Table of Content

10 November 2023, Volume 4 Issue 11 Previous Issue   

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A study on the development of nursing responsibilities at various stages of care for critically ill patients with emerging acute respiratory infectious diseases CUI Jiasong, ZHANG Enming, WANG Suxing, LI Yuan, DAI Zhengyue, FANG Qiong 2023, 4 (11):  965-972.  doi: 10.3761/j.issn.2096-7446.2023.11.001 Abstract ( 137 )   Save Objective In order to develop job duties for all phases at various stages for critically ill patients with emerging acute respiratory infections to provide a training reference for the establishment of a critical care emergency reserve team. Methods After reviewing domestic and international literature and preparing the first draft through expert interviews，two rounds of consultation with 17 experts in related fields were conducted using the Delphi method to determine the job responsibility for critical care nursing positions in emerging acute respiratory infectious diseases. Results The effective rsponse rates of the two rounds of expert correspondence were 100% and 88.2% ，respectively. The authority coefficients of the two rounds of experts were 0.930 and 0.885 respectively，and the Kendall’s harmony coefficients of the two rounds were 0.125 and 0.299 respectively（P<0.001）. The finalized nursing job responsibilities for all stages of care for critically ill patients with emerging acute respiratory infections included 4 primary indicators，13 secondary indicators，36 tertiary indicators，and 70 quaternary indicators. Conclusion The nursing job responsibilities for all stages of care for critically ill patients with emerging acute respiratory infections can provide a reference for cultivating respiratory infectious disease critical care nursing talents. Related Articles | Metrics

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Qualitative research on experience of the dilemma of surrogate decision-making among mechanical ventilation patients’ family members TANG Li, YU Xiaoyan, WANG Huaqin, LI Jinxiu 2023, 4 (11):  973-977.  doi: 10.3761/j.issn.2096-7446.2023.11.002 Abstract ( 108 )   Save Objective To explore the experiences of surrogate decision-making dilemma among mechanically ventilated patients’ family members，and to provide a guidance for improving the decision quality and satisfaction of proxy decision-makers. Methods From May 2020 to October 2020，semi-structured interviews were conducted with family surrogate decision-makers of mechanically ventilated patients in ICU of a tertiary care hospital in Hunan Province. The interview data were coded，categorized，interpreted，and analyzed by Colaizzi phenomenological analysis. Results The following three themes are obtained from the analysis: diverse types of decision-making behavior，com- plex inner activities of decision-making, multi-dimensional decision-making challenges. Conclusion It is necessary to pay attention to and identify the dilemmas and needs of family surrogate decision-makers for mechanically venti- lated patients，enhance communication and trust between medical staff and surrogate decision-makers，and optimize psychological support and coping strategies for family surrogate decision-makers，so as to improve the decision-mak- ing ability and satisfaction of surrogate decision-makers. Related Articles | Metrics

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Construction and application of the Internet of Things intelligent blood management scheme in ICU SUN Qiao, WANG Sumei, CHENG Cong, GUAN Chun 2023, 4 (11):  978-982.  doi: 10.3761/j.issn.2096-7446.2023.11.003 Abstract ( 121 )   Save Objective To explore and evaluate the application effectiveness of Internet of Things（IoT） blood man- agement scheme. Methods Based on radio frequency identification technology （RFID），we developed intelligent blood refrigerators and IoT blood transfer boxes，automated intelligent blood（bank） management systems and closed- loop blood transfusion information management systems，an intelligent management system for ICU blood use was constructed to implement full-process informatization supervision and traceability management，and conduct dynamic regulation and evaluation for blood transfusion management of critically ill patients. We selected and compared the blood management data of critically ill patients before the application of intelligent blood management system（May 2021 to October 2021） and after the allocation（November 2021 to April 2022），and evaluated the role of this sys- tem in blood management in ICU. Results Before the application of IoT intelligent blood management scheme，a total of 2170 cases of blood use were used in 180 critically ill patients，and 3611 cases of blood use were used in 158 critically ill patients after the application. The non-cold chain time of blood bag decreased significantly from 8（5.5，15） min before implementation to 0.5（0.5，1） min after implementation. The average delivery time of each bag of blood decreased from 8（5.5，15） min before implementation to 1（0.5，1） min after implementation. The ICU pre- ventive blood preparation rate increased from 12.0%（260/2 170） before the implementation to 59.0%（2 130/3 611）.The qualified rate of medical record examination increased from 68.3% to 89.9%. The differences were statistically significant（P<0.001）. Conclusion The IoT intelligent blood transfusion scheme was helpful for the precise blood management for critically ill patients，improving the efficiency of blood use，and ensuring the ICU blood safety. Related Articles | Metrics

