Nursing Experience of Early Application of Nasoenteric Tube for Enteral Nutrition in Critically Ill ICU Patients

Objective:To investigate the effective nursing measures of early application of nasoenteric tube for enteral nutrition in critically ill patients in ICU,and to summarize the nursing experience.Methods:The study was carried out in June 2023–November 2023.62 samples of ICU critically ill patients were selected,all of whom used enteral nutrition by mesenteric tube and were grouped into an observation group(n=31)and a control group(n=31)by using the numerical table randomization method.The patients in the control group were basic nursing interventions,and the patients in the observation group were comprehensive quality care,comparing the nutritional indexes,complication rates,and nursing satisfaction between the two groups.Results:All nutritional indicators of the observation group were higher than those of the control group after nursing intervention(P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05);the nursing satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Comprehensive quality nursing care during the early application of a gastroenteric tube for enteral nutrition in critically ill patients in the ICU can improve nutritional indexes,reduce the incidence of complications and improve nursing satisfaction.

The Role of Grid-Style Nursing Management Model in Critically Ill Patients

Objective:This study aims to gain insight into the effects and potential advantages of the grid-style nursing management model in the care of critically ill patients.Methods:Eighty critically ill patients admitted to our hospital between May 2020 and May 2021 were selected and randomly divided into the control group and the grid group,each with 40 patients.The control group implemented traditional nursing management,while the grid group adopted a grid-style nursing management model.The quality of care,quality of life,nursing satisfaction,and treatment adherence of the two groups were compared.Results:Compared with the control group,the grid group had significantly higher quality of care and quality of life(P<0.001);in terms of nursing satisfaction,the score of the grid group was 8.26±0.85,which was significantly higher than that of the control group(6.65±0.77)(P<0.001);90.00%(36 patients)of the grid group showed good treatment adherence,significantly higher than 70.00%(28 patients)of the control group(P<0.001).Conclusion:The implementation of the grid-style nursing management model in critically ill patients can significantly improve the quality of care,quality of life,and satisfaction of patients,and effectively promote patients’treatment adherence.These positive results provide strong support for the promotion and application of this model in clinical care.

Research on Nursing Effect of Individualized Nursing Intervention on Critically Ill Patients with Continuous Blood Purification

Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification therapy.Methods:89 cases of critically ill patients who were treated from June 2021 to June 2023 were randomly divided into groups,with individualized care in group A and routine care in group B.The differences in clinical indicators,purification effect,quality of life,and complications of blood purification were compared between the groups.Results:Heart rate,respiration,body temperature,and other indicators in group A were better than those in group B,P<0.05.C-reactive protein(CRP),β2-microglobulin(β2-MG),blood urea nitrogen(BUN),and phosphorus(P)in group A were lower than those in group B,P<0.05.Group A had higher quality of life than Group B,P<0.05.The complication rate of blood purification in Group A was lower than that in Group B,P<0.05.Conclusion:During continuous blood purification in critically ill patients,individualized nursing intervention can enhance the effect of blood purification,improve the physiological indicators of patients,and reduce the complications of blood purification,which is highly effective and feasible.

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.

Facilitating and hindering factors of community nurses'emergency and critical care treatment abilities:A qualitative study

BACKGROUND This study adopts a descriptive phenomenological approach to investigate the facilitators and barriers of community nurses'abilities in managing critical and emergency conditions.With the transition of healthcare systems to the community,the evolution of nursing practices,and the attention from policies and practices,community nurses play a crucial role in the management of critical and emergency conditions.However,there is still a lack of comprehensive understanding regarding the factors that promote or hinder their capabilities in this area.AIM To understand the facilitators and barriers of community nurses in managing critical and emergency conditions,exploring the fundamental reasons and driving forces influencing their treatment capabilities.METHODS This study utilized the destination sampling method between May 2023 and July 2023.It employed a descriptive phenomenological approach within qualitative research methodologies.Through objective sampling,17 community nurses from 7 communities in Changning District,Shanghai,were selected as the study subjects.Semi-structured interviews were conducted to gather data,which were subsequently organized and analyzed using Colaizzi's seven-step analysis method,leading to the extraction of final themes.RESULTS The barrier factors identified from the interviews encompassed three topics:resource allocation,professional factors,and personal literacy.The facilitators comprised three themes:professionalism,management attention,and training and continuing education.We identified that the root causes of the barriers included the lack of practical treatment experience among community nurses,insufficient awareness of self-directed learning,and limited knowledge and technical proficiency.The professional quality of community nurses and management attention serve as motivation for them to enhance their treatment abilities.CONCLUSION To enhance the capability of community nurses in treating acute and critical patients,it is recommended to bolster training specifically tailored to acute and critical care,raise awareness of first aid practices,and elevate knowledge and skill levels.

Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

Objechive:Investigate the effectiveness of mursing risk management in the care of cntically ill patients in the respiratory umit.Methods:Among the cntically ill respiratory patients admitted to our hospital between May 2019 and April 2020,78 patients were randomly selected and divided into an observation group and a control group,each consisting of 39 patients.In the observation group.a mursing nisk management model was implemented,i.e,patients'clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group.Results:The heart rate,respiratory rate,and pH of patients in the observation group were more stable than those in the control group,and their respiratory status was better,with differences in data.There was also sigmifcant statistical significance(P<0.05).The incidence of patient-provider disputes,unplanned extubation,and uplammed events were lower in the observation group conpared to the control group,and their data difference was satistically siguificant(P-0.05).The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the contol group,and there was also a statistically sigmificant difference in the data(P<0.05).Conclusion:The musing nisk management model has a significant therapeutic effect in the care of cnitically ill respiratory patients.Therefore,it is worth popularizing to use in the clinical mursing of respiratory cnitical patients.

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.

Comparison of Nurses’ and Families’ Perception of Family Needs in Critical Care Unit at Referral Hospitals in Malawi

This study compared needs of family members as perceived by nurses and the family members themselves. The study design was descriptive and utilized quantitative data collection and analysis method. Nurses (n = 62) working in the Intensive Care Units (ICU) and High Dependency Units (HDU) of three tertiary health facilities in Malawi at the time of the study consented to participate in the study. In addition, family members (n = 62) who were looking after a critically sick relative in the ICU and HDU in the same tertiary facilities consented and participated in the study. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory for a period of 7 days. STATA version 10 was used to analyze data. The rank correlation between the mean scores of perceived needs across major need categories of support, comfort, information, proximity and assurance between the nurses and family members was significantly different from zero (r = 0.97, p = 0.005). Nurses and family members, respectively ranked assurance (90% and 92%) as the highest priority need, followed by information (78% and 85%) and comfort (78% and 84%) and then support (70% and 73%) and proximity (66% and 69%). The ranking however between the 2 groups on 16 out of 45 individual needs were significantly different (p < 0.05). Among the nurses, the rankings by registered nurses were significantly higher (p < 0.05) from those of nurse midwife technicians. There were also significant differences (p < 0.05) in the mean scores between the gender of family members with men demanding more “comfort” than females. Results show a need for facility authorities to formulate ICU policies and strategies that ensure provision of friendly services to family members of critically ill patients.

快速反应团队工作模式对重症孕产妇抢救效率及救治结局的影响

目的:观察对重症孕产妇实施快速反应团队(RRT)工作模式的干预效果。方法:回顾性收集2021年10月-2022年10月开展常规护理模式的148例重症孕产妇临床资料纳入对照组,2022年11月-2023年11月开展RRT工作模式的152例重症孕产妇临床资料纳入观察组。比较两组抢救效率、救治结局、新生儿情况、重症孕产妇并发症。结果:观察组处理时间(22.6±4.0min)、抢救情况(10.5%)、剖宫产率(35.5%)、新生儿死亡率(0)、ICU入住率(2.0%)、住院时间(7.56±1.34d)、并发症总发生率(2.6%)均少于对照组(33.0±4.5min、18.9%、52.0%、4.1%、27.7%、10.86±3.33d、12.2%),预警情况(40.1%)、有效处理率(98.0%)、5minApagar评分(8.74±0.58分)、脐带血pH值(7.64±1.96)高于对照组(27.7%、81.8%、8.46±0.64分、4.96±1.34)(均P<0.05),两组孕产妇死亡率、新生儿1minApagar评分无差异(P>0.05)。结论:RRT工作模式可提高重症孕产妇的抢救效率,改善救治结局、新生儿情况。

