Value of improved nursing measures and enhanced nursing management to reduce the occurrence of adverse events in pediatric infusion

BACKGROUND Intravenous infusion is a common method of drug administration in clinical practice.Errors in any aspect of the infusion process,from the verification of medical orders,preparation of the drug solution,to infusion by nursing staff,may cause adverse infusion events.AIM To analyzed the value of improving nursing measures and enhancing nursing management to reduce the occurrence of adverse events in pediatric infusion.METHODS The clinical data of 130 children who received an infusion in the pediatric department of our hospital from May 2020 to May 2021 were analyzed and divided into two groups according to the differences in nursing measures and nursing management:65 patients in the control group received conventional nursing and nursing management interventions,while 65 patients in the observation group received improved nursing measure interventions and enhanced nursing management.The occurrence of adverse events,compliance of children,satisfaction of children’s families,and complaints regarding the transfusion treatment were recorded in both groups.RESULTS The incidence of fluid extravasation and infusion set dislodgement in the observation group were 3.08%and 1.54%,respectively,which were significantly lower than 12.31%and 13.85%in the control group(P<0.05),while repeated punctures and medication addition errors in the observation group were 3.08%and 0.00%,respectively,which were lower than 9.23%and 3.08%in the control group,but there was no significant difference(P>0.05).The compliance rate of children in the observation group was 98.46%(64/65),which was significantly higher than 87.69%(57/65)in the control group,and the satisfaction rate of children’s families was 96.92%(63/65),which was significantly higher than 86.15%(56/65)in the control group(P<0.05).The observation group did not receive any complaints from the child’s family,whereas the control group received four complaints,two of which were due to the crying of the child caused by repeated punctures,one due to the poor attitude of the nurse,and one due to medication addition errors,with a cumulative complaint rate of 6.15%.The cumulative complaint rate of the observation group was significantly lower than that of the control group(P<0.05).CONCLUSION Improving nursing measures and enhancing nursing management can reduce the incidence of fluid extravasation and infusion set dislodgement in pediatric patients,improve children’s compliance and satisfaction of their families,and reduce family complaints.

Thai nurses' perceptions and practices of family-centered care: The implementation gap

Objectives:This study was conducted to examine the differences between perceptions and practices of family-centered care among Thai pediatric nurses.Methods:This mixed-methods study consisted of two phases,in the first phase,a descriptive comparative design using the Family-Centered Care Questionnaire-Revised(FCCQ-R)was administered to 142 pediatric nurses from a university hospital in Bangkok,Thailand.in the second phase,qualitative interviews were conducted with 16 pediatric nurses to gather complementary information regarding the major findings from the first phase.Results:The results revealed that family strengths and individuality were rated the highest as the most important elements and the most frequent practices.Parent/professional collaboration was perceived as the least important element,while the design of the heath care delivery system was rated as the least frequent practice.The qualitative data revealed that the major reasons for suboptimal implementation included a common perception that family-centered care is a Western concept,nurses'weak attitudes towards their roles,and a shortage of nurses.Conclusions:Nurses agreed that the identified elements of family-centered care were necessary but that they did not incorporate the concepts into their daily nursing practice to maintain their endorsement of the family-centered care model.Further study is needed to explore how family-centered care is understood and operationalized by Thai nurses and how hospital administration and environments can be modified to support this care model.

Multicenter application of a nursing workload measurement scale in adult hospitalization units

Objectives:The study aimed to the multicenter application of a nursing workload measurement scale in the internal medicine and surgery adults hospitalization units.Methods:The study design was a multicenter,observational,and descriptive study.A multicenter application of the MIDENF®nursing workload measurement scale was carried out,which consists of 21 items,and covers the four nursing functions(patient care items,teaching,manager,and researcher),in units of hospitalization of adults of internal medicine and surgery of four different hospitals.Each item contains one or more of the nursing interventions of Nursing Interventions Classification(NIC)and has an assigned time,after comparing the real time it takes to perform each intervention with the North American Nursing Diagnosis Association(NANDA)standardized time.The study was carried out during nine months of the year 2020,measuring two days each month in the three work shifts(morning,evening,and night)to all patients admitted on the days of measurement in the indicated units.Results:The descriptive and inferential analysis of 11,756 completed scales,5,695 in general surgery and 6,061 in internal medicine,showed a greater care load for the two units during the morning shift(227,034 min in general surgery,261,835 min in internal medicine),especially in the items of“self-care”,“medication”,“common invasive procedures”,“fluid therapy”,and“patient and family support”,while the managerial function was similar during the three work shifts in the two units studied,getting values between 57,348 and 62,901min.In the analysis by shift and unit,statistical significance was obtained both for the total workload and the four nursing functions(P<0.001).Conclusions:It is shown that the use of validated scales with the standardized language of nursing functions,adapted to the units,provides objective information to adjust the nursing staff to the real situation of care in any hospital and unit where it is applied,improving quality and patient safety.