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Construction and application of a multidisciplinary team approach for extracorporeal cardiopulmonary re- suscitation WU Jiehua, CHEN Hua, XIA Ye, LENG Xiahua, WANG Mengmeng, CHEN Huan, YAN Chengkun 2023, 4 (11):  983-988.  doi: 10.3761/j.issn.2096-7446.2023.11.004 Abstract ( 193 )   Save Objective To construct a multi-disciplinary team （MDT） approach for extracorporeal cardiopulmonary resuscitation（ECPR） and evaluate its application. Methods An expert group discussion method was used to con- struct a MDT protocol for extracorporeal cardiopulmonary resuscitation. Using a convenience sampling method，35 patients who underwent ECPR from January 2020 to December 2021 were selected as the experimental group，and 32 patients who underwent ECPR from January 2018 to December 2019 were selected as the control group. The experimental group implemented the extracorporeal cardiopulmonary resuscitation MDT protocol on the basis of the conventional process and care，while the control group was given the conventional emergency receiving and nursing care. Compared the time spent on each session，48h return of spontaneous circulation rate，48h survival rate and in- hospital survival rate between the two groups of patients. Results 31 cases were collected in the experimental group and 27 cases in the control group. The time spent in each session was significantly lower in the experimen- tal group than that in the control group after the intervention，and the difference was statistically significant（P<0.001）. The 48h return of spontaneous circulation rate，48h survival rate and in-hospital survival rate were significantly higher than those in the control group，and the differences were statistically significant （P<0.05）. Conclusion The application of the MDT approach for extracorporeal cardiopulmonary resuscitation can shorten the resuscitation time of patients with extracorporeal cardiopulmonary resuscitation，promote medical and nursing cooperation，and improve the resuscitation success rate. Related Articles | Metrics

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Optimization and effect evaluation of arterial puncture catheterization process for invasive blood pressure monitoring YANG Fei, SUN Qingmei, PAN Jian, SU Wei, LÜ Ying, ZHAO Qun, MA Yingqin, ZHANG Yingying 2023, 4 (11):  988-992.  doi: 10.3761/j.issn.2096-7446.2023.11.005 Abstract ( 425 )   Save Objective To optimize the invasive blood pressure monitoring arterial cannulation procedure using catheter tip intracavitary electrocardiogram （ECG） positioning technology and to evaluate its effectiveness. Methods From June 2021 to June 2022，60 patients each from a tertiary level A hospital and a secondary level A hospital in Xinjiang Uygur Autonomous Region undergoing invasive blood pressure monitoring were selected. Based on the cannulation method，they were randomly divided into the optimization group（60 patients） and the traditional group（60 patients） by the random number table method. The optimization group optimized the connection process be- tween arterial puncture cannula and pressure transducer，and introduced intracavitary electrogram localization tech- nology at the tip of arterial puncture. The traditional group used penetrating arterial puncture catheterization. The primary evaluation indicators included first-attempt cannulation success rate，post-puncture bruising，puncture bleed- ing，pain score，and patient satisfaction. Results Compared to the traditional group，the first-attempt cannulation suc- cess rate in the optimization group significantly increased（95.0% vs 83.3%，P=0.04）. The post-puncture bruising rate significantly decreased（5.0% vs 28.3%，P=0.01）. The puncture bleeding rate significantly decreased（0 vs 100.0%，P= 0.04）. The proportion of patients with mild pain significantly increased（95.0% vs 75.0%，P=0.02），while the propor- tion with moderate pain significantly decreased （5.0% vs 25.0%，P=0.02）. Patient satisfaction also improved（95.0% vs 75.0%，P=0.01）. Conclusion Optimizing the procedure of arterial cannulation for invasive blood pressure moni- toring can effectively improve the first-attempt puncture success rate，reduce complications，and enhance patient sat- isfaction. It offers a safer and more efficient cannulation method. Related Articles | Metrics

