ICU气管插管患者非计划性拔管的原因分析及护理对策

目的 探讨重症监护气管插管患者非计划性拔管的原因进行分析并提出相应的护理对策.方法 选取江苏省徐州市沛县人民医院重症科2014年1月~2016年6月收治的40例气管插管患者为此临床观察的观察对象,并给予40例ICU气管插管患者优质护理,并观察40例患者经优质护理干预前后非计划拔管情况,并总结患者出现非计划拔管的原因并提出相应的护理对策.结果 40例重症气管插管患者经优质护理干预后非计划拔管情况明显少于实施护理前,差异明显具有统计学意义P<0.05.结论 优质护理能减少重症气管插管患者非计划性拔管,护理效果较好,值得在临床上广泛推广.     

在重症监护病房运用品管圈降低气管插管非计划拔管发生率的效果观察

目的:探讨品管圈在重症监护病房气管插管非计划拔管的应用效果。方法:开展品管圈的工作模式对气管插管患者进行管理,针对存在的问题,制定对策并实施。结果:实施品管圈工作模式后气管插管非计划拔管发生率由18.57%降至5.71%,差异具有统计学意义。结论:在重症监护病房开展品管圈工作模式可促进护理质量持续改进,确保医疗护理安全。     

PDCA循环管理模式对气管插管非计划性拔管的影响

目的:研究PDCA循环管理模式对气管插管非计划性拔管和患者家属满意度的影响。方法:选择2016年7月-2017年7月医院收治的行气管插管的患者88例,随机分为对照组和观察组,每组患者44例。对照组患者采用常规护理方法,观察组患者采用PDCA循环管理模式。对比两组患者非计划性拔管率,以及两组患者家属满意度。结果:观察组患者非计划性拔管率为4.55%,低于对照组患者的22.73%(P0.05)。观察组患者家属总满意率为90.91%,高于对照组患者家属的72.73%(P0.05)。结论:在气管插管患者中,采取PDCA循环管理模式开展护理管理,能够显著减少非计划性拔管率,提高患者家属满意度,具有重要的临床价值。     

品管圈在降低ICU患者气管插管非计划性拔管发生率中的应用

目的:探讨品管圈在降低ICU患者气管插管非计划拔管中的作用.方法:将我院2015年收治的60例ICU气管插管患者作为对照组,实施ICU的常规护理;将我院2016年收治的60例ICU气管插管患者作为观察组,实施品管圈管理方式.比较两组ICU患者非计划性拔管的发生率.结果:观察组ICU患者的非计划性拔管的发生率低于对照组患者,两组ICU患者在非计划性拔管发生率上的比较具有统计学意义(P<0.05).结论:品管圈式护理有效的降低ICU患者非计划性拔管的发生率,有效的提高临床护理质量,促进患者的康复预后.     

针对性护理干预在重症医学科气管插管患者非计划性拔管中的应用

目的 分析针对性护理干预在重症医学科气管插管患者非计划性拔管中的应用效果。方法 选取2021年3月-2022年3月本院重症医学科收治的72例气管插管患者,随机分为对照组和研究组,每组各36例。对照组患者运用传统护理干预,研究组患者运用针对性护理干预。对比两组患者心理状态、睡眠质量、护理满意度、并发症发生率和非计划性拔管发生率。结果 干预前,两组患者心理状态、睡眠情况对比差异无统计学意义（P>0.05）;干预后,研究组患者SDS评分（33.29±6.47）分、SAS评分（33.31±6.54）分和PSQI评分（6.49±1.58）分均低于对照组（P<0.05）。研究组患者护理满意度97.22%高于对照组的77.78%(P<0.05)。研究组患者并发症发生率2.78%低于对照组的22.22%(P<0.05)。研究组患者非计划性拔管发生率2.78%低于对照组的25.00%(P<0.05)。结论 重症医学科气管插管患者给予针对性护理干预,可有效减少不良心理状态,维持良好睡眠情况,提高护理满意度,降低并发症发生率和非计划性拔管发生率。     

责任到位护理对肝胆手术置管患者非计划拔管的影响分析

目的:对责任到位护理对肝胆手术置管患者非计划拔管的影响进行研究及判定。方法:选取本院2014年2月至2015年1月收治的60例肝胆手术置管患者作为本次的研究对象,分为对照组、观察组,2组患者各30例,对照组予以传统护理,观察组于对照组基础上予以责任到位护理,并观察2组患者的非计划拔管率。结果:观察组肝胆手术里管患者的非计划拔管率为3.33%,低于对照组,p0.05。结论:予以肝胆手术置管患者予以责任到位护理可降低患者的非计划拔管率,其效果显著,值得在临床中推广实施。     