基于信息化平台的急诊危重症患者护理核查单的设计及应用

目的探讨基于信息化平台的急诊危重症患者护理核查单的设计及应用效果。方法基于院内信息化平台,设计急诊危重症患者护理核查单。采用前瞻性类实验性研究方法,观察危重症患者护理核查单应用前后护理交接班的遗漏率、临床护理效果和护理质量。结果应用急诊危重症患者护理核查单后,护士在管路、通气方式、留置针、用药、皮肤和约束方面的交接班遗漏率显著低于应用前(均P<0.05);临床护理效果和护理质量较核查单应用前显著提升(均P<0.05)。结论基于信息化平台的急诊危重症患者护理核查单的应用可减少护士交接班的遗漏内容,提高护理记录准确性,并缩短书写时长,提高护理质量。

皮肤花斑评分在重症病人中应用的研究进展

总结皮肤花斑的病理生理学机制、皮肤花斑评分的评估标准和临床意义,以及在重症病人中的应用现状,以期为重症病人病情监测、临床诊疗与护理提供参考。

重症监护病房护理缺失现状及原因分析

目的:调查重症监护病房(ICU)内护理缺失现状并分析其原因,为减少ICU护理缺失,提升重症患者护理质量提供参考。方法:采用便利抽样法,于2023年12月1日至30日在湖南省5家医院选取305名ICU护士作为研究对象,使用一般资料调查表以及ICU护理缺失量表进行调查。结果:ICU护理缺失得分为(64.48±20.60)分,有91.8%的护士报告了他们在工作期间至少发现了一项护理缺失活动。其中缺失最多的项目为重症患者心理社会评估、早期康复、心理护理以及肌力和营养状况评估。ICU护理缺失受护士学历、职称、所在ICU类型的影响(P<0.05)。ICU护理缺失原因得分为(61.29±16.28)分,最主要的原因是护士人力资源不足。结论:护理缺失在ICU内发生率高,其发生受多种因素影响,提示护理管理者应重视ICU内护理缺失的发生现状及原因,并采取相应措施,进一步提高ICU护理质量。

老年危重症患者发生再喂养综合征的危险因素回归方程的构建及干预措施分析

目的构建老年危重症患者发生再喂养综合征(RFS)的危险因素回归方程,并分析相应的干预措施。方法回顾性分析2021年1月—2023年3月重症监护室(ICU)收治的154例老年危重症患者的临床资料,根据RFS发生情况分为RFS组51例和非RFS组103例。采用Logistic回归模型分析影响发生RFS的因素;采用受试者工作特征(ROC)曲线分析预测因子对RFS的预测价值;构建并验证相关Logistic回归方程,拟定相关护理干预内容。结果老年危重症患者发生RFS与急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、营养风险筛查2002(NRS2002)评分、有创机械通气、喂养前禁食时间、D-二聚体水平、营养摄入方式和喂养前血磷、血钾、血镁水平有相关性(P<0.05)。Logistic回归分析显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平均为影响老年危重症患者发生RFS的独立危险因素(P<0.05)。ROC曲线结果显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平和联合预测因子预测老年危重症患者发生RFS的曲线下面积(AUC)分别为0.754、0.723、0.707、0.783、0.774和0.859(P<0.05)。发生RFS的Logistic回归方程为L=0.085×APACHEⅡ评分-0.337×NRS 2002评分+0.537×营养摄入方式-0.776×喂养前血磷水平-0.207×喂养前血钾水平+0.942。该方程预测价值良好,可根据方程拟定针对性的护理干预措施。结论危险因素回归方程可用于老年危重症患者RFS发生风险的临床预测,临床可根据回归方程制订相关护理干预措施,预防RFS的发生。

