Table of Content

10 January 2023, Volume 4 Issue 1 Previous Issue    Next Issue

Commentary

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Development of emergency medicine and construction of integrated emergency platform——inspiration for emergency and critical care nursing LÜ Chuanzhu, LUO Shanjun, YUAN Suping, LI Youqing, SONG Fei, FENG Li, ZENG Xia, LI Quan, ZHOU Ning 2023, 4 (1):  10-16.  doi: 10.3761/j.issn.2096-7446.2023.01.001 Abstract ( )   PDF (1284KB) ( )   Save To review the development achievements of emergency medicine in China for more than 40 years,emergency medicine has initially formed a theoretical system and operation mode which is suitable for the national condition,and the emergency medical service system has gradually been improved. Emergency medicine in China has entered the era of 3.0 since the introduction of the strategy of comprehensively promoting the construction of a large platform for emergency medical care in 2017. To further accelerate the high-quality development of the emergency medicine,take advantages of the good opportunity created by the construction of integrated emergency platform for the development of the discipline,we summarized the existing problems in the development of the discipline,discussed the key points of the future construction and development of the discipline,and put forward the direction and goals of the discipline development. Meanwhile,in order to comply with the development situation of emergency medicine,emergency nurses need to have more comprehensive ability through summarizing the challenges for the development of emergency nursing and identify the future development direction. References | Related Articles | Metrics

Research Paper

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The optimization and effect evaluation of management process of difficult intubation after unplanned extubation in patients with tracheotomy WANG Shuyun, SHI Yanrong, JIANG Fangfang, WU Nannan 2023, 4 (1):  17-21.  doi: 10.3761/j.issn.2096-7446.2023.01.002 Abstract ( )   PDF (863KB) ( )   Save Objective To optimize and verify the clinical effect of management procedure for difficult intubation after unplanned extubation（UE）in patients with tracheotomy. Methods An expert team was set up to sort out the unplanned extubation management process of patients with tracheotomy,apply medical failure mode and effect analysis to conduct failure analysis on the process steps,formulate optimized plans and organize implementation. The differences of each indicator before（January-December 2019）and after（January-December 2020）process optimization were compared. Results After process optimization,the unplanned extubation rescue time of patients with tracheotomy was shortened from （32.18±3.21）min before optimization to （23.28±2.01）min（P<0.05）. Patients' satisfaction with nursing work increased from （86.24±4.93）to （89.48±2.48）（P<0.001）. Doctors' satisfaction with nursing work increased from（75.35±7.54）to （84.80±3.65）（P<0.05）. Conclusion The introduction of medical failure mode and effect analysis to optimize UE management process for patients with tracheotomy moved the risk window forward,which can effectively shorten the treatment time and improve the success rate and satisfaction of UE treatment for patients with tracheotomy. References | Related Articles | Metrics

Special Planning—Cardiovascular Disease Nursing

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Application of cardiac enhanced rehabilitation management protocol in patients undergoing radiofrequency catheter ablation for atrial fibrillation ZHU Haixiang, WANG Yunhe, HAN Xiaoxue, CHEN Qingqing, YANG Fan, WANG Jing 2023, 4 (1):  22-28.  doi: 10.3761/j.issn.2096-7446.2023.01.003 Abstract ( )   PDF (1190KB) ( )   Save Objective To explore the effects of an enhanced rehabilitation program on patients undergoing radiofrequency catheter ablation for atrial fibrillation. Methods 561 patients undergoing radiofrequency catheter ablation for atrial fibrillation from January 2020 to December 2021 were included. Patients from January to December 2021 were included as the intervention group,and those from January to December 2020 patients as the control group. The intervention group was managed by enhanced rehabilitation program management,the control group was managed by conventional methods. And the differences of postoperative mobilization time,length of hospital stay,hospitalization cost,postoperative complications,Atrial Fibrillation Effect on Quality-of-Life,improvement of cardiac function and recurrence rate of atrial fibrillation between the two groups were compared. Results The patients in intervention group mobilized 4.9 h earlier,were discharged 5.6 h shorter,and costed 0.7 million less（P<0.001）. The score of postoperative quality of life in intervention group was higher（P<0.05）,the LVEF improvement was significantly better than control group,and recurrence rate was less than control group at 3 months after operation（P<0.05）. Conclusion The cardiac enhanced rehabilitation program helps to promote the early rehabilitation of patients with radiofrequency catheter ablation for artrial fibrillation,shorten the hospital stay,facilitate the improvement of quality of life and cardiac function,and reduce recurrence ate. References | Related Articles | Metrics

