Nurses' experiences of caring for the relatives of patients in ICU

To date there have been no published qualitative studies looking solely at the experiences of nurses caring for the relatives of patients who are critically ill. This small-scale phenomenological study explores such experiences. Three intensive care units in North West England were included; the nine participants were D grade or above, with a minimum of three months' ICU experience. Each nurse attended a tape-recorded, unstructured interview to discuss caring for relatives. A thematic analysis of the nurses' comments was then performed. Although many of the nurses understood the benefits of performing the care-giver role to families, some nurses felt inadequately prepared. There were also issues about whether they felt supported by colleagues in undertaking this role.     

The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person

PurposeIn the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.MethodsWe developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.ResultsAmong 144 staff, 128 were contacted; 99 completed the questionnaire (77% response rate; 20 physicians [11 residents], 51 nurses, 28 nurse's aides). Items classed as most important attributes for a reference person were knowledge of patient's wishes and values, emotional attachment, adequate understanding of the clinical history, and designation as a surrogate before admission. There were no significant differences according to respondent's age, job title, or experience.ConclusionCaregivers identify a reference person based on criteria such as knowledge of the patient's wishes, emotional bond with the patient, an adequate understanding of the clinical history, and designation as surrogate before admission.     

Looking for a nursing home for an elderly person: reasons appointed by relatives

This study, conceived in order to try to understand the situations that motivate families to place elderly relatives in nursing homes, used a methodological qualitative approach. Data collection was conducted through open interviews. The analysis of the answers resulted in two categories: the placement in a nursing home as a way to meet the elder person's needs; and the search for the best place for the elder to live and keep the bond with the family. Living through the process of placing an elder relative in a nursing home constituted a transition period in which different factors were taken into account and contributed for the decision. When this decision is taken, the family looks for the best place in terms of physical structure, care and social living, with equals and with other people, because it is believed that through visits family and affective bonds can be kept.     

护理干预对ICU患者亲属焦虑状态的影响

目的探讨护理干预对ICU患者亲属焦虑状态的影响。方法对干预组患者亲属进行健康教育及心理疏导,对照组采用常规宣教,在患者入住ICU后24～36h,采用状态焦虑量表对患者亲属进行调查。结果ICU患者亲属的状态焦虑问卷得分明显低于对照组,差异具有统计学意义（P〈0．01）。结论有针对性地进行健康教育和心理疏导可减轻ICU患者亲属的焦虑程度。     

Family caregivers' preferences in caring for their hospitalized elderly relatives

We know little about family preferences in participating in hospital care for elders. This pilot study was conducted to explore the kind of care actions that family caregivers prefer to do for their hospitalized elderly relatives. The instrument used was a 14-item questionnaire based on a qualitative study conducted by the author. The results indicated that 95% of these family caregivers (n = 40) would prefer to participate in 10 or more types of family care actions. The implications for nursing practice are discussed. Future research will focus on identifying factors influencing family preferences, the relationship between the preferences and actual performance, and how nurses can help family caregivers participate in the care they desire.     

ICU住院患者胃残余量监测相关情况调查分析

目的调查危重患者肠内营养治疗期间胃残余量监测情况。方法采用不记名问卷调查方法对两所三甲医院的ICU护理人员进行关于危重患者肠内营养治疗期间胃残余量监测的有关内容调查;再选取开展胃残余量监测较多的ICU病房护理人员进行第二轮问卷调查,重点调查胃残余量超声监测开展情况。结果本次调查对象111名,其中,108人(占97.1%)经常使用胃残余量指标判断患者是否耐受肠内营养治疗,监测频率以"每4h1次"为主(占66.3%);常用监测手段为注射器抽吸(占72.1%),若大于200mL,判定为胃残余量过多。在对ICU病房开展超生监测GRV情况调查中,有23.5%(4/17)被调查对象表示其所在单位胃残余量监测规范中提及使用超声监测技术。护理人员评价超声监测技术具有无创、直观、患者依从性好等特点,其推广应用有利于护理技术改进。结论胃残余量仍是目前临床评估肠内营养不耐受的主要指标,常用注射器抽吸法测定,监测频率为1次/4h。     