ECMO联合机械通气治疗危重症患者气道管理标准化护理程序的探讨

目的分析对于体外膜肺氧合(ECMO)联合机械通气治疗的危重症患者接受标准化护理程序气道管理的应用效果。方法选取2020年5月至2022至12月本院收治的ECMO联合机械通气治疗的危重症患者80例为研究对象,基于随机数字表法分组,分别接受气道常规护理与标准化护理程序气道管理,依次记为对照组(n=40)与观察组(n=40)。对比观察两组患者术后临床症状改善情况,包括机械通气时间、ECMO治疗时间、呼吸困难缓解时间、住院时间,血气指标包括氧分压、二氧化碳分压、氧合指数变化,同时还观察两组并发症发生率。结果观察组治疗后机械通气时间、EMCO治疗时间、呼吸困难缓解时间、住院时间短于对照组(P<0.05);观察组经干预后PaO_(2)与氧合指数表达水平高于对照组,PaCO_(2)表达水平低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论在危重症患者接受ECMO联合机械通气治疗时,开展标准化护理程序气道管理,有助于促进患者病情转归,减少不良事件发生。

个性化护理策略在老年危重症患者人工气道管理中的应用

目的 探讨个性化护理策略在老年危重症患者人工气道管理中的应用效果。方法 选取2022年7—12月三明市第二医院重症医学科收治的急性呼吸衰竭和慢性呼吸衰竭加重期老年危重症患者140例为研究对象,采用随机数表法分为观察组和对照组,每组各70例,对照组采用常规护理方法,观察组采用个性化护理策略。比较两组患者人工气道管理效果。结果 观察组患者痰液引起的刺激性咳嗽、胃内容物反流及气道黏膜损伤发生率均低于对照组,差异有统计学意义(P <0.05);观察组患者人工气道堵管以及医院获得性肺部感染发生率均低于对照组,吸痰间隔时间长于对照组,差异有统计学意义(P <0.05)。结论 个性化护理策略在老年危重症患者气道管理中的效果显著,可降低并发症发生率,提高护理质量,值得临床应用。

急危重症护士感知管理关怀、角色压力与职业生涯成功的相关性研究

目的:探究急危重症护士感知管理关怀、角色压力与职业生涯成功的相关性。方法:采用便利抽样法,选取常州市中医医院2021年7月—2022年6月在职的急危重症领域护士160名作为研究对象,采用自制一般资料问卷收集护士信息,采用职业生涯成功量表、感知管理关怀量表、角色压力量表进行测评,采用单因素分析、多元线性回归分析筛选急危重症护士职业生涯成功的影响因素,采用Pearson相关性检验分析急危重症护士感知管理关怀、角色压力与职业生涯成功的相关性。结果:160名急危重症护士职业生涯成功量表总分为(40.18±5.18)分、感知管理关怀量表总分为(128.72±13.86)分、角色压力量表总分为(50.72±5.81)分;Pearson相关性检验结果显示,急危重症护士角色压力与职业生涯成功呈负相关(均P<0.05),感知管理关怀与职业生涯成功呈正相关(均P<0.05);单因素分析、多元线性回归分析结果显示,急危重症护士职业生涯成功的影响因素有月夜班次数、定期接受专科培训、职业生涯规划、课题研究/发表论文、护护关系、感知管理关怀、角色压力(P<0.05)。结论:急危重症护士职业生涯成功处于中等水平,其影响因素复杂,且感知管理关怀、角色压力与护士职业生涯成功有相关性,临床应加强急危重症护士的管理关怀,积极疏导角色压力,以强化其职业生涯成功感。

耳穴揿针疗法在急重症患者镇痛管理中的研究进展

疼痛是急重症患者的常见症状,其疼痛程度和住院环境、操作性诊疗等因素密切相关。镇痛管理是急重症患者治疗的重要组成部分。耳穴揿针疗法作为一种中医特色疗法,具有安全性高、无针感、实施简便等优势,临床应用越来越广泛,其实用性和疗效可持续性得到证实。本文通过查阅相关文献,从急重症患者的镇痛管理、耳穴揿针的作用机制及其应用方面进行综述,以期为后续研究提供参考。