Effect of Supportive Measures Guidelines on Nurses’ Practices during Labor

Objectives: To investigate the effect of supportive measures guidelines on nurses’ practices during labor. Methods: A quasi-experimental design (an interventional pre and post-test study). Setting: The study was conducted at obstetric wards and intrapartum units at Nasser Institute Hospital. Sample: All nurses provide guided direct care, there were 40 nurses included in the study. Tools: Three tools were used to collect data named self-administered questionnaire sheet, labor supportive measures’ observational checklists, and nurses’ satisfaction sheet. Results: There was a highly significant improvement in total knowledge and total practical skills among the studied sample pre-intervention compared to immediate post and follow-up intervention (p ≤ 0.01). Additionally, 95% of the studied sample was satisfied with the advanced knowledge included in the guidelines. Conclusion: The supportive measures guidelines had an efficient improving nurses’ knowledge and practices post-intervention. Also, the majority of the studied sample was satisfied with the implemented guidelines. Recommendations: Implementation of labor supportive measure guidelines in different childbirth units to improve nurses’ practice. Further research is required to investigate parturient woman’s satisfaction with the childbirth process after implementing labor supportive measures and the effect of labor supportive measures on childbirth process outcome.

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.

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.

精细化护理管理模式在控制医院感染中的效果

目的探讨将精细化护理管理模式运用于医院感染控制中的效果。方法选取吉林省前卫医院医院感染率较高的重点科室(重症医学科、普通外科、心内科、综合内科)的住院患者及护理人员作为研究对象,其中2023年1月至3月为干预前阶段设为对照组(住院患者1850例,护理人员74人),4月至6月实施精细化护理管理模式为干预后阶段设为观察组(住院患者1880例,护理人员74人),分析比较实施精细化护理前后医院感染监测指标、医院感染知识掌握及院感措施落实情况。结果观察组的院内感染发生率低于对照组,住院患者治疗前病原学送检率高于对照组,差异有统计学意义(P<0.05);两组的多重耐药菌检出率比较,差异无统计学意义(P>0.05);观察组护士的感控知识知晓率、环境清洁消毒合格率、消毒物品管理合格率、无菌物品的管理合格率高于对照组,差异有统计学意义(P<0.05);两组的医疗废物管理情况比较,差异无统计学意义(P>0.05)。结论在医院感染管理中实施有针对性的精细化护理管理模式,能够显著提高护理质量,有效控制医院感染。

持续质量改进对急诊科低年资护士急救应急能力的影响

目的:探讨持续质量改进对急诊科低年资护士急救应急能力的影响。方法:选取2022年6月—12月我院急诊科13名低年资护士作为研究对象,并实施持续质量改进,共实施6个月。比较实施前后低年资护士的急救知识、急救技能、应急能力等成绩考核情况。结果:实施持续质量改进后,低年资护士的急救理论考核成绩[(90.94±5.79)分]高于实施前[(60.14±6.88)分],急救技能考核成绩[(91.21±8.68)分]高于实施前[(55.15±3.97)分],急救应急能力考核成绩均高于实施前,差异均有统计学意义(P<0.05)。结论:持续质量改进可提高急诊科低年资护士的急救理论和急救技能水平,从而有效提高急救应急能力,不仅培养了低年资护士的综合素养,还有利于提高急诊科护理质量,具有重要的研究价值。