某医院ICU住院患者耐药菌感染危险因素分析

目的通过调查山东省某三甲医院重症监护病房(ICU)住院患者耐药菌感染情况,探讨其耐药菌感染的危险因素,为开展多重耐药菌感染防控提供依据。方法选取2016年ICU住院患者454例进行前瞻性目标监测,填写《ICU住院患者耐药菌感染目标性监测调查表》,采用Logistic回归分析耐药菌感染危险因素。结果 ICU住院患者耐药菌感染率为28.90%,住院天数、急性生理与慢性健康评分(APACHEⅡ评分)、机械通气、基础疾病、有无手术、入ICU前应用抗菌药物是ICU住院患者耐药菌感染的独立危险因素。结论 ICU住院患者耐药菌感染率较高,ICU住院患者住院天数、APACHEⅡ评分、机械通气、基础疾病、有无手术、入ICU前抗菌药物应用与耐药菌感染独立相关。     

重症监护中心急性肾功能衰竭的临床特点分析

目的分析我院重症监护中心（ICU）中急性肾功能衰竭（ARF）的临床特点。方法回顾2005年10月30日至2008年5月30日在我院ICU中87例ARF患者的病例资料,分院内及社区两组。比较分析其发病年龄、病因、合并症以及转归等临床特点。结果院内组及社区组均以肾前性ARF为主,比例分别为73．17％和56．52％;院内组肾性ARF基本为医源性的,社区组肾性ARF主要与本身疾病有关;ICU的ARF患者死亡率较高（58．62％）,院内组死亡率为70．73％明显高于社区组（47．83％）,然而社区组ARF合并多器官功能衰竭的比例（39．13％）却明显高于院内组（17．07％）。结论ICU中ARF患者多为肾前性,常合并多器官功能衰竭,院前ARF患者尤应注意有无合并多器官功能衰竭;对有ARF危险因素的住院患者应积极预防医源性ARF。     

我科实施住院费用“一日清单”制的做法与体会

目的为使病人准确、及时地了解住院费用情况,减少因此引发的医患纠纷。方法运用"军卫1号"医院信息管理系统应用软件,将住院病人的医嘱及各项医疗费用及时录入计算机,生成住院费用"一日清单"。结果病人对住院费用是否清晰的满意度由实施前的83.33%提高到实施后的98.67%,未发生因费用引发的医患纠纷;住院费用结算错误率由6.67%降低到0.67%。结论实施住院费用"一日清单"制,是顺应医疗发展的必然举措,是提高病人满意度的有效方法。     

Caring for a demented elderly person — burden and burnout among caregiving relatives

Fifty-two family caregivers for demented elderly people were investigated for burden and burnout experiences. A structured burden questionnaire and the Burnout Measure were used. Burnout is described in relation to the caregiver's gender, age, family relationship and the demented person's living place. Older wives and daughters-in-law also risked developing burnout. Regression analysis showed that limitation in social life, poor health and a lack of positive outlook on caring were the most important independent variables explaining variance in burnout among caregivers having their demented elderly person living at home and those having them in an institution.     

A systematic approach to very important person preparedness for a trauma center

Hospitals across the United States are more involved in disaster/rapid response planning than ever. This collaboration is often driven by continuing federal and state preparedness and all-hazards planning efforts that provide cooperative agreement and/or grant support. These efforts currently include programs administered by the US assistant secretary for preparedness and response, the US Centers for Disease Control and Prevention, the US Department of Defense, and the US Department of Homeland Security. Beyond legislated support or mandates, key emergency management regulations governing hospital-specific disaster planning and response activities are required of hospitals by The Joint Commission, the largest national hospital accrediting body. Despite this ongoing, heightened awareness and inclusion of health care in local and regional emergency response planning, there is 1 partnership to yet strengthen: the relationship between community trauma centers and US Secret Service staff responsible for White House travel and health care contingency plans. One Michigan hospital system designed a program that has made preevent communications and preparedness for rapid very important person response with the Secret Service as important as other local all-hazards planning; the evolution of this partnership is the focus of this article.     

