Table of Content

10 February 2024, Volume 5 Issue 2 Previous Issue    Next Issue

Research Paper

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A field study of the status and contents of nursing practice in the management of blood glucose in critically ill adults HUANG Miao, GAN Xiuni, ZHANG Chuanlai, ZHOU Wen 2024, 5 (2):  101-107.  doi: 10.3761/j.issn.2096-7446.2024.02.001 Abstract ( )   PDF (1079KB) ( )   Save Objective To understand the status and contents of current nursing practice in the management of blood glucose in critically ill adult patients in China. Methods From September 2021 to April 2022,an 8-month non-participatory observation of glucose management practice in the intensive care units of four tertiary care hospitals in Chongqing was conducted using field research. Quantitative data were collected using the ICU patient glucose management profile form and nursing staff glucose management practice record form. We repeatedly read the field notes and summarized existing nursing practices and existing problems in current blood glucose management nursing practices,further categorized and conducted in-depth analysis of the data. Results All four field observation sites had paper-based insulin infusion protocols,and the mean duration of the use of the protocols was（9±2.92） years,and the contents of the protocols differed across the fields. A total of 60 hyperglycemic patients were observed,and there were no statistically significant differences in the duration of hyperglycemia,the time required to reach target blood glucose level,and the maintenance of the target blood glucose range among patients from different field sites. The main tasks of the 12 nurses in glucose management included insulin infusion and adjustment,glucose monitoring,patient nutrition management,and hypoglycemia treatment. However,there was still a gap with the best evidence on blood glucose monitoring method,insulin use,whether nutritional support should be combined with insulin infusion,etc. Conclusion Nursing staff need to enhance their clinical decision-making skills,and further construct and implement a comprehensive and standardized practice plan for glucose management in critically ill adult patients based on the best evidence. This is a main solution to address current glucose management practice issues in the field sites. References | Related Articles | Metrics

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Development of indicators for reviewing sleep promotion strategies in ICU awake patients and analysis of barrier factors GU Tiantian, CHEN Wei, LI Xiaojuan, CHEN Junxi 2024, 5 (2):  108-114.  doi: 10.3761/j.issn.2096-7446.2024.02.002 Abstract ( )   PDF (1043KB) ( )   Save Objective To understand the current status of clinical application of the evidence on sleep promotion strategies for awake patients in ICU,analyze the barriers and facilitators,and initially formulate strategies for change,so as to provide references for the clinical translation of the evidence. Methods Through the pre-evidence summary,21 pieces of best evidence were included and 13 audit criteria with 22 audit indicators were developed for clinical audit,and based on the results of the audit,barriers and facilitators were analyzed and strategies for change were developed. Results The clinical implementation rate for the 22 audit indicators ranged from 0 to 100%,and 8 of the review entries had an implementation rate of 0 percent. The barrier factors were mainly the lack of knowledge of sleep management among ICU nurses,gaps in the relevant systems and processes in the department,and irrational settings in the ward environment,while facilitators were the good ability of the researcher and the team to translate the evidence,active support for change from the departmental administrators,the support of the hospital's policy to build a humanistic ward,and the strong willingness of the nurses in the department to accept and support the change. Conclusion There is still a large gap between the evidence of sleep promotion strategies for awake patients in ICU and clinical practice,so a comprehensive and in-depth analysis of barrier and promotion factors should be conducted to formulate scientific and reasonable change strategies,promote the translation of evidence,and provide a reference basis for clinical practice. References | Related Articles | Metrics