医护合作多站点宣教模式对高危人工流产患者避孕效果及满意度的影响

目的:探讨医护合作多站点宣教模式对高危人工流产患者避孕知识的掌握、避孕措施的落实及满意度的影响。方法:选取2021年6月至2021年10月本院收治的高危人工流产患者400例为研究对象,随机分为观察组(200例)和对照组(200例)。对照组常规实施流产后关爱,观察组在对照组的基础上,设立计划生育门诊、PAC咨询室、术前宣教室3个宣教站点,实施医护合作多站点宣教模式,两组均随访1年。比较两组避孕知识的掌握、高效避孕措施立即落实、满意度情况,观察两组患者术后1个月、3个月、6个月、12个月的重复流产率、高效避孕措施续用率、随访应答率。结果:与对照组比较,观察组患者对避孕知识的掌握、高效避孕措施立即落实、满意度、高效避孕措施的续用率及随访应答率更优,重复流产率更低,P<0.05,差异均具有统计学意义。结论:医护合作多站点宣教模式可提高高危人工流产患者的避孕节育风险意识,提升高效避孕措施立即落实率和满意度,降低重复流产率的发生,减少流产带来危害,保护其生殖健康。

基于中医复合病机理论探讨肺结节的调护思路

肺结节为临床常见病症,但因其病因不明确、多数良性,西医一般不予治疗。文章从中医经络循行、脏腑功能等复合病机理论角度开展肺结节病因病机研究,指出从经脉循行分析,足厥阴肝经上注于肺,足太阴脾经经脉上膈贯肺,二者功能失调必影响于肺;从脏腑气机升降分析,肝气从左升,肺气从右降,维持气机升降运动;从脏腑气血津液调节功能分析,肝肺气机升降实则也是气血之升降,肝肺之间气血津液的调节功能失调,必会影响痰饮、结节的形成;从五行乘侮而论,肝木之气郁滞而反侮肺金之气,即木火刑金;脾土为生痰之源,肺金为储痰之器,脾肺之间互为影响。故认为病机主要因于肝气郁滞,或久郁化火,灼伤肺金,炼液为痰,痰气交阻;或因脾运不健,致痰饮稽留于肺,痰气交阻而成结节,临床从肝气犯肺、木火刑金、肺脾两虚、痰饮犯肺等主要证候开展辨治选方治疗,肝气犯肺以四逆散合消瘰丸合茯苓杏仁甘草汤化裁以疏肝柔肝养肝、宽胸理气、化痰消结;木火刑金选丹栀逍遥散合小陷胸汤、消瘰丸化裁以清肝泄火、柔肝养肝、理气化痰、软坚散结而消结;肺脾两虚选择补肺汤合苓桂术甘汤化裁,以健脾补肺、化痰散结;痰饮犯肺选择射干麻黄汤合小陷胸汤化裁以宣肺散寒、化痰散结。同时调护措施上注意:情志调护上当进行心理疏导、调畅情志;饮食调护上避免生冷寒凉;用药调护上根据患者情况合理选择用药;施以耳穴贴压、足浴、热奄包等中医特色护理技术进行干预,为肺结节的预防和治疗提供了思路和方法,以促进肺结节的预防效果,提升患者健康水平。

浅谈神经外科NICU吞咽困难患者发生误吸的风险因素及护理措施

目的 探讨神经外科NICU吞咽困难患者发生误吸的风险因素及护理措施。方法 选择2019年1月~2023年6月期间,泰兴市人民医院神经外科NICU吞咽困难患者132例为研究对象,对所有患者采用才藤氏吞咽障碍7级评价法进行误吸风险等级评估,根据其风险等级分为观察组(Ⅰ~Ⅲ级,n=62例)和对照组(Ⅳ~Ⅵ级,n=70例),并对主要观察数据采用单因素和多因素Logistic回归分析,获取影响误吸发生的可能风险因素。结果 单因素分析提示,Ⅱ-Ⅲ级疾病程度的患者占比、GCS评分、是否存在吞咽中枢受损、是否建立人工气道、人工气道留置时长≥7天、吞咽功能评分≥24分、进食体位的依从性评分、可进食物稠度最高分级及合并心动过速、合并败血症等情况均对神经外科NICU吞咽困难患者发生误吸产生较大影响,观察组患者上述指标与对照组比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析提示,吞咽中枢受损(OR=1.213)、吞咽功能评分≥24分(OR=1.030)、人工气道留置时间≥7天(OR=2.093)、合并心动过速(OR=7.547)是增加神经外科NICU吞咽困难患者发生误吸的独立风险因素。结论 神经外科NICU吞咽困难患者存在吞咽中枢受损、吞咽功能评分≥24分、人工气道留置时间≥7天及合并心动过速等是其发生误吸的独立风险因素。护理人员在护理过程中,对有独立高危因素的重点人群应加强护理管理,规范护理操作,以减少其误吸的发生率。

