Table of Content

10 September 2023, Volume 4 Issue 9 Previous Issue    Next Issue

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Establishment of quality evaluation indicator system of analgesia and sedation care in adult ICUs WANG Li, HE Xuehua, CHEN Xiangping, GONG Xiaoyan, ZHANG Kai, SUN Lei, SHEN Yunxia 2023, 4 (9):  773-778.  doi: 10.3761/j.issn.2096-7446.2023.09.001 Abstract ( 381 )   Save Objective To construct a quality evaluation indicator system of analgesia and sedation care in adult ICUs，and to provide a reference standard for monitoring and management of nursing quality of analgesia and sedation in adult ICUs. Methods From February to November 2022，the content and weights of quality evaluation indicators of analgesia and sedation care in adult ICUs were determined by using literature review，expert meeting method，Delphi method and analytic hierarchy method based on the three-dimensional “structure-process-outcome” quality model. Results The effective recovery rates of 2 rounds of questionnaires were 100% and 92% ，the authority coefficients were 0.87 and 0.88，the variation coefficients were 0.04～0.32 and 0～0.21，and the Kendall harmony coefficients were 0.245 and 0.260. The final quality evaluation indicator system of analgesia and sedation care in adult ICUs included 3 first-level indicators，11 second-level indicators and 45 third-level indicators. Conclusion The quality evaluation indicator system of analgesia and sedation care in adult ICUs has high Scientificity and reliability，reflects professionalism and specificity，and has a reference value on evaluating the nursing quality of analgesia and sedation in ICU. Related Articles | Metrics

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Study on the status and influencing factors of knowledge，attitude and practice of initiating do-not- resuscitate among nurses in emergency department REN Ying, DING Chuanqi, WANG Yuwei, WANG Sa, ZHANG Yuping, JIN Jingfen 2023, 4 (9):  779-784.  doi: 10.3761/j.issn.2096-7446.2023.09.002 Abstract ( 205 )   Save Objective To investigate knowledge，attitude，and practice （KAP） status of initiating do-not-resuscitate （DNR） among nurses in Chinese emergency department （ED），and analyze the related influencing factors. Methods A questionnaire survey was conducted by multi-stage sampling of ED nurses in 36 tertiary Garde A hospitals in 18 provinces（municipalities and autonomous regions） across China. The questionnaire consisted of two parts：general in- formation of the respondents and the Knowledge-Attitude-Practice Scale of Initiating DNR among emergency medical staff. Results A total of 701 valid questionnaires were returned. The scores of knowledge，attitude and practice dimensions were （42.68±6.23），（44.13±6.62） and （37.45±7.31），respectively，with a total score of （124.26±17.58）. The results of correlation analysis showed that there was a two-by-two correlation between knowledge，attitude and practice of DNR initiation among ED nurses（P<0.05）. The results of multiple linear regression analysis showed that the years of working in ED was an influencing factor of knowledge；ethnicity，years of working in ED，employment type and previous experience of DNR communication were influencing factors of attitude；ethnicity，previous experi- ence of DNR communication and the presence of DNR-related system in the department were influencing factors of practice. Conclusion ED nurses have a good level of initiating DNR knowledge and a moderate level of attitude and practice. Nursing managers and educators should establish and improve a systematic DNR education and train- ing system so as to improve the DNR clinical communication practice of ED nurses. Related Articles | Metrics

