ICU气管插管患者非计划性拔管的防护进展

总结了ICU气管插管患者非计划性拔管(UEX)的原因,并提出了针对性防护措施.认为严格ICU人员准入制度、加强对ICU人员的技术培训和管理、运用循证医学进行UEX风险评估,采取预见性护理、制定非计划性拔管应急预案、合理镇静,加强护患沟通,改善患者的舒适、关注高危人群、规范常规护理操作、设置合适的通气模式,适时撤机拔管、控制ICU意外拔管率应列入ICU质量管理范畴等是主要的防护措施,可使非计划拔管的发生率降低到最低限度,从而确保患者安全,全面提高重症监护患者的护理质量.     

ICU气管插管患者非计划性拔管原因分析及护理干预

目的:探讨ICU气管插管患者非计划性拔管(UEX)的相关因素,总结护理对策,以达到有效预防非计划性拔管的发生。方法:分析ICU气管插管患者非计划性拔管的原因,预见性给予护理干预。结果:充分了解UEX事件发生的原因,及时预见性进行护理人员干预,可将UEX拔管率降至最低,提高护理质量。结论:加强临床护理安全的管理、规范医疗护理操作流程、妥善固定导管、合理使用镇静剂、及时使用约束带等护理干预可使非计划性拔管的发生率下降。     

重症监护室21例气管插管非计划性拔管原因分析及护理对策

[目的]探讨重症监护室（ICU）病人气管插管非计划性拔管（UEX）的原因,总结护理对策,有效预防非计划性拔管的发生.[方法]回顾性分析21 例ICU 病人气管插管非计划性拔管的原因.[结果]UEX的发生与未充分使用镇静剂、缺乏有效的固定、未采用适当的肢体约束措施以及医疗护理操作不当等有关.[结论]加强护理责任心,对清醒病人进行相关宣教,适当应用镇静剂,及时使用约束带等有效措施可使非计划性拔管的发生率下降.     

ICU气管插管患者非计划性拔管的临床特征分析及对策

目的 分析ICU气管插管非计划性拔管(unplanned extubation,UEX)的临床特征,探讨有效预防护理对策.方法 回顾性分析2008年4月-2010年6月各ICU科室共发生的34例非计划性拔管患者的资料.结果 经口气管插管患者非计划性拔管构成比高于经鼻气管插管和气管切开患者,夜间非计划性拔管构成比高于白天,未镇静或镇静无效的患者容易发生非计划性拔管,气囊管理不规范易致非计划性拔管发生,本组34例计划性拔管患者中44%拔管后48 h内不需重新置管.结论 尽景采取经鼻路径气管捕管方式;合理安排护理人力资源,加强重点时段和重点患者监护;合理使用镇静剂,规范镇静评分:采取合适有效的约束方法;规范气囊管理可以降低ICU非计划性拔管的发生率.临床上对气管插管拔管指征可能偏于保守,对拔管指征应有更新更全面的掌握,减少患者置管时间.     

集束干预措施在预防ICU非计划性拔管中的应用

目的探讨集束干预措施在预防ICU患者非计划性拔管(unplanned extubation,UEX)中的应用效果。方法选择2008年6月-2009年5月本院ICU置管患者173例,随机分为对照组86例和实验组87例。对照组采用导管常规护理,实验组在此基础上采用集束干预措施,比较两组患者UEX的发生率。结果对照组UEX发生率为12.8%,实验组为4.6%,两组比较,P<0.05,差异具有统计学意义,实验组UEX发生率低于对照组。结论采取集束干预措施能有效降低ICU患者UEX的发生率,提高护理质量,保证患者安全。     

非计划性拔管风险预测在急性呼吸窘迫综合征气管插管患者中的应用研究

目的:探讨风险预测在预防急性呼吸窘迫综合征(ARDS)患者非计划性拔管(Unplanned Extuba-tion,UEX)的应用效果。方法:回顾分析2014年1月-2015年12月入住本院ICU行气管插管的ARDS患者88例为对照组,采用常规的气管插管非计划性拔管的预防方法。选择2016年1月-2017年12月入住本院ICU行气管插管的ARDS患者85例为观察组,应用《非计划性拔管风险预测评估表》评估患者的UEX风险程度,并根据评估结果在对照组的基础上采取相应的预防措施。结果:观察组UEX发生次数、约束时间均低于对照组,差异有统计学意义(P0.05)。结论:应用《非计划性拔管风险预测评估表》,根据评估结果采取预防性的护理措施,可降低UEX的发生率,减少不必要的约束。     