砒砂岩区十大孔兑沙棘生态减沙工程现状调查及管理对策研究

砒砂岩区沙棘生态减沙工程是我国晋陕蒙区防风治沙、强化水土保持的重要举措,该工程的发展现状及管理对策值得引起特别关注。本文以十大孔兑上游砒砂岩丘陵沟壑区沙棘林为研究对象,通过实地调研与问卷调查等研究方法,明确砒砂岩区十大孔兑沙棘生态减沙工程发展现状、实施现状、沙棘林生长状况、抚育措施及其经济效益等情况,提出了统一筹划构建沙棘林长效管理机制、多举并措健全沙棘林抚育措施实施方案、因地制宜完善沙棘资源产业化开发方案等管理对策,为晋陕蒙区砒砂岩区十大孔兑沙棘生态减沙工程的实施与管理提供科学支撑。

循证实践营养措施结合改良式袋鼠式护理对支气管肺发育不良早产儿喂养情况及病情控制的影响

目的探讨循证实践营养措施结合改良式袋鼠式护理在支气管肺发育不良(BPD)早产儿中的应用效果。方法选取2019年1月至2022年1月收治的80例BPD早产儿,以随机数字表法将其分为对照组和观察组,各40例。对照组施以常规护理,观察组施以循证实践营养措施结合改良式袋鼠式护理。比较两组的干预效果。结果观察组的开始经口喂养时间、全经口喂养时间及全胃肠营养时间均短于对照组(P<0.05)。观察组的无创通气时间与总氧疗时间短于对照组(P<0.05)。干预后,观察组的吸气峰压(PIP)、吸氧浓度(FiO_(2))及动脉血二氧化碳分压(PCO_(2))均低于对照组(P<0.05)。结论循证实践营养措施结合改良式袋鼠式护理能提高BPD早产儿的喂养效果,缩短无创通气时间与总氧疗时间,改善呼吸功能,值得推广。

护理缺失研究进展

护理缺失是指护理行为的缺失,其存在必然导致护理质量降低,影响患者安全。本文就护理缺失的概念、理论模型、主要缺失内容、测评工具、不良影响及相关干预措施进行阐述,并对未来研究提出建议和展望,以期引起国内护理工作者和管理者的重视,为相关研究的开展提供借鉴和参考。

护理工作负荷的概念分析和启示

目的 探讨护理工作负荷的概念及内涵,为护理人力资源管理提供参考。方法 系统检索国内外数据库中护理工作负荷的相关文献,采用经典概念分析法进行分析。结果 归纳出护理工作负荷概念的定义属性包括:完成护理工作,具有一定的工作数量和强度,消耗相应的生理、认知和情绪。结论 护理工作负荷内涵复杂,受到患者、护士和环境的影响。护理管理者应全面梳理护理工作,明确护理工作负荷的内涵;加强护理人才培养,优化护理工作环境,以减少不良因素对护理工作负荷的负性影响;构建科学测量工具,指导人力资源合理配置。

2型糖尿病住院患者核心护理标准化语言的构建

目的构建2型糖尿病住院患者核心护理标准化语言,为规范临床护理记录提供参考。方法聚焦2型糖尿病住院患者的护理,通过文献检索、回顾医院护理记录及专家咨询确定2型糖尿病住院患者核心护理诊断,通过“国际北美护理诊断协会分类(North American Nursing Diagnosis Association International,NANDA-Ⅰ)、护理措施分类(Nursing Interventions Classification,NIC)、护理结局分类(Nursing Outcomes Classification,NOC)”(简称NNN链接)初步筛选核心护理诊断所匹配的核心护理结局、护理指标及核心护理措施、护理活动,邀请21名专家进行2轮函询进行修订完善,最终形成2型糖尿病住院患者核心护理标准化语言。结果2型糖尿病住院患者核心护理标准化语言包括6项护理诊断、11项护理结局(52项护理指标)、15项护理措施(126项护理活动)。结论本研究构建的2型糖尿病住院患者核心护理标准化语言符合我国国情、文化背景、语言理解及临床实践,具有专业性、科学性,有利于实现护理语言的标准化,提升糖尿病专科护理质量。

