重症监护室专科护士规范化培训方案的实施效果

目的建立重症监护室（intensive care unit,ICU）专科护士规范化培训方案并评价实施效果。方法制订ICU专科护士规范化培训方案,并于2006年10月至2009年5月对275名ICU专科护士进行培训,采用问卷调查和综合考核方式评价培训效果。结果 275名参训护士对课程设置、教员教学及教学管理的平均满意率分别为97.6%、95.0%及97.4%,毕业考核通过率为97.9%。结论 ICU专科护士培训方案受到参训护士的好评,并取得较好的培训效果。     

Infant Positioning Assessment Tool: Transcultural adaptation and validation for Portuguese Preterm Neonates

AimCross-cultural adaptation and validation of the Infant Positioning Assessment Tool for Portuguese Preterm Neonates.BackgroundTherapeutic positioning provides postural support, with immediate and long-lasting impacts on development. Some studies have suggested the importance of applying positioning-related instruments.MethodsA scoping review identified the Infant Positioning Assessment Tool, which was used in a methodological and cross-cultural study. Its psychometric validation was performed in a nonprobability preterm neonates sample (n = 90). Internal consistency and item sensitivity were assessed by using Cronbach's alpha coefficient and asymmetry and kurtosis coefficients, respectively. The following empirical indices were used to assess convergent validity (CV): chi-square over degrees of freedom (df), a goodness-of-fit index (GFI), a normed-fit index (NFI), an incremental-fit index (IFI) and root mean square error of approximation (RMSEA), an average extracted variance index, and composite reliability (CR).ResultsConfirmatory factor analysis of the factorial model showed an insufficient goodness-of-fit adjustment for the first model, with six items. One item was removed, and the resulting second model was adjusted to five items and showed more acceptable results (X2(9) = 52.70; p < 0.001; X2/df = 5.85; n = 90; GFI = 0.86; NFI = 0.64; IFI = 0,68; CFI = 0,67; RMSEA = 0.234); CR = 0.74 and CV = 0.50.ConclusionThe Portuguese version of the Infant Positioning Assessment Tool, with five items, proved to be a sensitive, valid, and reliable instrument for observing positioning of newborns, which is why its use in neonatal units is suggested.     

Evaluation of time to antibiotic administration for suspected late-onset sepsis in the Neonatal Intensive Care Unit: A quality improvement project

Late-onset sepsis is a significant cause of morbidity and mortality, with mortality increasing by 8–9% for each hour delay in antibiotics. The primary objective of this study is to evaluate the time to antibiotic administration for late-onset sepsis after implementation of a newly developed process for performing sepsis evaluations. A retrospective chart review was conducted utilizing electronic medical records to obtain data for select time points within the sepsis evaluation process. There were 42 patients evaluated prior to the quality improvement project (Group 1) and 59 patients evaluated after (Group 2). The average time to antibiotic administration was 2 h and 48 min in Group 1 and 1 h and 7 min in Group 2 (p < 0.0001). Time to antibiotic administration for late-onset sepsis in the Neonatal Intensive Care Unit (NICU) significantly decreased after implementation of a newly developed process, however, several barriers still exist.     

视频探视系统在ICU的应用及效果

目的探索将视频探视系统应用于重症监护病房(intensive care unit,ICU)的效果,探讨体现人文关怀、杜绝交叉感染的新型ICU探视与管理模式。方法将2007年9月至2009年1月期间入住创伤重症监护病房(trauma intensive careunit,TICU)的192例患者作为观察组,采取视频探视方式;将同期入住急救内科重症监护病房(emertency intensive care unit,EICU)的211例患者作为对照组,采取入室探视方式,比较两个监护室物体表面的细菌数及家属满意度、监护室在班护士压力。结果观察组监护室物体表面细菌数采样的超标率明显低于对照组,差异有统计学意义(χ2=57.94,P<0.01);观察组患者家属对探视方式的满意度明显高于对照组,差异有统计学意义(χ2=45.61,P<0.01);对照组调查的15名护理人员中,有13名工作压力过大,观察组调查的15名护理人员中,有3名工作压力过大,两组比较,差异有统计学意义(χ2=5.21,P<0.01)。结论利用视频探视系统对ICU重症患者进行探视不仅可有效控制医院感染,而且较大程度上满足了患者及家属的心理需求,缓解了家属的焦虑情绪,减轻了护理人员的工作量,减少了探视管理成本,体现了以人为本的服务理念。     

Recognizing and mitigating infant distress in Neonatal Intensive Care Unit (NICU)

Admission to the Neonatal Intensive Care Unit (NICU) is a psychologically and physically distressing event for infants. Preterm infants suffer from higher rates of depression and anxiety in childhood, adolescence, and adulthood, likely, at least in part, related to the experiences they have in the NICU. The parent-infant relationship is of paramount importance in determining the future trajectory of both the parent's and infant's mental health, and therefore it is critically important to both assess and support its development in the NICU. The challenges parents face in responding to their preterm, ill and fragile infants, and strategies to mitigate infant distress are outlined.     

Sleep Promotion for Preterm Infants in the NICU

Sleep is a crucial human physiologic need. Preterm infants in the NICU are exposed to noxious stimuli that often disrupt and shorten their sleep periods. Sleep disruption may have a negative effect on clinical outcomes, growth, and development and may also delay hospital discharge. Increasing evidence suggests that sleep quality is critical for brain development and synaptic plasticity and is associated with long-term neurodevelopmental outcomes. The purpose of this article is to discuss the importance of sleep in preterm infants, describe tools commonly used to assess infant sleep and identify different sleep–wake states, and identify interventions that promote sleep in preterm infants in the NICU. Nurses play a vital role in implementing appropriate interventions that promote preterm infants’ sleep.     