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Study on the risk factors of puncture site complications after radiofrequency ablation in patients with atrial fibrillation CHEN Jieying, SHAO Cuimei 2023, 4 (1):  28-32.  doi: 10.3761/j.issn.2096-7446.2023.01.004 Abstract ( )   PDF (778KB) ( )   Save Objective To analyze the risk factors of complications at the puncture site in patients with atrial fibrillation and propose corresponding nursing countermeasures. Methods Using a case-control study design,92 patients with atrial fibrillation by femoral vein radiofrequency ablation admitted in a tertiary class A hospital in Zhejiang Province from March 2022 to June 2022 were included,among which 46 patients had puncture site complications,and 46 patients without postoperative complications were matched 1:1 by age and gender. Univariate analysis and multivariate Logistic regression were used to analyze independent risk factors for puncture site complications after operation. Results Logistic regression analysis showed that BMI（OR=1.372）,perception of local bandage tightness（OR=3.596）,stretch bandage time（OR=1.524）,and international standardized ratio（OR=10.563）were independent risk factors of of puncture site complications after radiofrequency ablation in patients with atrial fibrillation（P<0.05）. Conclusion The incidence of local complications after atrial fibrillation radiofrequency ablation was mainly related to obesity,international standardized ratio and excessive bandage. It is recommended to address risk factors to reduce the risk of complications. References | Related Articles | Metrics

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Nursing experiences of transcatheter tricuspid annulus clip in six patients with tricuspid regurgitation SUN Qianhui, GAO Xin, WENG Fengxia, TENG Peng, WEI Jianhua 2023, 4 (1):  33-35.  doi: 10.3761/j.issn.2096-7446.2023.01.005 Abstract ( )   PDF (701KB) ( )   Save To summarize the nursing experiences in six elderly patients with tricuspid regurgitation undergoing the transcatheter tricuspid annulus clip. Focusing on the perioperative complications such as arrythmia,pneumonia and anxiety,we improved preoperative assessment,and implemented preoperative pre-rehabilitation strategy,the monitoring of postoperative hemodynamics and coagulation function,early rehabilitation training and humanistic nursing with family participation. All six patients recovered and were discharged after meticulous treatment and individualized nursing care. References | Related Articles | Metrics

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Nursing care of a patient with low cardiac output syndrome treated by bedside extracorporeal membrane oxygenation combined with cardiopulmonary bypass ZHOU Sha, ZENG Fei, MAO Qinna, SHOU Feiping, HUANG Guifei 2023, 4 (1):  36-39.  doi: 10.3761/j.issn.2096-7446.2023.01.006 Abstract ( )   PDF (876KB) ( )   Save The nursing experience of a patient with low cardiac output syndrome after heart valve replacement and treated by extracorporeal membrane oxygenation combined with cardiopulmonary bypass was reported. In view of the patient's critical and complex condition and rapid progression,a series of measures were taken,including bedside thoracotomy for hemostasis under cardiopulmonary bypass by multidisciplinary collaboration,actively correcting reversible factors leading to low cardiac output,bedside seamless management of cardiopulmonary bypass and extra corporeal membrane oxygenation（ECMO）,the precision management of ECMO anticoagulation after cardiopulmonary bypass,monitoring and management of brain function,capacity and distal limb ischemia during the running of venous-arterial ECMO to ensure sufficient blood and oxygen supply of heart,lung,brain and other important organs and no fatal complications,make patients go through pump failure. After 6 days of careful treatment and nursing,the cardiac function of the patient recovered to the expected goal,and the ECMO was successfully evacuated. References | Related Articles | Metrics