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Application of best evidence for aspiration prevention in patients with mechanical ventilation YAO Huan, FANG Jinyan, FU Rong, ZHONG Lijun, WAGN Xiaoyan, HUANG Ganying 2023, 4 (9):  785-791.  doi: 10.3761/j.issn.2096-7446.2023.09.003 Abstract ( 322 )   Save Objective To summarize and evaluate the application effects of the best evidence of aspiration pre- vention in adult patients with mechanical ventilation. Methods The best evidence for the prevention of aspiration in patients with mechanical ventilation was developed into an evidence-based practice plan by using the method of evidence-based nursing. After baseline review，obstacle factor analysis，and construction of the best evidence applica- tion strategy，the best evidence was implemented in the emergency intensive care unit of a tertiary hospital in Hangzhou from October 1 to November 20，2022. The incidence of aspiration in patients before and after evidence- based practice，the implementation rate of review indicators，and the scores of emergency intensive care unit nurses on the knowledge questionnaire of aspiration prevention and management in patients with mechanical ventilation were compared. Results Finally，23 evidences were included and 19 review indicators were formed. After evidence- based practice，the incidence of aspiration in patients with mechanical ventilation decreased from 21.43% to 6.67%，and the incidence of ventilator-associated pneumonia （VAP） decreased from 28.57% to 6.67%. Except for indicator 10 and 19，the implementation rate of the other review indicators increased to more than 90%. The score of nurses’ questionnaire on knowledge of aspiration prevention and management in patients with mechanical ventilation increased from （78.04±1.58） points to （91.04±0.98） points，and the difference was statistically significant （t=-11.879，P＜0.001）. Conclusion Applying the best evidence to clinical nursing practice is conducive to reduce the incidence of aspiration in patients with mechanical ventilation，improve the quality of clinical nursing. Related Articles | Metrics

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Risk factors of intra-abdominal hypertension in adult ICU patients：a Meta-analysis LI Zhiru, WANG Huafen, LU Fangyan, ZHENG Li, DONG Li, BAO Ruijie 2023, 4 (9):  792-798.  doi: 10.3761/j.issn.2096-7446.2023.09.004 Abstract ( 202 )   Save Objective To identify the risk factors of intra-abdominal hypertension among adult ICU patients by meta-analysis. Methods We searched databases including CNKI，Wanfang Data，VIP，CBM，Cochrane Library， PubMed，Web of Science and Embase from inception to December 2022，to collect studies on risk factors for intra- abdominal hypertension of adult ICU patients. 2 reviewers independently screened literature according to the inclusion and exclusion criteria，extracted data，and assessed the quality of included studies. Meta-analysis was conducted by RevMan 5.4. Results A total of 17 pieces of the literature involving 3 250 adult ICU patients were included. The statistically risk factors were BMI（MD=3.09），24 h fluid input（MD=0.98），mechanical ventilation（OR= 3.40），PaO2 /FiO2 （MD=-17.18），APACHEⅡ Score （MD=4.04），sepsis （OR =2.42），intestinal obstruction （OR =11.67）， abdominal surgery （OR=2.10）. Conclusion Higher BMI，larger 24 h fluid input，higher APACHEⅡ Score，lower PaO2/ FiO2，mechanical ventilation，sepsis，intestinal obstruction and abdominal surgery were independent predictors for intra-abdominal hypertension in adult ICU patients. Medical staff should dynamically assess the intra-abdominal pressure and take targeted and individualized interventions to prevent the occurrence of intra-abdominal hypertension. Related Articles | Metrics

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A Meta-analysis of risk factors for postoperative low cardiac output syndrome in patients with heart valve disease HUANG Aoli, CHEN Xia 2023, 4 (9):  798-804.  doi: 10.3761/j.issn.2096-7446.2023.09.005 Abstract ( 167 )   Save Objective To identify the risk factors for low cardiac output syndrome（LCOS） in patients with heart valve disease after surgery by meta-analysis and to provide a basis for early identification，prevention and improve- ment of low cardiac output syndrome. Methods The relevant articles about postoperative LCOS risk factors in pa- tients with heart valve disease published from inception to December 2022 were searched in CNKI，Wanfang，VIP databale，CBM database，PubMed，CINAHL，Web of Science，Embase. After evaluating the quality of the literatures，the RevMan 5.4 software was used for meta-analysis. Results A total of 11 articles were included，with a total sample size of 2 117 cases. The risk factors of postoperative patients with LCOS were underweight （OR=3.59） or overweight（OR=1.34），old age（OR=3.74），hypertension（OR=2.84）， pulmonary hypertension（WMD=27.28），preoperative cardiac dysfunction （OR=20.52），water-electrolyte disorder （OR=3.42），preoperative renal insufficiency （OR=3.00）， postoperative arrhythmia （OR=4.34），excessive intraoperative blood loss （OR=3.76） and postoperative blood loss （OR= 4.48），long cardiopulmonary bypass time（OR=1.63），long aortic cross clamp time（OR=3.18），not use of intraoperative ultrafiltration（OR=0.27）. Conclusion According to the above risk factors，medical staff can make early risk warning judgement，prevention and treatment of LCOS patients，so as to take relevant interventions to prevent or improve LCOS-related symptoms of patients. Related Articles | Metrics

