Critical care nurses' knowledge about pressure ulcer in southeast of Iran

Pressure ulcer prevention needs nurses' awareness of sore classification/onset, its item characteristics, and its prevention. Using Pieper's Pressure Ulcer Knowledge Test, 126 critical care nurses' knowledge about pressure ulcer was examined. The questionnaire was divided into three categories including: (1) sore classification/onset; (2) wound characteristics, and (3) preventive measure. The level of nurse's knowledge was insufficient. The highest rate of correct answers belonged to section 2 - prevention of pressure ulcer. Programs aimed at raising nurses' knowledge accompanied by interventions intended to decrease incidence of pressure ulcer are important parts in educational programs. Continuing education may need to be added to the pressure ulcer care to improve the quality of care at intensive care units.     

Getting evidence‐based pressure ulcer prevention into practice: a multi‐faceted unit‐tailored intervention in a hospital setting

The aim of the study was to evaluate whether a multi‐faceted, unit‐tailored intervention using evidenced‐based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi‐experimental, clustered pre‐ and post‐test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi‐professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre‐ and post‐test surveys. This multi‐faceted unit‐tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.     

肿瘤科护理人员安心卡工作坊死亡教育培训实践

目的探讨安心卡工作坊在肿瘤科护理人员死亡教育培训中的应用效果,为护士死亡教育培训提供参考。方法选取185名肿瘤科护士体验安心卡工作坊,首先采用中文版死亡态度描绘量表(修订版)调查护士的死亡态度;参加安心卡工作坊后评价结果。结果共开展安心卡工作坊23次。实施安心卡工作坊前后护士死亡恐惧、自然接受、逃离接受得分比较,差异有统计学意义(P<0.05,P<0.01)。90.27%护士认为安心卡工作坊有助于提升死亡教育能力,84.86%护士愿意推广安心卡,81.08%护士会尝试与患者谈论死亡相关议题。结论安心卡工作坊的开展有助于引导护士思考死亡与人生的价值,是一种有效的死亡教育模式。     

Pilot process and outcome evaluation of the introduction of a clinical nutrition pathway in the care of in-hospital renal patients.

OBJECTIVE: Our objective was to investigate the effect of in-service education and the use of a clinical decision-making pathway on nurses' knowledge related to nutritional needs of renal patients and referrals to a dietitian. DESIGN: This was a before-and-after evaluation study of the effect of the implementation of a clinical nutrition pathway on nurses' knowledge and dietitian referrals. SETTING: The setting was a renal in-patient unit in southeast Queensland, Australia. PARTICIPANTS: There were two groups of participants. Part 1 consisted of 53 registered nurses working in the renal unit of a regional general hospital, and Part 2 consisted of the medical records of two cohorts of more than 100 patients admitted to the renal unit. INTERVENTION: A clinical nutrition pathway and a resource package were developed to support nurses' decision-making related to the nutritional care of renal patients. Thirty-minute in-service education sessions were conducted to explain the use of the pathway, and to develop nurses' confidence in dietary decision-making for renal patients. MAIN OUTCOME MEASURES: The main outcome measures consisted of the nurses' knowledge of nutritional interventions with renal patients and the frequency of dietitian referrals. RESULTS: The nurses' knowledge increased, and referrals to dietitians remained constant. CONCLUSIONS: In-service education and access to unit-based resources, including a decision-support clinical nutrition pathway, improved nurses' knowledge of nutritional care for renal patients. Nurses continued to refer patients for dietitian consultation after the intervention.     

Nurses' knowledge of wound irrigation and pressures generated during simulated wound irrigation.

OBJECTIVE: Our objective was to describe nurses' knowledge of wound irrigation and their ability to produce appropriate irrigation pressures established by the US Agency for Healthcare Research and Quality (AHRQ) during simulated procedures. Subjects and setting: A convenience sample of 28 registered nurses and licensed practical nurses from a university medical center in the Northwest United States comprised the subjects. METHODS: Participants were asked to complete a demographic data sheet and a questionnaire related to wound irrigation and to perform 2 simulated wound irrigations. The questionnaire developed for the study contained 9 questions about general knowledge of wound irrigation and 9 questions about wound irrigation technique. A device to measure the pressures generated by the participants during simulated wound irrigation was developed and calibrated using a transducer calibrated by the National Institute of Science and Technology. RESULTS: Participants' scores were high on items querying general knowledge of wound irrigation but lower on questions relating to irrigation technique. Thirteen participants achieved irrigation pressures within the guidelines established by the AHRQ, 14 fell below the guidelines, and 1 produced pressures exceeding the guidelines. CONCLUSION: The majority of nurses participating in this small study had some difficulty answering questions relating to wound irrigation technique. In addition, performance on simulated irrigation showed that the majority were not able to generate pressures in the recommended range. Nursing professionals and educators should be aware of these knowledge and performance issues and incorporate educational content and experiences in nursing programs designed to aid nurses in improving wound irrigation practice.     

