Effects of high-quality neurosurgical nursing care on improving clinical nursing quality

BACKGROUND With continuous advancements in medical technology,neurosurgical nursing is constantly developing and improving to provide higher-quality nursing services.AIM To explore the effects of different types of high-quality nursing care on clinical nursing quality and patient satisfaction in neurosurgical nursing.METHODS Eighty patients who received neurosurgical treatment in the Affiliated Hospital of Southwest Medical University from June to December 2020 were selected as study participants and categorised into study and control groups.The study group comprised 40 patients who received 4 different types of high-quality nursing care,whereas the control group comprised 40 patients who received conventional nursing care.After a specific period,nursing satisfaction levels and adverse event and complication rates were compared between the two groups.RESULTS Satisfaction with high-quality care was higher than that with conventional care,and high-quality health services and regional services showed the highest satisfaction levels,with an average score of 12 on the Glasgow scale.The satisfaction levels of the study and control groups were 75%and 57%,respectively,with a statistically significant difference(t=7.314,P<0.05).During the nursing period,the adverse event and complication rates were the highest in patients with level III pathology grade and those who underwent neurosurgery(40.02%and 85.93%,respectively),and the difference was statistically significant.CONCLUSION In neurosurgical nursing,employing appropriate high-quality nursing methods can effectively reduce adverse event and complication rates in patients,thereby improving the quality of nursing care and increasing clinical nursing value.

Application of “Swanson’s Middle Range Caring Theory” in Sweden after miscarriage

Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarriage in preg-nancy week 18-20. Methods: Twenty-five tape recorded interviews with women four weeks after their early miscarriages and thirteen tape recorded semi-structured interviews with midwives and nurses who had the experience of caring for women who have been diagnosed with a missed miscarriage during a routine ultrasound scan. The interviews were transcribed verbatim and interpreted deductively from the text using the theory. Results: Each woman described her personal experience of miscarriage in the relative terms of a human experience. The midwives and nurses described their experiences with women who received care for missed miscarriage. The interviews included information about the treatment provided by the caregivers during the period afterward of the diagnosis. The caregiver attitude was formed from Swanson’s caring categories: “Maintaining belief”, “knowing”, “being with”, “doing for”, “enabling”. Conclusions: Swanson’s Middle Range Caring Theory as applied to the caregiver includes being emotionally present, giving support with respect for the woman’s dignity, being competent, meeting each woman’s own individual needs. Given the proper care after a miscarriage every woman has the power within herself to improve their wellbeing.

Elderly Disabled Patients in Oral Anticoagulation Treatment: An Evaluation of a Bioanalyst-Led Management Program Reaching an Average of 72% of Time in Therapeutic Range

Introduction: The need for anticoagulation therapy increases with age, mainly due to the increased prevalence of atrial fibrillation. Time in therapeutic range (TTR) is a marker of the quality of the therapy as TTR is inversely correlated with adverse reactions. We developed a bioanalyst-led management program for control of warfarin treatment in elderly disabled patients in their own home and maintain a high TTR. Material and Methods: Residents in nursing home settings were included. Visiting nurses measured INR with a point of care testing device. If INR was within Therapeutic Range (TR), the nurse dosed warfarin unaltered. If INR was out of TR, the visiting nurse contacted a specially trained bioanalyst by phone. An explanation was sought, and a new dosage plan was made. Results: A total of 579 patients were included;356 females (61%). Mean age was 79.6 years. Approximately 10% were residents in nursing home settings and the rest in domiciliary care. TTR was 72%. The subtherapeutic values were 15% and supratherapeutic values 13%. In total, 139 patients died during the study period. Ten deaths could be related to possible side effects of warfarin treatment. Conclusions: Our results indicate that a bioanalyst-led program is able to simplify anticoagulation monitoring, while maintaining INR control similar to a specialized clinic. Furthermore, we avoided hospitalizations when INR was unacceptably high by treating the patient with oral vitamin-K at home. Our findings could be helpful when planning warfarin treatment in elderly, fragile patients.