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Research progress on the occurrence characteristics and the prediction of biological markers for recurrent pressure injury WANG Xiaohui, GONG Xiaoyan, CHEN Ting, CHEN Zhuoying, WANG Tingting, WANG Kaili 2023, 4 (9):  805-808.  doi: 10.3761/j.issn.2096-7446.2023.09.006 Abstract ( 169 )   Save Pressure injury is a common complication in hospitalized patients，and the recurrent pressure injury means some cured patients develop another pressure injury in the original site or other sites. In this paper，the definition，vulnerable people，common sites，risk factors，risk prediction of biological markers were reviewed to improve the awareness of recurrent pressure injury for clinical medical staff，as well as to promote the development of related research，laying a foundation for the development of risk prediction tools and prevention and treatment measures of recurrent pressure injury. Related Articles | Metrics

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Prevention for respiratory complications in a group of burn patients with inhalation injury DU Yong, CHEN Huaqing, LU Fuchang, XIA Yilan 2023, 4 (9):  809-812.  doi: 10.3761/j.issn.2096-7446.2023.09.007 Abstract ( 126 )   Save Fifteen burn patients with varying degrees of inhalation injury were treated with phased predictive care. During the shock phase，the goal of preventing airway obstruction and pulmonary edema was achieved through early establishment of artificial airways and fluid resuscitation based on hemodynamic monitoring. And we achieved the goal of maintaining airway patency through graded airway management during the stable period. During the rehabilitation period，the goal of restoring lung function and preventing atelectasis was achieved through early lung rehabilitation. By implementing comprehensive hospital infection and control management throughout the process，the goal of preventing lung infections was achieved. All 15 patients recovered and were discharged from the hospital without any complications such as respiratory obstruction，pulmonary edema，atelectasis，or severe pulmonary infection. Related Articles | Metrics

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Nursing of septic shock caused by vibrio vulnifificus infection in a patient with sea fish puncture DAI Qiaoyan, GUO Xuemei, PENG Mingxia, YANG Jiantao 2023, 4 (9):  812-815.  doi: 10.3761/j.issn.2096-7446.2023.09.008 Abstract ( 179 )   Save To summarize the nursing of septic shock caused by vibrio vulnifificus infection in a patient with sea fish puncture. In view of the patient’s special mechanism of injury，acute onset，rapid progress of the disease，critical condition and etc.，key points of nursing included early recognition and observation of vibrio vulnificus sepsis and predicted preparation of emergency treatment，fine fluid resuscitation and management to prevent septic shock， reasonable use of antibiotics to prevent infection from worsening，enhanced care of different types of infected wounds and close observation of blood circulation of the affected limb to promote wound healing and the recovery of limb function，psychological support and nutritional nursing at the same time. After 58 days of active treatment and care，the patient recovered and was discharged from the hospital. The patient was followed up for 6 months， she was in good condition，the function of the right lower limb recovered and can walk normally. Related Articles | Metrics

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Early identification and emergency care of patients with abdominal hemorrhage after cesarean section WANG Fang, GU Huimin, LOU Congyu, ZHANG Yue, XU Xiaowen, SHU Limei 2023, 4 (9):  816-819.  doi: 10.3761/j.issn.2096-7446.2023.09.009 Abstract ( 264 )   Save Abdominal hemorrhage after caesarean section is difficult to identify in the early stage. It is often found when the vital signs are unstable，which may endanger the life of the pregnant woman. This paper retrospectively summarized the experience of effective identification and emergency care of 6 cases of abdominal hemorrhage after caesarean section. Through early identification and warning of abdominal bleeding，strict monitoring of changes in the condition，timely standardized reporting of medical history，preparation for second operation， initiation of a multidisciplinary rapid response team，optimization of fluid resuscitation，maintenance of multiple organ function，and proper care for complications，all 6 patients in this group recovered and were discharged from the hospita. Related Articles | Metrics

