减少身体约束护理方案在重症医学科气管插管病人中的应用

目的:探讨减少身体约束护理方案在重症医学科气管插管病人中的应用效果。方法:按照随机数字表法将2018年2月—2019年1月综合重症监护室(ICU)收治的240例气管插管病人分为对照组与观察组各120例,对照组给予常规护理方案干预,观察组给予减少身体约束护理方案干预。比较两组病人约束时间、身体约束率、非计划性拔管(UEX)发生率、皮肤损伤情况,调查两组病人护理满意度,干预前后采用症状自评量表(Self-reporting Inventory)评估病人心理健康水平。结果:观察组病人约束时间短于对照组,身体约束率、UEX发生率、皮肤损伤发生率低于对照组,护理满意度高于对照组(P<0.05);观察组病人干预后症状自评量表评分低于对照组(P<0.05)。结论:在重症医学科气管插管病人中应用减少身体约束护理方案可缩短约束时间,降低身体约束率、UEX和皮肤损伤发生率,提高病人护理满意度,改善病人心理状况。     

PBL教学法在重症医学科护士身体约束培训中的应用研究

目的探讨以问题为导向的学习(PBL)教学法对提升重症医学科护士实施身体约束培训的应用效果。方法选取四川省某4所三级甲等综合医院重症医学科94例护士为研究对象,按照随机数字表法将其分为对照组和观察组,每组47例。对照组在身体约束培训中采用带教老师示范并讲解要点的传统临床带教培训模式。观察组使用PBL教学法进行身体约束培训。比较两组护士在身体约束理论知识、态度、行为3个维度得分差异,以及两组研究对象的培训满意度。结果培训后,观察组在身体约束的理论知识、态度、行为3个维度得分高于对照组,差异均有统计学意义(P 0.05)。观察组满意度为91.49%(43/47),高于对照组89.13%(41/46),但差异无统计学意义(χ2=1.037,P=0.309)。结论使用PBL教学法对重症医学科护士进行身体约束培训,可有效提高培训效果,值得推广应用。     

护士规范化培训的创新性探索

目的 探讨新型规范化培训模式对护士规培成效的影响.方法 反思2018年某院规范化培训护士在卫健委统一组织的规培护士结业考核的结果及存在的问题,自2019年开始采用创新性规培模式对规培护士进行培训.回顾性分析2018年(对照组)、2019年(创新组1)、2020年(创新组2)在某院进行规培的护士的结业考核成绩,比较各组护士考试合格率的差异.结果 2018年规范化培训护士38名,院内结业首次考核合格率为65.8％,卫健委统一组织的规范化培训护士结业考核率为94.7％;2019年和2020年规范化培训护士共42名,院内结业首次考核合格率和卫健委组织的规培护士结业考核合格率均为100％;其中,创新组规培护士院内结业考核合格率与对照组的差异有统计学意义(P<0.05);各组卫健委考核合格率无统计学差异(P>0.05).此外,创新组护士的个人职业满意度优于对照组.结论 创新性规培模式不仅提升了规培护士院内结业考核合格率,还提高了个人职业满意度,值得推广应用.     

柯氏模型在护士规范化培训效果评价中的应用

目的运用柯氏模型全面评估护士规范化培训的效果。方法对本院44名规范化培训护士进行为期1年的岗前、临床实践培训和考核,观察其在反应层次、学习层次、行为层次和结果层次方面的效果。结果 (1)反应层次:规范化培训学员对培训总体满意度为83.23%。(2)学习层次:培训后,护士理论和操作成绩显著高于培训前,差异有统计学意义(P 0.05)。(3)行为层次:他评与自评比较,在医疗安全意识、对规培的认知、基础护理技术操作能力三方面差异有统计学意义(P 0.05),医疗安全意识、基础护理技术操作能力方面自评好于他评。(4)结果层次:护士长对规培护士在患者满意度、护理不良事件、有利于改进目前护理工作方面的评价得分为88分,规培护士对培训有利于自身更新知识及促进个人发展方面的评价得分为86分,即均给予了较高评价。结论柯氏模型在对护士规范化培训效果评价中的应用效果良好,能对培训效果进行系统性和多层次的评估,起到循环上升持续改进的作用。     