Study on the Effect of High-quality Nursing Combined with Breathing Exercises on Patients with Chronic Obstructive Pulmonary Disease

Objective:To study the effect of high-quality nursing combined with breathing exercises on patients with COPD.Methods:Using the random number table method of medical experiments,60 patients with COPD received in our hospital from March 2020 to March 2021 were used as research samples.According to the differences in treatment measures,they were equally divided into control group and intervention group.Symptomatic support treatment and nursing routine,high-quality nursing combined with respiratory function exercise treatment and nursing were given respectively,and the application effects of the two groups were compared and analyzed.Results:The controllable rate of disease between the intervention group and the control group was 93.33%(28/30)and 66.67%(20/30)respectively,which was statistically significant(P<0.05).The comparison between the intervention group and the control group on the pulmonary function indexes of VT,TPTEF/Te,VEF/Te/,Ti/Te was statistically significant(P<0.05).The results of the intervention group on exercise pulse and 6-minute walking distance were significantly higher than those of the control group(P<0.05).Conclusions:The combination of high-quality nursing care and breathing exercises has outstanding disease controllable rate in patients with COPD,especially in improving the lung function of the patients and the level of treatment and care.It can be used as a feasible measure in the subsequent clinical treatment and nursing practice of patients.It is worthy of clinical promotion and implementation.

Effect of High-Quality Nursing on Patients with Hemorrhagic Fever with Renal Syndrome

Objective:To explore and analyze the effect of high-quality nursing on patients with epidemic hemorrhagic fever with renal syndrome.Methods:Ninety patients with epidemic hemorrhagic fever with renal syndrome treated in Huyi District People’s Hospital from October 2021 to January 2022 were randomly divided into an experimental group and a control group,with 45 cases in each group.The control group received routine nursing and the experimental group received high-quality nursing.The effect of routine nursing and high-quality nursing were compared and analyzed based on the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),the degree of satisfaction with nursing care,and the patients’quality of life.Results:Before nursing,there was no significant difference in the patients’psychological state between the two groups(P>0.05);after nursing,there was significant difference in the patients’psychological state between the two groups(P<0.05);the degree of satisfaction with nursing care of the experimental group was significantly higher than that of the control group(P<0.05);comparing the quality of life of the two groups,the quality-of-life score of the control group was significantly lower than that of the experimental group(P<0.05).Conclusion:For patients with epidemic hemorrhagic fever with renal syndrome,high-quality nursing can significantly and effectively improve their psychological state,level of satisfaction with nursing care,and quality of life.

Building Knowledge: The Concept of Care

Aim and Objectives: The aim of this article is to explore whether the specific levels of caring described in Swanson’s Middle Range Caring Theory which include characteristics of caring, people’s concerns and commitments underlying caring, conditions that enhance/inhibit caring and consequences of caring and non-caring could be used in categorizing findings from two literature reviews investigating the concept of care. Background: Nursing has a long legacy as a caring/healing profession where caring is increasingly posited as one of the core concepts in modern nursing science. However, the meanings given to the concept of care remain elusive, ambiguous and unclear. Design: Two systematic literature reviews. Method: Twenty-nine articles based on strategic inclusion and exclusion criteria were synthesized. Data was retrieved from CINAHL, Medline, Embase and PsycInfo covering the period 2003-2016. The literature search used the key words care, concept analysis, systematic review, meta-synthesis, meta-analysis and narrative review. Results: Major themes found were related to the following characteristics of caring persons: compassionate, knowledgeable, positive and reflective. Concerns and commitments underlying caring were doing the right thing, connecting, focusing on the others’ experience, acknowledging individual dignity and worth and being present. Conditions that enhanced/inhibited caring were situational constraints, personality traits, communication skills, health problems and organizational features. Consequences of caring and non-caring actions included both positive and negative emotional, spiritual, physical, and social outcomes for patients, families and nurses. Conclusion: The specific levels of caring described in Swanson’s Middle Range Caring Theory are highly suitable for categorizing the findings from three literature reviews on the concept of care. Relevance to Clinical Practice: Swanson’s Middle Range Caring Theory can be used to guide clinical practice and encourage an individual approach to care. It has been shown to contain clear, comprehensible language in its theoretical basis;this encourages use in clinical practice.

