上海市三甲医院ICU气管插管患者口腔护理现状调查

目的 了解ICU气管插管患者口腔护理现状及其影响因素,为制定针对性改进对策提供参考.方法 应用自行设计的调查问卷,对上海市3所三甲医院195名ICU护士进行调查.结果 ICU护士对口腔护理操作规范及评估标准描述不一致,66.67%护士采用擦拭与冲洗相结合的口腔护理方式,65.64%选用氯己定溶液作为口腔护理液;对口腔护理的认知得分为(11.89±2.74)分;态度得分为(3.77±1.15)分;影响因素中口腔护理设备不足得分最高,为(4.23±0.79)分.结论 ICU气管插管患者口腔护理临床实践缺乏统一科学的规范,应加强ICU护士相关口腔护理认知及态度的培养,有效改进口腔护理用具,构建基于循证的临床实践指南,以提高口腔护理质量.     

ICU护士预防呼吸机相关性肺炎的循证护理认知调查

目的 了解lCU护士预防呼吸机相关性肺炎(VAP)循证护理的认知现状及影响因素.方法 采用自行设计的问卷调查表,对江苏省某地区危重症护理人员专科知识培训班的72名学员进行问卷调查.结果 ICU护士预防VAP循证护理的认知评分为4.54±1.55.影响其认知的因素有不同的科室、学历、ICU工作年限等.阻碍护士认知的主要因素有"科室没有预防VAP的教育墙报或操作图片强化学习和提醒、没有可依从的预防VAP的护理指南和操作规范"等.结论 应加强ICU护士VAP专业知识的培训和循证护理教育,逐步完善相关的护理指南和操作规范,确保有效落实预防VAP的循证护理.     

ICU机械通气患者早期四级康复训练效果

目的探讨ICU机械通气患者早期四级康复训练的实施效果。方法将100例入住综合ICU的重症患者随机分为干预组和对照组各50例,对照组按ICU护理常规给予四肢被动活动和功能锻炼,干预组在机械通气24h内开始实施早期四级康复训练。干预后对两组肌力变化、Barthel指数、机械通气时间、ICU住院时间、总住院时间、ICU获得性肌无力发生率、呼吸机相关性肺炎发生率、深静脉血栓发生率、压疮发生率进行评估。结果干预组出院前1天肌力、Barthel指数评分显著高于对照组,机械通气时间、ICU住院时间、总住院时间显著短于对照组,ICU获得性肌无力、呼吸机相关性肺炎发生率显著低于对照组(P0.05,P0.01)。结论早期四级康复训练可提高ICU机械通气患者的肌力和自理能力,预防患者获得性肌无力的发生,缩短住院时间,利于患者早日康复。     

ICU护士预防气管插管非计划性拔管护理知信行调查

目的了解ICU护士预防非计划性拔管护理知信行现状,分析其影响因素。方法采用自行设计的ICU护士预防气管插管非计划性拔管护理的知识、态度、行为问卷对80名护士进行调查分析。结果ICU护士预防非计划性拔管知识、态度、行为得分中位数分别为4.50分、7.50分、5.50分;ICU工作年限、职称和工作年限是认知水平的影响因素,ICU工作年限是态度和信念水平的影响因素,职称和科室是行为水平的影响因素(P0.05,P0.01)。结论ICU护士预防气管插管非计划性拔管护理的态度较为积极,但认知和行为状况不佳。应重点加强低年资、低职称的护士预防非计划性拔管的知识技能培训,以提高ICU护士知识水平和护理质量。     

ICU护士对声门下吸引相关知识认知及依从性影响因素调查

目的 了解ICU护士对声门下吸引相关知识的认知程度及其依从性的影响因素,为提高声门下吸引实施依从性提供依据.方法 采用自行设计的ICU护士声门下吸引认知及依从性影响因素问卷,对87名ICU护士进行调查.结果 ICU护士对声门下吸引知识认知总分为37.15±2.36,认知最好的条目是监测气囊压力及声门下-气囊上滞留物是VAP重要发病原因之一,认知最低的条目是机械通气患者声门下间隙容积;排前3位的影响因素为工作量大无法顾及声门下吸引操作,声门下吸引会引起患者黏膜受损、呛咳等不适,无精确的声门下吸引配套装置.结论 ICU护士对声门下吸引知识认知总体水平为一般,医院管理者应采取多元化形式对ICU护士及护士长进行声门下吸引培训,针对影响依从性的因素采取相应的对策,提高声门下吸引实施依从性.     

