提高护理质量 降低危症监护病房院内感染

CCU(危症监护病房)院内感染是威胁重危病人生命的主要原因之一,它还可导致病人住院时间延长加重病情或产生多器官功能衰竭等严重后果,增加了病人和国家经济负担,因此,积极预防和控制CCU院内感染其目的非同小可,多年来我们认真地做好了此项工作,收到了较好的成效,介绍如下: 1994年3月,我院建立了感染管理委员会,以临床,感染管理、微生物监测三方面人员组成院内感染监控机构。在CCU组成由护士长为核心的院内感染监控小组,并接受机构人员的指导、检查和帮助。1994年3月～1999年3月5年间,监护病人为3841人次,监护时间为3～10天,其中院内感染人数为153人,

连续APACHEⅢ评分在重症监护病房的应用

目的连续评估重症监护病房(ICU)危重症患者急性生理学及慢性健康状况评分Ⅲ(APACHEⅢ),探讨其应用价值。方法收集、整理320例急危重症患者的资料,应用APACHEⅢ评分系统连续3d评估患者病情严重程度,预测预后,并追踪最终结果。结果 APACHEⅢ评分分值增高,实际病死率亦随之增加,评分分值>90分者病死率明显增高。APACHEⅢ评分与MODS呈正相关,其相关性为0.67。结论连续APACHEⅢ评分系统有助于ICU患者病情程度及预后评估,是提高医疗质量及合理利用ICU资源的依据。

床旁超声预测重症监护病房感染性休克患者容量反应性的临床价值

探究床旁超声预测重症监护病房感染性休克患者容量反应性的应用价值。方法:本研究选取了2019年1月~2021年2月期间在我院重症监护病房治疗的112位采用机械通气的感染性休克患者为研究对象,对所有患者进行补液试验,在补液前后,均使用超声测量患者的血流动力学指标心率、平均动脉压、中心静脉压、肱动脉最大速度变异率、下腔静脉扩张指数、主动脉峰值流速呼吸变异率,并根据患者出现反应的情况将其分为有反应组和无反应组,分析超声在预测重症监护病房感染性休克患者的应用价值。结果:两组患者在补液前的心率、平均动脉压、中心静脉压均无显著差异(P>0.05),但有反应组患者的肱动脉最大速度变异率、下腔静脉扩张指数及主动脉峰值流速呼吸变异率均明显比无反应组患者高 (P>0.05);补液后,两组患者心率、平均动脉压与补液前无显著差别(P>0.05),但中心静脉压相较于补液前有了明显的升高(P<0.05),在肱动脉最大速度变异率、下腔静脉扩张指数、主动脉峰值流速呼吸变异率三个指标方面,有反应组患者与补液前相比显著降低(P<0.05),无反应组患者则与补液前无显著区别(P>0.05)。结论:床旁超声对于预测重症监护病房感染性休克患者容量反应性具有良好的预测作用,值得推广使用。

EICU患者医源性贫血与检验失血量的相关性研究

目的探讨EICU危重患者贫血与检验等医源性失血量及其预后的相关性。方法采用回顾性研究方法，收集两家医院EICU住院危重患者159例，根据性别、年龄、人院时有无贫血、疾病严重程度、是否存活等分组，对贫血、检验失血量、日均检验失血量、APACHEII评分及死亡率等观察指标进行相应比较。结果EICU重症患者贫血发生率高达49．18％，贫血患者死亡率13．84％，显著高于对照组。人院时EICU危重患者合并贫血与APACHE1I评分呈正相关，与检验失血量、日均检验失血量无关。入院后疾病严重程度与贫血、检验失血量差异有统计学意义（P〈0．01）；救治成功率与年龄、APACHEⅡ评分、检验失血量、日均检验失血量等差异也有统计学意义（P〈0．05）。结论EICU重症患者住院期间常合并医源性贫血，这与检验失血量呈正相关，并与疾病严重程度、死亡率的影响明显相关。提高临床医师对检验性失血的重视程度，优化检验流程，采取计划性抽血送检、精确最小检验需血量、剩余血样储存备检及节省血样新式动脉导管等，是降低医源性贫血的有效方法，对提高重症患者救治成功率、降低危重患者死亡率具有极其重要的临床意义。

Effects of white noise on procedural pain-related cortical response and pain score in neonates:A randomized controlled trial

Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.