护士知识继续社会化认知状况的调查分析

目的 探讨护士知识继续社会化的认知状况，寻求提高护士知识社会化水平的方法和途径。方法 采用随机抽样的方法对506名护士进行问卷调查。结果 91．1％的护士认为护理工作好坏对医院形象有较大影响，52．2％的护士对具备护理知识和技能就能做好护理工作持正面评价，88．3％的护士认为应该不断学习，83．0％的护士认为护士有必要开展科研；90．0％以上的护士比较需要和非常需要接受继续教育；不同年龄、学历、职务、职称的护士对接受继续教育的认知一致，经统计学处理，χ^2=34.3、11．1、8．7、9．5，均P＞0．05，差异无显著性意义。结论 目前护士知识社会化程度并不高，知识继续社会化的任务仍然很重，医院应有计划、有组织抓好护士知识继续社会化工作，为护士继续教育提供更好的条件。     

The management of chronic wounds: factors that affect nurses' decision-making

This study sought to determine how registered nurses make decisions regarding the management of chronic wounds. A self-administered questionnaire consisting of both Likert-type and open-ended questions was used to survey registered nurses working in hospitals and community services in a large Australian city. A total of 140 questionnaires were returned from a variety of clinical settings. The study revealed that registered nurses had a significant role in chronic wound management. However, they relied primarily on their own experience and that of colleagues for decision making in which they had varying degrees of autonomy. The authors conclude that nurses and medical staff require more objective, research-based education on wound assessment and management.     

Venous leg ulcer care: how evidence-based is nursing practice?

OBJECTIVES: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. DESIGN: The practice variation study group was an audit of nursing agency client records to determine the provision of care. SETTING AND SUBJECTS: The study population was a home care cohort of persons with venous leg ulcers (n = 66) who received care from one Ontario home care nursing agency between March 1999 and November 1999. INSTRUMENT: The audit tool was developed with a checklist reflecting the common recommendations from 3 international practice guidelines, as well as organizational and clinical factors that may influence or reflect best practice. RESULTS: Half of client records (35/66) included an identified etiology of the leg ulcer. An Ankle Brachial Pressure Index score was documented prior to the initiation of compression on fewer than half of the records (21/44). Regular ulcer measurement was done for 11% of the clients (7/64). Two thirds of the clients (44/66) were treated with compression. More than 60% of the clients (40/66) had been seen by either a dermatologist or a vascular surgeon. Topical antibiotics were prescribed for two thirds of clients (44/64). Fifteen percent of clients (10/66) were assessed for pain, and 17% (11/66) received some form of pain management. Documentation of client education specific to the leg ulcer was present on 3% of records (2/66). The mean number of different nurses providing leg ulcer care to each client was 19. A registered practical nurse was the classification of nurse assigned to 43.8% (29/66) of the clients. CONCLUSION: Several gaps were identified in the care provided. A standardized approach to care is needed that includes a comprehensive leg ulcer assessment to determine the ulcer etiology, determination of an Ankle Brachial Pressure Index score to screen for the presence of arterial disease, and compression for all clients who meet the criteria for venous disease. A reorganization of services is required, which includes an increased role for community nurses in leg ulcer assessment and management. Organizational and clinical factors influencing the delivery of best practice need to be identified and addressed.     

武警部队医院护理人员创伤救护知识调查分析

目的了解武警部队医院护理人员创伤救护理论和技能的现状.方法随机抽取157名护士进行创伤救护知识问卷调查.结果武警部队护理人员创伤救护知识呈及格水平(平均15.30分),理论成绩好于技能成绩.其中军人护士救护技能得分高于合同护士(P＜0.05);内陆地区护士救护理论得分高于沿海地区护士(P＜0.05).结论亟需建立一套系统的理论与实践相结合的创伤救护培训体系,以提高武警部队医院护理人员的救护水平.     