成人非计划性拔管风险因素及全过程管理研究进展

非计划性拔管(UEX)是临床常见护理不良事件,可导致严重不良后果.防范UEX的发生成为护理安全管理的重要内容.本研究对UEX相关研究进行综述,探讨成人UEX的特征及全过程护理管理措施,防范和减少UEX的发生.     

气管插管患者非计划性拔管24例的原因分析及护理

目的:探讨ICU气管插管患者非计划性拔管的原因及如何采取有效的护理措施,预防非计划性拔管.方法:回顾分析2004-10/2008-10我院ICU 5 362例留置气管插管患者的临床资料.结果:发生非计划性拔管24例.结论:非计划性拔管与置管方式、护理操作不当等因素有关.提高医护人员的认识,采取针对性的预防护理措施,对气管插管实施正确的管理,是防止非计划性拔管的有效措施.     

6例ICU气管插管非计划拔管脱管原因分析及防护措施

总结了6例ICU患者发生气管插管非计划性拔管的原因,包括患者因素,导管因素及医护人员因素3个方面。认为加强ICU护理安全管理,规范操作程序,合理用药,提高护理人员的业务水平是有效的防护措施。     

重症监护病房3项护理质量敏感性指标的研究进展

对非计划性拔管(UEX)发生率、导管相关性血流感染(CRBSI)发生率及呼吸机相关性肺炎(VAP)管理3项反映重症监护病房(ICU)护理质量敏感指标及其管理进行综述,并在此基础上分别进行了指标管理的展望,以期为ICU护理管理人员提供参考。     

重症监护室护士眼部护理知识掌握与实践状况分析

目的调查重症监护室（ICU）护士眼部护理知识掌握情况及其眼部护理实践状况。方法自行设计ICU患者眼部护理知识调查表和ICU患者眼部护理实践调查表对上海市3所三级甲等医院145名相关ICU护士进行问卷调查。结果按百分制计算，ICU护士眼部护理知识的总得分为65．66±5.0，引发眼部并发症的危险因素得分为91.5±9．5，眼部护理不当可能导致的并发症的认知为37．0±5.2；知识的掌握与其在ICU工作年限呈正相关。在护理实践方面，分别有80．7％和88.3％的护士表示能做到评估和清洁眼部，100％的护士表示对眼睑闭合不全采用了必要的干预。结论应对相关专业人员进行重症患者眼部护理知识的教育以有效防治ICU患者眼部并发症。     

综合护理措施预防ICU患者压疮中的效果观察

ICU患者大多病情严重,需要卧床治疗、局部制动或接受镇静治疗,呼吸循环能力下降,感染高发,而机体处于高代谢状态,压疮的发生率较高。据相关报道,ICU患者中压疮的发生率为4%～51%。压疮的出现不仅增加了ICU患者的痛苦,延迟了康复,严重者还可导致患者死亡[1]。压疮也是引发医疗纠纷的重要原因,治疗压疮所需的费用是预防压疮的3～4倍,给患者及其家属带来了相应的经济压力,也增加了护理人员50%的工作量[2]。目前,临床上对压疮上缺乏特效的治疗方法,护理工作的重点在于识别危险因素,准确预测压疮风险,采取相应的预防措施。上海市第八人民医院ICU于2016年1月至6月对73例患者由专业的压疮护理小组实施护理,取得了满意的效果     

重症监护病房患者的心理压力分析与护理

目的研究重症监护病房(ICU)患者的心理压力因素及其心理疏导护理。方法采用ICU病人心理护理调查量表对入住ICU的清醒患者进行心理调查,对61例ICU患者的心理压力因素进行了测定,针对患者的不良心理反应进行心理疏导工作。2周后,对其中52例患者进行第2次调查评估。结果ICU患者常见的环境压力因子为:害怕死亡、疼痛、有插管在鼻子或口中、不知道在ICU住多少天、思念配偶或恋人及担心费用问题等。绝大多数ICU患者存在不同程度的抑郁、焦虑等不良心理反应。结论针对ICU患者的心理压力因素及不良心理反应进行心理疏导工作,有助于患者的配合治疗及顺利康复。     

