Clinical decision support systems for patient safety: a focus group needs assessment with Korean ICU nurses

An ICU is known as a data-rich environment, and information technology can improve the quality of care by utilizing stored clinical data and providing decision support effectively and in a timely manner to clinicians. The necessity of clinical decision support systems is emphasized now more than ever because patient safety and nursing-sensitive outcomes in the clinical setting have become a critical issue. The purpose of this study was to explore nursing-sensitive outcomes issues related to patient safety in critical care and to understand the types and contents of clinical decision support systems that nurses desire in a clinical practice setting. Focus group interviews were conducted with 37 nurses who worked in one university hospital system in Korea. Our findings are summarized into threats to patient safety, nursing-sensitive outcomes, and the types and contents of clinical decision support systems, which are categorized into the following groups: (1) reminders, notification, alert, and warning systems; (2) point-of-care guidelines; and (3) references for information/guidelines. Nurses consistently stated that clinical decision support systems can help improve nursing outcomes by applying standardized nursing care. Our study is expected to provide a practical suggestion for developing and designing a new clinical decision support system or for refining an existing one.     

层级护理管理模式在ICU护理管理中的应用

目的探讨层级护理管理模式在ICU护理管理中的应用方法和效果。方法在ICU护理管理中,实施APN连续性排班,制订工作指引和质量标准及实行分层级培训和考核晋级。评价和比较实施层级护理管理模式前后ICU护士心理状况、ICU护士工作满意度和危重病人护理质量的差异。结果实施层级护理管理模式后ICU护士负性情绪较实施前低,护士工作满意度和危重病人护理质量较实施前提高,实施前后比较,均P<0.01,差异具有统计学意义。结论实施层级护理管理模式在为病人提供连续性护理,提高护理质量和护士工作满意度的同时,改善了ICU护士的心理状况。     

ICU医疗器械相关性压力性损伤闭环管理系统的构建及应用

目的 构建ICU医疗器械相关性压力性损伤（medical device-related pressure injuries,MDRPI）闭环管理系统,探讨其在临床中的应用效果。 方法 构建由风险评估、临床护理决策、质量与安全管理模块组成的ICU MDRPI闭环管理系统,于2019年7月在广东省某三级甲等医院ICU病房中使用,比较闭环管理系统应用前后6个月患者入ICU时MDRPI评估率、MDRPI住院评估率、MDRPI高风险患者筛查率、临床护理决策实施率、MDRPI发生率。 结果 闭环管理系统应用后,患者入ICU时MDRPI评估率从64.3%上升至96.8%,MDRPI住院评估率从44.9%上升至98.2%,MDRPI高风险患者筛查率从51.3%上升至98.9%,临床护理决策实施率从39.6%上升至95.8%,MDRPI发生率从15.9%下降至7.3%,差异均具有统计学意义﹙P<0.001﹚。 结论 ICU MDRPI闭环管理系统能帮助ICU护士科学、客观地评估MDRPI,并作出合理的护理决策,可规范MDRPI管理流程,有效降低MDRPI发生率。     

Deciding Not to Resuscitate

After discussing the decision with the staff, physicians should investigate the conditions for a do-not-resuscitate (DNR) order, make the decision, and inform the patient and the family. But, according to the present and other studies, they are not taking the full responsibility for these tasks. Nurses are supposed to participate in the discussions with the physicians prior to a DNR decision, but not to make the decision or to inform the patient and the family. Physicians and nurses have different opinions about their legitimate roles when DNR orders are initiated and made. However, 8% of the nurses in the present study state that they have made a DNR decision and 37% declare that the nurse should do so. We propose a model where the skills of the responsible physician (to make the diagnosis and prognosis) and the skills of the responsible nurse (to communicate with the patients by virtue of their close relationship) are combined. Accordingly, future guidelines should stress the joint responsibility of physicians and nurses to investigate the conditions precedent for a DNR order, to make the DNR decision, and to inform the patients and the family.     

“三定”管理方案在ICU护理实践中的实施及效果

目的:总结"三定"管理方案在ICU护理实践中的实施方法,并评价其实施效果。方法:根据ICU专科建设规范,按照定员管理原则合理配置护理人员,对规范化护士、准专科护士、专科护士三个阶段进行ICU专科护理人才的定向培养,并根据定能分级实现对护士能力的分层次使用及绩效分配。结果:ICU实施"三定"管理后,VAP发病率、CRBSI发病率和人工气道脱出率较实施前下降,护士的工作满意度明显提高。结论:"三定"管理方案在ICU切实可行,提高了护理质量,促进了护理队伍的内涵建设和护理专科化发展,激发了护理人员的工作热情和创新能力,为优质护理服务打下了坚实的基础。     

