【摘要】目的：探讨器械护士术中分区精细化器械管理对心脏瓣膜置换术（HVR）手术效率及安全性的影响。方法：研究对象包括2024年6月~2026年5月至我院行HVR治疗的110例心脏瓣膜病（VHD）患者，以及同期参与手术的22名器械护士，采用随机数字表法将入组患者及护士分别列为常规组（55例患者、11名护士）、试验组（55例患者、11名护士），常规组内护士术中实施常规器械管理，试验组内护士术中实施分区精细化器械管理。比较两组患者的手术效率、围手术期安全事件，以及两组护士所参与手术的工作效率、术中器械管理情况。结果：在不同器械管理模式下，试验组内患者的主动脉阻断时间、体外循环时间、术中非必要等待时间、手术总耗时均低于常规组（t=8.817，5.730，20.609，9.632；P＜0.05）。试验组内患者的围手术期安全事件发生率9.09%（5/55）低于常规组25.45%（14/55）（x2=5.153；P＜0.05）。试验组内护士的器械摆台时间、器械传递反应时间、手术中断次数、器械整理时间、器械移交时间均低于常规组（t=3.347，6.505，5.971，3.795，5.838；P＜0.05）。试验组内护士的器械管理差错率低于常规组（x2=5.238；P＜0.05）。结论：器械护士术中分区精细化器械管理能提高HVR患者的手术效率并降低围手术期安全事件发生风险，对提高器械护士的器械管理质量、预防器械管理差错有积极影响

[Abstract]Objective:To explore the impact of refined intraoperative instrument management by operating room nurses on the efficiency and safety of HVR surgery.Methods:The study subjects included 110 patients with VHD who underwent HVR treatment at our hospital from June 2024 to May 2026, along with 22 instrument nurses who participated in the surgeries synchronously. Using the random number table method, the enrolled patients and nurses were divided into a control group (55 patients, 11 nurses) and an experimental group (55 patients, 11 nurses). Nurses in the conventional group implemented routine instrument management during surgery, while nurses in the experimental group implemented zoned and refined instrument management during surgery. The surgical efficiency, perioperative safety events of the two groups of patients, as well as the work efficiency and intraoperative instrument management of the surgeries participated by the nurses in the two groups were compared.Results:Under different instrument management modes, the aortic occlusion time, extracorporeal circulation time, intraoperative non-essential waiting time, and total surgical time of patients in the experimental group were all lower than the control group (t=8.817，5.730，20.609，9.632; P<0.05). The incidence of perioperative safety events in the experimental group was 9.09% (5/55) lower than that in the control group 25.45% (14/55) (x2=5.153; P<0.05). The instrument placement time, instrument delivery response time, number of surgical interruptions, instrument sorting time, and instrument handover time of nurses in the experimental group were lower than those in the control group (t=3.347，6.505，5.971，3.795，5.838; P<0.05). The error rate of nurses in the experimental group was lower than the control group (x2=5.238; P < 0.05).Conclusion:Refined intraoperative zone-specific instrument management by instrument nurses enhances surgical efficiency for HVR patients and reduces the risk of perioperative safety incidents, thereby positively impacting the quality of instrument care provided by nurses and preventing instrument-related adverse events.

       目的   系统评价护士的护理伦理敏感性现状及影响因素，为针对性干预提供参考。方法   检索国内外相关数据库，检索时限为2024年7月护士的护理伦理敏感性现状及影响因素的相关文献。由两名分析人员独立筛选文献、提取资料、质量评价后采用Stata 15.0和RevMan 5.3软件进行meta分析。结果   纳入16篇文献，包括4 961例研究对象。Meta分析结果显示，护士的护理伦理敏感性处于中等偏高水平，总分为［OR=67.29，95%CI（53.24，81.34）］分。年龄［OR=2.78，95%CI（1.45，5.33），P=0.002］、工作年限［OR=3.55，95%CI（1.35，9.33），P=0.001］、伦理知识教育［OR=14.60，95%CI（4.24，50.32），P＜0.001］、共情能力［OR=1.35，95%CI（1.01，1.80），P＜0.001］、工作场所氛围［OR=1.85，95%CI（0.42，4.51），P＜0.001］、工作嵌入量［OR=3.60，95%CI（0.40，32.84），P=0.001］是护士护理伦理敏感性的主要影响因素。结论   当前证据表明，护士的护理伦理敏感性处于中等偏高水平，影响因素较多，管理者需结合人群特征实施干预，以提高护士护理伦理敏感性水平。