综合ICU机械通气患者气道感染监测结果分析与对策

目的分析综合ICU有刨机械通气患者气道病原菌分布规律,提出解决及预防气道感染发生的对策。方法采用前瞻性研究与回顾性调查相结合的方法,对入住综合ICU的25例有创机械通气患者的气道进行感染监测,并对其临床资料进行分析。结果呼吸机相关性肺炎发生率为64．00％;下呼吸道与呼吸机管路存在多重菌感染,二者病原菌一致;呼吸机管路的污染率随通气时间延长而升高。结论加强气道管理与感染监控,缩短呼吸机管道更换周期,是预防呼吸机相关性肺炎的重要措施。     

Good nursing care to ICU patients on the edge of life

Critically ill patients are admitted to intensive care units (ICUs) to receive advanced technological and medical treatment. Some patients seem not to benefit from the treatment, and sometimes questions are raised as to whether treatment should be withheld or withdrawn. This study was conducted using ICU nurses' experiences with the aim of acquiring a deepened understanding of what good nursing care is for these patients. The study was performed at an adult ICU in Norway, where 14 ICU female nurses were included as participants. The research design was based on interpretative phenomenology and data was collected by group interviews inspired by focus-group methodology. The participants were divided into two groups and each group was interviewed four times. Colaizzi's model was used in the process of analysis. The results show that good nursing care depended on several basic conditions: continuity, knowledge, competence and cooperation, and included clear goals to give appropriate life-saving -- or end-of-life treatment and care. Cornerstones in good nursing care were nurses' verbal communication and nurses' use of their hands. The study emphasises several consequences for future ICU nursing practice and education to enhance good nursing care to patients on the edge of life.     

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study

PurposeThis study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients.DesignThis is a single-center, cross-sectional survey.MethodsNineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ² test and 1-way analysis of variance were used for data analysis.FindingsQuestionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were “drug preparation, administration, and assessment of effectiveness," “patient surveillance and assessment," and “care associated with pain”; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were “inadequate number of nursing personnel," “unexpected rise in patient volume or acuity," and “heavy admission or discharge activity".ConclusionsThe findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.     

对ICU患者实施动态人文关怀护理的方法及效果

目的 探讨对ICU住院患者实施人文关怀护理的方法及效果。 方法 2012年1月-2015年12月ICU逐步实施针对性的人文关怀措施并持续动态改进。统计2012~2015年ICU护理不良事件发生情况、患者满意度及护理人员职业认同情况。 结果 2012~2015年ICU患者护理不良事件由40例下降至17例;患者住院满意度由70.4%上升至96.8%;ICU护理人员职业认同感在自我效力感、有意义感、自己决定感维度得分提高。结论 对ICU住院患者实施动态人文关怀护理,可以减少护理不良事件的发生,提高ICU患者的住院满意度,同时提升ICU护理人员的职业认同感。     

Pressure ulcer prevention in intensive care patients: guidelines and practice

Background  Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention.
Design  The design of this study was a cross-sectional study (point prevalence).
Setting  The study setting was intensive care units. The sample consisted of 169 patients – 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards.
Results  The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients.
Conclusions  The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines.     

护理干预对ICU清醒患者不良情绪的影响

目的:探讨护理干预对ICU清醒患者不良情绪的影响,并制定有利于患者健康的相应对策,为ICU临床护理提供依据.方法:将124例ICU清醒患者随机分为干预组61例和对照组63例,对照组给予常规护理,干预组在对照组基础上给予信息告知护理、社会支持护理、睡眠护理、舒适护理和非语言沟通等干预措施.应用焦虑自评量表和抑郁自评量表进行调查.结果:干预组与对照组比较,焦虑和抑郁程度差异有统计学意义(P<0.05).结论:护理干预可缓解ICU清醒患者不良情绪,护理人员应在实施护理的过程中灵活应用信息告知护理、社会支持护理、睡眠护理、舒适护理和非语言沟通等干预措施提高护理服务质量.