Emergency Care Research

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Emergency nursing of a patient with acute mesenteric venous thrombosis secondary to lung cancer HU Han, LI Erli 2023, 4 (1):  40-42.  doi: 10.3761/j.issn.2096-7446.2023.01.007 Abstract ( )   PDF (562KB) ( )   Save To summarize the nursing experience of a patient with acute mesenteric venous thrombosis secondary to lung cancer. In terms of the abdominal pain presenting in lung cancer patients with severe chest pain,nurses patrolled and assessed patient's condition in time,valued on the patient's main complaint of abdominal pain,got early diagnosis of acute mesenteric venous thrombosis to get time for subsequent treatment. During the course of the patient's anticoagulation therapy,nurses promptly assessed the patient's bleeding risk and bleeding tendency,balanced the contradiction between anticoagulation and bleeding. Multi-team cooperation care ran through the whole rescue process. The patient was smoothly discharged from the hospital after 20 d of care. References | Related Articles | Metrics

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Nursing care of a child with propionic acidemia complicated with status epilepticus LIU Bihong, CHEN Xiaochun, XU Hongzhen 2023, 4 (1):  43-45.  doi: 10.3761/j.issn.2096-7446.2023.01.008 Abstract ( )   PDF (583KB) ( )   Save The nursing experience of a child with propionic acidemia complicated with status epilepticus was summarized. According to the characteristics of the urgent onset and rapid progress of this case,specimens were collected in time to strengthen the dynamic observation of the child's condition. Key points of nursing also included emergency care for epileptic seizures;nutrition screening and assessment,proper protein consume and maintenance of water,electrolyte and acid-base balance;early observation and prevention of hyperammonemia encephalopathy;observation and prevention of hypoglycemia;guide of family emergency management. After 8 days of active treatment and careful nursing,the patient's condition was controlled and discharged. The parents were followed up by telephone for 2 years,and the child's condition was stable. References | Related Articles | Metrics

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The emergency nursing of modified Heimlich maneuver for a patient with asphyxia during interventional embolization YANG Qing, LI Zhonghui 2023, 4 (1):  46-48.  doi: 10.3761/j.issn.2096-7446.2023.01.009 Abstract ( )   PDF (531KB) ( )   Save The successful nursing experience of sudden massive hemorrhage and asphyxia during interventional embolism in a patient with nasopharyngeal carcinoma was summarized. The patient suffered from sudden maxillofacial bleeding during surgery,and he was immediately turned over,body drainage and the negative pressure attraction were both used,but the blood flowed into the respiratory tract too fast and the negative pressure attraction was incomplete,asphyxia occurred. The modified Heimlich emergency method was immediately adopted. The patient was placed in the right prone position to perform Heimlich maneuver,and the respiratory tract was successfully cleared. During the rescue,the multidisciplinary team cooperated closely to prepare the intraoperative body position,pipeline,airway management and rescue materials. After active rescue and nursing,the patient was saved,and the interventional embolization and hemostasis surgery was successfully completed. The patient was weaned from the invasive ventilator on postoperative day 1,received maxillofacial debridement and flap trans-plantation on day 13,and right nasopharyngeal and oral mucosa reconstruction on day 18,and was discharged with complete wound healing on day 75. References | Related Articles | Metrics

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Emergency care of a patient with lung cancer complicated with pulmonary arteriovenous rupture and massive hemorrhage during thoracoscopy YANG Xiaona, DAI Qiurong, ZHANG Lei, ZHANG Yuping 2023, 4 (1):  49-51.  doi: 10.3761/j.issn.2096-7446.2023.01.010 Abstract ( )   PDF (535KB) ( )   Save To summarize the emergency care of a patient with lung cancer undergoing thoracoscopic surgery and complicated with pulmonary arteriovenous rupture and massive hemorrhage,and then undergoing unplanned bilateral thoracotomy. In view of the emergency during the operation and the rapid progress of the disease,the rescue team was immediately set up and the reasonable division of team members was carried out in an orderly manner. The key points of nursing care included division of nursing staff,key nursing points of rescue coordination and the prevention and treatment of complications. The patient was successfully saved from massive haemorrhage after 4 hours of rescue by the rapid response team. On the 13th day after the surgery,the patient recovered and was discharged. References | Related Articles | Metrics

