喉罩在危重病急救中的应用及护理

目的 为危重病患者快速有效地建立人工气道.方法 给31例危重病患者应用喉罩通气,动态观察血氧饱和度、血气分析、心率、心律及血压的变化.结果 经喉罩通气后,27例患者SaO2提高至95%以上,4例患者SaO2维持在92%～95%,胸部扩张满意.31例患者的心率、心律、血压在置入喉罩后无明显变化.结论 喉罩通气能快速有效地为危重病患者提供比较充足氧供.     

内科危重病并发褥疮的护理方法探讨

多年来，对褥疮临床常用庆大霉素换药，外敷或磺酒涂擦，但疗效不甚满意，且影响疗效因素很多。作者采用利福平广谱抗菌及密闭式换药方法，经临床证明，其疗效倨于上述药物治疗。     

个体化护理在老年危重病住院患者的应用效果

目的：探讨个体化护理在老年危重病住院患者的应用效果。方法选取收治的老年危重症患者500例，将2006年1月至2009年12月收治的患者250例设为传统护理组，将2010年1月至2013年1月收治的患者250例设为个体化护理组。 A组患者实施传统的护理措施，B组患者实施个体化护理。比较两组患者的临床效果和护理效果。结果 B组患者的血糖、ALB、CRP、NRS及HAMA指标均优于A组（P＜0．05），不良反应明显少于A组（P＜0．05），患者及家属满意度明显高于A组（P＜0．05）。结论对老年危重病住院患者实施个体化护理，其临床效果和护理效果均优于传统护理模式。     

危重病患者毛细血管渗漏综合征的护理进展

毛细血管渗漏综合征(capillary leak syndrome,CLS)是指由于毛细血管内皮细胞损伤、血管通透性增加而引起毛细血管水肿,大量血浆蛋白渗透到组织间隙,从而出现低蛋白血症、低血容量休克、急性肾缺血等临床表现的一组综合征[1],是系统性炎性反应综合征(system is inflammatory response syndrome,SIRS)的一种严重并发症,CLS的危害在于肺泡水肿、气体交换受限、组织缺氧,从而加重毛细血管损伤,使局部发生炎症改变,乃至不能有效控制的全身炎症病变,最终可能导致器官功能障碍,甚至多脏器功能障碍综合征(MODS),大大增加了临床救治的难度[2].危重病患者发生CLS的比例很大,已引起临床医师的重视,作为与医疗密切相关的护理领域,有必要了解并掌握CLS的临床特点、治疗及护理,以配合医生更好的救治患者,本研究就危重病患者CLS的护理进展综述如下.     

362份危重病患者护理记录缺陷分析及干预的研究

目的:探讨规范危重病患者护理记录书写应遵循的原则和规范,提高护理病历质量。方法:对362份危重病患者护理记录单存在的缺陷进行统计分析。结果:确定了危重病患者护理记录单的缺陷原因,提出相应的干预措施,保证护理质量和病案的完整性。结论:要加强质量监督,确保护理文书的规范化,以防护理纠纷的发生,便于医院内病案实行统一规范化。     

小儿临床护理中危重病护理评分法应用的可行性研究

目的探讨小儿临床护理中危重病护理评分法应用的可行性。方法对该院2012年3月至2014年3月收治的80例急危重症患儿的临床资料进行统计分析,根据评分将患儿分为3个组。结果 3组患儿的危重评分均随入院时间的延长而上升。极危重组患儿入院时、入院后1、2、3、7d的危重评分均显著低于危重组和非危重组,差异有统计学意义(P0.05)。危重组患儿入院时、入院后1、2、3、7d的危重评分均显著低于非危重组,差异有统计学意义(P0.05)。极危重组患儿的器官功能衰竭数显著多于危重组和非危重组,多系统器官衰竭发生率也显著高于危重组和非危重组,差异均有统计学意义(P0.05)。危重组患儿的器官功能衰竭数显著多于非危重组,多系统器官衰竭发生率也显著高于非危重组,差异均有统计学意义(P0.05)。患儿预后和危重评分呈显著的正相关关系(P0.05),与器官功能衰竭数呈显著的负相关关系(P0.05)。结论危重病护理评分法能够对患儿的病情及预后进行有效判断,具有临床意义。     

老年危重病患者胃肠功能障碍的观察与护理

多功能障碍综合征(muliple organ dysfunction syndrome MODS)是危重病患者死亡的重要原因. 老年危重病患者易发生胃肠功能障碍,并因此而引发其它器官的功能障碍,所以,防治MODS的重要环节是及时发现和预防胃肠功能障碍.回顾及分析我院2005年1月～2006年6月ICU收治的180例老年危重病患者,其中102例发生胃肠功能障碍,发生率56.6%,护理体会总结如下.     