   Objective  To systematically evaluate the current status of nurses’  ethical  sensitivity in  nursing  and influencing factors that influence it，in order to inform targeted interventions．Methods  Domestic and international databases were searched to collect literature related to the current status of nurses’ ethical sensitivity in nursing and the factors influencing it from the year of construction to July 2024．Meta-analysis was performed by two analysts independently screening the literature，extracting information，and quality evaluation using Stata 15.0 and RevMan 5.3 software．Results  Sixteen papers including 4 961 study subjects were included．Meta-analysis results showed that nurses had moderately high level of ethical sensitivity in nursing with a total score of 67.29（95%CI［53.24，81.34］）．Age（OR=2.78，95%CI［1.45，5.33］，P=0.002），years of experience（OR=3.55，95%CI［1.35，9.33］，P=0.001），education on ethical knowledge（OR=14.60，95%CI［4.24，50.32］，P＜0.001），and empathic ability（OR=1.35，95%CI［1.01，1.80］，P＜0.001），workplace atmosphere（OR=1.85，95%CI［0.42，4.51］，P＜0.001），and the amount of job embeddedness（OR=3.60，95%CI［0.40，32.84］，P=0.001） were the main influences on nurses’ ethical sensitivity in nursing．Conclusions  The previous evidence suggests that nurses have moderately high levels of nursing ethical sensitivity，with a high number of influencing factors，and managers need to give interventions that incorporate the characteristics of the population in order to increase the level of nursing ethical sensitivity among nurses．

目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组（n=53）与对照组（n=53）。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表（WHOQOL-100）及癌因性疲乏程度（PFS）,最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表（VAS）评分、术后住院时间均优于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）;干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组（P<0.05）;观察组护理满意度高于对照组（P<0.05）。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。

Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection．Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group（n=53）and a control group（n=53）using a random number table method．All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care．The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared．Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale（VAS）score and postoperative hospital stay compared to the control group（P<0.05）．The incidence of complications in the observation group was lower than that in the control group（P<0.05）．After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group．The PFS score decreased,and the observation group was lower than the control group（P<0.05）．The nursing satisfaction of the observation group was significantly higher than that of the control group（P<0.05）．Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction．

目的 探讨对分课堂对《老年人健康照护技术》实训教学效果的影响,为进一步完善智慧健康养老服务与管理专业实训教学方案提供参考依据。方法 以广州卫生职业技术学院2022级智慧健康养老服务与管理专业学生为研究对象,设定其中一班为观察组,另一班为对照组,在《老年人健康照护技术》实训教学过程中,观察组采用对分课堂的实训教学模式,对照组采用传统实训教学模式;实训结束后对两组均进行理论和技能考核,并在教学前后均采用《一般自我效能感量表》对两组学生进行测评。结果 试验开始之前,对两组学生一般自我效能感测评得分进行比较,差异无统计学意义（P>0.05）;试验结束后,将观察组与对照组的理论和技能考核成绩、一般自我效能感得分进行比较,观察组均明显高于对照组,差异有统计学意义（P<0.01）;且观察组一般自我效能感得分优于本组试验前,差异有统计学意义（P<0.01）。结论 对分课堂有利于提高学生的一般自我效能感,有助于改善《老年人健康照护技术》的实训教学效果,能够为进一步完善智慧健康养老服务与管理专业实训教学方案提供参考依据。