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Establishment of norms of ICU Healthy Work Environment Assessment Tool in the tertiary general hospitals of Zhejiang Province DING Zhuyu, ZHUANG Yiyu, ZHANG Jiajia, CHEN Xiangping, LI Qiujing, LAO Yuewen, FU Wenyao, ZHANG Yi 2023, 4 (11):  993-999.  doi: 10.3761/j.issn.2096-7446.2023.11.006 Abstract ( 106 )   Save Objective To establish the norm of ICU Healthy Work Environment Assessment Tool in the tertiary general hospitals of Zhejiang Province. Methods From June to November 2022，A total of 1 734 ICU nurses from 32 tertiary general hospitals in Zhejiang Province were selected by using the equal proportion stratified sampling method，the AACN Healthy Work Environment Assessment Tool was used to investigate the work environment. The mean norm，classification norm，percentile norm and demarcation norm were established on the basis of analyzing the characteristics of ICU nursing work environment. Results The total mean norm of ICU Healthy Work Environment Assessment Tool in Zhejiang Province was （73.79±15.79），skilled communication was （75.00±16.23），true collaboration was （73.73±17.45），effective decision making was （70.05±18.47），appropriate staffing was （75.93±16.74）， meaningful recognition was （73.39±16.74），authentic leadership was （74.66±16.47）. For the different characteristics， five classification norms were established by multiple linear regression analysis，including region，position，number of night shift，health status and number of reported accidents in one year. The percentile norm was established with 5% interval，and the delimiting norm was established with 5 grades院excellent（≥87.50），good（75.00~87.49），average （65.28~74.99），relatively poor（50.00~65.27）and poor（<50.00）. Conclusion This study initially constructed the norm of ICU Healthy Work Environment Assessment Tool in tertiary general hospitals in Zhejiang Province，which can provide a reference standard for studying the level of healthy work environment perceived by ICU nurses，and also provide a theoretical basis for further exploring the influencing factors of healthy work environment in ICU. Related Articles | Metrics

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Meta-integration of a qualitative study on the experience of ethical dilemmas of ICU nurses YU Ran, GAN Qingwen, LIAN Zerong, SUN Xiaoxuan, LING Hua 2023, 4 (11):  1000-1005.  doi: 10.3761/j.issn.2096-7446.2023.11.007 Abstract ( 107 )   Save Objective To systematically evaluate ICU nurses’ experiences of moral dilemmas to inform the development of evidence-based interventions for moral dilemmas. Methods Computerized search of relevant databases for qualitative studies on ICU nurses’ experiences of ethical dilemmas was conducted with a time frame of construction to July 2023. The quality of the included literature was evaluated using the 2016 Australian Joanna Briggs Institute （JBI） Center for Evidence-Based Health Care qualitative research quality assessment tool，and the results were integrated using meta-integration methods. Results A total of 16 papers were included，54 findings were distilled，and 8 categories were grouped to form 3 integrated findings：negative physical，psychological，and cognitive behavioral experiences of ICU nurses；root causes of ethical dilemmas of ICU nurses；and ways of coping with ethical dilemmas of ICU nurses. Conclusion Nursing managers should pay attention to the physical and psychological discomfort experience brought by moral dilemmas to ICU nurses，and should use a variety of interventions to actively respond to moral dilemmas，so as to reduce the level of ICU nurses’ moral dilemmas and improve the quality of nursing services. Related Articles | Metrics