新型医用约束带在危重症手足口病患儿中的应用效果观察

目的探讨新型医用约束带在危重症手足口病患儿中的应用效果。方法选取我院重症医学科2012年6月至2018年9月收治确诊危重型重症手足口病患儿83例作为研究对象,将其随机分为对照组38例和观察组45例,对照组采用普通肢体约束带实施肢体约束,观察组采用新型医用约束带进行肢体保护性约束。比较两组患儿护理不良事件发生率,两组患儿家属满意度。结果观察组患儿护理不良事件发生率明显低于对照组,家属满意度明显高于对照组(P 0. 05)。结论新型医用约束带的使用能降低危重症患儿护理不良事件发生率,提高家属满意度,适合在儿科使用。     

ICU身体约束护理实践标准的建立及应用

目的规范重症医学科危重患者身体约束的护理实践。方法将身体约束护理实践标准应用前后重症医学科中身体约束专项护理质控检查成绩和患者及家属对身体约束的护理满意度进行效果评价。结果重症医学科中身体约束护理实践标准应用后身体约束专项护理质控检查成绩、患者对身体约束的护理满意度明显提高(P0.05)。结论重症医学科身体约束临床实践标准的建立,有助于缩减身体约束率,规范重症专科护士对危重症患者身体约束行为,在保证护理安全同时,实现"进一步改善医疗服务行动计划"的目标。     

导管风险评估表在预防ICU患者非计划拔管中的应用

目的探讨导管滑脱风险评估表在预防重症医学科患者非计划拔管的效果观察。方法采用便利抽样法,选取2018年1月—2018年9月入住本院重症医学科的80例患者作为研究对象,按照随机数字法分配纳入对照组和实验组,各40例。对照组按常规护理方法,未采用导管风险评估表,出现护理风险时给予对症处理。实验组采用导管风险评估表,并采取系统护理措施。比较两组患者留置导管过程中的护理风险发生率。结果实验组的护理风险发生率明显低于对照组,对照组的护士满意度低于实验组的护士满意度(P 0. 05),两组比较差异有统计学意义(P 0. 05)。结论对重症医学科留置导管的患者进行评估导管风险评估表,并采取系统护理措施,有效减少意外拔管及相关并发症的发生,提高护理质量和患者满意度。     

二维码技术在手术室电外科设备培训与管理中的应用

目的探讨二维码技术在手术室电外科设备培训与管理中的应用效果。方法制作手术室电外科设备的操作视频,内容包括设备相关知识、操作使用方法和常见故障排除方法,并将视频生成二维码粘贴到电外科设备操作界面闲置区。选择2017年—2018年进入某三甲医院手术室的25名规培护士作为对照组,采用常规培训与管理模式。选择2018年—2019年进入该三甲医院手术室的23名规培护士作为观察组,在常规培训与管理的基础上应用二维码技术的培训与管理模式。比较两组的理论与操作成绩、设备故障排除率和规培护士对培训方式满意度。结果观察组在电外科设备的理论、操作成绩、故障排除率以及对培训方式的满意度均高于对照组,差异有统计学意义(P0.01)。结论应用二维码技术的培训与管理模式有助于提高手术室规培护士对电外科设备理论知识的掌握程度、操作水平和故障排除率;同时提高了设备的管理水平,保证了手术室护理质量和安全管理,提高了手术室规培护士的满意度。     

现场追踪与迷你临床演练评价量表在儿童医院骨科护生培训考核中的应用

[目的]探讨现场追踪与迷你临床演练评价量表在儿童医院骨科护生培训考核中的应用效果。[方法]选择2017年9月—2018年4月骨科60名进行培训的护生为研究对象,2018年1月—2018年4月30名培训护生为观察组,2017年9月—2017年12月30名培训护生为对照组,比较两组考核情况、护生对考核方法的满意度及患儿和家属的满意度。[结果]观察组护生培训考核成绩优于对照组,观察组护生对考核方式的满意度及患儿和家属对护生的满意度均高于对照组,差异有统计学意义。[结论]现场追踪结合迷你临床演练评价量表考核有助于提高护生的临床综合能力,提高患儿和家属的满意度。     

