Evaluation of a clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patients

Deep vein thrombosis (DVT) is the third leading cause of morbidity in critically ill trauma patients but it can be prevented by performing appropriate risk assessment and preventive strategies. The purpose of this study was to evaluate of implementing a clinical nursing practice guideline (CNPG) for preventing DVT in critically trauma patients at Songklanagarind Hospital. The CNPG content with 37 items initially developed from evidence-based knowledge related to DVT and its prevention was validated and approved by the consensus of an expert panel. The ‘expert panel’ consisted of a clinical (critical surgical patients) nurse specialist, a trauma surgeon, a medical doctor who experts in developing CNPG, and two surgical care nurse educators. The revised 30 from 37 items were tested for reliability thereafter and yielded of 0.90 and 1.00, respectively. Forty-two nurses participated in this study. The effectiveness of this CNPG was evaluated in terms of (1) feasibility and difficulty of using the CNPG, (2) nurse's satisfaction in implementation of CNPG, and (3) the patient's femoral blood flow velocity before and after 7 days. Results have shown that 23 items were performed by more than 90% of nurses and there were 7 items performed at rates lower than 90%. 79% of nurses rated their satisfaction at high (M = 8.06, SD = 0.96). There were no differences in femoral venous blood flow velocity before and after 7 days and without signs of DVT. The findings indicated that the use of evidence-based clinical practice guidelines for deep vein thrombosis prevention could enhance the quality of care in terms of early detection for DVT and maintaining blood flow velocity in those patients who are at risk. Further study could be explored to confirm its effectiveness with the large sample size.     

妊娠期糖尿病临床护理实践指南的整合研究

目的 整合现有的妊娠期糖尿病孕产妇管理相关指南,形成高质量本土化证据资源。方法 以ADAPTE方法为指导,形成妊娠期糖尿病临床护理实践指南草案,采用专家现场论证及孕产妇论证对草案进行评审,修订形成正式版指南。结果 共纳入14份相关指南,49份系统评价,整合形成的指南内容包括妊娠期糖尿病的诊断、产前护理、分娩期护理、新生儿护理、产后护理5个主题,21个健康问题,69条推荐意见。结论 本次指南整合形成了妊娠期糖尿病管理领域高质量的循证资源,为临床护理实践提供参考和依据。     

学生区病房在护生临床实习中的应用

[目的]了解实习护生对学生区病房实习模式的认可度。[方法]采用问卷法对50名护生进行行为表现自评。[结果]90.0%的护生对学生区病房的临床实习模式持赞成态度,实习结束时护生对学生区病房模式的评价均高于进入病区时。[结论]实习护生对学生区病房临床实习模式的认同度较高。     

对肝移植患者进行多学科护理查房的做法与效果

目的探讨护理查房对肝移植患者护理质量的影响。方法对2006年住院的203例肝移植患者进行多学科护理查房,监测围手术期患者的抢救成功率、基础护理合格率、患者满意度及护理并发症发生率,并与2005年进行比较。结果 2006年肝移植患者围手术期的抢救成功率、基础护理合格率、患者满意度均高于2005年(P<0.05),护理并发症发生率低于2005年(P<0.05)。结论多学科护理查房保障了患者围手术期的医疗护理安全,是提高肝移植患者护理质量的有效方法。     

The challenge of developing the nursing clinical practice guideline: neurogenic bladder management

The development of the nursing clinical practice guideline was methodically structured to create a research-based guideline to assist nurses in caring for bladders of neurologically impaired individuals. The rigor with which it was developed is reflected in the end product.     

医护联合查房在精神科临床实践中的应用

目的探讨医护联合查房在精神科的临床应用效果。方法自2005年以来在我院开展了医护联合查房,并对患者满意度、意外事件、患者或家属投诉3个方面进行了开展前后的对比。结果开展医护联合查房后患者满意度提高（X2=85．369,P=0．000）,各类意外事件发生率、投诉率下降。结论医护联合查房促进了“交流-协作-互补”型医护关系的建立,提高了患者满意度,减少了意外事件发生,提升了护士自身价值感。     

Development of an evaluation tool for a clinical practice guideline on nursing assessment and device selection for vascular access.

This study developed and tested a chart audit tool to assess the implementation of evidence-based recommendations for vascular access nursing assessment and device selection. Chart audits of 71 patients were conducted in a home healthcare agency and a community hospital prior to guideline implementation. Observations of initial infusion therapy and chart audit documentation of 31 patients were also compared. Results from observations indicated that nurses provided care consistent with the recommendations, but findings from chart audits indicated that assessment and decisionmaking were poorly documented. Studies that use only precomparison and postcomparison by chart audit may miss changes in nursing practice.     