Special Planning—Emergency Nursing of Trauma

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Latent profile analysis and factors influencing early post-traumatic growth in young and middle-aged accidental trauma patients SU Xin, GAO Yufang, LIU Dun 2024, 5 (2):  115-120.  doi: 10.3761/j.issn.2096-7446.2024.02.003 Abstract ( )   PDF (907KB) ( )   Save Objective Based on potential profile analysis,to understand the category characteristics of post-traumatic growth level of young and middle-aged accidental trauma patients,and to explore the influencing factors of different categories of post-traumatic growth level in accidental trauma patients. Methods Through a cross-sectional study,225 young and middle-aged accidental trauma patients in the Department of Trauma Surgery of a tertiary hospital in Qingdao City from October 2022 to March 2023 were selected by convenience sampling method. A general information questionnaire and the simplified Chinese version of the Posttraumatic Growth Rating Scale were used for survey. Results The results of potential profile analysis showed that the posttraumatic growth characteristics of young and middle-aged accidental trauma patients could be categorized into four potential categories：low-growth group （1.8%）,medium-growth group （62.3%）,medium-growth-high-relationship group （32.6%）,and high-growth group（3.4%）. The results of the multiple logistic regression analysis showed that age,per capita monthly family income,payment method,and type of trauma were the influencing factors of posttraumatic growth in young and middle-aged accidental trauma patients（P<0.05）. Conclusion There is obvious heterogeneity in the level of post-traumatic growth of young and middle-aged accidental trauma patients,and it is recommended that healthcare professionals carry out interventions such as psychological counseling and appropriate information support according to the characteristics of different post-traumatic growth categories in patients in order to improve the level of post-traumatic growth of patients. References | Related Articles | Metrics

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Postoperative nursing care of a patient with multiple rib fractures combined descending aorta rupture bleeding and traumatic wet lung YU Na 2024, 5 (2):  121-124.  doi: 10.3761/j.issn.2096-7446.2024.02.004 Abstract ( )   PDF (976KB) ( )   Save This article summarized the nursing experience of a patient with multiple rib fractures combined with descending aorta rupture bleeding and traumatic wet lung. Nursing points included early identification of the risk of rebleeding,active prevention of pulmonary complications,implementation of phased exercise to prevent deep vein thrombosis,refined nutritional care and personalized psychological care. By implementing multi-level intervention measures,the prognosis of patients was improved and he was discharged 10 days after surgery. The patient was followed up for one month and recovered well. References | Related Articles | Metrics

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Perioperative nursing of a child with fireworks burn combined with abdominal blast injury ZHOU Qiongqiao, ZHU Hongmei, ZHU Jihua, ZHU Shuangping, HE Jie, CHEN Xiaoli 2024, 5 (2):  124-127.  doi: 10.3761/j.issn.2096-7446.2024.02.005 Abstract ( )   PDF (799KB) ( )   Save To summarize the perioperative nursing experience of a child with fireworks burn combined with abdominal blast injury. In view of the problems of early abdominal wound and organ continuous bleeding,postoperative abdominal infection and complications after injury,we adopted early rapid assessment,efficient anti-shock rescue,postoperative multi-measures combined with control of infection,and strengthening observation and symptomatic treatment of complications,personalized pain care,dynamic assessment and implementation of enteral nutrition and other nursing measures. After 36 days of treatment and nursing,the patient recovered and was discharged. References | Related Articles | Metrics

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Nursing care of a patient with severe polytraumatic entero-atmospheric fistula undergoing segmented nutrition therapy YIN Wei, QIAO Li, LIU Baochen, WU Cuili, YE Xianghong, ZHANG Li 2024, 5 (2):  128-130.  doi: 10.3761/j.issn.2096-7446.2024.02.006 Abstract ( )   PDF (549KB) ( )   Save To summarize the nursing experience of segmented nutrition therapy in a patient with severe polytrauma and entero-atmospheric fistula. In view of the difficulty of wound care around entero-atmospheric fistula,the disruption of the continuity of the digestive system,and the difficulty of nutritional support,the fistula and intestinal tube protection at the open abdomen with vacuum-assisted closure technology was adopted,combined with segmented enteral nutrition therapy and nursing of intestinal fluid reinfusion treatment. The intestinal fluid from the fistula was drained smoothly,and abdominal wall defect healed well in the later period,the enteral nutrition support reached the target amount. After 60-day hospitalization,the patient finally recovered and was discharged. References | Related Articles | Metrics

