冠心病监护病房患者常见不满及护理对策

目的探讨冠心病监护病房（CCU）患者常见的不满问题。方法采用住院患者满意度调查表对2010年1-6月入住我科室CCU的80例患者进行调查,满意度为90.4%。针对征集的不满意见,采取切实可行的护理干预,并对80例患者在转出CCU时再次发放满意度调查表。结果 CCU患者的不满主要集中在对入住CCU及陪人探视制度的不理解等,通过采取相应的干预措施后,满意度提高到98.8%。结论 CCU患者满意度直接影响护理质量,必须引起护理人员的重视,采取干预措施,提高工作满意度,有利于患者疾病康复。     

新进CCU轮转护士上岗培训的方法与体会

目的:对新进CCU轮转的护士进行系统规范化上岗培训,使其尽快掌握专业理论和操作,适应CCU工作,保证CCU护理质量。方法:对2003年7月至2008年5月24名新近CCU轮转护士进行为期3个月的专科理论、专科操作以及综合能力等方面的上岗培训,培训结束进行考核评价。结果:24名轮转护士培训前后在专科理论、专科操作以及综合能力等方面的评分均有显著性差异(P0.05)。结论:对新进CCU轮转的护士进行系统的规范化培训后可使护士获得扎实的理论知识与临床实践,提高CCU护理质量。     

实施死亡病例护理讨论 提高CCU护士综合能力

目的探讨开展死亡病例护理讨论对提高CCU护士能力的效果。方法组织全科护士从护理的角度对CCU死亡病例进行讨论和分析,找出护理工作的不足,总结经验教训,提出相应的改进措施。结果CCU护士的应变能力、抢救技术和CCU病房管理能力、病人满意度得到明显提高。结论死亡病例护理讨论是一种理论联系实际的好形式,有利于CCU护士综合能力和护理质量的提高。     

以护理问题为依据护理分级量表在CCU的应用

目的:探讨CCU应用以护理问题为依据的护理分级量表。方法:由护士长或资深护士应用自行编制的CCU护理干预分级量表对CCU住院患者分别进行2次护理分级评分。结果:CCU心脏骤停复苏的患者以4级护理为主,其他患者以3级护理为主要级别,其次为2级护理。结论:量表的护理分级措施清楚、护理目标明确,涵盖了患者心理、ADL、治疗情况、病情、观察等方面的内容,原则性和操作性强,保证了护理质量。     

基于ACE Star循证模式在CCU急性心肌梗死病人中的应用

目的:探讨基于ACE Star循证模式在冠心病监护病房(CCU)急性心肌梗死(AMI)病人中的应用。方法:将2019年1月—2019年12月CCU收治的62例AMI病人设为对照组,将2020年1月—2020年12月收治的65例AMI病人设为观察组,对照组行CCU常规管理,观察组在常规护理基础上行基于ACE Star循证模式护理,比较两组遵医行为、并发症发生率、不良情绪、预后情况及护理满意度评分。结果:观察组遵医行为率(包括合理饮食、合理用药、合理作息、心电监护、情绪管理)高于对照组(P<0.05),观察组心力衰竭发生率、压疮发生率低于对照组(P<0.05),观察组干预后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分低于对照组(P<0.05),观察组心绞痛缓解时间、住院时间短于对照组(P<0.05),观察组满意度评分高于对照组(P<0.05)。结论:基于ACE Star循证模式能有效减轻CCU AMI病人不良情绪,提高病人遵医行为,从而降低并发症,改善预后,提高护理满意率。     

CCU心肌梗死患者抢救无效时同诊断患者心理体验的质性研究

目的探索CCU心肌梗死患者抢救无效状态下其他心肌梗死患者的真实心理体验,以寻求合适的护理对策。方法在CCU出现心肌梗死患者抢救无效宣告死亡的12~24 h内,对其他11例CCU的心肌梗死患者采用质性研究的方法,通过半结构式深度访谈及Colaizzi内容分析法分析资料。结果提炼出4个主题:(1)当前心理状态表现为淡漠、焦虑、恐惧,且各个心态大相径庭。(2)对疾病的感知从认为自己没病、心肌梗死没那么可怕到对疾病感到迷茫。(3)对他人的需求,表现为:渴望医生护士提供康复知识;渴望心理护理;需要家人的理解与支持。(4)对CCU规章制度的态度,表现为:更加遵守CCU的规章制度;希望CCU规章制度能够更加灵活。结论 CCU抢救无效状态下其他心肌梗死患者心理体验是复杂的。医护人员应该重视CCU抢救无效状态下其他心肌梗死患者的心理体验,及时给予合适有效的心理护理;把握该特殊时期,提高患者健康教育的有效性;CCU规章制度需灵活变通。     

A review of the information needs of patients with acute coronary syndromes

The individual nature of information required by hospitalized patients with coronary heart disease (CHD) has been of concern to nurses for over 20 years. An information need is not necessarily a gap in knowledge that can be satisfied by education. It represents what the patient wants to know from the professional in order to cope effectively with the current situation. Through analysis of available literature, it seems that patients appear to prioritize information that is pertinent to survival, such as symptom management, rather than broader lifestyle issues such as exercise and diet. Although information needs are individual and subjective to each patient, trends emerge within patient groups. Information needs of patients with CHD in coronary care unit and ward setting occur across eight or more common areas. Through patient-centred communication, patients' f preferences for information in these topics can be derived and used as the basis for information delivery. Individual idiosyncratic needs can also be noted and addressed.     

重症监护病区患者对护患沟通障碍的体验

目的探讨重症监护病区患者对护患沟通障碍的内心感受。方法采用质性研究方法,以半结构式的访谈问卷对12例患者进行深入访谈,使用内容分析法分析资料。结果将重症监护病区患者的护患沟通障碍归纳为4个主题:①患者对CCU环境的困惑;②患者对疾病的担忧;③护患关系的物化导致护患沟通障碍;④患者对护患沟通的渴望。结论重症监护病区患者存在护患沟通障碍,护士应有针对性地采取措施,减少沟通障碍。     

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Objectives

ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a “contemporary” (CV > 10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI).

Design and methods

856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤ 4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24 h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V = absolute increase (after log conversion of cTnI measurements) / delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters.

Results

A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p < 0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6 h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p < 0.0001). In the elderly (> 75 years), the cTnI V was significantly increased.

Conclusion

STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.