早产儿袋鼠式护理的临床效果和母亲满意度的Meta分析

目的评价早产儿袋鼠式护理（kangaroo mother care，KMC）的临床效果和母亲对KMC满意度的影响。方法计算机检索PubMed、EMbase、Ovid、Spnnger数据库，中国期刊全文数据库，台湾电子期刊全文数据库，中国生物医学文献数据库；此外，还手工检索学术会议记录、专题论文集。检索时间均从建库至2007年9月。纳入袋鼠式护理早产儿的所有随机对照试验，并对纳入文献进行行质量评价。采用RevMan4．2软件进行Meta分析。结果最终纳入5篇随机对照试验。KMC组患儿病死率、重症感染发生率及12个月随访时精神运动功能发育与常规护理组比较，差异无统计学意义（P〉0．05）。KMC组院内感染发生率、6个月随访时的上呼吸道感染发生率及出院时牛奶喂养发生率均低于常规护理组（P〈0．05）。KMC组的母亲对早产儿在普通新生儿和重症监护病房对他（她）进行照顾的自信心较常规护理组增强，对早产儿在普通新生儿病房的担心和焦虑情况较常规护理组减轻、患儿出院时体重增加（P〈0．05）。结论Meta分析结果表明KMC是一种科学、有效、人性化的新生儿护理模式，但对患儿的死亡率和长期精神运动功能发育的影响还不能肯定，需要进行大样本、多中心的随机对照试验进行评价。     

439名ICU护士工作压力源水平及相关因素分析

目的了解ICU护士的工作压力状况,探讨相关影响因素。方法采用《中国护士工作压力源量表》,对广东省内10所二级甲等以上医院的439名ICU护士,进行问卷调查,分析不同人口学特征护士压力源的水平差异、总体压力源水平及其与工作时间和主观满意度的相关性。结果女性护士的工作压力源总分高于男性护士(t=3.67,P0.01);不同职称、不同编制、不同职务的ICU护士,在工作压力源总分的差异有统计学意义(P0.01或P0.05);从事ICU工作时间与工作压力源总分呈一定正相关(r=0.163,P0.01);对生活总体满意度与工作压力总分呈一定负相关(r=-0.191,P0.01)。结论 ICU护士中,女性、护师、护士长和在编护士的工作压力较大,工作年限、对目前生活的满意度评价与工作压力感受有一定关系,重视上述人群和针对有关因素进行干预可望调节ICU护士工作压力。     

Implementation and Evaluation of an Individualized Developmental Care Program in a Neonatal Intensive Care Unit

PURPOSE. This study aims to detect differences in outcomes for very preterm infants after the introduction of developmental care in a neonatal nursery, and to evaluate the effect of developmental care on parental well‐being. DESIGN AND METHODS. Prospective before and after cohort study of very preterm babies, with education for all staff between cohorts. RESULTS. No significant differences were found between cohorts for short‐term outcomes for babies or parental anxiety levels or depression. All infants scored within normal temperament ranges at 4 months. PRACTICE IMPLICATIONS. Developmental care is a safe practice model. The interdisciplinary study facilitated professional development and increased the knowledge of nurses.     

Part 1: Narrative overview of developmental care interventions for the preterm newborn

The development of synaptic connections in the foetus' brain peaks during the third trimester of gestation. In case of preterm birth, the infant is vulnerable in the neonatal intensive care unit because of its immature and rapidly developing neurologic system. Therefore, developmental care interventions (DCI) are particularly important during the NICU hospitalization to optimize short and long-term outcomes, as well as neurodevelopment, in infants born prematurely. The aim of this article is to provide a narrative overview by summarizing findings of a thorough literature review on the latest findings regarding the effectiveness of six DCI on preterm infant's outcomes such as sleep, stress and neurodevelopment. Various DCI have been evaluated in empirical studies. Research related to these interventions is rapidly evolving but is still a priority in the neonatal research field.     

Addressing the Needs of Mothers with Infants in the Neonatal Intensive Care Unit: A Qualitative Secondary Analysis

PurposeMothers of infants hospitalized in neonatal intensive care units (NICUs) need to be recognized as essential partners of the care team as their presence and involvement are key to infants' health and developmental outcomes. Addressing mothers' perceived needs is beneficial for the improvement of supportive nursing care; however, little qualitative research on their unmet needs has been conducted in South Korea. This study assessed mothers' perspectives on their NICU experiences and their unmet needs within the South Korean cultural context.MethodA cross-sectional, multicentered, secondary analysis study was conducted using the written responses to an open-ended questionnaire. Of the 344 NICU-experienced mothers, 232 throughout South Korea (seven cities and five provinces) voluntarily completed the questionnaire via smartphone-based or web-based surveys. Their narrative responses were analyzed using thematic content analysis guided by the critical incident technique.ResultsFour themes emerged. NICU-experienced mothers of preterm infants referred to the “family-friendly environment” (16.4%) as a positive experience. The greatest unmet need was “relationship-based support” (58.2%), followed by “information and education-based support” (20.0%) and “system-level challenges” (5.4%).ConclusionThe importance of creating a family-friendly NICU environment should be emphasized by ensuring 24-hour unrestricted access and encouraging active parental involvement in infant care, as well as actively supporting NICU families through supportive words and actions. The assurance of antiinfection management and better staffing levels should be fundamentally guaranteed to NICU staff.