ICU患者谵妄管理临床决策支持系统的构建与应用研究

目的 构建ICU患者谵妄管理临床决策支持系统,并评价其应用效果。方法 构建包括风险评估与风险识别、智能决策、效果评价等功能的ICU谵妄管理临床决策支持系统,2022年6月—8月在江苏省某三级甲等医院ICU病房中正式使用,比较系统应用前后患者的谵妄发生率、首次接受谵妄预防措施的时间、护理记录书写耗时及护理记录缺陷率,收集护士对系统的满意度。结果 ICU患者谵妄管理临床决策支持系统应用后,患者的谵妄发生率、首次接受谵妄预防措施的时间、护理记录书写耗时及护理记录缺陷率均较应用前降低,差异均具有统计学意义（P<0.05）;护士对该系统的总体满意度评分为（100.88±4.06）分。结论 ICU患者谵妄管理临床决策支持系统能够为护士提供科学的决策依据,提高ICU患者谵妄预防管理的质量,护士对系统的满意度处于较高水平。     

依据APACHEII评分配置ICU护理人力的实践及效果评价

目的：探讨急性生理学及慢性健康状况评分系统（APACHEⅡ）在ICU护理人力资源合理配置中的应用价值。方法：将ICU的29名护士作为研究对象,比较应用APACHEⅡ作为人力分配依据前后的各项护理质量和护理服务质量满意度。结果：实施后的各项护理质量检查评分均高于实施前,尤其在基础护理、危重病人护理,消毒隔离、护理文书方面有日月显提高（P〈0．05）;患者、家属、医生对护士的满意度均高于实施前,特别是患者、医生对护士的满意度明显提高（P〈0．05）。结论：应用APACHEⅡ评估ICU护理工作量并配置护理人力资源,能提高护理工作质量和满意度。     

The unilateral DNR order--one hospital's experience

Hospital or institutional policies that guide the activity of nurses in the care of their patients may, at times, be controversial. Nursing staffs often act as gatekeepers of patient care activities and the implementers of institutional policy. When nurses raise questions as to the appropriateness of a given policy statement, the institution should take serious notice and, perhaps, even study the policy outcomes that relate to the concerns expressed by the nursing staff. This article introduces a policy that originally prompted serious concerns by the nursing staff at one institution. The nursing staff voiced their concerns regarding a revision in the DNR policy that would allow physicians to write unilateral do-not-resuscitate (DNR) orders. Because of this, a review of this policy took place and the results were used to dispel unfounded concerns and also to improve the use of the policy. This article may help nursing administrators to understand better the importance of policy-related studies and it may also encourage nurses to question policy statements and guidelines that may present some concerns. Enhanced patient care will ultimately result by such teamwork and scholarly activity.     

ICU护士长对气管插管患者口腔护理管理体验的质性研究*

目的深入了解重症监护室(intensive care unit,ICU)护士长对气管插管患者口腔护理的管理体验。方法采用质性研究中的现象学研究法,对上海市7所三级甲等医院10个不同ICU的10名护士长进行半结构式深入访谈。结果目前气管插管患者口腔护理现状较混乱,操作规范不具针对性,且与临床实践脱节,尚无系统的口腔护理评估、评价及培训体系,护理工具实用性欠缺,一线ICU护理人员配备不足且工作负荷大;但护理管理层及临床护士对口腔护理的认知及重视程度已有所提升。结论亟需构建基于循证的气管插管患者口腔护理临床实践指南,改进口腔护理用具,完善ICU口腔护理管理体系,以提升临床护理实践质量。     

The Influence of Patient Safety Culture and Patient Safety Error Experience on Safety Nursing Activities of Emergency Nurses in South Korea

IntroductionThe unique nature of the space and environment of emergency departments is a threat to patient safety. Enhancing patient safety and minimizing safety-related issues are important tasks for ED health care staff. The purpose of this study was to examine the relationships among patient safety culture, patient safety error, and safety nursing activities of emergency nurses in South Korea.MethodsA convenience sample of 200 emergency nurses working in 12 general hospitals in South Korea were surveyed for safety nursing activities using the Hospital Survey of Patients’ Safety Culture, a 4-item questionnaire for patient safety error and ED safety management items in the Guidelines for Patient Safety (seventh revision).ResultsHierarchical regression analysis revealed that the potential factors associated with safety nursing activities were safety training experience (β = 0.180, P=.01), organizational learning–continuous improvement (β = 0.170, P=.04), age (β = 0.160, P=.02), and implementation of domestic and foreign accreditation (β = 0.147, P=.03).DiscussionTo improve patient safety, it is essential to identify problems in medical institutions, determine areas of improvement, and improve the organization’s patient safety activity system on the basis of patient safety error experience reports. After training the emergency nurses for continuous improvement, the effect of patient safety activities must be analyzed.     