生大黄粉治疗危重病患者胃肠功能衰竭的疗效与护理

目的了解生大黄粉对危重病患者胃肠功能衰竭的治疗效果,探讨其观察要点及护理措施。方法将108例危重病患者随机分成对照组(奥美拉唑治疗)及研究组(生大黄粉治疗),比较两组患者胃肠功能衰竭伴消化道大出血的治疗效果及肾功能变化,同时加强消化道护理。结果对照组及研究组的治疗有效率分别为69.5%及90.3%,有显著性差异(P<0.05);两种药物对肾功能均无不良影响,两组患者无显著性差异。结论生大黄粉对治疗危重病患者的胃肠功能衰竭具有较好效果,只要用药、护理得当,可以明显提高重危病患者胃肠功能衰竭时的治疗有效率。     

ICU危重病患者院内转运的护理对策

目的通过评估ICU危重病患者院内转运的风险,持续改进ICU患者安全转运的护理对策。方法总结ICU 415例危重病患者院内转运。结果转送成功率为99.3%,出现意外发生率为0.7%。结论对危重病患者进行风险评估和预处理,熟练掌握抢救技术,不断完善转运流程,各种抢救物品处于备用状态,可提高危重病患者院内转运的安全性。     

The role of technology in critical care nursing

Title.  The role of technology in critical care nursing.
Aim.  This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice.
Background.  The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres.
Method.  An ethnographic study was conducted and data were collected on one critical care unit in a large teaching hospital over a 6-month period in 2004. The methods included participant observation, interviews and the collection of field notes.
Findings.  The overall theme 'The nursing–technology relation' was identified. This comprised three sub-themes: definition of technology, technology transferred and technology transformed. Novice nurses took a task-focussed approach to weaning, treating it as a 'medical' technology transferred to them from doctors. Expert nurses used technology differently and saw its potential to become a 'nursing technology'.
Conclusion.  Nurses need to examine how they can adapt and to 'reconfigure' technology so that it can be transformed into a nursing technology. Those technologies that do not fit with nursing may have no place there. Rather than simply extending and expanding their roles through technology transfer, nurses should transform those technologies that preserve the essence of nursing and can contribute to a positive outcome for patients.     

The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation

BACKGROUND: Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. However, questions remain about what criteria are most appropriate for evaluating qualitative research. To date, little systematic evaluation of qualitative research in palliative care has been conducted. AIMS: This paper is based on a larger study in which we conducted a critical review of qualitative research in palliative care from nursing, medicine, specialist palliative care, sociology, death studies, medical anthropology, and gerontology journals published between 1990 and 1999. The aim of this paper is to present an account of the strengths and weaknesses of qualitative palliative care research in nursing, using data from this review. METHODS: In the larger study, 138 papers from 50 journals were reviewed critically using a tool developed to assess both content and quality; in one part of this tool reviewers recorded open-ended comments on the strengths and weaknesses of each paper. In this paper, we present a thematic analysis of reviewers' comments on a subgroup of 67 nursing papers from the main review, together with an analysis of comments on 29 papers from a comparison group of death studies, medical anthropology, and sociology journals. Patterns of positive and negative evaluation are identified and used to generate an account of strengths and weaknesses in qualitative palliative care research in nursing. FINDINGS: Over 40% of the subgroup of papers from nursing journals received positive comments on topic and quality of writing; around 30% received positive comments on contribution to understanding, practical value, and conceptual or theoretical issues. Less than 20% received positive comments on other critical dimensions. Over 40% of nursing papers received negative comments on the link between data, analysis, and findings, other aspects of method and theoretical and conceptual issues. A higher proportion of papers in the comparison group received positive comments on conceptual and theoretical issues and contribution to understanding. CONCLUSIONS: Nearly half the nursing papers reviewed were judged to be well written or to have a well-chosen topic. However, more than 40% of papers drew negative comments about key methods-related issues. Arguably therefore efforts to improve the quality of research evidence should focus on this area.     

The critical incident technique and nursing care quality research

The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers' expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients' experiences in health care settings, exploring dimensions of nurse-patient interactions and identifying patients' responses to illness and health care treatment.     

Multidisciplinary team perception of games-based therapy in critical care: A service evaluation

Background

As survivorship following critical illness improves, there is greater focus on maximizing recovery. As well as physical effects, critical illness often results in cognitive impairments such as delirium, anxiety, or disorientation. In other populations, such as delirium, non-pharmacological approaches to manage these conditions are preferred, including re-orientation and ensuring personal care needs are met. Cognitive rehabilitation is also well documented for patients with neuropsychological deficits. Treatments include memory aids, compensation strategies, and functional execution. In other hospital populations, games and activities have been utilized to optimize patient engagement, stimulation, and aid recovery, but it is considered an emerging therapy in intensive care.

Aims

This service evaluation aimed to gather multidisciplinary team members' perceptions of the use of games based therapy (GBT) in critical care, including patient engagement and acceptability in clinical practice.