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Nursing care of huge abdominal wall hematoma secondary to acute cerebral infarction in an aged patient CHEN Jinhua, MA Yaying, MAO Yingli, WU Xiaofei 2023, 4 (9):  819-822.  doi: 10.3761/j.issn.2096-7446.2023.09.010 Abstract ( 140 )   Save To summarize the nursing experience of huge abdominal wall hematoma secondary to acute cerebral infarction in an aged patient. Key points of care院early identification and management of huge abdominal wall hematoma；emergency perioperative nursing of intercostal artery embolization once active bleeding was found； prevention of embolic events during anticoagulation cessation and early multidisciplinary rehabilitation nursing. After 19 days of treatment and nursing，the patient was discharged stably. The patient was followed up for 1 month and he was in good condition. Related Articles | Metrics

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Emergency nursing care of a patient with severe multiple injuries complicated with traumatic diaphragmatic hernia JIANG Qi, WANG Yuwei, WANG Sa, WU Zuojia 2023, 4 (9):  823-825.  doi: 10.3761/j.issn.2096-7446.2023.09.011 Abstract ( 113 )   Save This paper summarized the nursing experience of a patient with severe multiple injuries complicated with concealed diaphragmatic hernia. In view of the characteristics of traumatic diaphragmatic hernia，such as strong concealment and lack of specificity，some measures were taken，such as the application of trauma team treatment mode led by trauma nurses，rapid identification of traumatic diaphragmatic hernia，application of limited fluid resuscitation，and timeliness management of process. After 27 days of treatment and nursing，the patient was transferred to the rehabilitation hospital in a stable condition and continued rehabilitation treatment. Related Articles | Metrics

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Nursing care of a case with congenital left ventricular aneurysm undergoing ventricular angioplasty JIN Chendi, YANG Shanfeng, YAN Chuanchuan, LIN Nan, LI Shuaini, ZHANG Zewei, ZHU Jihua 2023, 4 (9):  826-829.  doi: 10.3761/j.issn.2096-7446.2023.09.012 Abstract ( 92 )   Save To summarize the fetal-neonatal perioperative nursing experience of a case of rare left ventricular aneurysm. In view of the high risk in the fetal period，preoperative cardiac insufficiency and postoperative circulatory instability，close follow-up in the fetal period was adopted，and we improved cardiac function，prevented thrombus shedding and tumor rupture before the operation in the neonatal period. We set target blood pressure according to age characteristics after the operation，regulated body fluid balance through early volume management， did a good job in sedation and analgesia management to reduce myocardial oxygen consumption，promoted cardiopulmonary rehabilitation through phased nursing intervention，and strictly observed and prevented complications. We improved the health education and follow-up measures at the discharge stage. After 32 days of intensive care，the patient was discharged from the hospital in a stable condition. After more than 1 month of follow-up after discharge，the patient’s cardiac function recovered well. Related Articles | Metrics

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Nursing care of a patient with prolonged venous sinus thrombosis treated with anticoagulation combined with intravascular therapy XU Xiaowei, WANG Ping, HU Yanying 2023, 4 (9):  830-834.  doi: 10.3761/j.issn.2096-7446.2023.09.013 Abstract ( 93 )   Save To summarize the nursing care of a patient with prolonged venous sinus thrombosis treated with anticoagulation combined with intravascular therapy. In response to the preoperative increase in intracranial pressure，we adopted dynamic assessment and treatment of postoperative anticoagulation and bleeding risks，and nursing care of indwelling thrombolytic microcatheters in this patient，a dual track observation system，target oriented monitoring，and proper management of posture，skin，and activity during the indwelling thrombolytic microcatheters. After treatment and care，the patient recovered 9 days after thrombolysis and was discharged from the hospital. After 6 months of follow-up，there was no recurrence of venous sinus thrombosis. Related Articles | Metrics

