冠心病监护病房临床护理带教常见问题及对策

临床实习是护理学专业人才培养方案中非常重要的环节,是护理实习生（以下简称护生）将理论和实践相结合以及培养良好职业道德的过程。冠心病监护病房（coronary care unit,CCU）是将心血管疾病的危重症及介入治疗手术后的患者集中监护的病房,承担着危重患者的治疗和护理,这对进入CCU的护生提出了更高的要求。本文旨在探讨在CCU临床护理教学中的常见问题及对策,从而提高CCU的护理实习带教水平,保证护理人才培养的质量。     

ICU护士重症监护基本护理能力及其影响因素分析

目的：评估ICU护士重症监护基本护理能力及其影响因素。方法对某三级甲等医院166名ICU护士发放危重症监护护理能力量表。计算危重症监护护理能力量表自评得分,比较分析不同特征护士危重症监护护理能力得分的差异及其影响因素。结果 ICU护士自评危重症监护基本护理能力优秀,其中态度与价值观基础维度优秀,知识、技能和经验基础维度良好,临床能力和专业能力子领域中得分最低分别为护理干预和发展工作。工作年限和最高学历是ICU护士重症监护基本护理能力的影响因素（P<0.05）。结论 ICU护士自评具备了重症监护实践的能力,应针对薄弱领域强化专科培训,建立长效机制稳定重症监护队伍,持续改善重症监护基本护理能力。     

监护环境对病人心理的影响及对策

随着近年来危重病学及整体护理的发展,监护环境已被很多医院重视。面对重症监护病房的环境,改善病人心理因素,给病人舒适健康的生活氛围,已成为各个ICU的心理护理重点。改善监护环境对病人心理的负性影响,减轻病人心理负担,达到对监护病人心理护理的目的,最终提高疾病的康复水平。1监护环境对心理的影响因素1.1静态环境对心理的影响ICU病房因其治疗的特殊性,对病人的监护都用一些仪器及设备,各种设备与病人连接,限制了某些行为活动;某些仪器突发的报警等声,光刺激以及病室的温     

创伤致急性呼吸窘迫综合征患者的护理

总结了27例创伤致急性呼吸窘迫综合征患者的临床护理体会。在对患者的救治和护理过程中，加强气道的护理，及时地监护患者的病情变化，加强呼吸系统、循环系统的护理与监控，有效缓解疼痛，细致的心理护理等措施能提高患者临床治疗的效果，有助于其康复。     

危重症孕产妇人文护理的研究进展

随着医学技术的不断发展,人文关怀护理在临床护理工作中的显著作用得到了医学界的高度认可,人文关怀护理可以充 分体现出医护人员对患者生命健康、权力、人格尊严、身心需求等各方面的尊重及关心。人文护理关怀在临床中的应用与发展, 全面提高了护理人员在人文关怀方面的能力,也加强了护理实践操作的水平,使护患之间沟通交流更为紧密,对危重症孕产妇 预后具有积极作用。危重症孕产妇作为危重症患者中极为特殊的一类人群,对危重症孕产妇实施人文关怀护理,能够提高危重 症孕产妇临床治疗依从性,提升治疗效果,有效促进术后快速康复。     

心理护理干预对冠状动脉粥样硬化性心脏病患者负性情绪的影响

随着生活水平的提高和生活方式的改变,中国冠状动脉粥样硬化性心脏病（冠心病）的发生率逐步升高,且有年轻化趋势。冠心病患者往往具有动机强烈、紧迫感较强等 A 型行为特征,发病后更易产生紧张、焦虑等负性情绪［1－2］。加强对冠心病患者的心理干预,缓解负性情绪,可有效提高临床疗效,促进机体康复。本研究观察了心理护理干预对冠心病患者抑郁、焦虑等负性情绪的影响,现报告如下。     

加强心理健康管理提高护理人员心理健康水平

临床护理人员承担着对患者的观察、护理、急救等诸多任务,护士在各种负性因素的影响下,易产生烦燥、焦虑等负性情绪。护士心理健康水平影响着整体护理质量,进而影响患者的治疗和康复效果。但压力并非都是有害的,     

护理程序在院前急救危重症患者呼吸道管理中的应用

目的:探讨护理程序在院前急救危重症患者呼吸道管理中的应用效果。方法:对我院2008年3月~2010年3月院前转运的149例危重症患者临床资料进行回顾性分析,对其实施护理程序,包括护理评估、护理诊断、护理计划、护理实施、护理评价。结果:149例危重症患者中,呼吸道现存的护理问题得到有效解决,潜在护理危险也到得到了有效预防;无一例患者因呼吸道的管理问题造成严重不良后果甚至危及患者生命。结论:院前急救中护理程序在危重症患者呼吸道管理中的应用取得了良好的成效,提高了院前急救的质量。     

