing,and the joint group adopted the medical care cooperative responsibility system nursing management combined with selfefficacy education.The self-efficacy scores,coping style scores,self-experience burden scores,and postoperative complication rates of the two groups before and after intervention were counted.RESULTS After intervention,the daily life behavior management,cognitive symptom management,and disease management scores of the two groups were higher than those before the intervention,and those of the combined group were higher than those of the conventional group(all P=0.000).After the intervention,the positive response scores of the two groups were higher than those before the intervention,the negative response scores were lower than those before the intervention,and the combined group was better than the conventional group(all P=0.000).After the intervention,the two groups’emotional,economic,and physical factor scores were lower than those before the intervention,and the combined group was lower than the conventional group(all P=0.000).The incidence of infection in the combined group(1.96%)was lower than that in the conventional group(15.69%)(P=0.036).CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients,change the response to disease,and reduce the risk of postoperative infection.

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

基于Anderson模型社区老年人医养结合服务的利用水平及影响因素研究

目的探究基于卫生服务利用的Anderson模型,了解社区居家老年人目前医养结合服务利用水平及影响因素,旨在推进优化服务体系建设。方法对上海市浦东新区某街道内长护险服务覆盖的居家养老老年人进行问卷调查并分析,调查内容包括倾向特征、促进资源和需要三个层面的影响因素和医养结合服务利用水平现状。结果调查共收到问卷2348份,有效问卷2302份,问卷有效回收率为98.04%。不同长护险评估等级的老年人中年龄段(年龄段占比)、文化程度、疾病数量、需要帮助程度,差异均有统计学意义(P<0.05)。27项生活护理服务中,利用率排名前六的项目依次为指/趾甲护理、手/足部清洁、沐浴、梳理/洗发、温水擦浴、头面部清洁;15项常用医疗护理服务方面,目前“未利用任意一项”的占比为61.86%。多元线性回归模型提示,倾向因素中的年龄对生活照护服务、整体医养结合服务利用均有正向影响(P<0.05),文化程度对生活照护服务、整体医养结合服务利用均有负面影响(P<0.05);促使因素中的医保类别、生活来源、照护费用对各服务利用均无影响(P>0.05);需要因素中的需要帮助程度、疾病数量、长护险等级对生活照护服务、医疗护理照护服务、整体医养结合服务利用均有正向影响(P<0.05)。结论长护险制度协调了居家养老的老年人的服务需求与服务供给,各项服务的利用水平仍有待进一步提升,服务模式有待优化。

Guided Care护理模式干预对老年原发性高血压患者服药依从性及生活质量的影响

目的探讨Guided Care护理模式干预对老年原发性高血压患者服药依从性及生活质量的影响。方法将146例老年原发性高血压患者按建档时间分为两组,各73例。两组均给予常规护理干预,研究组在此基础上给予Guided Care护理模式干预,观察2个月。干预前及干预1个月、2个月末采用Morisky服药依从性问卷评定服药依从性,采用自我护理能力量表评定自我护理能力;干预前后采用生活质量综合评定问卷-74评定生活质量,采用纽卡斯尔护理服务满意度量表评定患者满意度。结果干预1个月、2个月末研究组Morisky服药依从性问卷评分显著低于对照组(P<0.01),自我护理能力量表评分显著高于对照组(P<0.01)。干预后研究组生活质量综合评定问卷-74的躯体功能、心理功能、社会功能、物质生活状态维度分及纽卡斯尔护理服务满意度量表评分均显著高于对照组(P<0.05或0.01)。结论Guided Care护理模式干预能增强老年原发性高血压患者的服药依从性,增强自我护理能力,提高患者满意度及生活质量。

北京市老年人医养结合的难点与对策:机构的视角

中国老年群体在全国人口中的比例越来越大,如何通过医养结合真正做到老有所养、病有所医,是当前亟须解决的重要难题。以北京市为例,分析了北京市医养结合的发展形势,通过对北京三种主要的医养结合模式进行实地调研,从组织机构的视角总结不同模式面临的困难和挑战,建议进一步统筹协调京津冀医养结合政策,加快长期照护险落地,加强养老人才队伍的专业化建设,强化对养老机构的标准化建设和监管,大力发展科技养老、智慧养老。

基于政策工具的河南省医养结合政策文本分析

目的:选取2016~2023年河南省医养结合政策文本为研究对象,研究分析政策文本内容的特征及不足,提出合理化建议,为完善河南省医养结合政策体系提供参考。方法:以政策工具为视角,结合参与主体维度构建二维分析框架,采用内容分析法对27个政策文本进行分析,得到有效编码172条。结果:政策工具结构不平衡,供给型政策工具占29%,需求型政策工具占8%,环境型政策工具占63%;参与主体分布不均衡,政府参与占61%,养老机构参与占8%,医疗卫生机构参与占16%,社会组织参与占12%,健康产业参与占3%。结论:河南省医养结合政策内容丰富、层次鲜明、目标清晰,但政策工具结构不平衡、参与主体分布不均衡,要优化政策工具间结构、协调各参与主体在政策工具中分布、加强各参与主体在各个政策工具中的交互协作,促进河南省医养结合政策发展。