Health personnel's experience with resident-centered care in nursing homes in Korea: A qualitative study

ObjectivesChanging the culture in nursing homes in South Korea comes with challenges, and the key issues of resident-centered care have been described. This study aims to describe health personnel's experience in providing resident-centered care in nursing homes.MethodsQualitative data were collected through individual and focus group interviews consisting of registered nurses (n = 4), certified nurse assistants (n = 2), and long-term caregivers (n = 12) working at nursing homes in South Korea. The participants (n = 18) completed the interviews from May to June 2018, and all interviews were recorded, transcribed, and analyzed by employing the content analysis method.ResultsFive main categories are conceptualized: (1) residents’ participation in decision making, (2) the sharing of the history and story of residents, (3) the recognition of facility- or task-based attitudes, (4) the guarantee of private time and space for residents, and (5) the need for standardized guidelines.ConclusionsResults corroborate that health personnel regard resident-centered care as a desirable nursing paradigm. However, facility- or task-centered care is the most effective in hectic situations. A standardized protocol on the application of resident-centered care based on the facility-tailored specification is unavailable. Therefore, health personnel's perception and practice of resident-centered care can differ. Efficient nursing intervention programs should be developed after clarifying facility culture.     

Managing daily intensive care activities: An observational study concerning ad hoc decision making of charge nurses and intensivists

Introduction  

Management of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, we know only a little about the content of the real clinical decision making of ICU shift leaders.     

ICU护士严重感染和感染性休克治疗指南的培训效果

目的了解ICU护士对《严重感染和感染性休克治疗指南》相关知识的掌握程度,评价集中专题知识培训的效果。方法以指南内容为基础对我院ICU护士进行集中培训,并采用问卷调查了解培训前后护理人员对感染性休克复苏治疗相关知识的掌握程度。结果本组ICU护士对指南内容的知晓率培训后较培训前提高28．5％;培训前后总分及4个方面得分的比较,培训前总分为（14．50±3．53）分,培训后为（16．08±4．29）分,差异有统计学意义（P〈0．05）。结论ICU护士对严重感染和感染性休克治疗相关知识的掌握程度不够,进行相关知识的培训可提高护理人员对知识的掌握程度。     

ICU护士护理谵妄患儿体验的质性研究

目的深入了解ICU护士在护理谵妄患儿过程中的体验及遇到的困难,为提高护士谵妄护理能力提供参考依据。方法采用现象学研究方法 ,于2020年5月—10月在上海市某三级甲等儿童专科医院对12名护理过谵妄患儿的ICU护士进行半结构式深入访谈,并使用Colaizzi 7步分析法进行数据的收集及整理,分析提炼出主题。结果分析得出ICU护士护理患儿谵妄体验的4个主题,分别为:护理过程中存在诸多压力、积极实施针对性的谵妄护理干预策略、期望掌握谵妄知识以提升对谵妄患儿的照护能力、渴望得到医生及家长的支持。结论需要重视ICU护士在护理谵妄患儿过程中的压力与需求,在促进护士身心健康的同时,强化谵妄专业知识、优化医护协作与家庭参与模式,提高ICU护士谵妄护理能力。     

Preliminary Development of Two Predictive Models for DNR Patients in Intensive Care

The purpose of this study was to identify which variables are the best predictors of a do-not-resuscitate (DNR) classification and develop a model to predict the nursing care required by DNR patients in the ICU. Data collected on DNR and non-DNR patients included nursing care requirements, severity of illness, resource allocation and sociodemographic characteristics. One model identified the best predictors of a DNR classification in intensive care as the origin of admission and the severity of illness score on the day of admission to intensive care. The second model identified the best predictors of nursing care requirements for DNR patients in intensive care as the number of days spent in intensive care prior to the DNR order, the average daily resource allocation points after the DNR order, and the severity of illness score on the day the DNR order was designated.     

气管插管非计划性拔管预警及决策支持系统的研发与应用

目的 研发针对经口气管插管患者的气管插管非计划性拔管(unplanned endotracheal extubation,UEE)预警及决策支持系统,并评价其应用效果.方法 组建研发小组,构建UEE预警及决策支持系统,包括评估、预警、决策3个模块.2020年9月在天津市某三级甲等医院ICU中应用,比较系统应用后(202...     

护理活动评分系统在ICU人力资源管理中的应用

目的探讨护理活动评分系统在ICU人力资源管理中的应用效果。方法采用护理活动评估量表（nursing activities scale,NAS）测量在本院ICU住院的149例病人的护理工作量,根据工作量计算护士人数,并预见性地合理安排每班护士人数。结果 ICU病人当天需要的护理工作量得分最低为30.50分,最高为129.70分,平均（53.23±18.12）分。所需护患比为1～2∶1的占了68.73%。实施护理活动评分系统后护理不良事件总发生率为18.12%,明显少于实施前33.12%,实施前后比较,χ2=8.909,P〈0.001,差异具有统计学意义。结论 ICU护士人力应以所收治病人实际需要的护理工作量进行动态合理分配。采用护理活动评分系统进行人力资源管理可提高ICU护理质量。