丘墟透照海运动针法联合循经按摩对肩袖损伤患者肩关节活动度及自理能力的影响

目的:探究丘墟透照海运动针法联合循经按摩对肩袖损伤患者肩关节活动度及自理能力的影响。方法:将2022年3月—2023年2月来本院治疗肩袖损伤的患者88例随机分为观察组44例与对照组44例,对照组患者使用循经按摩的方式进行治疗,在对照组的基础上观察组加用丘墟透照海运动针法治疗,比较两组患者治疗前后的临床疗效、肩关节功能、关节活动度和生活自理能力变化。结果:对照组的总有效率为77.27%(34/44),明显不及观察组的95.45%(42/44),两组比较差异具有统计学意义(P<0.05);与治疗前比较,两组患者日常活动能力、肩关节疼痛程度、关节活动范围及肩关节肌力强弱分值均有不同幅度的提升,差异具有统计学意义(P<0.05),且观察组优于对照组,差异具有统计学意义(P<0.01);两组患者关节外旋、内旋、外展、前屈和后伸均较治疗前有较大提升,差异具有统计学意义(P<0.05),且观察组优于对照组,差异具有统计学意义(P<0.05);两组患者治疗后FIM,差异具有统计学意义(P<0.05),评分与治疗前比较均有所增加,差异具有统计学意义(P<0.05),且观察组优于对照组,差异具有统计学意义(P<0.01)。结论:丘墟透照海运动针法联合循经按摩能够对肩袖损伤患者的关节活动度有明显提升作用,改善了患者的自理能力。

腕踝针疗法联合阶段性运动康复训练治疗肩袖损伤术后患者的效果

目的:观察腕踝针疗法联合阶段性运动康复训练治疗肩袖损伤术后患者的效果。方法:选取2022年3月至2023年4月该院收治的92例肩袖损伤术后患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各46例。对照组实施阶段性运动康复训练治疗,观察组在对照组基础上联合腕踝针疗法治疗,两组均治疗12周。比较两组康复优良率,治疗前后自理能力[功能独立性评定量表(FIM)]评分、疼痛[视觉模拟评分法(VAS)]评分、肩关节活动度(外旋、外展、前屈),以及不良反应发生率。结果:观察组康复优良率为95.65%(44/46),高于对照组的80.43%(37/46),差异有统计学意义(P<0.05);治疗后,观察组FIM评分高于对照组,VAS评分低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组外旋、外展、前屈等肩关节活动度均大于对照组,差异有统计学意义(P<0.05);两组治疗期间均未见明显不良反应。结论:腕踝针疗法联合阶段性运动康复训练治疗肩袖损伤术后患者可提高康复优良率、自理能力评分,增大肩关节活动度,降低疼痛评分,效果优于单纯阶段性运动康复训练治疗。

急速老龄化进程下中国老年人全程健康照护模式探讨

老年人常常多病共存,且患病率高、进展缓慢、病程长,兼具失智与失能者较多,因此,需要连续全程(急性照护-中期照护-长期照护)长期健康照护。对老年人实施全程健康照护是应对"健康中国2030"国家战略提出的"全方位、全周期保障人民健康"的国家卫生战略方针的措施之一。本文以四川大学华西医院老年医学中心引进国外老年人健康照护模式的病房经验为基础,介绍了华西医院急性期快速恢复病房、生活品质促进病房以及缓和照护病房的老年人照护模式,分析我国老年人照护模式存在的问题,并探讨适合我国的老年人全程健康照护模式,以期对我国老年人全程健康照护模式的建立与完善起到推动作用。

ICU水龙头及其周围污染情况的调查

目的检测重症监护病房(ICU)中水龙头污染情况及污染范围,为水龙头周围的合理布局及降低水源性感染提供依据。方法选取某三级综合医院ICU两处水龙头出水口及其周围环境进行棉拭子取样,以出水口为中心,每20~30 cm取一个样本,使用ATP检测技术、常规微生物检测以及二代测序技术(NGS)三种方式对标本进行检测,分析水龙头及其周围污染情况及飞溅范围。结果在常规清洁的情况下,水龙头及其周围70 cm范围内污染严重。ATP检测合格率为60.0%,常规微生物检测合格率为73.3%。两个水龙头出水口棉拭子ATP检测结果分别为2 526、687 RLU/件,微生物检测显示菌落数均>105 CFU/cm2。在距离出水口70 cm的区域采样检测,菌落数仍然超标。NGS检测显示,从水龙头出水口到周围环境,均发现覆盖度较高的奥斯陆莫拉菌,与出水口细菌分布一致。结论水龙头是病区内重要的污染源,应重视水龙头及其周围环境的清洁,1 m范围内,不应放置清洁物品以及与患者相关的物品。