综合性护理干预降低ICU小儿气管插管非计划性拔管的效果分析

目的探讨综合性护理干预降低ICU小儿气管插管非计划性拔管的效果。方法选取我院2014年5月至2015年3月收治的140例气管插管患儿作为研究对象。使用随机数字表法将患者分为观察组和对照组,各70例。对照组患儿实施气管插管常规护理,观察组实施综合护理干预。观察两组患儿在气管插管期间的非计划性拔管发生情况,并分析非计划性拔管发生的原因。结果观察组非计划性拔管发生率为1.43%(1/70),对照组非计划性拔管发生率为11.43%(8/70),两组比较差异具有统计学意义(P<0.05)。非计划性拔管发生原因包括痰液阻塞气道引起喉部痉挛而拔管2例,镇静药物用量不足,患儿烦躁不安而拔管4例,护理人员在为患儿翻身时造成了管道脱落2例,导管固定不牢脱管1例。结论对ICU气管插管患儿实施综合性护理干预,能有效降低非计划性拔管风险,保障患儿安全。     

呼吸道护理在ICU气管插管患者中的应用效果

目的 观察对ICU气管插管患者实施呼吸道护理的临床效果。方法 选取医院2022年5月-2023年5月ICU收治的40例气管插管患者作为研究对象，根据组间性别、年龄、疾病类型等基线资料均衡可比的原则分为对照组（20例）和观察组（20例）。对照组气管插管患者给予常规护理，观察组气管插管患者在对照组患者的基础上加强呼吸道护理。对比分析两组患者的生命质量评分、治疗时间、并发症发生率以及护理满意度。结果观察组气管插管患者治疗期间并发症总发生率低于对照组，但差异无统计学意义（P>0.05）；观察组患者健康意识、生命价值观、日常活动以及社会关系等生存质量评分均高于对照组，差异有统计学意义（P<0.05）；观察组患者气管插管时间、重症监护时间以及住院时间均短于对照组，差异有统计学意义（P<0.05）。观察组患者对护理的总满意率（100.00%）优于对照组（75.00%），差异有统计学意义（P<0.05）。结论 对于ICU气管插管患者而言，进行呼吸道护理，能有效优化患者生存质量，缩短临床治疗时间，提高护理满意度。     

重症医学科护理风险分析与防范探讨

目的:分析在重症监护病房开展护理风险管理措施与成效.方法:以2015年10月一2016年10月医院重症监护病房的64例患者作为研究对象,并将其分为对照组和观察组,对照组采取常规的护理管理模式,观察组在对照组的基础上进一步采取护理风险管理,比较两组患者的护理质量情况、消毒隔离情况及病房管理情况;以及患者发生不安全事件危险率、护理投诉率及护理满意率.结果:两组患者的基础护理各个方面都有改善,观察组护理质量提高程度显著高于对照组(P<0.05).结论:在重症监护病房实施护理风险管理,可有效避免护理不安全事件的发生,在提高护理工作治疗质量的同时,保障患者安全.     

综合性护理防控措施在预防MICU非计划拔管中的体会

目的:分析内科重症监护病房(MICU)发生非计划拔管的原因,探讨实施综合性护理防控措施的对策和应用效果.方法:MICU护理组于2016年建立非计划拔管防控小组,对既往两个年度非计划拔管的原因进行分析,制订防控对策,并给予综合性防控措施并观察防控效果.结果:将采取防控措施前后的患者认知度、护理质量评分、患者舒适度指数、非计划拔管率、患者满意度等指标进行比较,差异有统计学意义(P<0.05).结论:对MICU接受治疗并行管道留置的患者实施综合护理防控措施,能显著降低非计划拔管率,提高患者对护理工作的满意度,使MICU的护理质量得到持续有效的提升.     

Disparities in depression care in managed care settings

The implementation of managed health care two decades ago produced sweeping changes in the delivery of health care. A large number of patients who have depression are cared for in managed care settings. Despite the fact that managed health care programs have offered the advantage of affordable and effective treatment of depression to many patients, racial and ethnic minorities remain underdiagnosed and undertreated. Diagnosis of depression, prescribing of antidepressant therapy, and referral for psychotherapy occur significantly less often in minority patients compared with whites. In the managed care setting, a number of issues at the physician level may negatively affect the quality of depression care, including attitudes toward psychiatry and mental health services, unfamiliarity with best practice guidelines for depression, and lack of cultural competency. On the other hand, a number of innovative approaches (eg, collaborative care) have demonstrated effectiveness in managed care settings. In some cases, physician education can be integrated with these approaches to assist health care providers in managed care organizations to provide the best possible depression care. This article focuses on issues relevant to depression care of minorities in the managed care sector, cites strategies for improving quality of depression care, and discusses implications for CME.     