重症监护病房住院患者急性肾损伤的发病及预后分析

目的：分析重症监护病房(ICU)住院患者并发急性肾功能损伤(AKI)的发病及影响预后的危险因素,为临床更好的预防 AKI 的发生、改善预后提供依据。方法调查本院2010年1月至2013年12月所有 ICU 住院患者1100例,以急性肾损伤网(AKIN)推荐的 AKI 定义筛选出病史完整的 AKI 患者105例,回顾性分析 AKI 患者的一般临床资料、病因、临床特点,采用 logistic 回归分析影响其预后的危险因素。结果符合入选标准的住院 AKI 患者105例,肾前性、肾性、肾后性 AKI 分别占71.4%、23.8%、4.8%,肾前性病因中,脓毒症是 ICU 患者 AKI 发生的最主要的原因(占45.0%),随着 AKI 程度的增加,AKI 患者 ICU 住院时间明显延长(F =3.450,P <0.05),28天病死率亦明显增高(χ2=16.500,P <0.01)。应用多因素 logistic 逐步回归分析法显示 AKI 患者基础疾病的严重程度[相对比值比(OR )=3.259,95%可信区间(95% CI )=1.453~5.087,P <0.01]、肾外器官衰竭数(OR =1.275,95% CI =1.071~1.421,P <0.01)、年龄(OR =2.315,95% CI =1.015~3.684,P <0.01)、行肾替代(CRRT)治疗与否(OR=2.018,95% CI =1.852~3.014,P <0.01)是 AKI 患者肾功能未恢复的独立危险因素。结论 AKI 是 ICU 住院患者的常见并发症之一。脓毒症是住院 AKI 最常见的原因。合并严重基础疾病、肾外器官衰竭、年龄、行 CRRT 治疗与否是 AKI 患者肾功能未恢复的独立危险因素。     

某医院重症医学科鲍曼不动杆菌感染及其耐药性研究

目的了解重症监护病房(ICU)医院感染鲍曼不动杆菌状况及其耐药情况,为临床合理用药提供参考。方法采用病原菌分离鉴定检验技术,对某医院重症医学科2012-2013年住院患者送检标本进行病原菌检测,分析鲍曼不动杆菌感染与耐药情况。结果从住院患者送检标本中共分离到鲍曼不动杆菌105株,其中90.48%菌株分离自痰标本,反映出呼吸道感染鲍曼不动杆菌占主导。分离的鲍曼不动杆菌对临床常用抗菌药物均不同程度耐药,对氨苄西林全部耐药;2013年度该细菌对亚胺培南、美罗培南和氨曲南的耐药率达到90%以上。鲍曼不动杆菌耐药率呈现上升趋势。结论该医院重症医学科鲍曼不动杆菌感染主要为呼吸道,该菌严重耐药,对碳氢酶烯类耐药最值得关注。     

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

Purpose

Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the closest relative a handwritten condolence letter.

Methods

Multicenter randomized trial conducted among 242 relatives of patients who died at 22 ICUs in France between December 2014 and October 2015. Relatives were randomly assigned to receiving (n = 123) or not receiving (n = 119) a condolence letter. The primary endpoint was the Hospital Anxiety and Depression Score (HADS) at 1 month. Secondary endpoints included HADS, complicated grief (ICG), and PTSD-related symptoms (IES-R) at 6 months. Observers were blinded to group allocation.

Results

At 1 month, 208 (85.9%) relatives completed the HADS; median score was 16 [IQR, 10–22] with and 14 [8–21.5] without the letter (P = 0.36). Although scores were higher in the intervention group, there were no significant differences regarding the HADS-depression subscale (8 [4–12] vs. 6 [2–12], mean difference 1.1 [?0.5 to 2.6]; P = 0.09) and prevalence of depression symptoms (56.0 vs. 42.4%, RR 0.76 [0.57–1.00]; P = 0.05). At 6 months, 190 (78.5%) relatives were interviewed. The intervention significantly increased the HADS (13 [7–19] vs. 10 [4–17.5], P = 0.04), HADS-depression subscale (6 [2–10] vs. 3 [1–9], P = 0.02), prevalence of depression symptoms (36.6 vs. 24.7%, P = 0.05) and PTSD-related symptoms (52.4 vs. 37.1%, P = 0.03).