情境领导理论对神经外科规培护士带教质量及护士综合能力的影响

目的探讨情境领导理论在神经外科规培护士带教中的应用效果。方法采取便利抽样的方法选取河南省人民医院2018年6月至2020年6月神经外科规培护士51名和带教老师16名,分为对照组(25名护士,带教老师8名)与观察组(26名护士,带教老师8名),对照组规培护士采取常规带教模式,观察组则运用基于情境领导理论的培训,比较两组的培训效果、带教质量、护士综合能力。结果观察组规培护士基础知识和操作技能考核评分、对带教老师的总体满意度、带教老师对规培护士的总体满意度高于对照组,差异有统计学意义(P<0.05)。培训前两组规培护士综合护理能力调查问卷评分差异无统计学意义(P>0.05);培训后,观察组规培护士该问卷6维度评分与总分均高于对照组,差异有统计学意义(P<0.05)。结论对神经外科规培护士采取基于情境领导理论的培训能取得较好的效果,改善带教质量,有效提升规培护士的综合能力,增强培训效果。     

四种评分系统对呼吸重症监护室病人预后评估的比较

目的　研究APACHEⅢ、SAPSⅡ、MPMⅡ 0和APACHEⅡ评分系统对呼吸重症监护室病人预后评估中的适用性和可行性 ,同时比较其优劣。方法　回顾性分析 2 16例呼吸重症监护室病人临床资料 ,进行APACHEⅢ、SAPSⅡ和APACHEⅡ评分 ,计算SAPSⅡ、APACHEⅡ和MPMⅡ 0的预计病死危险度。比较由SAPSⅡ、APACHEⅡ和MPMⅡ 0计算的病人院内病死概率和病人实际病死率之间的差异 ;同时用Hosmer-Lemeshow拟合优度检验和ROC曲线比较APACHEⅢ、SAPSⅡ和APACHEⅡ评分之间校准度和精确度的差异。结果　 2 16例病人中死亡 77例 ,存活 139例 ,实际病死率 35 6 5 %。死亡组与存活组病人的APACHEⅡ、APACHEⅢ及SAPSⅡ评分在存活组与死亡组之间差异均有统计学意义 (P <0 0 5 )。APACHEⅡ、APACHEⅢ和SAPSⅡ的AUROCC分别为 0 74 4、0 74 1和 0 75 4 ,APACHEⅡ -PHM与实际病死率无显著性差异 (P >0 0 5 ) ,而SAPSⅡ -PHM和MPMⅡ 0与实际病死率有显著性差异 (P <0 0 5 )。结论　各种病情评价系统均可用于评价呼吸重症监护室病人的预后 ,4种病情评价系统中以APACHEⅡ最适于RICU病人。     

Assessment of severity of the state and intensive care of newborns in the intensive care units

A point-based evaluation of the severity condition was made on the bases of an analysis of clinical findings (cardiovascular, respiratory, central nervous, urinary and gastrointestinal systems) for 130 newborns who were admitted to the intensive care and resuscitation unit: 3-5 points--severe condition, 6-10 points--highly severe condition and 12-15 points--extremely severe condition. The severity assessment scale as applicable to newborns and based only on the clinical findings enables the practitioner to optimize the conducted therapy in accordance with a severity degree.     

Impact of an intensive communication strategy on end-of-life practices in the intensive care unit

Purpose

Since the 2005 French law on end of life and patients’ rights, it is unclear whether practices have evolved. We investigated whether an intensive communication strategy based on this law would influence practices in terms of withholding and withdrawing treatment (WWT), and outcome of patients hospitalised in intensive care (ICU).

Methods

This was a single-centre, two-period study performed before and after the 2005 law. Between these periods, an intensive strategy for communication was developed and implemented, comprising regular meetings and modalities for WWT. We examined medical records of all patients who died in the ICU or in hospital during both periods.

Results

In total, out of 2,478 patients admitted in period 1, 678 (27%) died in the ICU and 823/2,940 (28%) in period 2. In period 1, among patients who died in the ICU, 45% died subsequent to a decision to WWT versus 85% in period 2 (p < 0.01). Among these, median time delay between ICU admission and initiation of decision-making process was significantly different (6–7 days in period 1 vs. 3–5 days in period 2, p < 0.05). Similarly, median time from admission to actual WWT decision was significantly shorter in period 2 (11–13 days in period 1 vs. 4–6 days in period 2, p < 0.05). Finally, median time from admission to death in the ICU subsequent to a decision to WWT was 13–15 days in period 1 versus 7–8 days in period 2, p < 0.05. Reasons for WWT were not significantly different between periods.

Conclusion

Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.     

Expanding intensive care medicine beyond the intensive care unit

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.     

Expanding intensive care medicine beyond the intensive care unit

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.     

Hemosorption in the intensive therapy of agranulocytosis

The authors describe a case of successful treatment of medicamentous agranulocytosis (induced by mercasolyl) using hemoperfusion, an extracorporeal method for the treatment of intoxications. In the severe total intoxication syndrome, application of hemoperfusion in multimodality therapy of myelotoxic agranulocytosis improves the disease prognosis.     