Demands of experiential training for ICU nurses in Hunan of China

Objective:To assess intensive care unit(ICU)nurses’demands for specialized experiential training and to provide inputs for developing an experiential training program for ICU nurses.Methods:A questionnaire for assessing ICU nurses’demands for experiential specialty training was distributed to 360 ICU nurses,selected through purposive sampling from two secondary hospitals and six tertiary hospitals in Hunan Province,China.Results:Of the survey participants,63.6%had undergone a specialty training program for ICU nurses.Of these individuals,53.0%were satisfied with the training.Certification as a qualified nurse was considered an essential criterion for admission of trainees into the program by 81.8%of respondents,while 77.1%of respondents considered clinical working experience to be a critical requirement for selecting trainers.A total of 48.1%of the respondents preferred part-time training,and 36.1%considered a training cycle of 9 e12 weeks to be reasonable.Moreover,they felt that the training methods should be tailored to different stages of the experiential learning cycle.Demands for experiential training among ICU nurses were quantified,with high demand reflected in an overall score of 4.41±0.48.The“intensive care technology”experiential training module was ranked highest in terms of demand,with the top five sub-modules being specialty operating technology(4.67±0.53),care of critically ill patients(4.66±0.55),critical patient rescue procedures(4.65±0.56),assessing monitoring indexes(4.63±0.56),and the application of relevant instruments(4.61±0.57).Conclusion:Nearly half of the respondents indicated that their experiences of specialty training programs were not satisfactory,and they had high demands for experiential training.Thus,to optimize training outcomes,continuous updating of training methods is essential.Moreover,a systematic,comprehensive,and multilevel experiential training program that targets the specific needs of ICU nurses is essential.

Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool(the COMHON Index)

Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.

Early mobilization implementation for critical ill patients:A cross-sectional multi-center survey about knowledge,attitudes,and perceptions of critical care nurses

Objective To explore critical care clinicians’knowledge,attitudes and perceptions toward early mobilization of critically ill patients in ICUs.Design A cross-sectional national survey was conducted.From January to August 2020,ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge,attitudes and perceptions of ICU early mobilization.Results Totally 512 nurses completed the questionnaire.The respondents’mean score for knowledge of early mobilization was 6.89±2.91.The level of knowledge was good in 2.5%(13/512),fair in 52.3%(268/512).The attitudes toward early mobilization were positive in 31.4%(161/512).In terms of perceived implementation of ICU early mobilization,42.9%(220/512)of nurses did not believe that this should be a top priority in intensive care.The attitudes of nurses from different ICUs were significantly different(F=3.58,P<0.05).The knowledge(7.34±2.78 vs.6.49±2.97,t=3.37,P<0.001)and attitudes(3.82±0.58 vs.3.52±0.56,t=5.63,P<0.001)of nurses who had early mobilization related training were higher than those of nurses who had no training.Conclusions The importance of early ICU early mobilization is increasingly recognized by critical care providers.However,there is still a gap in the knowledge,attitudes and perceptions of ICU early mobilization among nurses.In future studies,it is necessary to further systematically identify the reasons leading to the gaps in these aspects and implement targeted interventions around these gaps.Meanwhile,more nurses should be encouraged to participate in decision-making to ensure the efficient and quality implementation of ICU early mobilization practices.

Nurses’experiences of caring for preterm infants in pain:A metaethnography

Objective:Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit(NICU)hospitalization.Despite advancements in pain alleviation,nurses remain challenged to provide timely and effective pain management for preterm infants.Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population.The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’experiences of taking care of preterm infants in pain.Methods:An extensive literature search in PubMed,CINAHL,PsycINFO,Scopus,BIOSIS and ProQuest Dissertation and Theses Database was conducted,including studies within the past 10 years.Two nursing researchers conducted data extraction and analysis independently.Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants.Studies published in a language other than English,articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’experiences were excluded.Critical Appraisal Skills Programme was used for literature quality evaluation.Results:Eight studies remained after further screening according to inclusion and exclusion criteria.These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran,Canada,the United States,Finland,Sweden,Switzerland,and Australia.Five themes emerged on the nurses’perspectives of taking care of preterm infants in pain:1)They sense the neonatal pain;2)Adverse consequences of unrelieved pain;3)Barriers of managing pain;4)Concerns of available approaches for pain relief;5)Failure to work with parents.Conclusions:This meta-ethnography identified nurses’understanding of pain in preterm infants that can be assessed,and they acknowledged that unrelieved pain could cause developmental deficits in infants.The barriers are lack of training and support on pain assessment and intervention in preterm infants.Optimizing workload and environment,developing age-specified pain assessment and intervention,receiving emotional support and training,and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.