2009年国际危重症急救监护研讨会会议通知

为进一步推进我国危重症急救护理事业的发展，努力与国际接轨，我们拟在今年8月29—30日在上海举办首届国际危重症急救监护研讨会。本次会议旨在追踪国际危重症急救监护的前沿，提升专科护理水平，搭建国内外交流平台，接轨国际护理水准。会议将邀请美国、澳大利亚等国外危重症急救监护方面的专家和教授以及香港、北京、上海、河北等城市的知名专家、专业权威人士来会交流临床理论和实践等方面的知识，会议还特别邀请了SCI杂志《Cancer Nursing》主编、     

早期康复护理对幻肢觉患者心理状况的影响

目的探讨早期康复护理对幻肢觉患者心理状况的影响。方法对22例幻肢觉患者实施早期康复护理，内容包括：按摩患肢与健肢、心理暗示疗法、暴露疗法和刺激疗法及重视家属支持，并进行康复护理前后患者负性心理发生率的比较。结果康复护理前后患者各种负性心理发生率比较，均P〈0．05，差异有统计学意义。结论早期康复护理对减轻幻肢觉患者的负性心理，促进患者的健康心理状态具有积极的意义。     

Clinical decision-making in the intensive care unit: A concept analysis

AimTo operationally define clinical decision-making as it relates to intensive care unit nursing.BackgroundClinical decision-making is an intricate cognitive process that is demanding on intensive care nurses due to the severity of their patients’ illnesses, consistent exposure to high-stakes situations, and prevalent patient mortality. When compromised, it can lead to adverse patient events. However, clinical decision-making specific to the intensive care unit is a concept seldom defined in nursing research.DesignConcept analysis.MethodsUsing Walker and Avant’s eight-step method, nursing databases were searched for studies between 1980 and 2022 describing the antecedents, defining attributes, consequences, and empirical referents of clinical decision-making in the intensive setting.FindingsIntensive care unit clinical decision-making is a complex cognitive process in which nurses recognize a clinical problem in their patient and respond promptly by implementing interventions to improve their patient’s rapidly and frequently changing health status to a more favorable condition in an intensive care setting. The defining attributes are: assessment of the patient situation, prompt recognition of cues, efficient comprehension of patient data abnormalities, prior knowledge and experience, prompt response to the clinical problem(s), colleague collaboration, formulation of interventions to treat clinical problem(s), and appraisal of risks/benefits.ConclusionIntensive care unit clinical decision-making is a skill that is different from traditional clinical decision-making in nursing. Prompt action characterizes this concept due to the unstable health status of these patients. More research on this concept is needed to enhance nurse performance and patient outcomes in intensive care.Implications for clinical practiceA definition of this concept opens doors for potential studies on promoting effective decision-making among intensive care nurses. This can improve the safety and outcomes of critically ill patients. Additionally, it generates new questions regarding how nursing schools and hospital orientation programs can promote and develop competent decision-making skills in future intensive care nurses.     

15例早产儿慢性肺部疾病的护理体会

目的:通过呼吸道的管理,严格控制氧疗指征,加强肺部护理,合理喂养,针对家长的恐惧心理做好相应的心理护理,从而提高早产儿慢性肺部疾病(CLD)的生活质量,减少住院天数,改善预后,降低死亡率的发生。方法:对15例慢性肺部疾病的早产儿采取保持适宜体温、合理喂养、维持有效呼吸、氧疗护理、早期监测血糖、预防感染、发育支持等综合护理干预。结果:本组患儿经过精心护理及治疗后有13例康复出院,1例合并多功能衰竭死亡,1例放弃治疗。结论:建立有效的护理措施,有助于降低死亡率,减少并发症,改善愈后。     

机械通气患者呼气末二氧化碳分压监测异常的原因分析及护理

目的:分析影响机械通气患者呼气末二氧化碳分压(PetCO2)监测异常的原因,及时发现异常情况,判断患者病情发展,提高机械通气治疗效果。方法:对2006年1月～2008年12月收治本院ICU治疗的108例机械通气的患者进行PetCO2监测的数值、波形变化情况及其影响因素进行回顾性分析。结果:记录到8种212次PetCO2异常波形和数值,异常发生率为13.40%。其中呼吸环路漏气占30.66%,气管导管位置不当占6.60%,气囊漏气占11.32%,分泌物阻塞占22.17%,通气过度占12.74%,通气不足占7.55%,肺灌注不足占5.66%,机械故障占3.30%。结论:机械通气患者通过持续的监测PetCO2数值和波形曲线变化,结合心电图进行分析,可及时发现异常情况并采取相应处理措施,提高危重患者的救治率。     

Admission and discharge guidelines for the pediatric patient requiring intermediate care

During the past three decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units being opened across the country. Many patients who are admitted to the hospital require a higher level of care than the routine inpatient general pediatric care, yet not to the degree of intensity as pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multiple disciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions but usually do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to the institution's resources and capacity in caring for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and improve the healthcare affordability for patients receiving intermediate care.     