ICU护士对临终关怀认知和行为的质性研究

目的了解ICU护士对于临终关怀的认知、行为以及影响因素。方法通过深入访谈的形式,访谈11名护理过临终患者的ICU护士,将获得的资料进行分析、整理,提炼主题。结果共提炼出ICU护士认为临终关怀和安乐死有区别,对患者死亡存在多种感受,对临终患者的要求有一定认知,临终关怀相关知识的获取途径多为非正式渠道,在实际工作中实施临终关怀服务很少,临终关怀受到心理护理技能、疼痛认知、医患关系、家属态度以及社会重视程度等方面的影响等主题。结论临终关怀需要关注患者及家属生理、心理及社会多方面的需求,为了更好地开展临终关怀服务,应该增加教育力度,培养ICU护士专业技能,增加社会宣传,普及优逝理念,组建临终关怀团队,以为临终患者提供高质量的临终关怀服务。     

ICU护士眼部护理临床能力调查研究

目的调查ICU护士眼部护理临床能力现状,并探讨其影响因素。方法采用横断面调查法,便利抽取符合纳入标准的天津市3所三级甲等医院128名ICU护士,使用中文版ICU眼部护理临床能力量表(ECCI)对其进行调查。结果 ICU护士眼部护理临床能力总分为(79.12±7.80)分,其3个维度"眼部护理知识"、"眼部护理态度"和"眼部护理行为"得分分别为(12.80±2.38)分、(30.98±2.69)分和(35.34±5.27)分。学历和ICU工作年限是ICU护士眼部护理临床能力的影响因素(均P<0.01)。结论ICU护士眼部护理临床能力中等偏上,但仍有待提高,医院管理者应重视ICU护士眼部护理临床能力的培养,建立眼部护理相关指引。对专科学历和ICU工作年限低于6年的ICU护士应重点关注,加强眼部护理方面的培训教育,提高ICU眼部护理临床能力,以减少ICU眼部并发症的发生。     

ICU护士自我同情现状及影响因素分析

目的了解ICU护士自我同情现状,分析影响因素,为临床护理管理和干预提供依据。方法采用分层随机整群抽样法,应用自我同情量表对浙江省21所综合性医院的508名ICU护士进行问卷调查。结果 ICU护士自我同情总分(109.21±9.76)分;年龄、工作年限、月收入、工作满意情况是ICU护士自我同情的影响因素(P0.05,P0.01)。结论浙江省ICU护士自我同情总体水平良好;护理管理者应针对低年资、低收入及对工作不满意护士人群,制定有效的干预措施,提升其自我同情水平。     

ICU医护人员对高级实践护士认知和期望的调查分析

目的了解ICU医护人员对高级实践护士(APN)的认知现状及期望。方法采用自设医护人员对APN认知和期望调查表对ICU护士350名和医生80名进行问卷调查。结果 96.0%护士和73.8%医生知晓"专科护士";84.6%护士和61.2%的医生认为直接临床护理能力为APN最重要的能力,42.4%护士和41.3%医生认为本科学历与至少5年ICU工作经验为最佳适任资格;91.6%护士和93.8%医生期望APN首要工作内容为解决疑难患者的护理问题;51.7%护士和48.7%医生认为APN的职能范围应以护理为主、医疗为辅;45.1%护士和48.7%医生认为APN的岗位职权应"仅次于护士长,拥有分配床位和(或)排班的权利";57.1%护士和53.8%医生认为APN的岗位名称应为"高级实践护士";42.9%护士认为APN应该"分管床位,照顾复杂、危重病患",而47.5%医生认为APN应"负责整体管理,不具体分管床位"。结论ICU医护人员对APN的认知和期望较为一致,可作为推进我国ICU-APN角色发展的参考依据。     

ICU过渡期护理人员角色认知质性研究的Meta整合

目的 系统评价ICU过渡期护理人员对个体角色的认知,为实施优质的ICU过渡期护理提供参考。方法 计算机检索PubMed、Web of Science、CINAHL、Embase、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,搜索ICU过渡期护理人员对自身角色认知的质性研究,检索时限均从建库至2023年2月。采用Meta整合方法对纳入文献的研究结果进行归纳、诠释、总结。结果 共纳入13篇文献,提炼出50个结果,将相似结果归纳为10个新的类别,并综合成4个整合结果：保障护理连续性,提供健康教育、知识技术及情感支持,保障ICU过渡期护理安全,促进护理服务质量及康复结局转归。结论 护士视角下ICU过渡期护理人员发挥多样化的角色作用,伴有较强的角色认同感。护理管理者应扩大ICU过渡期护理人员角色范畴,优化角色内涵,构建优质化ICU过渡期护理团队。     