Objective To explore the impact of split courses on the practical training and teaching effectiveness of “Elderly Health Care Technology”,and to provide reference for further improving the practical training and teaching plan of smart health and elderly care services and management．Methods A study was conducted on students majoring in Intelligent Health and Elderly Care Services and Management from Guangzhou Health Vocational and Technical College in 2022．One class was set as the observation group and the other as the control group．During the training and teaching process of “Elderly Health Care Technology”,the observation group adopted a split courses training teaching mode,while the control group adopted a traditional training teaching mode．After the practical training,theoretical and skill assessments were conducted on both groups,and the General Self Efficacy Scale was used to evaluate both groups of students before and after teaching．Results Before the start of the experiment,there was no statistically significant difference in the general self-efficacy evaluation scores between the two groups of students（P>0.05）．After the experiment,the theoretical and skill assessment scores, general self-efficacy scores of the observation group, and the control group were compared．The observation group was significantly higher than the control group,with a significant statistical difference（P<0.01）,and the general self-efficacy score of the observation group was better than before the experiment,with a statistically significant difference as well（P<0.01）．Conclusions split courses were beneficial for improving students’ general self-efficacy,enhancing teaching effectiveness,and providing reference basis for further improving the practical training teaching plan for smart health and elderly care services and management．

目的 调查非重症监护室护士对住院卧床老年患者肺康复的知信行现状,探讨其影响因素。方法 采用自行设计的卧床老年患者肺康复知信行现状调查问卷,对广州市第一人民医院的555 名非重症监护室护理人员进行调查。结果 共回收有效问卷513份。调查对象肺康复知信行总分为（76.01±12.27）分,知识维度、态度维度、行为维度得分分别为（14.09±3.25）、（21.89±3.38）、（40.03±9.87）分。多元回归分析显示,主要影响护士对住院老年卧床患者实施肺康复知信行的因素为护龄、是否参加过肺康复相关培训及科室是否已开展肺康复（P<0.05）。结论 非重症监护室护士对卧床老年患者肺康复的态度积极,行为良好,但知识有待提升。建议开展卧床老年人相关肺康复培训,激励护士主动学习肺康复新理念的积极性和主动性,强化理论联系临床实践,从而提高临床护理质量。

Objective To investigate the knowledge,attitude and practice of non-intensive care unit（ICU）nurses about pulmonary rehabilitation of hospitalized bedridden elderly patients,and to explore the influencing factors．Methods A self-designed questionnaire on the status of knowledge,attitude and practice about pulmonary rehabilitation of bedridden elderly patients was used to investigate 555 non-ICU nurses in our hospital．Results A total of 513 valid questionnaires were collected．The total score of pulmonary rehabilitation was（76.01±12.27）,and the scores of knowledge,attitude and practice were（14.09±3.25）,（21.89±3.38）and（40.03±9.87）,respectively．Multiple regression analysis showed that the main factors affecting nurses' knowledge,attitude and practice in implementing pulmonary rehabilitation for hospitalized elderly bedridden patients were nursing age,whether they had participated in training related to pulmonary rehabilitation and whether pulmonary rehabilitation had been carried out in the unit（P<0.05）．Conclusions Non-ICU nurses have positive attitudes and good practice toward pulmonary rehabilitation for bedridden elderly patients,but their knowledge needs to be improved．It is recommended that training on pulmonary rehabilitation for the bedridden elderly be carried out to motivate nurses to learn new concepts of pulmonary rehabilitation,strengthen the link between theory and clinical practice,and improve the quality of clinical care．

