Discussion on the clinical pathway of cultivating humanistic care ability in the practical teaching of nursing college students / 中华医学教育探索杂志

Objective:To examine the effect of applying clinical pathway model in the cultivation of humanistic care ability of nursing college students in clinical practical teaching.Methods:The study collected 52 nursing students who practiced in the department of gynecology of a tertiary first-class hospital in Xi’an from July to October, 2017 as the control group, and 52 nursing students who practiced in the same unit from July to October, 2018 were selected as the experimental group. The control group adopted the teaching method of infiltrating humanistic care education into the training process of operational skills, while the experimental group adopted the teaching method of cultivating humanistic care ability of nursing college students through clinical pathway. The differences of humanistic care ability scores between the two groups were compared. SPSS 19.0 was used for t test. Results:Before the internship, there was no statistically significant difference in humanistic care scores between the two groups ( P>0.05). After the internship, the total scores of nursing students in the experimental group were significantly higher than those in the control group ( P<0.05). Conclusion:Applying the clinical pathway model to the cultivation of humanistic care ability of nursing students in clinical practice teaching is a new cultivation model of humanistic care ability, which is helpful to improve the humanistic care ability of nursing students.

Distribution and drug resistance analysis of carbapenems-resistant Klebsiella pneumoniae / 中华全科医师杂志

Objective To investigate the clinical distribution and drug resistance of carbapenemsresistant Klebsiella pneumoniae (CRKP).Methods A total of 134 clinical strains of CRKP were collected from inpatients in our hospital from January 2014 to December 2016.VITEK-2 compact automatic microbiological analyzer was used to identify the bacteria and the supporting gram-negative bacterial drug susceptibility card was used for susceptibility testing.The sensitivity of other clinical commonly used antimicrobial agents was measured by K-B method.And the clinical distribution of CRKP and its resistance to antimicrobial agents were investigated and analyzed.Results The clinical strains of CRKP were isolated mainly from urine (n=70,52.2％) and sputum (n=38,28.4％).Klebsiella pneumoniae was identified in samples from the department of neurosurgery,including neurosurgery ICU (47.8％,64/134),ICU (23.9％,32/134),department of hepatobiliary surgery (8.2％,11/134) and department of urology (6.0％,8/134).Among all 22 antimicrobial agents tested,the resistant rates of CRKP to 16 antimicrobial agents were ＞90％,especially for ampicillin it was 100％,and those to 19 antibiotics were ＞80％,only for tigecycline it was 23.1％.There were 16 strains of CRKP with positive extended spectrum β-lactamases (ESBLs) (11.9％).All the CRKP strains were resistant to more than three kinds of antimicrobial agents,except one strain that was resistant to two kinds.Conclusion There is a wide range of clinical distribution of CRKP,which is resistant to most of antimicrobial agents,while tigecycline still has a strong antibacterial activity to CRKP.

Sleep Quality and Coping Styles in Cervical Cancer Patients undergoing Radiotherapy / 中国医学伦理学

Objectives:To explore the relationship between sleep quality and coping styles in cervical cancer patients undergoing radiotherapy.Methods:68 cervical cancer patients were assessed by convenient sampling,who had been investigated with Pittsburgh Sleep Quality Index (PSQI) and Jalowiec coping scale (JCS-60).Results:Global PSQI score was (8.60 ± 4.47).Optimistic coping scored highest with score of (2.11 ± 0.45),which was the style most often applied by cervical cancer patients.Emotive coping scored lowest with score of (0.97 ± 0.62).Among 60 coping items,Hoped that things would get better was the most often used coping strategy,Took a drink to make yourself feel better was the least used coping strategy.Global PSQI score was positively correlated with fatalistic coping(r =0.325,P =0.008).Confrontive coping was positively correlated with subjective sleep quality score(r =0.318,P =0.009),while supportive coping was negatively related to subjective sleep quality score(r =-0.306,P =0.013),and palliative was negatively related to daytime dysfunction(r =-0.245,P =0.047).Gonclusions:Sleep problems are a common complaint in cervical cancer patients undergoing radiotherapy.Health care workers should guide the patients to adopt active coping styles to improve sleep quality.