Use of computerized ICU documentation to capture ICU core measures

BACKGROUND: Intensive care unit (ICU) core measures that target the prevention of catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP) in ventilated ICU patients are underway across the United States. Implementation often requires additional personnel to educate providers and collect the data. We hypothesized that use of our current computerized ICU flowsheet could provide timely, accurate data on ICU core measures without additional personnel dedicated to data capture. METHODS: In a 10-bed, closed surgical ICU with existing protocols for deep vein thrombosis (DVT) prophylaxis, stress ulcer bleeding prophylaxis (SUP), ventilator weaning parameters, and glucose control, we created a reporting tool that would document daily weaning parameters, head of bed (HOB) at 30 degrees , glucose levels, DVT prophylaxis, and SUP. Our glucose protocol targeted <150 mg/dL, with all daily glucose values reported rather than just the morning value. The results from the previous 12 am to 11:59 pm were available to the rounding team at 7 am. We examined compliance at the start and after education of medical staff (March/April for HOB up, DVT, and SUP; May/June for glucose control). RESULTS: During 2005, compliance with all protocols improved. Percent compliance for DVT prophylaxis, SUP, and HOB up rose from as low as 32% at the start of the documentation process to consistently higher than the target level of 95%. Compliance for glucose control increased after intensive education of nursing and physicians with the mean glucose falling from 144 to 122 mg/dL. There was increased nursing workload for checking glucose levels in which the mean number of glucose checks rose from a low of 1.5 per patient to as high as 8.2 per patient per day. CRBSI and VAP rates did not decrease during this period compared with the prior year. Length of stay and mortality were unchanged. CONCLUSIONS: Reporting of ICU core measures to treating staff can be done accurately and promptly with a computerized system. Education was effective in improving compliance levels. No additional personnel were required to create reports, capture data, or improve compliance after initial development and testing. Although compliance with core measures met target levels at the end of the year, we did not observe improved outcomes in terms of CRBSI, VAP, mortality, or length of stay.     

Psychiatric emergencies on ICU

Psychiatric emergencies are catatonia, stupor, central serotonine syndrome, malignant neuroleptic syndrome, suicide risk and agitation. In this article some clinical features of the aforementioned and its therapy are summarized.     

The long-stay ICU patient

The physical, psychological and cognitive effects of a prolonged stay on the intensive care unit (ICU) can be profound. Physical challenges include difficulty in weaning the patient from mechanical ventilation, problems with sedation, and critical illness neuropathy and muscle wasting. Psychological aspects include the development of delirium, post-traumatic stress disorder and cognitive dysfunction. It is essential that these patients are appropriately assessed and managed to minimize the long-term impact of these problems.     

Dying in the ICU

Die Anaesthesiologie - With modern intensive care medicine, even older patients and those with pre-existing conditions can survive critical illnesses and major operations; however, unreflected...     

Haematological malignancy in ICU

The admission of patients suffering haematological malignancyto the intensive care unit (ICU) is controversial due to theirpoor prognosis. The dilemma regarding admission has escalatedwith the development of more aggressive forms of chemotherapy.Whilst improving survival from primary disease these treatmentsalso result in an increase in life-threatening complicationsrequiring ICU admission.¹ Analysis of patients admitted to alarge ICU over a 3-yr period and data collected from surroundingregional hospitals has allowed determination of various prognosticfactors that may assist in patient management. A retrospective observational study on patients with haematologicalmalignancy admitted to ICU between January 1996 and July 1999was conducted. Patients admitted from medical and haematologicalwards and a regional cancer centre were included, as were datafrom regional ICUs. Data included malignancy type, reason foradmission, severity and duration of leucopenia, creatinine onadmission, Logistic Organ Dysfunction (LOD) score, requirementfor invasive ventilation and survival. Sixteen patients (8 male, 8 female) were admitted to the ICUwithin the specified time. An additional 13 patients were admittedto regional ICUs between January 1997 and July 1999. Haematologicaldiagnoses: Hodgkin’s lymphoma (7), non-Hodgkin’slymphoma (1), chronical lymphocytic leukaemia (3), chronic myeloidleukaemia (6), acute myelogenous leukaemia (6), acute lymphoblasticleukaemia (3), multiple myeloma (2). Admission to ICU was precipitatedby pneumonia (35%), adult respiratory distress syndrome (15%),sepsis (15%), multi-organ failure (15%), bleeding (12%) andgraft-versus-host disease (8%). On admission LOD scores rangedfrom 1–16 (average 6.5) and ICU mortality was 71%. Ofthe 30% surviving ICU, only 18% survived to long term (>6months). Survival was associated with not requiring mechanicalventilation, a normal white cell count or brief period of neutropenia.A creatinine on admission of greater than 200 µmol litre^–1was noted to be associated with mortality (P = 0.05). In logisticregression analysis haematological malignancy is significantlyassociated with in hospital mortality (P<0.005). This associationis strengthened when age is taken into account (P<0.001),but is not significant when organ severity is controlled for(P = 0.10). Relative risk of in hospital death for patientswith haematological malignancy admitted to ICU was 1.9 (OR 4.3695%CI 1.6–12.1). These results suggest that patients withhaematological malignancy are admitted to ICU with more severeillness than matched patients with other underlying disease. In conclusion it can be shown that a high mortality is associatedwith admission of such patients to ICU. Prognosis is guidedby several factors including the requirement for mechanicalventilation,² LOD score >10 and severe prolonged neutropenia.Improved prognosis is associated with normal white cell count,rapid recovery of bone marow³, normal admission creatinine andavoidance of mechanical ventilation.