目的 了解精神科护士的临床决策意识与其情绪智力水平的相关性。方法 采用护理临床决策量表(CDMNS),情绪智力量表(WLEIS)对来自广州市3家医院的230名精神科护士进行问卷调查,并对结果进行相关性分析。结果 精神科护士临床决策意识得分为(133.25±14.68)分,情绪智力得分为(74.15±11.77)分,精神科护士临床决策意识总分与情绪智力能力总分呈显著正相关(r=0.413,P＜0.05)。结论 精神科护士临床决策意识、情绪智力为中等水平,提高情绪智力水平有助于提高精神科护士的临床决策能力。

Objective To understand the correlation between the clinical decision-making awareness of psychiatric nurses and their emotional intelligence. Methods Using the clinical decision-making in nursing scale (CDMNS) and Wong & Law emotional intelligence scale (WLEIS), a questionnaire survey was conducted among 230 psychiatric nurses in 3 hospitals in Guangzhou, and correlation analysis was performed on the results. Results The clinical decision consciousness score of psychiatric nurses was (133.25±14.68), and the emotional intelligence score was (74.15±11.77). The total score of clinical decision consciousness of psychiatric nurses was significantly positively correlated with the total emotional intelligence ability score (r=0.413, P<0.05). Conclusions The clinical decision-making awareness and emotional intelligence of psychiatric nurses were at a medium level. Increasing the level of emotional intelligence can help improving the clinical decision-making ability of psychiatric nurses.

目的 调查临床护士对新型冠状病毒肺炎的知信行现状,为制定相关培训策略提供依据。方法 采用便利抽样法,2020年3月选取我院的1 007名临床护士作为研究对象,采用一般资料及临床护士对新型冠状病毒肺炎知信行问卷对其进行调查。结果 1 007名临床护士对新型冠状病毒肺炎的知识、态度、行为得分分别为(28.82±9.22)分、(52.04±5.52)分、(55.38±7.93)分,新型冠状病毒肺炎知信行总分为(136.24±14.52)分。不同年龄、职称、职务、工作年限、何时参加过穿脱防护服操作培训及考核新型冠状病毒肺炎知识得分比较,差异均有统计学意义(P<0.05);工作年限、何时参加过穿脱防护服操作培训及考核,其新型冠状病毒肺炎态度得分比较,差异均有统计学意义(P<0.05);是否参加过穿脱防护服操作的培训及考核、何时参加过穿脱防护服操作培训及考核、是否参加过咽拭子采集的培训及考核的新型冠状病毒肺炎行为得分比较,差异均有统计学意义(P<0.05)。结论 临床护士对新型冠状病毒肺炎的知识得分处于较低水平,态度和行为得分较好,建议护理管理者需加强临床护士对新型冠状病毒肺炎的知识学习及相关培训,以提高护士知识及技能水平。

Objective To investigate the current status of nurses' knowledge, attitude and behavior to new coronavirus pneumonia, to provide the basis for formulating relevant training strategies. Methods In March 2020, 1 007 clinical nurses in our hospital were selected as the research object. The general information and questionnaire about the new coronavirus pneumonia were investigated in these nurses. Results Scores of 1 007 nurses answered the knowledge, attitude and behavior to new coronavirus pneumonia were(28.82±9.22),(52.04±5.52), and(55.38±7.93), respectively. The total score of knowledge, attitude, and behavior to the new coronavirus pneumonia was(136.24±14.52). The differences of scores of knowledge about new coronavirus pneumonia between different ages, job titles, duties, working years, and when they participated in the training and evaluation of wearing and taking off protective clothing were statistically significant (P<0.05). There was a statistically significant difference in the attitude scores of the new coronavirus pneumonia between different working years and when they participated in training and evaluation of wearing protective clothing (P<0.05). There were statistically significant differences in the behavior scores to new coronavirus pneumonia between whether and when they have participated in the training and evaluation of wearing and taking off protective clothing, and whether they had participated in the training and evaluation of pharyngeal swab collection (P<0.05). Conclusion Nurses' knowledge scores for new coronavirus pneumonia are at a low level, but their attitude and behavior scores are higher. It is recommended that new coronavirus pneumonia knowledge and related training should be strengthened for nurses to improve nurses' knowledge and skills.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