以银发经济推进农村互助养老发展的政策支持研究——以J省X市颐养之家为例

我国首部“银发经济”政策文件出台,为农村互助养老模式提供了“有为政府”与“有效市场”相结合的实践场域。通过对具有全国性影响的J省X市颐养之家的典型案例分析发现,当前农村互助养老模式的主要政策目标是为有需要的农村留守、独居及困难老年人提供基本生活保障的兜底型养老。在银发经济“产品化-商品化-产业化”阶段性发展的大趋势下,农村互助养老还可以是普惠式养老,更应该是高质量的积极养老。针对农村互助养老模式在政策执行中分配基础、分配内容、输送策略、筹资机制等方面存在的不足,建议将发挥有效市场作用与有为政府作用更好结合,进一步完善优化政策支持,纳入“一老一小”,扩展受益对象;引进商品化竞争机制,丰富服务供给;推动多主体跨部门合作,形成网状输送;划定红线并链接资源,发展团结经济,着力推动农村互助养老高质量发展。

农村医养结合型养老服务政策的演进逻辑

伴随着健康中国战略的稳步推进,我国农村医养结合型养老服务体系经历了从供给不足到供需相对均衡的发展过程,逐步形成了与经济社会持续健康发展相协调的高质量社会养老服务体系,在满足公众需求、缓解社会矛盾、促进社会公平、增进老年福祉等方面发挥了重要作用。深入挖掘其在政策目标、政策内容、价值取向等方面的阶段性特征和变化趋势,通过社会网络分析发现,我国农村医疗卫生与养老服务相结合由点到面逐步拓展,二者由彼此独立走向有机融合,其结合、融合与整合的体制机制逐渐成熟,二者相结合由逐步成熟向深度融合阶段迈进。为了促进医养结合政策的有效衔接,我国应加快推进农村医养结合型养老服务体系建设,以县域医共体为核心发展农村医养结合型养老服务,探究不同类型政策工具之间的合理匹配,全方位提高农村医养结合型养老服务质量,不断提升老年人健康保障水平。

基于大学生生命教育理念的教学模式在本科危重症护理教学中的应用

目的:探讨基于大学生生命教育理念的教学模式在本科危重症护理教学中的应用效果。方法:采用整群抽样法,选取2022年9月学习危重症护理课程的护理本科1班学生63人为观察组,采用基于大学生生命教育理念的教学模式;护理本科2班学生64人为常规组,采用传统教学模式;比较2组课程考核成绩、批判思维能力评分、临床决策能力评分、核心急救能力评分以及对教学效果的满意度。结果:观察组基础理论考核成绩、综合操作技能考核成绩、批判性思维能力评分、临床决策能力评分、核心急救能力各维度得分以及对教学效果的满意度评分均高于常规组(P<0.01)。结论:在本科危重症护理教学中实施基于大学生生命教育理念的教学模式可促进学生掌握课程知识,培养批判思维能力与临床决策能力,提升核心急救能力,提高学生对教学的满意度。

医养服务机构质量评价指标体系的构建与初步应用

目的以“结构-过程-结果”理论为框架,构建医养服务机构质量评价指标体系并初步应用。方法基于文献研究、小组讨论、德尔菲法及层次分析法,确定评价指标体系和各指标权重。应用该指标体系在长沙市3家医养服务机构进行现场评价。结果共进行2轮函询,专家权威系数分别为0.915和0.927,协调系数分别为0.211和0.164,最终确定一级指标3个,二级指标13个,三级指标53个。评价指标体系的Cronbach'sα系数为0.786,平均内容效度指数为0.862。在3家医养服务机构进行的预调查效果较好。结论医养服务机构质量评价指标体系信度、效度较好。构建的指标科学、合理、实用性强,能有效评价医养服务机构质量并发现问题。

重症监护病房医护沟通现状及需求匹配策略研究

目的:采用混合性研究方法,调查ICU医护沟通实践现状并分析需求匹配策略,为促进医护沟通实践提供依据。方法:采用便利抽样法,对15所医院的435名ICU医护人员医护沟通现状进行问卷调查;采用目的抽样法对5所医院ICU的6名医生及11名护士,进行半结构式访谈。结果:医护沟通评价总分为(73.46±11.38)分;有序Logistic回归分析结果显示,沟通的开放性、沟通的准确性、理解能力、沟通培训经历是医护沟通满意度的影响因素。访谈结果显示医护沟通需求匹配策略主题包括3个:能力需求匹配策略(加强技能培训、强化认知);机会需求匹配策略(建设组织文化、营造沟通环境);内部动机匹配策略(激发职业获得感)。结论:ICU医护沟通实践存在提升空间。管理者可从能力、机会及动机三方面入手,通过加强医护沟通能力及专业培训,优化组织文化及沟通环境,提升医护人员职业获得感和专业价值感,促进ICU医护沟通实践。