Critical Care Research

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Nursing of PICC catheterization near the wound in patients with massive burns SHI Yun, LI Mei, ZHANG Fengying, ZHAO Ruiyi 2023, 4 (1):  52-54.  doi: 10.3761/j.issn.2096-7446.2023.01.011 Abstract ( )   PDF (525KB) ( )   Save The nursing experience of PICC catheterization in 18 patients with massive burns was summarized. Aiming at the problems of no normal skin tissue,difficulty in fixation,easy contamination of puncture points,and susceptibility to catheter-related infections at the puncture sites in this group of patients,a nursing practice plan was constructed. The catheter indwelling site was located away from the infected wound,and the upper extremity vein was preferred,and with the axillary vein as the secondary choice,small pieces of isolated skin should not be selected. Iodine disinfectant was used to replace alcohol disinfectant for reducing wound irritation. ECG localization technology was applied to monitor the tip position of the peripheral central venous catheter in real time during intubation. Stitching in combination with sterile gauze dressing was used to cross-fix catheters. We established targeted maintenance measures and focused on the risk of infection of PICC caused by wound dressing replacement and VSD drainage to prevent catheter related infection. We identified care problems timely through intravenous access checklists. 18 patients were successfully indwelled with PICC,of which 4 were shock patients,and the maximum indwelling time was 32 days. One case was confirmed as a catheter-associated hematogenous infection. PICC can meet the infusion needs of patients with massive burns and has a low infection rate. References | Related Articles | Metrics

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Nursing of goal-directed postural drainage for chemoradiotherapy related lung injury BAO Lifang, LI Qian, ZHU Yirong, WANG Lizhu 2023, 4 (1):  55-57.  doi: 10.3761/j.issn.2096-7446.2023.01.012 Abstract ( )   PDF (530KB) ( )   Save To summarize the nursing experience of goal-directed postural drainage during prone position for a patient with chemoradiotherapy related lung injury. For the multiple exudation and consolidation of lung in this patient,goal-directed postural drainage combined with precise airway clearance techniques was adopted. For the high risk of pressure injury in prone position,comprehensive and refined skin management was implemented. For the occurrence of diarrhea during prone position,fecal management system was used. After 35 days of careful monitoring and treatment,the patient was transferred to a general ward and recovered 7 days later. References | Related Articles | Metrics

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Nursing care of a patient with right aortic arch undergoing modified PICC intubation MA Yamin, JIANG Zifang, FU Linjuan, GAO Liqin 2023, 4 (1):  58-60.  doi: 10.3761/j.issn.2096-7446.2023.01.013 Abstract ( )   PDF (539KB) ( )   Save To summarize the nursing experience of PICC catheterization in a patient with right aortic arch congenital defect based on crisis prevention theory. In view of the risks and difficulties of catheterization caused by congenital vascular malformation,we established a multidisciplinary crisis management team in time. Before catheterization,we made a full assessment,analyzed the difficulties and risks of catheterization,and identified the crisis. We provided psychological support and consent to patients and their families,so that they could face the crisis calmly. Through crisis monitoring,such as catheterization,we put the patient in a special position and improved the catheterization method. At the same time,we reserved the length of catheterization for patients through various ways and combined with the method of body surface measurement,so as to ensure the safety of catheterization for the patient. After our careful care,the treatment of the patient was successfully completed and we removed the tube,no catheter-related complications occurred during the catheter indwelling. References | Related Articles | Metrics

Quality and Safety

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The management practice to improve anti-epidemic effect in fever clinic of a public hospital LUO Linna, XIA Ying 2023, 4 (1):  61-65.  doi: 10.3761/j.issn.2096-7446.2023.01.014 Abstract ( )   PDF (821KB) ( )   Save This paper summarized the management experience of a public hospital fever clinic in dealing with novel coronavirus pneumonia（COVID-19）. Through a series of measures,such as constructing new buildings and adjusting the layout,setting the regional management mode,optimizing the allocation of human resources,and improving the cleaning and disinfection methods,the emergency treatment capacity of fever clinic has been improved to prevent and control cross-infection and transmission within the hospital,and the success rate of treatment of critically ill patients has been increased. References | Related Articles | Metrics