Teaching the surgical airway using fresh cadavers and confirming placement nonsurgically

Study ObjectiveTo determine if teaching cricothyrotomy with fresh cadavers improves confidence with neck anatomy, patient positioning, procedural steps, and familiarity with a cricothyrotomy kit.DesignProspective pre- and post-educational.SettingUniversity medical center.Subjects16 anesthesiology residents, one certified registered nurse-anesthetist (CRNA), and 8 medical students.MeasurementsSubjects received workshop training with a PowerPoint presentation followed by an instructional video. Subjects then performed cricothyrotomy during supervision on cadavers. The comfort levels of 25 subjects before (pre) and after (post) the workshop were assessed using a 7-point Likert scale. Correct placement of the cricothyrotome was confirmed with visualization of the carina fiberoptically.Main ResultsThere was a significant increase (P < 0.001) between pre- and post-training comfort levels in identification of neck anatomy, surgical landmarks, and patient positioning (pre, 2.60 ± 1.56; post, 5.64 ± 1.22; mean ± SD); use of cricothyrotomy kit (pre, 1.72 ± 1.22; post, 5.52 ± 1.26), and surgical steps (pre, 1.76 ± 1.17; post, 5.52 ± 1.26). In 24 of 25 attempts (96% success rate), correct placement of the cricothyrotome was confirmed by visualization of the carina fiberoptically.ConclusionsA didactic workshop followed by performance of cricothyrotomy on fresh human cadavers may improve both physician and non-physician anesthesiology care providers’ confidence in performing cricothyrotomy.     

外科护士对麻醉相关知识认知现状调查与分析

目的调查并分析某三级甲等医院外科病房护士对麻醉相关知识的掌握情况及其影响因素,为围麻醉期护理管理提供参考。方法采用问卷调查法,对上海市某三级甲等综合性医院12个手术科室的护士进行麻醉相关知识调查。调查问卷在文献回顾基础上结合围麻醉期护理常规自行设计,经专家评议和预调查内容效度系数为0．90,信度系数为0．81-0．92。采用整群抽样法,调查所有符合纳入标准的330名护士。结果问卷的回收与有效率均为98．18％。324名外科护士对麻醉相关知识的平均得分,折合百分制后为（32±14）分;各维度得分由高至低依次为：麻醉前准备（54±29）分、麻醉后护理要点（31±18）分和基本概念（18±30）分。单因素方差分析显示：学历、职称、年龄、工作年限、科室、是否接受过麻醉课程培训均影响到护士的麻醉相关知识得分且差异有统计学意义（P〈0．05）;而进一步多元回归分析显示,仅年龄、科室以及是否参加过培训进入回归方程,可解释其总变异的35．6％。结论建议依据外科护士所在的科室、年资、培训经历等,有的放矢地实施围麻醉期的理论与技能培训,通过多途径系统化培训提高其对麻醉相关知识的认知水平和参与围麻醉期患者管理的能力,从而确保其能够为围麻醉期患者提供更为安全、专业的预见性护理。     

Postoperative incentive spirometry use

The authors hypothesized that the use of incentive spirometry by orthopedic patients is less than the recommended level and is affected by patient-related factors and type of surgery. To determine its postoperative use, the authors prospectively surveyed all patients in their institution's general orthopedic ward who had undergone elective spine surgery or total knee or hip arthroplasty during a consecutive 3-month period in 2010, excluding patients with postoperative delirium or requiring a monitored bed. All 182 patients (74 men, 108 women; average age, 64.5 years; range, 32-88 years; spine group, n=55; arthroplasty group, n=127), per protocol, received preoperative spirometry education by a licensed respiratory therapist (recommended use, 10 times hourly) and reinforcement education by nurses. Patients were asked twice daily (morning and evening) regarding their spirometry use during the previous 1-hour period by a registered nurse on postoperative days 1 through 3. All data were collected by the same 2 nurses using the same standardized questionnaire. Spirometry use was correlated with surgery type, postoperative day/time, and patient's age and sex. Student's t test, Spearman test, and one-way analysis of variance were used to compare differences (P<.05). Spirometry use averaged 4.1 times per hour (range, 0-10 times). No statistical correlations were found between spirometry use and age. Sex did not influence spirometry use. The arthroplasty group reported significantly higher use than did the spine group: 4.3 and 3.5 times per hour, respectively. Mean use increased significantly between postoperative days 1, 2, and 3.     