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Nursing care of a patient with severe burn complicated with Sheehan syndrome in stress state XIA Yilan, LU Fuchang, CHEN Huaqing, XU Ting 2023, 4 (9):  834-837.  doi: 10.3761/j.issn.2096-7446.2023.09.014 Abstract ( 86 )   Save To summarize the nursing experience of a patient with severe burn complicated with Sheehan syndrome in stress state. In order to solve the problems of long duration of stress state，complex condition and difficult identification of complications in patients with extremely severe burn complicated with Sheehan syndrome， we set a reasonable target value of fluid resuscitation in shock stage to quickly and accurately correct shock and restore pituitary blood supply，set a value of blood cortisol to guide hormone replacement therapy to correct blood pressure，timely monitor the changes of body temperature and blood sodium to correct high fever，shorten the duration of stress state. We identified and deal with enteral nutritional intolerance during hospitalization，adopted sequential nutritional support methods to achieve the target feeding amount as soon as possible，and took double isolation measures to prevent drug-resistant bacteria infection. The wound healed and the patient was discharged on the 34th day after admission. We strengthened disease knowledge education and home safety education guidance before discharge，and followed up for one month. The patient recovered well. Related Articles | Metrics

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Nursing care of a patient with anastomotic thrombus after parent field transplantation and underwent another allogeneic small intestine transplantation SHAO Dongling, HUANG Xuye 2023, 4 (9):  838-841.  doi: 10.3761/j.issn.2096-7446.2023.09.015 Abstract ( 80 )   Save To summarize the postoperative nursing experience of a patient with anastomotic thrombus after parent small intestine transplantation and underwent another allogeneic small intestine transplantation. In view of the difficulty of operation,complex condition changes,critical postoperative complications and other problems,we adopted early active prevention of vascular anastomotic thrombosis,strict monitoring of acute rejection,use of immunosuppressive drug to quickly correct,implementation of isolation measures throughout the process,prevention and control of infection and other measures. After 30 days of treatment and nursing,the patient’s condition was stable and discharged from hospital. The patient was in good condition during 12 months of follow-up discharge. Related Articles | Metrics

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Investigation of current status of emergency pre-examination triage in Zhejiang general hospitals FANG Jue, WANG Yuwei, WANG Sa, ZHOU Shuaishuai, WANG Meiling, ZHOU Wen, CHEN Chen, JIN Jingfen 2023, 4 (9):  842-847.  doi: 10.3761/j.issn.2096-7446.2023.09.016 Abstract ( 185 )   Save Objective To investigate the current status and differences of emergency pre-examination triage in general hospitals in Zhejiang province，so as to provide a basis for further improving the quality and level of hospital emergency triage. Methods Cluster sampling method was used to conduct a questionnaire survey on emergency prescreening and triage in 193 secondary and above hospitals in Zhejiang Province. The survey contents included the basic situation of emergency department，the implementation status of emergency prescreening and triage and the training needs of pre-screening and triage personnel，etc. The director of emergency department or head nurse filled in the questionnaire. Zhejiang Province and municipal emergency quality control centers assisted in implementing the delivery，recovery and checking of the questionnaires，and the investigation time was from October 24，2022 to December 06，2022. Results Finally，161 hospitals were included，among which 7 were secondary hospitals without pre-examination triage. In 154 hospitals，pre-examination triage was set up，including 48 tertiary class A hospitals，39 tertiary class B hospitals，47 secondary class A hospitals and 20 secondary class B hospitals. The total number of beds in hospitals，the total number of emergency patients，the number of critical patients，pre-examination triage settings，personnel training and assessment，quality control were statistically different among different grades of hospitals（P<0.05）. 85.1% of emergency pre-examination and triage were open for 24 hours，94.2% were carried out by emergency nurses alone，93.5% adopted the 2018 edition of Zhejiang Emergency pre-examination and triage standard（Level 4），50.0% used special software equipment for pre-hospital and in-hospital linkage，and 78.6% used special electronic pre-examination and triage system for registration. 87.7% required pre- screening personnel to have emergency related work experience，76.6% to carry out uniform and standardized pre-job training，55.8% to carry out post assessment，99.4% of hospital desired to unify the standards of emergency triage in the whole province，and the demand for homogeneous training was 100% . 72.1% carried out quality control of emergency pre-examination triage，44.8% adopted hierarchical number calling，29.9% had monitoring and early warning of emergency pre-examination and doctor’s receiving time. The contents of pre-examination triage assessment varied among patients in different grade of hospitals. Conclusion Emergency pre-screening and triage standards and training needs of general hospitals in Zhejiang province are relatively uniform，and the degree of information is high. However，there is a lack of perfect access standards，training assessment and evaluation system， and the level of emergency triage in secondary hospitals is low. In the future，the pre-examination and triage system should be continuously perfected to improve the emergency service capacity of primary units. Related Articles | Metrics