Professional Identity Status and the Influential Factors among Student Nurses in Shaanxi Province / 中国医学伦理学

Objective:To investigate the status of professional identity among student nurses and explore its influential factors.Methods:A total of 1,302 student nurses from 3 universities of different levels in Shaanxi Province were selected using stratified and cluster random sampling method and investigated by adopting Professional Identity Questionnaire for Nurse Students (PIQNS).Results:Student nurses in Shaanxi Province scored (57.56 ± 12.55) in professional identity,of which the lowest was independence of career choice in the 5 dimensions.It showed that educational status,gender,and the reasons to choose nursing specialty correlated to student nurses' professional identity (P ＜0.05).Conclusions:The professional identity of student nurses especially for the undergraduate nurses is not high,which should cause the attention of the nursing educators and nursing managers to stabilize nursing team.

The clinical features of 93 bacterial liver abscess cases / 中国医师杂志

Objective To investigate the clinical features of patients with bacterial liver abscess.Methods The clinical data of patients with liver abscess during January 2014 to December 2016 were retrospectively analyzed.Results There were 93 cases enrolled,26.88％ were accompanied by diabetes mellitus (DM),60.22％ were accompanied liver,gall bladder,pancreas diseases or had history of liver,bile duct or gastrointestinal surgery.The most common symptoms were fever (94.62％) and gastrointestinal symptoms (50.54％),while 15.05％ for shock;91.40％ were single abscess,and 73.12％ were in the right lobe.The white blood cell count (WBC),neutrophil (N),hypersensitive C-reactive protein (hsCRP),procalcitonin (PCT),alanine aminotransferase (ALT),and aspartate aminotransferase (AST) were elevated in 60.22％,65.59％,97.85％,82.93％ (34/41),47.31％,and 46.24％ of patients,respectively.12/62 (19.35％) were positive by blood culture and 32/54 (59.26％) were positive by pyogenic fluids or bile culture,the top two pathogenic bacteria were Klebsiella pneumonia (52.27％) and Escherichia coli (27.27％).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were between 0-25 points,72.04％ cases were (0-10) points,26.88％ case were (11-20) points and one patient was more than 20 points.Among the 93 cases,82.79％ were underwent antibacterial by carbapenem,penicillin enzyme compound preparation or combined with levofloxacin,and 45.16％ were underwent liver puncture of drainage treatment.A percentage (96.77％) of patients was cured or recovered.Conclusions Biliary retrograde infection is the main cause of hepatic abscess.In the early experiential antibacterial therapy,the first-line choices of antibiotics are those effective to extended spectrum 3-lactamase (ESBL) positive enterobacteriaceae bacteria.Liver puncture of drainage treatment may be effective and safety.APACHE Ⅱ score may be useful to assess the prognosis of live abscess.

Effect Evaluation of Penetrating Humanistic Care Educationinto Clinical Practice Teaching for Nursing Students-Taking Gynecological Nursing as an Example / 中国医学伦理学

Objective:To examine the effect of penetrating humanistic care educationin to gynecological clinical practice teaching to nursing students′humanistic care ability. Methods:A total of 236 nursing students in the First Affiliated Hospital of Xi′an Jiaotong University were allocated to the experimental group ( n=123 ) with the clinical practice teaching methods, of which the core was training humanistic care ability, while the control group ( n=113) in the Second Affiliated Hospital of Xi′an Jiaotong University with the routine method, which mainly trained the operating skills. The humanistic caring ability between these two group students was compared. Results: Be-fore the internship, there was no statistical significance between the two groups (P>0. 05). After the internship, the rewere no significant difference ( P>0 . 05 ) in the scores of assisting to meet the basic needs,providing a good environment, andhelping to solve the difficulty. For the dimensions ofinfusing faith and hope,health education,humanistic and altruistic value,solving health problems scientifically,promoting emotional com-munication, and the total scale, the scores were significantly higher than those of the control group (P<0. 05). Conclusion:In the clinical practice teaching, permeating humanistic care education helps to improve the nursing students′ability of humanistic care.