集束化护理在预防中心静脉导管相关性血流感染中的循证实践

目的 探讨集束化护理在预防中心静脉导管相关性血流感染中的应用并评价其效果。方法 纳入重症医学科在岗护士76名。选取2019年3-6月入住重症医学科留置中心静脉导管(central venous catfeter,CVC)的87例患者为对照组,2019年11月-2020年2月入住重症医学科留置CVC的83例患者为观察组,对照组采用常规护理,观察组采用基于循证实践的集束化护理,比较证据应用前后,ICU护士对CRBSI预防及管理的认知水平及2组中心静脉置管患者CRBSI的发生率。结果 最佳证据应用后,ICU护士对CRBSI预防及管理的相关知识得分高于应用前(t=16.367,P＜0.001),观察组导管相关性血流感染的发生率为明显低于对照组(χ²=4.088,P=0.043)。 结论 基于最佳证据的集束化护理措施的应用,可提升护理人员对证据相关知识的掌握程度,提高规范执行率,降低中心静脉导管相关性血流感染发生率,提高护理质量。     

Good nursing: perspectives of patients and family

This qualitative study aimed to explore patients' perspectives on good nursing for comparison with nurses' perspectives, as identified in a previous study. Purposive sampling was employed to recruit 53 patients and six family members from three medical centers and three regional hospitals, in northern, central, and southern Taiwan. The 59 participants were clustered into nine groups for focus-group interviews for data collection purposes, from March to June, 2003. Most of the participants were male (62.7%), and their mean age was 51.9 years (SD=15.6), with a range from 18 to 81 years old. All of the participants were hospitalized for at least three days and had the physical and mental strength to participate in a 60-90 minute group interview. The interviews were both hand-recorded and audio-taped on site, with permission from the participants, and then transcribed into verbatim narratives for data analysis. Content analysis was used to identify items in relation to good nursing/not-good nursing across narratives. The findings showed that four major categories of good nursing inductively emerged, including: (1) Providing professional nursing as a guardian angel, (2) Demonstrating professional skills with humanity, (3) Being accountable and competent, and (4) Showing self-improvement. The findings indicated that professional nursing competence is the essence of good nursing. Treating patients as relatives is also perceived as good nursing. In comparing the patients definitions of good nursing with those of nurses it was observed that there are similarities in terms of the main categories of the definitions. Patients, however, tend to use negative examples or normative moral terms, such as "should" or "ought to" to connote what is expected of good nursing and how good nursing is expressed in the context of patient-nurse interaction.     

Time oriented score system (TOSS): A method for direct and quantitative assessment of nursing workload for ICU patients

A method for direct quantitation of nurses' workload required by ICU patients is described. Each nursing activity has been timed in 14 different ICUs participating in the multicentre study, and the results averaged. Nursing acts were grouped in different homology lists, complied according to operative similarities. Some lists include general nursing acts, which are common to all patients admitted to ICU, others include acts peculiar to different organ system abnormalities or acts ancillary to the general group, finally one list includes emergency or occasional acts which are not encountered in every patient. The TOSS is a simple and rapid method for ICU nurses' workload assessment, can be computed both at admission and during the stay in ICU, and can provide factual information on the nurse/patient ratio necessary in a specific environment. TOSS validation was conducted with a yearly prospective study collecting 2710 patients. TOSS values varied according to diagnosis, severity of illness (SAPS) and intensity of processes (TISS), and TOSS specificity was demonstrated by the possibility of selecting a wide combination of nurse/patient ratios from 1:4 to 1:1 not possible with TISS.This work was supported in part by a grant from the IRCCS Ospedale Maggiore, Milano, Ricerca Corrente 1986 Cod. no. 533/02See the list of participants at the end of the paper     

ICU应用ICNSS与APACHEⅡ评分配置护理资源效果的比较研究

目的 探讨重症监护护理评分系统(ICNSS)在ICU护理资源配置中的应用价值.方法 将108例ICU患者随机分为观察组55例和对照组53例.观察组运用ICNSS量表评估护理工作量,并根据评估结果 配置护理资源;对照组动态监测急性生理学和慢性健康状况(APACHEⅡ)评分,依据评分结果 配置护理资源.比较2组住ICU时间、医疗费用、住ICU期间并发症的发生率以及护士对护理资源配置和患者/家属对护理工作的满意度.结果 观察组住ICU时间、医疗费用、住ICU期间并发症的发生率均显著低于对照组;而护士对护理资源配置以及患者/家属对护理工作的满意度明显高于对照组.结论 运用ICNSS配置护理人力资源比基于APACHEⅡ评分的护理资源配置模式能更有效地提高护理质量以及护士和患者/家属的满意度,值得在ICU推广应用.     