Developing a care program to better know the chronically critically ill

Patients requiring prolonged periods of intensive care and mechanical ventilation are termed chronically critically ill. These patients present a challenge to the healthcare team. In the fast-paced environment of the intensive care unit, their slow progress can be a source of frustration. At the University Hospital Geneva, a team, led by a clinical nurse specialist, addressed this problem by implementing a new care program with a goal to better know this patient population and improve their care. Values of emancipatory practice development guided the project, which utilized an action research methodology. Key assessment tools included a nursing focused patient history at admission and weekly nursing rounds, which allowed for periodic holistic assessment and care planning. New interventions focused on communication, physical care, and providing a context of understanding for the patient beyond hospitalisation, operationalised as a patient diary. The structure of the new program allowed the nurses to develop new skills and provided an environment for dynamic reflection. The care of this demanding patient population is beginning to be perceived by nurses as challenging and interesting.     

The nature of long-term care nursing work

Data from a pilot study on the nature of nursing work in long-term care (LTC) facilities are compared with data on nursing work in intensive care units (ICUs). The comparison suggests that the LTC nursing work environment is a complex, demanding, and interesting one that is different from, not less than, nursing work in acute care environments. The data also suggests that nursing educators and researchers should reconsider LTC nursing work environments. Long-term care nursing offers an ideal, relatively controlled environment for research on what nursing work is and how nursing interventions affect patient outcomes. Long-term care nurses, whose daily work has always involved working with a variety of professional and unlicensed staff members, can serve as models for delegation and interpersonal skills. Finally, the LTC setting offers the ideal environment for clinical sites in connection with the proposed curriculum changes in end-of-life care for patients and their families.     

Assessment and nursing care of patients in acute confusion in intensive care units

This article mainly discusses the causes of acute confusion and the factors affecting them among patients in intensive care units, while also identifying relevant assessment tools and important points for consideration in medical care. Clinically, it is often observed that patients in intensive care units (ICU) develop changes in the neurotransmitters of the brain that are due to rapid changes in their disease or to attention disorders or cognitive disorders resulting from lack of stimuli from the external environment in a closed space. These patients mostly fail to cooperate in their treatment, which leads to the occurrence of complications and further increases the probability of disability and death. Consequently, the workload of the ICU nurses becomes heavier, the patient's hospitalization is prolonged, and the hospital's costs increase. Usually nurses, who look after patients 24 hours a day, are the clinicians who first discover the patients' changes in physiology and psychology. In today's clinical practice, however, we lack an assessment tool which can help ICU nurses to diagnose early, and in a rapid, simple and effective way, the cognitive and attention disorders of patients in order to provide early medical interventions and effective nursing interventions and reduce the incidence of various complications. With reference to relevant domestic and foreign research reports, the author identifies some acute confusion assessment tools and relevant information on nursing interventions for the benefit of nurses, and as guidance in their clinical work.     

程序化护理干预在机械通气病人中的应用效果观察

[目的]观察程序化护理干预在机械通气病人中的应用效果。[方法]将110例机械通气病人随机分为观察组60例与对照组50例,对照组病人给予常规护理,观察组在此基础上给予程序化护理干预措施,比较两组病人机械通气时间、重症监护室（ICU）监护时间及发生医院感染、呼吸机相关性肺炎（VAP ）及死亡情况。[结果]观察组机械通气时间及 ICU监护时间均少于对照组（P〈0.01）,观察组病人医院感染、VAP 及死亡发生率均低于对照组（P〈0.05）。[结论]程序化护理干预在机械通气病人中应用可降低治疗风险、提高临床疗效。     

肾移植术后并发巨细胞病毒性肺炎的观察与护理

目的探讨肾移植术后并发巨细胞病毒(CMV)性肺炎的临床观察及护理。方法对15例肾移植术后并发CMV性肺炎患者的临床表现、监测内容及护理过程进行回顾性分析。结果15例并发CMV性肺炎患者临床主要表现均以发热、咳嗽起病,胸部X线检查均为间质性肺炎改变。15例中抗CMV-IgM阳性者13例,CMV-DNA阳性9例;9例治疗后外周血CMV抗原检测全部转为阴性,6例死亡,其中2例放弃治疗。结论肾移植术后并发CMV肺炎病情凶险,全面细致地观察与护理有利于CMV肺炎的早期诊断和治疗。     

Changes in the occurrences of coercive interventions and staff injuries on a psychiatric intensive care unit

The purpose of this study was to compare the occurrences of coercive interventions and violence-related staff injuries before and after a 2-year violence prevention intervention on a psychiatric intensive care unit. The intervention aimed to improve nursing care by addressing patient violence from multiple perspectives. During the study, the unit was reorganized toward a higher concentration of severely disturbed patients. The results showed an increased proportion of coercive interventions without a corresponding increase in staff injuries. Use of coercive interventions is discussed in relation to a safe environment for both patients and staff.