Table of Content

10 November 2023, Volume 4 Issue 11 Previous Issue    Next Issue

Research Paper

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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 ( )   PDF (1235KB) ( )   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. References | 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 ( )   PDF (768KB) ( )   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,complex 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 ventilated 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-making ability and satisfaction of surrogate decision-makers. References | Related Articles | Metrics

Special Planning—Management and Quality Control of Critical Care

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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 ( )   PDF (911KB) ( )   Save Objective To explore and evaluate the application effectiveness of Internet of Things（IoT）blood management 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 system 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 preventive 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. References | Related Articles | Metrics

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Construction and application of a multidisciplinary team approach for extracorporeal cardiopulmonary resuscitation 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 ( )   PDF (1080KB) ( )   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 construct 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 experimental 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. References | 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 ( )   PDF (977KB) ( )   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 between arterial puncture cannula and pressure transducer,and introduced intracavitary electrogram localization technology 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 bleeding,pain score,and patient satisfaction. Results Compared to the traditional group,the first-attempt cannulation success 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 proportion 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 monitoring can effectively improve the first-attempt puncture success rate,reduce complications,and enhance patient satisfaction. It offers a safer and more efficient cannulation method. References | 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 ( )   PDF (1067KB) ( )   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：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. References | 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 ( )   PDF (963KB) ( )   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. References | Related Articles | Metrics

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Research progress on ICU discharge delays without medical causes and intervention strategy WANG Chaoping, CHEN Junxi, WANG Benjin, CHEN Hongyan, YUAN Xiaoli 2023, 4 (11):  1006-1010.  doi: 10.3761/j.issn.2096-7446.2023.11.008 Abstract ( )   PDF (894KB) ( )   Save ICU discharge delay was defined as the time between when a patient is determined to be discharge ready and when they leave the ICU. The review describes the status quo,influencing factors,adverse consequences and intervention strategies of ICU discharge delays,in order to improve the attention of domestic intensive care staff to the delay of ICU discharge,and to provide reference for related research. References | Related Articles | Metrics

Guideline and Standard

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Interpretation for group standard of intubation and maintenance of nasointestinal tube in adult patients SHI Haiyan, LIU Aihua, MA Xiao, WANG Xiang, ZHANG Lijuan, MA Yanlan 2023, 4 (11):  1011-1015.  doi: 10.3761/j.issn.2096-7446.2023.11.009 Abstract ( )   PDF (1076KB) ( )   Save The Chinese Nursing Association issued the group standard "Intubation and Maintenance of Nasoentestinal Tube in Adult Patients" in December 2021,which standardized the basic requirements,intubation,maintenance,extubation,complication prevention and management of nasoentestinal tubes in adults. This article interprets the recommendation in the standard so as to provide clinical nurses the support for the implementation of this group standard. References | Related Articles | Metrics

Emergency Care Research

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The emergency nursing of a patient with ovarian cancer and concurrent acute ischemic stroke LI Zhengrong, YANG Lin 2023, 4 (11):  1016-1018.  doi: 10.3761/j.issn.2096-7446.2023.11.010 Abstract ( )   PDF (557KB) ( )   Save This article summarized the nursing experience in managing a case of ovarian cancer patient with concurrent acute ischemic stroke. Considering the patient's atypical stroke symptoms,the need for prompt diagnosis and the initiation of thrombolytic therapy,the nurse promptly initiated rapid response team （RRT）and played a leading role in facilitating interdisciplinary collaboration. During the thrombolysis period,meticulous monitoring and management of bleeding risks were emphasized. Additionally,special attention was given to preventing ischemic events during neoadjuvant chemotherapy. The patient underwent phased rehabilitation training to promote limb recovery. With meticulous nursing care,the patient was discharged smoothly. The patient completed subsequent timely and adequate chemotherapy,and followed by scheduled surgical intervention. A 3-month follow-up assessment revealed that the patient's condition was good. References | Related Articles | Metrics