新疆三级医院ICU护士鼻饲操作状况及其认知调查

目的 了解新疆地区三级医院ICU鼻饲方式现状及ICU护士对鼻饲方式的认知情况.方法 采用自行设计的问卷,以新疆地区9所三级综合医院237名ICU护士为对象,就获取鼻饲知识的途径、工作中使用的鼻饲方式、鼻饲相关护理情况、对鼻饲方式的认知进行调查.结果 ICU护士获得鼻饲方式知识的途径以科室理论学习为主(占45.2%);55.7%护士应用间断滴入法,40.1%应用持续泵入法,33.8%应用分次注入法,11.8%护士3种均采取;对鼻饲方式的认知评分为17.68±4.93,不同职称、学历、护龄、民族ICU护士对鼻饲方式的认知评分比较,差异无统计学意义(均P>0.05).结论 ICU护士为患者鼻饲的方式不统一,鼻饲相关护理存在不规范现象,对鼻饲方式的认知程度不够理想.应加强对科室理论学习管理的力度,使鼻饲操作规范化、系统化,以提高ICU护理质量.     

Impact of participation in team meetings on the stress and coping of lower status nursing employees in long‐term care

This pre‐test, post‐test control group pilot study sought to investigate the impact of including certified nursing assistants (CNAs) and licensed practical nurses (LPNs) in interdisciplinary team meetings on the variables of stress and coping. The data were analysed through analyses of variance and covariance. The results suggest that the effect of being included in a treatment team meeting on task‐centred coping is greater for the lower status worker (CNA) than for the worker who had more status (LPN). Qualitative data yielded information regarding the advantages and disadvantages of including lower status workers in treatment team meetings. Copyright © 2010 John Wiley & Sons, Ltd.     

重症监护护士对插管病人气管内吸痰术知识与实践调查

目的调查重症监护护士对吸痰术的认识与实践。方法研究时间2017年8月～2018年2月,研究人员来自两家医院从事重症监护室工作的护士包括ICU、EICU,共87名护士组成。所有参与者得到问卷调查,并对33名护士在重症患者气管插管后实施气管内吸痰(ETS)操作进行评估。结果大多数ICU护士获得较高的问卷调查分数,但现场操作考核分数较低,与知识问卷结果脱节,与学历高低以及工作时间有关联。33名护士中,只有10名护士(30.3%)在ETS前患者进行胸部听诊,无菌操作、吸痰来回次数、什么体征观察等是存在的主要问题。结论应加强护士的继续教育以适合所需的临床实际技能,这些因素可能需要进一步的监督和管理来预防。     

临床护理岗位分层培训管理模式的构建及成效

目的构建临床护理岗位分层培训管理模式并评价其成效。方法根据临床护理岗位的N1级、N2级、N3级、N4级和CNS级护士的培训需求确定培训内容及方法,制定各层级护理人员岗位胜任能力考核标准。结果临床护理岗位的N1级、N2级、N3级、N4级和CNS级护士对理论培训和操作培训满意度均分为4．02～4．37;培训后操作考核、理论测试、临床工作表现评分均在85分以上,岗位胜任能力达标率为97．51％～100％。结论分层培训管理模式得到了各层级护士认可,有利于提高其学习积极性和培训效果,提升临床护士的岗位胜任力。     

Wound care evidence,knowledge and education amongst nurses: a semi‐systematic literature review

The aims of this study were to determine the knowledge and skills of nurses involved in wound care, to provide a critical overview of the current evidence base underpinning wound care and to determine the extent of utilisation of existing evidence by nurses involved in the management of wounds in practice. A semi‐systematic review of the literature was undertaken on Cinahl, Medline Science Direct and Cochrane using the search terms: wound, tissue viability, education, nurse, with limitations set for dates between 2009 and 2017 and English language. Shortfalls were found in the evidence base underpinning wound care and in links between evidence and practice, prevalence of ritualistic practice and in structured education at pre‐ and post‐registration levels. The evidence underpinning wound care practice should be further developed, including the conduction of independent studies and research of qualitative design to obtain rich data on both patient and clinician experiences of all aspects of wound management. More structured wound care education programmes, both at pre‐registration/undergraduate and professional development levels, should be established.