目的 结合临床现状分析影响护士护患沟通能力的相关因素,并根据影响因素制定相关应对方案。方法 采用《护士临床沟通能力量表》对广州市某三甲医院的941名护士进行调查。结果 护士沟通能力得分为(4.19±0.43)(评分范围为1～5分),其中情感支持能力维度得分最低(4.05±0.37),护士性别、婚姻状况、职称、职务和培训次数不同,其护患沟通能力得分有差异(P<0.05))。结论 护士的情感支持能力有待提高,性别、婚姻状况、职称、职务和接受培训的次数是护患沟通能力的影响因素,管理者应根据护士特征应加强对护士的培训,以提高其护患沟通能力。

Objective Combined with the clinical situation, this paper analyzes the relevant factors that affect the nurse-patient communication ability, and makes relevant countermeasures according to the influencing factors. Methods 941 nurses in a tertiary hospital in Guangzhou were surveyed using the Nurse Clinical Communication Competence Scale. Results The communication competence score of nurses in the hospital was (4.19±0.43) (the score was ranged from 1 to 5), among which nursing staffs' emotional support competence were scored in lowest (4.05±0.37). There was statistically significant in communication competence between nurses with different gender, marital status, job title, position and training times. (P<0.05). Conclusion The emotional support competence of nurses needs to be improved. The gender, marital status, professional title, position and number of trainings are the influencing factors of nurse-patient communication ability. Nursing managers could improve nurses' communication competence by increasing the training of nurses according to their charateristics.

目的 本研究通过调查中国华南地区一间大型医疗机构(综合医院)中护士日间过度嗜睡的发生率及相关影响因素。方法 纳入了1 102名在职护士要求他们在一段规定的时间内完成一份自我报告问卷,其中包括人口学资料采集、生活习惯(BMI、小睡习惯、打鼾等)、失眠、抑郁、焦虑、MEQ分型、倒班、工作兴趣等与工作及睡眠相关的特征。了解EDS在被试人群中的发生率及其影响因素。结果 共有1 048名护士有效的完成了问卷(应答率为95.1%)。其中169名(16.1%)护士存在日间过度嗜睡(EDS)。抑郁症状(校正后的OR值= 2.24,95%的可信区间 1.51～3.31)、焦虑症状(1.65; 1.02～2.67)、失眠(2.29; 1.56～3.36)、倒班工作(1.98; 1.03～3.83)和对工作的低兴趣(1.74; 1.01～2.99)是EDS发生的独立危险因素。结论 日间过度嗜睡(EDS)在华南地区的综合医疗机构中的青年护士群体中普遍存在。EDS的发生可能与抑郁症状、焦虑症状、失眠、倒班工作和对工作的低兴趣存在相关。

Objective To investigate the prevalence and correlates of excessive daytime sleepiness EDS in a population of hospital nurses in South China. Methods A total of 1 102 nurses working in a large medical center were invited to participate in this cross-sectional study (females 96.9%,mean age 29.6 years). They all completed a self-reported questionnaire consisting of items on demographic variables,lifestyle factors,insomnia,anxiety,depression,and both work-related and sleep related characteristics. Results A total of 1 048 nurses gave a valid response (response rate 95.1%). Among them,169 (16.1%) reported EDS as defined as an Epworth Sleepiness Scale≥14. Depression (adjusted odds ratio=2.24,95% confidence interval 1.51～3.31),anxiety (1.65; 1.02 ～2.67),insomnia (2.29; 1.56～3.36),rotating shift work (1.98; 1.03～3.83) and low interest in work (1.74; 1.01～2.99) were all independent risk factors of the occurrence of EDS. Conclusion EDS were common among this relatively young and healthy nurse population in south China. There were clear associations with EDS and depression,anxiety,insomnia,rotating shift work and low work-related interest.