重症监护临床信息系统在急诊重症监护室中的应用

目的探讨重症监护临床信息系统(ICIS)在急诊重症监护室(EICU)中的应用效果。方法将本院急诊医学部重症监护室2014年8月—2015年1月收治的重症患者366例设为对照组,2015年2月—2015年7月收治的重症患者353例设为观察组。对照组患者应用"军卫一号",观察组应用重症监护临床信息系统,观察比较2组病情记录时间、观察项维护时间、出入量维护时间、核对确认医嘱时间及病情记录差错率、观察项维护差错率、出入量维护差错率和核对确认医嘱差错率。结果观察组护理记录时间、核对确认医嘱时间、护理工作记录差错率及核对确认医嘱差错率均显著低于对照组(P0.05)。结论 ICIS的应用提高了临床工作效率,节省了护理记录时间,降低了护理差错率,明显提高了临床护理质量和患者满意度。     

Sedation in the intensive care unit

OBJECTIVE: To describe the goals of sedative use in the intensive care unit and review the pharmacology of commonly used sedative drugs as well as to review pertinent publications in the literature concerning the comparative pharmacology of these drugs, with emphasis on outcomes related to sedation and comparative pharmacoeconomics. DATA SOURCES: Publications in the scientific literature. DATA EXTRACTION: Computer search of the literature with selection of representative articles. SYNTHESIS: Proper choice and use of sedative drugs is based on knowledge of the pharmacology of commonly used agents and is an essential component of caring for patients in the intensive care unit. The large variability in pharmacokinetics and pharmacodynamics in the critically ill make it difficult to directly compare agents. Midazolam provides rapid and reliable amnesia, even when administered for low levels of sedation. Propofol may be useful when deeper levels of sedation and more rapid awakening are required. Lorazepam can be used for long-term sedation in more stable patients if rapidity of effect is not required. Further investigation in assessment of depth of sedation in the critically ill is needed. Continued study of costs, side effects, and appropriate dosing strategies of all sedative agents is needed to answer questions not sufficiently addressed in the current literature. Conclusion: An individualized approach to sedation based on knowledge of drug pharmacology is needed because of confounding variables including concurrent patient illness, depth of sedation, and concomitant use of analgesic agents. (Crit Care Med 2000; 28:854-866) KEY WORDS: sedation; anxiolysis; critical care; midazolam; lorazepam; propofol; benzodiazepines; intensive care unit; pharmacoeconomics; critical illness     

Delirium in the intensive care unit

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients, occurring in up to 80% of the sickest intensive care unit (ICU) populations. Critically ill patients are subject to numerous risk factors for delirium. Some of these, such as exposure to sedative and analgesic medications, may be modified to reduce risk. Although dysfunction of other organ systems continues to receive more clinical attention, delirium is now recognized to be a significant contributor to morbidity and mortality in the ICU, and it is recommended that all ICU patients be monitored using a validated delirium assessment instrument. Patients with delirium have longer hospital stays and lower 6-month survival than do patients without delirium, and preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. Little evidence exists regarding the prevention and treatment of delirium in the ICU, but multicomponent interventions reduce the incidence of delirium in non-ICU studies. Strategies for the prevention and treatment of ICU delirium are the subjects of multiple ongoing investigations.     

Rhabdomyolysis in the intensive care unit

Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents. There are many etiologies of rhabdomyolysis, classified here as congenital and acquired; compartment syndrome secondary to trauma with reperfusion injury is one common precipitating factor. Regardless of the underlying etiology, the pathophysiology follows a similar pathway via myocyte destruction and release of myoglobin into the systemic circulation. Rhabdomyolysis-induced renal failure is caused by the precipitation of myoglobin in the renal tubules which is enhanced under acidic conditions. A high index of clinical suspicion is required to promptly recognize rhabdomyolysis, especially in the unconscious patient. Presenting symptoms include tea-colored urine and muscle weakness or fatigue. The diagnosis is confirmed most reliably with the finding of elevated serum creatine kinase levels. Early, aggressive resuscitation with either normal saline or lactated Ringer's solution to maintain an adequate urine output is the most important intervention in preventing the development of acute renal failure. There is insufficient clinical evidence supporting the routine administration of diuretics and bicarbonate to protect against the development of acute renal failure.