Study design

A UK-based single-centre qualitative service evaluation. Purposive sampling was used to identify interviewees within an adult intensive care who had experience of using a recently implemented GBT intervention. Qualitative data were collected through semi-structured interviews, which were recorded and transcribed verbatim. Data were analysed using thematic analysis.

Results

Eight staff members across the multidisciplinary team were interviewed. One overarching theme of humanizing health care was identified, with three sub-themes of enhancing recovery, non-physical components of care, and bespoke tailoring. In addition, further recommendations for development of the service were summarized.

Conclusion

GBT was well received by staff in clinical practice. It was described as a supportive adjunct to traditional care and rehabilitation, enhancing staff-patient relationships. While it was recognized it may not suit all patients, GBT has the potential to enhance cognitive and physical recovery.     

Development of a patient classification system for critical care nursing based on nursing intensity

Aim

This study aimed to develop a valid and reliable new intensive care unit nursing classification tool, including direct and indirect nursing activities, by measuring the nursing intensity provided to patients.

Background

Prior tools primarily examine patients' medical records or disease severity/interactions, systematically failing to reflect comorbidity risk factors.

Design

The Delphi technique was used to test the content validity of the Korean Patient Classification System on Nursing Intensity for Critical Care Nurses (KPCSNIC).

Methods

Data were collected from four hospitals in two provinces from 26 December 2017 to 30 January 2018. To verify construct validity, staff nurses classified 365 patients, comparing differences by medical department and type of stay. To verify interrater reliability, data collectors and the head nurses of three intensive care units classified 87 patients.

Results

The KPCSNIC had 8 categories, 44 nursing activities and 105 criteria. Reliability was high (r = .84). Construct validity was verified by revealing differences according to medical department and type of patient. Using total scores, four KPCSNIC groups were identified.

Conclusion

The KPCSNIC developed in this study can support staffing for nursing intensity by providing more specific evaluation criteria. Moreover, it reflects nursing intensity, including direct and indirect nursing activities.     

Graduating nursing students' perceived preparedness for working in critical care areas

halcomb e.j., salamonson y., raymond d. & knox n. (2012)?Graduating nursing students perceived preparedness for working in critical care areas. Journal of Advanced Nursing68(10), 2229-2236. ABSTRACT: Aims. This article reports a study examining the relationships between undergraduate students' demographics, educational preparation and clinical experience and their self reported preparedness for employment in critical care. Background. Increasing demand for critical care services internationally, creates a need to grow the critical care nursing workforce. Limited data are available on factors affecting new graduate nurses' career choices. Methods. Final year nursing students from a multi-campus Australian university were surveyed during 2009. Results. Over half of the participants were interested in seeking employment in critical care following graduation. Main reasons for choosing critical care nursing were: (i) like varied and challenging work; (ii) opportunities for professional development; and (iii) like working one-on-one with patients. The main barriers identified by participants were related to the lack of knowledge and clinical skills required to work in critical care. Using the 9-item Confidence and Interest in Critical Care Nursing scale, the study revealed that male participants and those who spent more than 1 week clinical placement in critical care were significantly more likely to report greater confidence and interest in seeking employment in critical care areas. Conclusions. The value of placing nursing students in critical care areas for more than 1 week during undergraduate clinical placements is affirmed. Whilst most final year students report feeling prepared to work in critical care areas, the next step is to explore the transition of students as new graduates in critical care to identify professional and educational issues that impact on their retention.     

护理专业教师批判性思维能力调查研究

[目的]研究高校护理专业教师批判性思维的能力倾向,找出差距,为师资培训课程提供依据。[方法]采用一般情况问卷及香港理工大学中文版加利福尼亚批判性思维倾向量表(CTDI-CV)对某高校护理学院86名教师集中进行问卷调查和CTDI-CV测量。[结果]护理教师CTDI-CV测量结果中总分最低分为248分,最高分为386分;不同年龄、职称和工作压力的护理教师CTDI-CV中文版特质测量结果比较有统计学意义。[结论]高校护理教师具有较强的批判性思维倾向,但是开放思想等特质还需进一步提高;低年资教师及学院教师的系统化特质等还需进一步提高。     

护理专业教师批判性思维能力调查研究

[目的]研究高校护理专业教师批判性思维的能力倾向，找出差距．为师资培训课程提供依据。[方法]采用一般情况问卷及香港理工大学中文版加利福尼亚批判性思维倾向量表（CIDI—CV）对某高校护理学院86名教师集中进行问卷调查和（TDI—CV测量.[结果]护理教师CTDI—CV测量结果申总分最低分为248分，最高分为386分；不同年龄、职称和工作压力的护理教师CTDI—CV中文版特质测量结果比较有统计学意义。结论 高校护理教师具有较强的批判性思维倾向，但是开放思想等特质还需进一步提高；低年资教师及学院教师的系统化特质等还需进一步提高.