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Summary of best evidence for prevention of peripheral intravenous injury in ICU adult patients LIU Shengnan, YU Chao, HUANG Fangfang, GENG Ke, ZHAO Dandan, JIANG Yunlong, ZHOU Li 2023, 4 (9):  848-854.  doi: 10.3761/j.issn.2096-7446.2023.09.017 Abstract ( 211 )   Save Objective To search the literature and use evidence-based method to evaluate and summarize evidence，providing a basis for the prevention of peripheral intravenous injury in ICU adult patients and a reference for clinical practice. Methods Systematic search was conducted in related websites and databases on all evidence about the peripheral intravenous injury management for ICU adult patients，including clinical decision-making， guidelines，consensus，randomized controlled trials and systematic reviews. The search time limit was from January， 2018 to January，2023. Two researchers evaluated the quality of the literature，extracted and summarized the evidence independently. Results Totally 15 articles were involved，including two clinical decisions，one evidence summary，one guideline，four systematic reviews，four expert consensuses，and three randomized controlled trials. 22 pieces of best evidence were summarized from 6 aspects：catheter indwelling to prevent peripheral intravenous injury，catheter maintenance to prevent peripheral intravenous injury，peripheral phlebitis prevention，drug extravasation prevention，catheter obstructions prevention，and infection prevention. Conclusion This study summarizes the current best evidence for the prevention of peripheral intravenous injury in ICU adult patients and provides an evidence-based basis for the correct use and manage of peripheral vein. Evidence is recommended to guide clinical procedures and improve safety of peripheral vein use in ICU adult patients. Related Articles | Metrics

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Research progress of early rehabilitation intervention in patients with venovenous extracorporeal membrane oxygenation XIN Chen, GAI Yubiao, GUO Xiaojing, ZHANG Meng, ZHANG Yuchen, WEI Lili 2023, 4 (9):  855-859.  doi: 10.3761/j.issn.2096-7446.2023.09.018 Abstract ( 125 )   Save With the rapid development of severe disease rehabilitation and the wide application of extracorporeal membrane oxygenation technology，researchers at home and abroad have gradually realized that early rehabilitation of patients with venovenous extracorporeal membrane oxygenation can improve respiratory function，slow down muscle atrophy，shorten hospitalization time and prevent related complications caused by long-term bed rest. This study summarized the value of early rehabilitation intervention，domestic and international progress，pre-intervention evaluation，intervention measures and post-intervention evaluation indexes of patients with venovenous extracorporeal membrane oxygenation，so as to promote the implementation of rehabilitation measures. Related Articles | Metrics

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Research progress in psychological nursing of patients with left ventricular assist device implantation ZHU Xujing, CHEN Xia, HUANG Aoli, FENG Jiehui 2023, 4 (9):  860-864.  doi: 10.3761/j.issn.2096-7446.2023.09.019 Abstract ( 119 )   Save Heart transplantation is the most effective treatment for end-stage heart failure，but it is faced with problems such as donor shortage and postoperative immune rejection. Left ventricular assist device （LVAD） has become an important treatment for patients with end-stage heart failure. Patients with LVAD often experience psychological distress such as anxiety or depression，which not only affects the quality of life of patients，but also increases the fatality rate. This paper summarizes the psychological characteristics and influencing factors of LVAD implantation patients，nursing assessment，nursing intervention plan，and evaluation methods，in order to provide reference for psychological nursing of LVAD implantation patients. Related Articles | Metrics