Quality palliative care in long-term care settings

It is paramount that physicians and midlevel practitioners who care for residents in long-term care facilities be able to provide high-quality comfort care to their patients, the majority of whom are frail and suffering from chronic and progressive diseases. Physicians must be knowledgeable in the assessment, prevention, and relief of patients' physical, emotional, and spiritual distress, as well as develop appropriate attitudes, knowledge, and skills to care for patients who are in the last years of life. The provision of high-quality palliative care is the essence of long-term care medicine.     

Health care without managed care in Japan

The best gross health indices in the world and universal coverage with no overt signs of rationing characterize the Japanese health care system. The delivery system, which consists primarily of private physicians and private hospitals, is functionally independent, but the financing system is strictly regulated. The author argues that this combination is the key to the system's unique success.     

Orem自理模式在产科新生儿护理中的应用

目的 探讨Orem自理理论模式在产妇护理新生儿的应用效果.方法 选择施行剖宫产手术的初产妇100例,随机分为实验组和对照组各50例.实验组在常规护理基础上采用Orem自护理论模式让产妇实现自我护理新生儿,对照组按整体护理模式进行常规护理新生儿.观察两组产妇母乳喂养、新生儿护理技巧与理论知识掌握情况.结果 实验组产妇在掌握母乳喂养掌握情况、新生儿护理技巧及理论知识方面和产妇及家属对收取优质护理项目费满意度均明显优于对照组,差异有统计学意义(P均＜0.01).结论 将Orem自理理论应用在产科新生儿护理中,可发掘产妇护理新生儿的能力,体现了护士自身价值,提升优质护理的内涵,密切了护患关系,是更为先进、科学、合理的护理模式.     

Advance care planning in long-term care facilities

Residents of long-term care facilities are at risk of serious medical illnesses and being unable to express choices when difficult treatment decisions must be made. Advance care planning (ACP) allows residents to consider, make, and communicate their preferences for how medical decisions should be made if they are unable to participate in the decision-making process. This article reviews the three steps in ACP: consideration of options and expression of values, communication of decisions, and documentation of the choices. The article defines and describes the particular value of ACP in long-term care facilities, reviews the literature on successful ACP programs in long-term care, and concludes with practical suggestions on how to develop and implement ACP programs.     

Palliative care in a psychiatric-somatic care unit

Patients with severe psychiatric and somatic disorders may require admission to a combined psychiatric-somatic care unit. These units provide specialised psychiatric and somatic care as well as palliative care. This is illustrated by two case reports. A 51-year-old man with a malignant brain tumour was admitted to our psychiatric-somatic care unit after threatening his wife and children. He was aggressive and confused. Seizures were suspected and palliative care was needed. Within a few weeks his condition deteriorated. He died 1 day after terminal sedation had been initiated. A 78-year-old woman was admitted to receive daily electroconvulsive treatment (ECT) for depression with catatonia. The ECT had to be interrupted repeatedly due to comorbid infections and complications. She died 3 days after palliative care was initiated.     

Quality of care for primary care patients with depression in managed care

OBJECTIVE: To evaluate the process and quality of care for primary care patients with depression under managed care organizations. METHOD: Surveys of 1204 outpatients with depression at the time of and after a visit to 1 of 181 primary care clinicians from 46 primary care clinics in 7 managed care organizations. Patients had depressive symptoms in the previous 30 days, with or without a 12-month depressive disorder by diagnostic interview. Process indicators were depression counseling, mental health referral, or psychotropic medication management at index visit and the use of appropriate antidepressant medication during the last 6 months. RESULTS: Of patients with depressive disorder and recent symptoms, 29% to 43% reported a depression-specific process of care in the index visit, and 35% to 42% used antidepressant medication in appropriate dosages in the prior 6 months. Patients with depressive disorders rather than symptoms only and those with comorbid anxiety had higher rates of depression-specific processes and quality of care (P < .005). Recurrent depression, suicidal ideation, and alcohol abuse were not uniquely associated with such rates. Patients visiting for old problems or checkups received more depression-specific care than those with new problems or unscheduled visits. The 7 managed care organizations varied by a factor of 2-fold in rates of depression counseling and appropriate anti-depressant use. CONCLUSIONS: Rates of process and quality of care for depression as reported by patients are moderate to low in managed primary care practices. Such rates are higher for patients with more severe forms of depression or with comorbid anxiety, but not for those with severe but "silent" symptoms like suicide ideation. Visit context factors, such as whether the visit is scheduled, affect rates of depression-specific care. Rates of care for depression are highly variable among managed care organizations, emphasizing the need for process monitoring and quality improvement for depression at the organizational level.