Clinical leadership behaviors among critical care nurses in private and governmental hospital:A cross-sectional survey

Objectives This study aimed to investigate clinical leadership behaviors among critical care nurses and compare the differences between nurses in private and public hospitals.Methods A cross-sectional survey including 365 critical care nurses with a bachelor’s degree in nursing science were recruited in two Egyptian hospitals(a government teaching hospital and one private hospital from January to March 2019.A socio-demographic characteristics form and the Clinical Leadership Behaviors Questionnaire(CLB-Q)were used to collect data.For comparison and analysis,the mean score was calculated and converted to a percentage value.Results Results showed that the overall mean score of nurses’clinical leadership behaviors was 77.11±11.87,the level was higher,and the highest score of the communication dimension was 91.84±7.38.The mean score of nurses at a private hospital(90.48±5.53)was higher than that at a government teaching hospital(68.29±4.21)(P<0.001).On nursing experience,nurses with 5–10 years had higher mean score in self-awareness,advocacy and empowerment,decision making,quality and safety,teamwork,and clinical excellence dimension of clinical leadership behavior than those who worked less than 5 years or more than 10 years(P<0.01).Single nurses had higher mean score in advocacy and empowerment,decision making,quality and safety,and clinical excellence dimension of clinical leadership behavior than those who married(P<0.01).Conclusions Nurse managers should foster clinical leadership by enabling critical care nurses to practice clinical excellence and encouraging their attendance in training programs on quality and safety.Nurses in government hospitals need improvement in clinical leadership behaviors regarding all dimensions.

Professional nurses’facilitation of self-care in intensive care units:A concept analysis

Objective:This article aims to provide an in-depth analysis of the concept of self-care in the intensive care unit and outline its defining attributes,antecedents,consequences and empirical referents.Methods:The literature was searched electronically using databases such as CINAHL,Medline,Psych INFO,ERIC,ScienceDirect,Amed,EBSCO(Health Source:Nursing and Academic Edition),Sage,Ujoogle and Google Scholar.Articles from 2013 to 2020 were searched to target recent and up-to-date information about the definitions,attributes,antecedents and consequences of the concept of self-care.Walker and Avant’s framework was utilised to analyse the concept of self-care.Results:The results of the concept analysis identified seven attributes,namely process,activity,capability,autonomous choice,education,self-control and interaction.The seven identified antecedents are self-motivation,participation,commitment,resources,religious and cultural beliefs,social,spiritual and professional support,and the availability of time.The consequences are the maintenance of health and wellbeing,autonomy,increased self-esteem,disease prevention,empowerment,increased social support and the ability to cope with stress.

The development and implementation of a model to facilitate self-care of the professional nurses caring for critically ill patients

Objectives This article aimed to describe the development,implementation,and evaluation of the model’s effectiveness to facilitate self-care of professional nurses caring for critically ill patients in ICUs.Methods The methods of Chinn and Kramer,Walker and Avant were utilized to generate this model.The study included four steps to develop,implement and evaluate the model:Step 1-concept analysis;Step 2-placing the concept in relationship statements;Step 3-description and evaluation of the model;and Step 4-implementation and evaluation of the model.The implementation and evaluation of the model included two phases:a one-day workshop to present the model,and three months of model implementation.The study was conducted in a specific tertiary hospital in Gauteng Province,South Africa.Twenty-five participants were identified amongst the five ICUs,and only eight participants accepted the invitation.Out of the eight participants,only six professional nurses working in different ICUs in the public sector were interviewed.Results The model was divided into three stages:relationship,working,and termination;it comprised the primary and secondary contexts in which the facilitation of self-care occurs.The model process occurred in a spiral form.The registered nurses benefitted holistically from the three presenters at the workshop,and the social worker contributed to their emotional self-care activities.Three themes emerged:The model brought positive experiences,change,and self-awareness;the model benefitted the registered nurses holistically;role modeling self-care practices motivated and benefitted others.Conclusion The model implementation assisted the registered nurses’in developing self-awareness and resilience.They gained more knowledge regarding self-care,and the model encouraged them to implement improved self-care practices.They became role models of self-care and motivated their friends and families.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region:Evidence from daily deaths,infections and needed hospital resources