Conclusions

In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms. Trial registration Clinicaltrials.gov Identifier: NCT02325297.

     

住院精神分裂症患儿陪护亲属的心理健康状况调查

目的：分析住院精神分裂症患儿陪护亲属的心理健康状况，并与全国常模及正常对照组比较。方法：选择2003-06／2004-06惠州市第二人民医院南二区的住院精神分裂症患儿陪护亲属47名为陪护组。所有患儿均符合中国精神疾病分类方案与诊断标准第3版关于儿童精神分裂症的诊断标准，年龄〈16岁，性别不限，陪护为精神分裂症患儿的一级亲属，年龄18～60岁，无严重躯体及精神疾病。在普通人群随机选择60人为正常对照组，其家庭成员及本人均无严重躯体及精神疾病。所有调查对象均获全面知情同意并志愿接受调查。陪护亲属的心理健康状况采用症状自评量表评定[包括躯体化、强迫、人际关系敏感、忧郁、焦虑、敌对、恐怖、偏执、精神病性等9项因子共90个条目，采用0-4的五级评分，0分为从无，1分为轻度，2分为中度，3分为相当重，4分为严重1。陪护亲属的生活质量采用综合生活质量问卷评定[包括躯体健康（睡眠与精力，身体不适感，进食与性生活，躯体运动与感官）、心理健康（精神紧张度，正负情感，认知功能，自尊）、社会功能（社交与社会支持，娱乐与学习，工作，婚姻与家庭）、物质生活（住房，经济状态，社区服务，生活环境）四个维度，共16个因子64个条目，评分越高，生活质量越好]。精神分裂症患儿均予常规抗精神病药治疗，在患儿治疗前及治疗后l周，2周，4周，6周对陪护组进行症状自评量表评定并与国内常模比较；于治疗前及治疗后6周对其进行综合生活质量问卷评定并与正常对照组比较。组间比较采用X^2检验或t检验。结果：陪护组47人及正常对照组60人全部进入结果分析。①症状自评量表评分结果：陪护组症状自评量表总分及躯体化，强迫症状，忧郁，焦虑4个因子分均高于全国常模（P〈0．01-0．05），在精神分裂症患儿治疗4周后陪护组的躯体化，强迫症状，忧郁，焦虑各因子分显著低于患儿治疗前（P〈0．01-0．05）。②综合生活质量问卷各维度评分结果：除认知功能、住房、生活环境3个因子外，其它各因子分陪护组均显著低于正常对照组（P〈0．01-0．05）。治疗6周后陪护组躯体健康维度及其睡眠与精力因子，心理健康维度及其精神紧张度因子、自尊因子，社会功能维度及其社交与社会支持因子、娱乐与学习因子，物质生活维度及经济状态因子、社区服务因子分同样显著低于正常对照组（P〈0．01～0．05）。治疗6周后陪护组在躯体健康维度及其所有4个因子、心理健康维度中的正负性情感、社会功能维度中的工作、婚姻与家庭2项因子显著高于治疗前（P〈0．01～0．05）。结论：①住院精神分裂症患儿陪护亲属症状自评量表总分及躯体化，强迫症状，忧郁，焦虑4个因子分均高于全国常模，说明其心理健康状况较差。②在综合生活质量问卷中除了认知功能、住房、生活环境3个因子外，其他各因子均低于正常对照组，说明其生活质量较差。③经过4～6周治疗患儿病情稳定或基本稳定后，陪护亲属的心理健康状况及生活质量有所改善和提高，但与正常对照组比较仍存在较多的心理及社会问题。     