重症监护室目标监测感染控制范围的建立及应用

目的:建立重症监护室(intensive care unit,ICU)的月医院感染发病率的控制范围,为医院感染的控制提供一种科学的方法。方法:依据统计学医学参考值范围的原理:正态分布下曲线面积的规律,数值落在(-∞,x+1.64s)的区域概率为95%,若有数据超出此值,则需要提醒临床科室注意;数值落在(-∞,x+2.33s)的区域概率为99%,若有数据超出此值,则表明质量失控。分别统计本院2011年1月至2012年6月呼吸ICU、神内ICU、中心ICU、神外ICU、心胸外ICU目标监测的资料,确立各ICU月医院感染发病率的预警限和控制限,于2012年7月至今对超出预警限的临床科室进行反馈,对超出控制限的临床科室进行反馈干预。结果:确立了各ICU月医院感染发病率的预警限和控制限,其中神外ICU月医院感染发病率的控制限是22.39%,2012年8月神外ICU的医院感染发病率超出控制限,分析反馈干预后,该ICU 9月至11月的医院感染发病率下降。结论:本文已确立ICU的月医院感染发病率的控制范围,可以此来判断ICU的医院感染的流行趋势,及时预警,作为各ICU比较的衡量标准,保证持续改进的质量控制过程,是一种值得推荐的科学方法。

开展全程化药学服务,促进抗菌药物合理应用

目的探讨促进抗菌药物合理应用的有效途径。方法分析和评价全程化药学服务在促进抗菌药物合理应用中的作用。结果全程化药学服务是促进抗菌药物合理应用的有效途径。结论医院药学应积极开展全程化药学服务,以促进抗菌药物合理应用,使有限的抗菌药物资源得到最大限度的利用。

基层医疗卫生机构的基本医疗服务范围研究——基于常见病、多发病的视角

目的基于常见病、多发病的视角界定基层医疗卫生机构的基本医疗服务范围。方法以广东省A市为例,根据A市基本医疗保险参保人的微观数据,统计分析了A市的常见病、多发病,并对A市128个医疗机构进行问卷调查。结果分别确定了社区卫生服务中心104个病种、乡镇卫生院101个病种、社区卫生服务站38个病种和村卫生室34个病种作为4类基层医疗卫生机构的基本医疗服务范围。结论应依据4类基层医疗卫生机构的基本医疗服务范围从诊疗项目、药品目录、基层首诊制等方面进行政策调整与完善。

人性化护理在自然分娩产妇中的应用

[目的]探讨人性化护理对孕妇及新生儿的影响。[方法]将2002年在我院住院分娩的1803例产妇作为观察组,将人性化护理贯穿分娩全程;2001年1368例产妇作为对照组,给予常规护理。观察两组剖宫产率、产后大出血率及新生儿窒息率。[结果]观察组产妇剖宫产率、产后大出血率、新生儿窒息率均低于对照组(P<0.05)。[结论]人性化护理能促进自然分娩,提高产科质量。

结构化教育联合规范化康复护理对股骨骨折行弹性髓内钉术患儿术后关节活动度及运动发育的影响

目的 探讨结构化教育联合规范化康复护理对股骨骨折行弹性髓内钉术患儿术后关节活动度及运动发育的影响,以期为临床相关治疗提供参考。方法 选取2020年5月—2022年1月黄河三门峡医院收治的80例行弹性髓内钉术治疗的股骨骨折患儿作为研究对象。采用随机数字表法将患儿分为观察组(n=41)与对照组(n=39)。行弹性髓内钉术治疗后,给予对照组患儿常规护理。观察组患儿在对照组基础上采用结构化教育联合规范化康复护理。比较2组患儿干预第7、30天髋关节Haris量表评分。比较2组患儿干预前与干预第30天Peabody运动发育量表(PDMS-2)评分。比较2组患儿并发症发生情况。结果 2组患儿干预第30天髋关节Haris量表中关节功能、疼痛、畸形、关节活动度评分均高于干预第7天,且观察组高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿PDMS-2中(GMQ)、精细运动商(FMQ)及总运动商(TMQ)评分比较,差异无统计学意义(P>0.05)。干预第30天,观察组患儿PDMS-2中GMQ、FMQ及TMQ评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患儿并发症发生率为7.32%,低于对照组的33.33%,差异有统计学意义(P<0.05)。结论 结构化教育联合规范化康复护理对股骨骨折行弹性髓内钉术患儿术后关节活动度及运动发育有积极影响,在临床治疗中具有指导意义,值得推广。