Objectives:To measure the effect of social distancing on reducing daily deaths,infections and hospital resources needed for coronavirus disease 2019(COVID-19)patients during the first wave of the pandemic in Nordic countries.Methods:The observations of social distancing,daily deaths,infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds,beds needed in ICUs and infection wards,nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation(IHME)by the University of Washington.The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME.The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark,Finland,Iceland,Norway and Sweden.Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.Results:Results of dynamic long-run models confirm that a 1%rise in social distancing by reducing human contacts may decline daily deaths,daily infections,all hospital beds needed,beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%,15.26%,1.10%,1.17%and 1.89%,respectively.Moreover,results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing,the lengths of restoring back to equilibrium are 67,62,40,22 and 49 days for daily deaths,daily infections,all hospital beds needed,nurses/beds needed in ICUs and nurses/beds needed in infection wards,respectively.Conclusion:Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries.The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Respiratory and Cardiac Characteristics of ICU Patients Aged 90 Years and Older:A Report of 12 Cases

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit （ICU） patients. Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients＇ clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound results. Results The mean age of the included patients was 95 years with a male predominance （8 to 4, 66.7%）. Regarding the reasons for admission, 6 （50.0%） patients had respiratory failure, 1 （8.3%） patient had shock, while 5 （41.7%） patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 during spontaneous breathing trial. patients with diastolic dysfunction showed bilateral B-lines Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heartdysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.

中性粒细胞/淋巴细胞和降钙素原检测重症肺炎患者的临床意义

目的探讨中性粒细胞/淋巴细胞比值(NLR)和降钙素原(PCT)联合检测重症监护病房(ICU)重症肺炎(SP)患者的临床意义。方法选取2017年1月至2020年12月本院收治的76例ICU SP患者为对象,统计治疗1个月内预后情况,对比预后不良组和预后良好组临床资料。Logistic多因素回归分析影响SP预后的因素。结果ICU SP患者治疗1个月内,预后不良发生率为24.36%。Logistic回归分析,多因素分析结果显示,PSI评分、血清NLR、PCT均为影响ICUSP患者预后不良的因素(OR=3.865、3.582、4.204,P<0.05)。血清NLR、PCT预测ICU SP患者预后不良的最佳截断点分别为8.79、6.85 ng/L,两者联合的特异度为98.25%,高于血清NLR、PCT单独进行评估的特异度,且血清NLR、PCT两者联合预测ICU SP患者预后不良的曲线下面积(AUC)为0.881,显著高于血清NLR、PCT单独预测(P<0.05)。结论ICU SP预后不良患者NLR、PCT水平异常偏高,NLR、PCT两者联合对预测ICU SP患者预后不良价值,可作为评估ICU SP患者预后的参考指标。

Survey of attitudes and behaviors of healthcare professionals on delirium in ICU

Objective： To assess the medical community＇s awareness and practice regarding delirium in the intensive care unit （ICU）. Methods： One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University. Results： A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU （P〈0.05）. Primary disease of the brain （agreed by 82.1% of the respondents） was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority （92.4%） of respondents had little knowledge on the diagnosis and the standard treatment of delirium. Conclusions： Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.

Importance of recognizing and managing delirium in intensive care unit

Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units （ICU）, resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors. Narcotic or psychoactive medication is one of the major risk factors that contribute to ICU delirium. Surveys conducted in several countries indicated that delirium in ICU was inad- equately monitored, underdiagnosed and lacked standardized treatment. In order to improve the prevention and treatment of ICU delirium, it is imperative that the ICU professionals should enrich their knowledge about this comorbidity, familiarize themselves with its screening and management, as well as standardize the administration of narcotic and psychoactive medications.