神经外科重症病人大便失禁早期气囊导管的应用与护理

为了降低神经外科重症病人大便失禁所致护理并发症发生,我科对重症大便失禁患者采用早期留置气囊导管,并加强护理,取得了良好疗效,现总结报告如下。1资料与方法1.1病例资料选取2003年10月至2005年10月我院神经外科收治的重症病人112例,其中男性80例,女性32例,最小年龄为26岁,最     

护理关怀理念对 ICU 危重患者护理质量及满意度的影响

目的：探讨护理关怀在ICU危重患者护理中的应用效果。方法选取我院2012年12月至2013年12月收治的80例ICU危重患者为研究对象,随机分为观察组和对照组,每组40例,对照组采用常规护理,观察组将人文关怀理念融入到护理中,比较两组的护理质量及患者的护理满意度。结果观察组的焦虑、抑郁评分低于对照组,沟通率好于对照组,ICU监护时间、拔管时间短于对照组,疼痛评分低于对照组,睡眠质量好于对照组,并发症少于对照组,差异均有统计学意义（ P＜0.05）;观察组在治疗性护理、健康教育、心理疏导等方面的护理满意度高于对照组,差异均有统计学意义（ P＜0.05）。结论护理关怀能够满足ICU危重患者的身心需求,帮助患者建立治疗信心,减少疼痛,提高护理满意度。     

Works of art: a complement to theoretical knowledge when teaching nursing care

Visual art dialogues were used in student nurses' education as a teaching and learning complement to theoretical knowledge of nursing care. An intervention group as well as a control group discussed what was characteristic of good nursing care. The control group was used to control for the effects of visual art dialogues in the intervention group. The study was undertaken at two university colleges of health sciences in Sweden. Data were collected from student nurses (n = 267) during their first year of study. The Wheel Questionnaire was used in the intervention group and control group. It measured three aspects of student nurses' perception of nursing situations: structure, the extent of emotional involvement, and motivation. The results showed statistical differences (one way ANOVA) between the intervention group in which visual art dialogues were implemented and the control group. Students in the intervention group, compared to the control group, were more structured, motivated and emotionally balanced when they expressed the elements most typical of good nursing care. They showed personal readiness in caring situations.     

Pilot training experience in lip-reading skills for nurses in intensive care units

In the intensive care unit (ICU) of Mestre hospital (Italy) a research was carried out to analyse the possibility to improve nurses' lip-reading skills. METHODS: A specialized speech therapist organized a 20 hour training course for 34 health workers in ICU. RESULTS: The participants had a lip-reading test at the beginning and at the end of the course and six months later. The final test revealed that participants could recognize a greater number of typical words in ICU in comparison to the initial test. Yet, after 6 months the skill decreased to the level shown at the beginning of the course. On the other hand, the trend shows that some participants' skill did not decrease. Neither the starting level nor intermediate stage are conditioned by sex, age, profession, and experience. In order to measure clinic efficacy, the participants had another test to understand if improved lip-reading skill could influence the following variables: word comprehension, nurse attitude to communication toward non-speaking people, patient emotional status and nurse emotional status. The training course seems to have had good effects on nurses' attitudes towards their patients and on their communication. Yet, study results do not show if increased lip-reading skills have real positive effects on ICU communication and whether this method is better than usual communication methods (e.g. mimic or alphabetic board).     

脓毒症患者的集束化护理及效果观察

目的 探讨对脓毒症患者实施集束化护理的临床效果.方法 选取该院ICU 20 l2年1月~2015年12月收治的患者120例,分为实验组62例和对照组58例.对照组实行应用传统护理方法;实验组在传统护理方法的基础上实行集束化护理,如早期液体复苏目标检测、早期床旁CRRT及其监测护理、胸部物理治疗护理及开展院感目标性监测预防感染等.对比两组患者集束化护理前后的CVP、MAP、乳酸、尿量、液体平衡、APARCHⅡ评分、SCr、机械通气时间、ICU治疗时间、院内感染发生率及28 d生存率.结果 实验组液体复苏达标时间缩短、血流动力学稳定、肾功能恢复显著、机械通气时间、ICU治疗时间缩短、院内感染发生率下降、28 d生存率提升(P<0.05).结论 集束化护理是一种较好的护理方式,减少了护理并发症,改善患者的预后,值得在危重症护理领域推广.     

Evolution in the postoperative intensive care of patients with liver transplantation

As liver transplantation has evolved (receptor selection, surgical technique, immunosuppressant treatment, etc.), experience has increased and nursing care has evolved. The admission of a patient to the ICU after liver transplantation no longer requires changes in nursing schedules to ensure proper patient care. This study was undertaken to evaluate differences in the evolution of nursing care in two consecutive groups of patients. A retrospective study was made of all nursing and medical records for two patient groups: patients who underwent transplantation in 1994-95 (G-I) and patients who underwent transplantation in 1996-98 (G-II). Medical history, surgical incidents and postoperative evolution (care treatment and complications) were evaluated for every patient. Mean age was similar for both groups, 57.7 years. The patients in the 1996-98 group had a shorter ICU stay, 3.5 days vs. 4.4 days for the 1994-95 group (p < 0.05). Oral feeding was tolerated soon in all patients, but somewhat earlier for the patients in the 1996-98 group. The infection rate (respiratory, urinary, vascular catheter) was low; there were no surgical wound infections. The average number of bacteriological controls was lower in the 1996-98 group, 5 vs. 19 for the 1994-95 group (p < 0.05). Other parameters were similar in both groups. In conclusion, the shorter ICU stay and elimination of routine analyses over the years benefited patients, reduced costs, and increased the availability of ICU beds. This was achieved without any reduction in the quality of care or results obtained.     