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Perioperative care of a patient with Guillain-Barré syndrome combined with bleeding gastric ulcers：a case report JIANG Yuehong, ZHU Huidi, LI Beibei, XU Qiaoying 2023, 4 (11):  1019-1021.  doi: 10.3761/j.issn.2096-7446.2023.11.011 Abstract ( )   PDF (573KB) ( )   Save To summarize the perioperative nursing experience of a patient with Guillain-Barré syndrome combined with gastric ulcer bleeding. The following nursing measures were taken to address the patient's major problems of respiratory failure and difficulty in hemostasis for recurrent bleeding from combined gastric ulcer during the progression of Guillain-Barré syndrome,including risk assessment of gastrointestinal bleeding and emergency care,monitoring and care of respiratory failure,implementation of early nutrition program and motor program aimed at neurological rehabilitation,personalized discharge instruction. After 23 days of treatment and care,the patient was successfully discharged from the hospital. He was in good condition and his weight gained 2 kg at 1-month follow-up. References | Related Articles | Metrics

Critical Care Research

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Nursing care of a patient with severe pulmonary hypertension complicated with severe heart failure undergoing lung transplantation WU Xia, ZENG Fei 2023, 4 (11):  1022-1025.  doi: 10.3761/j.issn.2096-7446.2023.11.012 Abstract ( )   PDF (722KB) ( )   Save To summarize the postoperative nursing experience of a patient with severe pulmonary hypertension and severe heart failure undergoing lung transplantation. The nursing points included early warning of left ventricular dysfunction after lung transplantation,postoperative VA-ECMO monitoring and withdrawal management,implementation of phased respiratory management and individualized exercise rehabilitation program to promote cardiopulmonary rehabilitation. At the same time,multi-model and advanced analgesia management were carried out. After multidisciplinary joint diagnosis and treatment and careful nursing,the patient recovered and was discharged 29 days after surgery. Follow-up for half a year showed that the patient was in good condition. References | Related Articles | Metrics

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Nursing care of a patient with cardiac amyloidosis undergoing the first stage daratumumab chemotherapy CHEN Xi, CHEN Hailian, HUANG Dandan 2023, 4 (11):  1026-1029.  doi: 10.3761/j.issn.2096-7446.2023.11.013 Abstract ( )   PDF (757KB) ( )   Save To summarize the nursing experience of a patient with myocardial amyloidosis accompanied by severe heart failure undergoing the first stage daratumumab chemotherapy. Since the end diastolic volume of the left ventricle had shrunk to less than 1/2 of normal,the patient had heart failure and pleural effusion before chemotherapy,so non-invasive auxiliary ventilation to treat acute heart failure,and the dynamic volume balance under strict cardiac function monitoring was the key point of nursing. Properly admixture,infusion,and adverse reactions observation of daratumumab,reasonable catheters use to reduce the risk of infection,and extracardiac symptoms management were implemented. The patient accomplished the first stage of chemotherapy,the left ventricular end-diastolic volume increased and the patient was discharged after 63 days. References | Related Articles | Metrics

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Nursing of a child with early hepatic artery embolism after liver transplantation LU Lu, LU Fangyan 2023, 4 (11):  1030-1032.  doi: 10.3761/j.issn.2096-7446.2023.11.014 Abstract ( )   PDF (624KB) ( )   Save To summarize the nursing experience of a child complicated by early hepatic artery embolism after liver transplantation. In view of the sudden hepatic artery embolism,the rapid progression of the disease,and the problems of coagulation imbalance and withdrawal symptoms that were very easy to occur during the treatment process,measures such as activating emergency plans,implementing interventional postoperative care,reasonable sedation and analgesia,providing progressive nutrition programs and continuous nursing were adopted. After 20 days of active treatment and meticulous nursing,the child's condition improved and he was successfully transferred to the general ward. The child was discharged from the hospital on the 32nd day after surgery,and he was in good condition during 2 months of followed up. References | Related Articles | Metrics