基于岗位胜任力的呼吸危重症专科护士护理培训体系的构建

目的:采用德尔菲专家咨询法构建基于岗位胜任力的呼吸危重症专科护士的培训课程体系,旨在为护士的呼吸危重症培训提供理论依据,进而提高护士的危重症护理能力。方法:通过查阅文献、小组讨论、专家会议等方法,结合呼吸危重症专科护士的岗位胜任力标准,初步形成呼吸危重症专科护士培训课程体系。采用德尔菲法对27名专家进行两轮问卷函询,运用层次分析法确定各级指标权重。结果:共进行两轮专家函询,两轮专家函询的问卷回收率均为100%。两轮函询专家的权威系数为0.856,0.897,各级指标肯德尔和谐系数为0.148~0.873(均P<0.001),各指标变异系数均≤0.25。最终构建的培训课程体系包括4个一级指标(专业知识、专业技术、个人特质、专业能力)、28个二级指标、68个三级指标。结论:本研究构建的呼吸危重症专科护士护理培训体系具有较高的科学性及权威性,研究结果可信度高,对呼吸危重症专科护士的培养具有指导意义。

国内重症病人误吸相关研究的可视化分析

目的:剖析国内重症病人误吸相关研究的现状及未来趋势。方法:系统检索中国知网(CNKI)建库以来有关重症病人误吸的相关研究,使用GraphPad Prism 9、VOSviewer 1.6.19及R语言分别对研究年发文趋势、高载文期刊、作者合作网络、研究热点及未来趋势进行可视化分析。结果:研究共筛选出2406篇文献,年发文量呈上升趋势,尤其近10年发展较快;重症病人误吸相关研究发表在506本期刊上,护理与呼吸管理专刊发文较多;作者合作关系相对有限,多数作者发文量较少,原南京军区南京总医院和南方医科大学附属小榄人民医院为较大的合作团体;机械通气、急性呼吸窘迫综合征、肠内营养、颅脑损伤、吸入性肺炎及重症胰腺炎病人为当前该领域受关注较多的研究主题。结论:重症病人误吸相关领域研究不断受到人们关注,作者、结构间合作探索仍有待加强,未来应规范集束化护理干预方案,加强对误吸风险的认知与护理评估,进一步改善病人的预后和生活质量。

以呼吸道为主的专项护理对呼吸科危重症患者血气指标及恢复状况的影响

目的 探究以呼吸道为主的专项护理对呼吸科危重症患者血气指标及恢复状况的影响。方法 选取我院2021年2月-2023年7月收治的142例呼吸科危重症患者进行研究。随机数字表法进行分组,2组各71例。对照组实施常规护理。观察组实施常规+以呼吸道为主的专项护理。比较两组患者恢复状况、血气指标、不良事件发生情况及睡眠质量改善情况。结果 观察组ICU入住时间(10.62±2.50)d、住院时间(15.48±2.45)d低于对照组(12.25±2.65)d、(17.33±2.62)d,差异有统计学意义(t=3.770,P=0.000,t=4.346,P=0.000)。干预前,观察组与对照组血气指标相比差异不显著(t=0.298,P=0.766、t=0.279,P=0.781),干预后的两组氧分压均增加,二氧化碳分压均降低,差异显著(t=38.843,P=0.000,t=22.742,P=0.000)、(t=34.442,P=0.000,t=22.081,P=0.000),且观察组氧分压高于对照组,二氧化碳分压低于对照组,差异显著(t=3.805,P=0.000,t=2.087,P=0.039)。观察组不良事件总发生率(2.82%)低于对照组(12.68%),差异显著(c2=4.829,P=0.028)。干预前,观察组与对照组睡眠质量评分相比差异不显著(t=0.745,P=0.458),干预后的两组评分均降低,差异显著(t=25.051,P=0.000,t=19.808,P=0.000),且观察组(7.21±1.25)分低于对照组(8.58±1.15)分,差异显著(t=6.796,P=0.000)。结论 以呼吸道为主的专项护理能够改善呼吸科危重症患者血气指标,降低不良事件的发生率,改善患者睡眠,促进患者恢复。