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Retrospective analysis of early intervention effect of initiating rapid response system in hospitalized and non-hospitalized patients YAN Danping, WANG Yuwei, WU Zuojia, YE Chener, WANG Sa 2023, 4 (1):  66-70.  doi: 10.3761/j.issn.2096-7446.2023.01.015 Abstract ( )   PDF (750KB) ( )   Save Objective To analyze and compare the difference of early intervention effect of initiating the rapid response system（RRS）between hospitalized and non-hospitalized patients. Methods The RRS events initiated in a tertiary class A hospital in Zhejiang Province from January 2016 to December 2021 were collected retrospectively. Differences of initiating time,reasons,personnel and patient outcome between hospitalized and non-hospitalized patients were analyzed. Results From 2016 to 2021,983 RRS events were initiated,including 715 inpatients（72.74%）and 268 non-hospitalized patients（27.26%）. The main initiators of RRS were nurses（94.80%）. The res-ponse time of the emergency medical team（MET）after the initiation of RRS was 3（2,4）minutes and 2（1,3）minutes for inpatients and non-hospitalized patients respectively. The visiting departments were surgery（55.81%）and cardiovascular medicine（31.34%）. The main reasons for initiating RRS were sudden loss of consciousness（69.23%）and witnessing patients falling to the ground suddenly（57.84%）. Most required on-site intervention（92.77%）after the initiation of RRS. There was no particularity in the distribution of RRS initiating time periods for inpatients,while the initiating time of RRS for non-hospitalized patients was from 08：00 to 16：00. Conclusion Under homogeneous management,both inpatients and non-hospitalized patients reached MET within 5 minutes after the initiation of RRS. Non-hospitalized patients differed from hospitalized patients in terms of time,place,reasons,and outcome. Attention needs to be paid to the initiation of RRS when the condition of non-hospitalized patients suddenly change in the hospital. It is recommended to carry out RRS-related training and simulation exercises for all personnel in the hospital. References | Related Articles | Metrics

Guideline and Standard

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Interpretation of expert consensus on public response measures during pre-hospital first aid period ZHOU Ming, ZHANG Na, JIANG Xinjun, WANG Yixin, ZHANG Hua 2023, 4 (1):  71-74.  doi: 10.3761/j.issn.2096-7446.2023.01.016 Abstract ( )   PDF (646KB) ( )   Save The Emergency Medicine Branch of the Chinese Medical Association,the Emergency Physician Branch of the Chinese Medical Doctor Association,and the Emergency Medicine Professional Committee of the People's Liberation Army published an expert consensus on public response measures during the pre-hospital first aid waiting period on May 10,2022. It emphasized the importance of the public to rescue patients‘at the first time’ in the pre-hospital emergency waiting period. It is a necessary prerequisite to create a supportive social environment for the public to cope with the pre-hospital emergency waiting period. Through government-led and multi-industry participation,the first aid training system will be optimized to cultivate the‘first witness’ with skilled first aid ability,improve the first aid rescue rate of the whole people,so as to ensure the life safety of the people. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Family caregivers' experience for engagement in delirium management in intensive care units：a qualitative meta-synthesis LAO Yuewen, CHEN Xiangping, CHEN Qianqian, CHENG Junning, ZHANG Yi, GONG Xiaoyan, ZHUANG Yiyu 2023, 4 (1):  75-81.  doi: 10.3761/j.issn.2096-7446.2023.01.017 Abstract ( )   PDF (1151KB) ( )   Save Objective To conduct a meta-synthesis of the experience of family caregivers involved in delirium management in the intensive care unit,to provide reference for promoting family caregivers to participate in delirium management. Methods We searched databases including CNKI,Wanfang Data,CBM,PubMed,Web of Science,CINAHL,Embase,PsycINFO,and Cochrane Library to collect qualitative studies on the experience of family caregivers engaged in delirium management in the intensive care unit,the retrieval time limit was from the establishment of the database to April 2022. The quality of included studies were evaluated according to Australia JBI Critical Appraisal Tool for Qualitative Studies. The results were integrated by a meta-aggregative approach. Results A total of seven studies were included and 37 complete findings were grouped according to their similarities to classify seven new categories. These categories resulted into two synthesized findings-They were faced with many challenges and were eager to receive support;they were actively and effectively involved and affirmed their self-worth. Conclusion Health care workers should acknowledge the important value of family members of ICU patients in participating in delirium management,understand the feelings and needs during their involvement in delirium management,enhance communication,provide family members with delirium-related education,and ensure the effectiveness and comfort of family members' engagement. References | Related Articles | Metrics