下肢骨折深静脉血栓防治的研究进展

深静脉血栓形成(deep vein thrombosis,DVT)是下肢骨折术后的常见并发症,具有高发病率、高致残率、高死亡率等特点。目前临床上防治下肢骨折术后深静脉血栓的措施主要包括围手术期护理、医疗辅助器械干预、西药干预、中医干预、患者自身配合等。患者自身配合是一切防治方法顺利实施的基础,患者的积极合作是实现防治作用的前提。围手术期护理有助于患者了解术后DVT的危险因素及DVT发生后可能引起的危险性,指导患者饮食的选择,协助患者术后活动,进而改善患者血液流变学指标水平,减少术后DVT的发生。医疗器械可协助患者进行术后康复锻炼,改善血液动力学水平,促进患者康复及减少术后DVT的发生。西药如低分子肝素、利伐沙班、依诺肝素等抗凝药物可降低凝血因子的聚集及血液黏稠度,减少术后DVT的发生。中医干预主要包括中药内服及外治法如针灸、推拿等。中药内服可改善血流状态;针灸、推拿可调动脏腑功能,激发机体的正气而改善机体气血情况。各项防治措施都有其优缺点,临证运用时需结合具体条件及患者个体状况而选择合理的防治方式。中医干预DVT可在下肢骨折患者的术前及术后执行,且具有费用低、效果确切等特点,值得不断挖掘及传承创新。

儿科护士血压测量操作的现状调查

目的了解儿科护士血压测量操作现状,为规范儿童血压测量提供依据。方法采用便利抽样法抽取全国18个省、2个自治区、3个直辖市共230所医院的2817名儿科护士,使用自行编制的儿童血压测量操作现状问卷进行调查。结果有效调查2674名;788名(29.47%)护士选择的血压测量设备在儿童中经过验证;2037名(76.18%)护士根据儿童上臂围选择袖带型号,但1669名(62.42%)护士测量上臂围方法错误;护士血压测量次数及数值报告方法各异,甚至有17.31%的护士仅测量1次血压就取读数。结论儿童血压测量操作临床实践差异较大,需制定儿童血压测量规范化操作流程及标准,加强儿童血压测量技术的培训及推广,以提高儿科护士进行血压测量操作的规范性。

身体意象紊乱的NNN链接在肠造口患者护理中的应用研究

目的探讨身体意象紊乱的NNN模式在肠造口患者护理中的应用效果。方法选取2020年5月至2021年6月符合纳入标准的肠造口发生身体意象紊乱的80例患者为研究对象,随机分为观察组和对照组,每组40例。对照组给予常规护理,观察组在常规护理的基础上采用NNN链接护理方案,采用身体意象结局量表评定两组肠造口患者的结局状态。结果干预后,两组肠造口患者的结局评分[4个结局:包括适应身体障碍、身体意象、自尊、心理社会调整(即生活变化)]具有统计学意义(P<0.05);观察组的4个结局指标效果均优于对照组,差异均有统计学意义(均P<0.05)。结论在NNN链接护理模式的指导下,发生身体意象紊乱的肠造口患者心理健康和心理社会适应水平明显改善。

阿尔茨海默病护理的研究进展

随着人口老龄化问题的日趋严重,威胁老年人健康的各种问题也日趋增多。阿尔茨海默病作为老年人健康的一大杀手威胁着老年人的生命安全,且病因未明,患病后难以逆转,这给患者及其家庭带来极大的心理、经济及生活负担。因此,为改善阿尔茨海默病患者的生活质量,减轻患者及家属的经济压力,向患者家属提供适宜的生活照护方式,便捷的生活环境,实用的多样化的认知锻炼方式,本文就阿尔茨海默病患者专业化、全面化的评估方法及诊断方法,多样化的认知功能锻炼,安静、舒适、便捷的生活环境,各理论模式、药物性、非药物性及以新型护理技术为基础的护理方式展开综述,以期指导临床护理工作、给予患者家属帮助,更好地护理患者,减轻疾病对患者造成的不良影响。