86例严重多发伤病人的急救护理

本文对严重多发伤的急救护理、及时有效地救治进行了阐述,运用急救护理程序,充分调动了护士的主动性、积极性、果断性,提高了工作效率,缩短了抢救时间,提高了抢救成功率。     

成人经鼻胃管喂养临床实践指南的构建

目的 构建基于证据的成人经鼻胃管喂养的临床实践指南,为促进鼻饲护理实践,保证鼻饲安全提供参考。 方法 以JBI 循证卫生保健模式为理论框架,严格按照循证临床实践指南制定的方法,构建《成人经鼻胃管喂养临床实践指南》草案,采用 AGREE 系统对指南草案进行专家评审,根据专家评审结果和建议对指南进行修改,形成正式指南。结果构建的指南推荐意见涵盖了鼻饲的适应证和禁忌证、胃管的选择及置管、确定胃管位置的方式、鼻饲喂养、营养配方、鼻饲给药、鼻饲相关并发症等内容,最终形成19 个方面,99 条推荐意见的指南草案。指南的 AGREE 评价得分较高,符合临床实践指南编写原则,也适用于我国成人鼻胃管喂养临床应用的现状,是一份实用性的指导意见。 结论 成人经鼻胃管喂养临床实践指南是根据我国临床实际、患者意愿和偏好、专业人员判断以及最佳证据而形成的循证指南,可为鼻饲临床护理实践提供参考,证据转化和临床应用是下一步研究的重点。     

Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

BACKGROUNDMore than ten special scales are available to predict the risk of pressure ulcers in children. However, the performances of those scales have not yet been compared in China. AIMTo compare the Waterlow, Braden Q, and Glamorgan scales, and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit (PICU).METHODSTrained nurses used the Waterlow, Braden Q, and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital (China) within 24 h of admission from May 2017 to December 2020 in two stages. Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk. RESULTSThe incidence of pressure ulcers was 3/28 (10.7%) in the PICU and 5/314 (1.6%) in the general pediatric ward. For children in the general ward, the Waterlow, Braden Q, and Glamorgan scales had comparable area under the operating characteristic curve (AUC) of 0.870, 0.924, and 0.923, respectively, and optimal cut-off values of 14, 14, and 29 points. For PICU, the Waterlow, Braden Q, and Glamorgan scales had slightly lower AUC of 0.833, 0.733, and 0.800, respectively, and optimal cut-off values of 13, 16, and 27 points. Braden Q demonstrated a satisfactory specificity, and during the second stage of the study for PICU patients, the AUC of the Braden Q scale was 0.810, with an optimal cut-off value of 18.35 points.CONCLUSIONThe Waterlow, Braden Q, and Glamorgan scales have comparable performance, while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.     

Genetic predisposition for development of complications in multiple trauma patients

The care of multiple trauma patients has been improved through advances made in preclinical treatment, surgical procedures, and intensive care medicine. However, posttraumatic complications such as systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and sepsis remain a major problem following multiple trauma. Components of the innate immune system and other inflammatory mediators (e.g., procalcitonin) play a pivotal role in the pathophysiology of posttraumatic complications. Studies investigating the genetic predisposition for complications after multiple trauma have provided evidence for a genetic heterogeneity in the posttraumatic immune response. The differences in response to multiple trauma associated with single-nucleotide polymorphisms may contribute to the development of new genetically tailored diagnostic and therapeutic interventions improving outcome in this patient population. In addition, detrimental adverse effects of adjuvant therapy could be avoided in other patients who, by genotype, are predicted not to benefit.     

Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice

Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short‐term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July–December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2–2.0% vs 13.6%; CI 9.3–19.5%); more arrived with police (28.8%; CI 23.8–34.3 vs 5.1%; CI 2.7–9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8–15.0% vs 4.4%; CI 2.3–8.5%), as was the use of chemical restraint (4.2%; CI 2.4–7.2 vs 0.0% CI 0.0 – 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence‐based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services.     

临床实习初期影响本科护生与病人沟通因素的调查

[目的]探讨临床实习初期影响本科护生与病人沟通的因素与对策.[方法]采用方便抽样法整群抽取临床集中实习1个月的175名护生,进行团体问卷调查.[结果] 96.6%的护生认为护患沟通非常重要,94%以上的护生认为临床实习有必要进一步提高语言和非语言沟通的能力;影响临床实习初期本科护生与病人沟通的因素包括环境、护生、病人及教师4个方面.[结论]临床实习初期应从实习环境、护生、病人及教师4个方面,有针对性地引导和培养护生良好的护患沟通能力.     

产科病房实行人性化护理的新举措

目的探讨在产科病房实行人性化护理的新举措。方法开展全程无缝隙服务、导乐分娩和陪护分娩、创造温馨舒适的环境、构建健康交流平台-孕妇之家。结果护患关系更加融洽,病人满意度从70%上升到98%以上,两个效益增长跃居全院之首。结论人性化护理是提高病人满意度和赢得医疗市场的重要保证。