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Visual analysis of research hotspots and frontiers with interdisciplinary team care model in ICU GENG Ke, YU Chao, WANG Dan, LIU Shengnan, WANG Xiao, WANG Weiwei, GAO Chunhua, LIN Yan 2023, 4 (1):  81-86.  doi: 10.3761/j.issn.2096-7446.2023.01.018 Abstract ( )   PDF (1069KB) ( )   Save Objective To analyze the hot spots and frontiers of interdisciplinary care team model research in China to provide references for the ICU interdisciplinary team care research in China. Methods We searched CNKI and Web of Science database for literature on interdisciplinary care model research and used CiteSpace software to analyze key words of literature and understand the research hotspots and frontiers. Results A total of 155 Chinese articles and 124 English articles on the ICU interdisciplinary team care model were searched. The number of publications showed an increasing trend. Keywords analysis indicated that the hot topics of interdisciplinary team care model were early mobilization,interdisciplinary team building in Chinese literature,the research frontiers were interdisciplinary joint Internet plus,early rehabilitation,etc. The research hotspots focused on interdisciplinary nursing education,information and knowledge management in English literature,research frontier was the formulation of interdisciplinary team nursing standards/guidelines and the clinical application. Conclusion Compared with English studies,domestic research started late and had lower research quality. Nurses can learn experience from foreign researches and perform researches around the construction of interdisciplinary theoretical system and cooperation model. References | Related Articles | Metrics

Review

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Research progress of assessment tools for exercise tolerance in patients with stroke YANG Hongyan, CHEN Yuanyuan, CHEN Yanqin, WEI Hui, LAN Meijuan 2023, 4 (1):  87-91.  doi: 10.3761/j.issn.2096-7446.2023.01.019 Abstract ( )   PDF (650KB) ( )   Save Accurate evaluation of the stroke patients' exercise tolerance can help medical staff adjust exercise intensity timely,ensure the benefits of exercise and avoid excessive increase of cardiopulmonary burden,and provide a basis for the development of personalized exercise programs for stroke patients. This paper reviewed the assessment tools of exercise tolerance in stroke patients,including objective assessment tools,subjective assessment tools and intelligent device-based assessment tools. The main content and application status of the assessment tools were summarized,and the characteristics and limitations of the assessment tools were discussed in this paper. It can provide references for medical staff to select exercise tolerance assessment tools for stroke patients. But the standard assessment tools need to be established and improved. References | Related Articles | Metrics

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Research progress of barriers and interventions strategies related to standardized practice of drug administration via enteral feeding tubes DU Meijie, WANG Ying, HE Mei, JIANG Mengyao, ZHANG Xinyue, CUI Mengying 2023, 4 (1):  92-96.  doi: 10.3761/j.issn.2096-7446.2023.01.020 Abstract ( )   PDF (737KB) ( )   Save Drug administration via enteral feeding tubes refers to the delivery of therapeutically effective oral drugs directly into the gastrointestinal tract through a feeding tube. This article reviews the barriers and intervention strategies related to standardized practice of drug administration via feeding tubes. Barriers include insufficient training,lacking of standardized procedures,inadequate multidisciplinary collaboration,and lacking of quality control systems. Targeted intervention on the above barriers can promote the standardization of drug administration via feeding tubes. References | Related Articles | Metrics