神经重症监护联合长程视频脑电监测救治模式在难治性癫痫持续状态患者中的临床应用

目的 探讨神经重症监护联合长程视频脑电监测救治模式在难治性癫痫持续状态患者中的临床应用效果。方法 选取2018年5月至2020年5月赣州市人民医院神经外科重症监护室ICU收治的78例难治性癫痫持续状态患者作为研究对象,采用随机数字表法将其分为参照组(39例)和研究组(39例)。参照组患者采用神经重症监护干预,研究组患者采用神经重症监护联合长程视频脑电监测救治干预。比较两组患者的临床病情控制有效率、发作控制时间、插管时间、神经系统功能障碍发生率。结果 研究组患者的临床病情控制有效率高于参照组,差异有统计学意义(P<0.05);研究组患者的发作控制时间、插管时间短于参照组,差异有统计学意义(P<0.05);研究组患者的神经系统功能障碍发生率低于参照组,差异有统计学意义(P<0.05)。结论 难治性癫痫持续状态患者治疗期间应用神经重症监护联合长程视频脑电监测救治模式的干预效果显著,能够有效控制临床病情,缩短发作控制时间和插管时间,降低神经系统功能障碍发生率。

血糖监测技术及管理指标的临床应用进展

我国是全球糖尿病(DM)患者数最多的国家,且DM患者的血糖控制达标率偏低。血糖监测是DM管控的重要组成部分,目前血糖监测技术飞速发展,检测标本从尿液、静脉血、末梢血发展到组织间液、呼出气体等;监测手段从频繁地末梢取血到无创血糖监测;监测时点从传统的点时血糖发展到长达14 d的动态葡萄糖图谱(AGP)。床旁即时检验(POCT)应用于血糖管理逐步规范化、信息化,临床操作中应注意避免某些影响因素干扰检测结果;持续葡萄糖监测(CGM)因可提供葡萄糖连续瞬间波动及变化规律而成为血糖监测的新趋势,在DM及危重症患者治疗中发挥重要作用;目标范围内时间(TIR)和糖化血红蛋白(HbA1c)联合应用成为血糖监测和治疗效果评估的关键参考指标。该文就目前临床常用的几种血糖监测技术、血糖管理指标以及未来发展方向进行综述。

长期照护保险的支付体系研究

总结归纳我国长期照护保险16个试点城市以及德国、日本、韩国在长期照护保险的支付范围、支付标准及支付方式方面的具体政策,提出规范长期照护保险基金支付范围、优先支付急需服务项目、多种支付形式并存、失智照护单列、明确定额结算和限额结算,以及选择合适的支付比例等建议。

全程护理干预对介入治疗的糖尿病患者焦虑与疼痛的影响

目的探讨全程护理干预对糖尿病（DM）患者术前焦虑和术后疼痛的影响。方法46例糖尿病患者分为干预组和对照组各23例,对照组给予常规术前准备和告知同意,干预组在对照组基础上给予术前认知干预、心理干预、行为干预。应用焦虑自评量表于入院时和术前1 d进行效果评价分析;应用视觉模拟评分法对患者术后疼痛进行评价。结果干预组入院时焦虑自评量表评分高于术前1 d（P〈0.01）;对照组术前焦虑自评量表评分高于入院时（P〈0.05）;干预组术前1 d焦虑自评量表评分明显低于对照组（P〈0.01）;干预组术后疼痛明显低于对照组（P〈0.01）。结论全程护理干预可以减轻患者术前焦虑程度及术后疼痛程度,有利于患者手术进行及术后康复。

中国企业家慈善捐赠行为特征研究

鉴于中国企业家在慈善捐赠方面,目前不仅没有成功的实践经验提供示范,而且还缺乏相关系统的理论给予指导。为此,以福布斯2011-2013年发布的数据为基础,从样本特征、捐赠金额、捐赠方向和关怀范围四个方面,采用分类编码和统计分析的方法,研究了中国企业家慈善捐赠行为的共性特征和规律。结果发现:中国企业家慈善捐赠的主力军分布相对比较明显;慈善捐赠金额总体有下降趋势,捐赠区间分界线相对清晰;捐赠方向涉及范围广泛,重点比较突出;关怀范围虽符合道德发展阶段的规律,但仍处于初级阶段。