医养结合护理模式在老年患者髋关节置换术后的应用效果

目的探讨以医养结合为主体的中医护理模式在老年髋关节置换术后患者中的应用效果。方法便利抽取2021年4月至2022年4月在佛山市中医院关节外科行髋关节置换术的63例患者作为对照组,2022年5月至2023年5月的64例行髋关节置换术的患者作为观察组。对照组在术后采用常规的康复护理训练方案,观察组在对照组基础上,采用医养结合为主体的中医康复护理方案,干预1、3个月后评估两组的髋关节功能、恐动症、日常活动能力评分。结果干预1、3个月后,观察组的髋关节功能评分、恐动症评分、日常活动能力评分均高于对照组,差异有统计学意义(P<0.05)。结论基于医养结合的中医护理模式有助于提高老年髋关节置换术后患者髋关节功能和降低恐动症水平,并提升患者的日常生活能力,值得临床推广。

医联体背景下护理专科联盟的建设与思考

目的在医联体背景下建立护理专科联盟,探讨护理专科联盟建设的成效。方法2022年11月1日通过问卷星以南京医科大学附属淮安第一医院为护理专科联盟理事长单位的14个护理联盟发放调查问卷。比较实施前后各护理专科联盟单位护理专科联盟实施成效及护理专科联盟护理质量督查情况。结果实施后,护理专科联盟单位的护理管理能力、护士理论考核、护士操作考核、实境考核、护理人员职业认同感、患者满意度评分均高于实施前,差异有统计学意义(P<0.05)。实施后,护理专科联盟分级护理质量、急救药品物品质量、消毒隔离质量评分均高于实施前,差异有统计学意义(P<0.05)。结论成立护理专科联盟是优质护理资源下沉的新思路,有利于提升护理专科联盟的护理管理水平,护士的核心能力,提高基层护理服务质量,提升基层患者就医的获得感。

1例腰椎间盘突出症患者的医护一体化中医护理查房

总结1例腰椎间盘突出患者的医护一体化中医护理查房实践经验。分析患者临床资料,由责任护士汇报病例,医生分析病情,医护联合对重点护理内容进行讨论,协同制定护理措施。通过医护一体化查房,医护之间专业互补,重建医、护、患三位一体的治疗和护理模式,达到实施整体护理的效果。

“互联网+居家护理”在志愿护理服务中的应用效果

目的探讨"互联网+居家护理"在志愿护理服务中的应用效果。方法选取2020年12月至2021年12月"党群服务365平台"82例需要服务人群作为研究对象,采用随机数字表法将其分为对照组(41例)和观察组(41例)。对照组实施常规医疗服务,观察组实施"互联网+居家护理"服务,两组均持续护理12个月。比较两组的医院看病次数、医疗花费情况、日常生活能力、精神状态、照护者照护技能水平以及生活满意度。结果观察组医院看病次数、医疗花费情况均少于对照组,差异有统计学意义(P<0.05);观察组护理后日常生活活动能力量表(ADL)评分低于对照组,简易精神状态检查量表(MMSE)评分、照护技能水平评分均高于对照组,差异有统计学意义(P<0.05);观察组护理后生活满意度调查表(LSR)各项评分均高于对照组,差异有统计学意义(P<0.05)。结论通过互联网平台,护理志愿者对服务人群进行居家护理,能够改善服务人群的精神状态,促使其保持身心健康,提高生活自理能力,还能提高照护者的护理技能,一定程度上减少看病次数和医疗花费,从而提升服务人员满意度。

全程优质护理干预在致命性出血患者中的应用

目的 探讨全程优质护理干预在致命性出血患者救治中的应用效果。方法 以2018年1月至2020年1月湖南省人民医院致命性出血的196例患者为对照组,2020年2月至2022年2月致命性出血的200例患者为观察组。对照组实施传统的护理干预,观察组实施基于MEWS评分、SBAR交接模式、医护同组责任制管理等的全程优质护理干预。比较两组患者的并发症发生率、病死率、入住ICU总时长、医疗护理服务质量(包括护理不良事件发生率和患者护理满意度)。结果 观察组的并发症发生率、致死率、不良事件发生率以及入住ICU总时长均低于对照组(P<0.05)。患者护理满意度高于对照组,差异有统计学意义(P<0.05)。结论 实施基于MEWS评分、SBAR交接模式、医护同组责任制管理等的全程优质护理干预能显著提高致命性出血患者救治成功率,降低其不良事件的发生率,改善愈后,提升患者对护理工作的满意度。