住院精神分裂症患儿陪护亲属的心理健康状况调查

目的:分析住院精神分裂症患儿陪护亲属的心理健康状况,并与全国常模及正常对照组比较。方法:选择2003-06/2004-06惠州市第二人民医院南二区的住院精神分裂症患儿陪护亲属47名为陪护组。所有患儿均符合中国精神疾病分类方案与诊断标准第3版关于儿童精神分裂症的诊断标准,年龄<16岁,性别不限,陪护为精神分裂症患儿的一级亲属,年龄18～60岁,无严重躯体及精神疾病。在普通人群随机选择60人为正常对照组,其家庭成员及本人均无严重躯体及精神疾病。所有调查对象均获全面知情同意并志愿接受调查。陪护亲属的心理健康状况采用症状自评量表评定犤包括躯体化、强迫、人际关系敏感、忧郁、焦虑、敌对、恐怖、偏执、精神病性等9项因子共90个条目,采用0～4的五级评分,0分为从无,l分为轻度,2分为中度,3分为相当重,4分为严重犦。陪护亲属的生活质量采用综合生活质量问卷评定犤包括躯体健康(睡眠与精力,身体不适感,进食与性生活,躯体运动与感官)、心理健康(精神紧张度,正负情感,认知功能,自尊)、社会功能(社交与社会支持,娱乐与学习,工作,婚姻与家庭)、物质生活(住房,经济状态,社区服务,生活环境)四个维度,共16个因子64个条目,评分越高,生活质量越好犦。精神分裂症患儿均予常规抗精神病药治疗,在患儿治疗前及治疗后1周,2周,4周,6周对陪护组进行症状自评量表评定并与国内常模比较;于治疗前及治疗后6周对其进行综合生活质量问卷评定并与正常对照组比较。组间比较采用χ2检验或t检验。结果:陪护组47人及正常对照组60人全部进入结果分析。①症状自评量表评分结果:陪护组症状自评量表总分及躯体化,强迫症状,忧郁,焦虑4个因子分均高于全国常模(P<0.01～0.05),在精神分裂症患儿治疗4周后陪护组的躯体化,强迫症状,忧郁,焦虑各因子分显著低于患儿治疗前(P<0.01～0.05)。②综合生活质量问卷各维度评分结果:除认知功能、住房、生活环境3个因子外,其它各因子分陪护组均显著低于正常对照组(P<0.01～0.05)。治疗6周后陪护组躯体健康维度及其睡眠与精力因子,心理健康维度及其精神紧张度因子、自尊因子,社会功能维度及其社交与社会支持因子、娱乐与学习因子,物质生活维度及经济状态因子、社区服务因子分同样显著低于正常对照组(P<0.01～0.05)。治疗6周后陪护组在躯体健康维度及其所有4个因子、心理健康维度中的正负性情感、社会功能维度中的工作、婚姻与家庭2项因子显著高于治疗前(P<0.01～0.05)。结论:①住院精神分裂症患儿陪护亲属症状自评量表总分及躯体化,强迫症状,忧郁,焦虑4个因子分均高于全国常模,说明其心理健康状况较差。②在综合生活质量问卷中除了认知功能、住房、生活环境3个因子外,其他各因子均低于正常对照组,说明其生活质量较差。③经过4～6周治疗患儿病情稳定或基本稳定后,陪护亲属的心理健康状况及生活质量有所改善和提高,但与正常对照组比较仍存在较多的心理及社会问题。     

Evaluation of a computer-based clinical reference library in an ICU

A computer-based clinical reference library (CRL) was developed as a subsystem of the Hewlett-Packard 5600 A patient data management system for use in the 10-bed ICU at the University of Alberta Hospital. The CRL contains 20 information modules and can be accessed at both bedside and central consoles. Information is classified under headings of: definition, incidence, etiology, pathophysiology, pathology, bacteriology, clinical course, diagnosis, treatment, complications, prognosis, and references. The CRL was evaluated by a nonrandomized pretest/post-test, control-experimental research paradigm. Medical students and residents exposed to the system "acquired" significantly more knowledge than their counterparts in a control group. Medical students and nurses used the system for continuing medical education, whereas residents accessed the system for problem-solving. Nurses had strong negative views about the computerized patient data management system and tended not to use the CRL. Correlation between instruction time and gain scores was positive but test correlation coefficients for each subgroup were not significantly different.