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Nursing of children with giant omphalocele complicated with intra-abdominal hypertension after secondary repair ZHU Lina, SHENG Meijun, YE Feiya, ZHENG Hong, WANG Zhiwen 2023, 4 (11):  1033-1036.  doi: 10.3761/j.issn.2096-7446.2023.11.015 Abstract ( )   PDF (729KB) ( )   Save To summarize the nursing experience of 13 children with giant omphalocele complicated with intra-abdominal hypertension after secondary repair. Due to the severe trauma of secondary repair,postoperative intra-abdominal hypertension,long-term protective mechanical ventilation,difficult sedation and analgesia,obstruction of inferior vena cava reflux,we had to face hypoxemia,renal dysfunction and other difficult problems. We adopted targeted analgesia and sedation,optimized posture management strategy guided by intra-abdominal pressure value,strengthened the monitoring and management of respiratory system,closely monitored renal function,maintained circulatory stability,fully supported nutrition,and active promoted the of rehabilitation. After close monitoring and careful nursing,all the children successfully survived the period of intra-abdominal hypertension with good prognosis and were discharged smoothly. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Summary of the best evidence of digestive tract symptom group management in patients with ovarian cancer undergoing chemotherapy MENG Yuling, XIANG Zhenzhen, FENG Jiaojiao, CHEN Yafang, ZHANG Le, FENG Suwen 2023, 4 (11):  1037-1044.  doi: 10.3761/j.issn.2096-7446.2023.11.016 Abstract ( )   PDF (1158KB) ( )   Save Objective To search,evaluate,and summarize the best evidence for the management of digestive tract symptom group in patients with ovarian cancer undergoing chemotherapy. Methods According to the "6S" model,this study systematically searched the literatures related to the management of digestive tract symptoms in patients with ovarian cancer undergoing chemotherapy in domestic and foreign databases and websites,including clinical decision-making,guidelines,expert consensuses,evidence summaries and systematic reviews. The retrieval time was from January 2013 to March 2023. Results 18 articles were included,including 2 clinical decisions,5 guidelines,4 expert consensuses,2 evidence summaries and 5 systematic reviews. Twenty-eight pieces of evidence were summarized from five aspects：management of nausea and vomiting,management of diarrhea,management of oral mucositis,management of loss of appetite and taste change,and multidisciplinary teams. Conclusion The best evidence of digestive tract symptom group management of patients with ovarian cancer undergoing chemotherapy summarized in this study can provide an evidence-based basis for clinical practice,and medical staff can make personalized nursing management plans according to the actual symptoms and needs of patients. References | Related Articles | Metrics

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Clustering and evolution analysis of health system management policy topics for major infectious disease emergencies XU Ziwei, CHENG Kangyao, CHEN Rujie, GUI Li 2023, 4 (11):  1045-1051.  doi: 10.3761/j.issn.2096-7446.2023.11.017 Abstract ( )   PDF (1620KB) ( )   Save Objective To explore the theme and evolution trend of health system management policies for major infectious disease emergencies in China,providing a basis for formulating and improving the prevention and control policies for infectious disease health systems. Methods A web crawler route to obtain policy text data related to major infectious disease emergencies from the National Health Commission,the State Council policy document library,and the Peking University Treasure website platform was been designed. The retrieval time was from January 2003 to May 2023. Use Latent Dirichlet Allocation（LDA）to conduct thematic analysis on the included data,and draw the time intensity curve. Results A total of 129 policies were included,and the optimal number of themes in the text was 11 based on consistency calculation. Finally,it can be summarized into 10 hot topics,including government command role,hospital service quality,information monitoring and warning,and graded diagnosis and treatment. According to the time intensity curve,it is divided into heat stable themes,heat increasing themes,heat decreasing themes,and transient themes. Conclusion The release of health system policies for major infectious disease emergencies has significantly increased,and it has fluctuated significantly with the occurrence of specific infectious disease events,peaking in 2003 and 2020. The guiding role of the government in the field of health in sudden major infectious disease events is constantly strengthening,while emphasizing the promotion of graded diagnosis and treatment,and the concept of building a diversified social cooperation network led by the government is gradually being amplified. Medical institutions pay more attention to the full process intervention and response system construction of major infectious disease emergencies,and emphasize the reform and innovation of smart healthcare. References | Related Articles | Metrics

Review

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Research progress on risk prediction models of aspiration in patients with enteral nutrition support therapy ZUO Juntao, YE Xianghong, LI Jiaqi, XU Yao 2023, 4 (11):  1052-1056.  doi: 10.3761/j.issn.2096-7446.2023.11.018 Abstract ( )   PDF (768KB) ( )   Save Aspiration is one of the serious complications of enteral nutrition and is the leading cause of aspiration pneumonia,the occurrence of which increases patient mortality and prolongs hospitalization,affects economic burden of family and society. This paper reviews the research progress of the risk prediction models for aspiration in patients with enteral nutrition support,and introduces the basic situation of the risk prediction model for aspiration in enteral nutrition,the comparative analysis of the prediction models,and the revelation for the future,with the aim of providing a suitable model for the clinical health care personnels to assess and predict the risk of aspiration in patients,and providing a reference basis to realize the early prevention and timely intervention of aspiration References | Related Articles | Metrics