提高ICU护士法律意识 减少医疗纠纷

目的探讨提高ICU护士法律意识的方法,有效减少医疗纠纷.方法认真查找ICU护理工作中潜在性的医疗纠纷,采取从法律角度规范护理记录,加强责任心,尊重患者的合法权益,培养护士的法律意识等措施.结果有效减少了医疗纠纷发生.结论提高护士的法律意识、自我保护意识、维护病人权益意识,是减少医疗纠纷的重要措施.     

The meaning of caring in the intensive care unit

This qualitative research with a phenomenological approach searches to understand the meaning of care in the highly technical world of the Intensive Care Unit (ICU), viewed from the nurses' perspective. It was developed in a University Hospital in Porto Alegre, RS, between 1998-2000, with seven nurses as participants. The instruments used to gather information were observation and semi-structured interviews. The analysis was based on the proposal of Martins and Bicudo, using the phenomenological modality or structure of the situated phenomenon, with two stages. The phenomenon emerged under the aspect of sixteen propositions revealing care in the ICU from the nurses' perspective.     

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.     

共情护理干预对ICU患者焦虑情绪 心理韧性及满意度的影响

目的探讨共情护理干预对重症加强护理病房患者焦虑情绪、心理韧性及护理满意度的影响.方法将84例在重症加强护理病房住院的患者按护理干预方法不同分为研究组和对照组,每组42例.对照组予以常规护理,研究组在对照组的基础上予以共情护理,观察1周.护理前后采用焦虑自评量表评定焦虑情绪变化,心理弹性量表评定心理韧性状况,自制满意度调查表评定患者护理满意度.结果共情护理1周末两组焦虑自评量表评分较共情护理前显著下降(P<0.01),研究组显著低于对照组(P<0.01);两组心理弹性量表评分较共情护理前显著升高(P<0.01),研究组显著高于对照组(P<0.01).研究组护理满意度(95.2%)显著高于对照组(73.8%)(P<0.01).结论对重症加强护理病房患者及家属进行共情护理干预,能有效改善患者焦虑情绪,缓解家属心理压力,提高家属对患者的支持度,提高患者的心理韧性程度及护理满意度,有利于促进患者获得全面康复.     

The influence of telephonic nursing care coordination on patient satisfaction in a predominantly low-income, high-risk pregnancy population

The effect of telephonic nursing case management on patient satisfaction in a predominantly non-Caucasian low-income, high-risk pregnancy population was studied. Patient satisfaction of care was significantly higher for treatment group participants than for controls on 9 of 10 items measuring satisfaction. The satisfaction score of the treatment patients, constructed by summing scores for each item, averaged 8 points higher than the control group's score. Demographics made little difference. Telephonic case management was the strongest predictor of satisfaction in a multiple regression analysis. Satisfaction was unrelated to mode of delivery, infant birth weight, or gestational age. The satisfaction levels of treatment patients were high, whether or not they had outpatient charges. Participants rated the program highly for the nurses' ability to answer questions, overall program experience, the opportunity to ask the nurses questions, health teachings and instructions received, and confidence in the nurse coordinating their care or their child's care.     

Interactions of nurses with elderly patients: relationship to nurses' attitudes and to formal activity periods

Two different strategies are possible for improving nurses' interactions with elderly patients One is to arrange special periods, such as reality orientation, in which a high level of appropriate interaction is encouraged The other is to improve nurses' attitudes to patients and treatment, or select nurses with better attitudes, on the grounds that poor attitudes might underly poor behaviour This study was designed to find out whether nurses' interactions with elderly patients varied in relation to their attitudes, or differed between periods of routine care or of special activities based on reality orientation organized by the nurses Systematic observations were made of the behaviour of 27 nurses working on two psychogeriatric wards, before all nurses completed questionnaires measuring attitudes to nursing care and to elderly people A higher proportion of interactions were 'positive'(i e involved nurses' informing, questioning or making general conversation) during activity periods than at other times No attitudinal measure predicted the proportion of interactions which were positive, although this was greater in qualified nurses The results are consistent with the view that formal reality orientation periods can improve the quality of nurses' interactions with elderly patients, but are inconsistent with the view that targeting nurses' attitudes would be effective