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Risk factors of hypothermia in emergency trauma patients：a meta-analysis JING Chenyang, GUO Yue, FAN Luo, JI Li, WANG Tuohong, HE Guobao 2024, 5 (2):  131-137.  doi: 10.3761/j.issn.2096-7446.2024.02.007 Abstract ( )   PDF (1337KB) ( )   Save Objective To clarify the risk factors of hypothermia in emergency trauma patients by meta-analysis. Methods The cohort studies and case-control studies on the risk factors of hypothermia in the trauma patients were searched by computer in CNKI,VIP,WanFang data,CBM,PubMed,Web of Science,Embase,and Cochrane Library. The search time was from the inception of databases until July 2023. After independent literature screening,data extraction,and quality evaluation by two researchers,RevMan 5.4.1 was used for meta-analysis. Results A total of 10 articles were included,including 8 risk factors：systolic blood pressure（OR=0.99）,Revised Trauma Score（RTS）（OR=0.60）,Injury Severe Score（ISS）（OR=1.02）,patients lying on the ground when the ambulance arrived（OR=8.22）,temperature（OR=0.95）,winter（OR=2.20）,warm measures during transport（OR=0.25）and pre-hospital intubation（OR=6.41）. Conclusion Systolic blood pressure,RTS,ISS,lying on the ground when the ambulance arrives,air temperature,winter,keeping warm during transport and pre-hospital intubation are the influencing factors of hypothermia in emergency trauma patients. It is suggested that nurses can rely on the influencing factors,take targeted preventive measures to reduce the incidence of hypothermia,thereby reducing the risk of death in trauma patients. References | Related Articles | Metrics

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Research progress on triage of emergency elderly trauma patients CHEN Chen, WAGN Mingming, WANG Min 2024, 5 (2):  137-141.  doi: 10.3761/j.issn.2096-7446.2024.02.008 Abstract ( )   PDF (919KB) ( )   Save With the aging population,the incidence and mortality rate of elderly trauma patients are increasing,and trauma has become the fifth leading cause of abnormal death in the elderly population. Pre-examination triage is the first line of defense for evaluating trauma patients,which prioritizes and grades the severity of the patient's condition. This article elaborates on the age definition,triage criteria and assessment indicators,analyzes the relevant factors affecting the triage,and proposes future prospects,hoping to further establish and improve triage criteria for emergency elderly trauma patients. References | Related Articles | Metrics

Guideline and Standard

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Interpretation of the 2022 edition of the European Respiratory Society clinical practice guidelines：high-flow nasal cannula in acute respiratory failure JIN Jingfen, DING Chuanqi, XU Jianfeng, CHENG Shouzhen, LOU Jian, HUANG Tiancha 2024, 5 (2):  142-146.  doi: 10.3761/j.issn.2096-7446.2024.02.009 Abstract ( )   PDF (900KB) ( )   Save The European Respiratory Society published the“ERS clinical practice guidelines：high-flow nasal cannula in acute respiratory failure” in 2022. These guidelines aim to provide precise guidance for oxygen therapy in four different scenarios：acute hypoxemic respiratory failure,post-extubation in surgical patients,post-extubation in non-surgical patients,and hypercapnic respiratory failure. The guidelines covers eight topics,each with corresponding recommendations. Although the methodology for developing the guidelines is very systematic and rigorous,it should be noted that the current level of clinical evidence is not very high. This may require more research to further support the effectiveness of these recommendations. Nevertheless,the guidelines help healthcare professionals to better implement oxygen therapy for patients with acute respiratory failure. References | Related Articles | Metrics

Emengency Care Research

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Nursing care of a patient infected with novel Bunyavirus caused by cat bites WANG Deng, ZENG Fei 2024, 5 (2):  147-149.  doi: 10.3761/j.issn.2096-7446.2024.02.010 Abstract ( )   PDF (574KB) ( )   Save To summarize the nursing experience of a case of novel Bunyavirus infection caused by cat bites. Nursing points included identification of novel Bunyavirus by atypical wounds,establishment of leukocyte early warning mechanism,traditional Chinese medicine means to treat refractory vomiting,implementation of closed-loop infection control process,the prevention of post-traumatic syndrome. The patient was hospitalized for 7 days and discharged with good recovery. References | Related Articles | Metrics

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Nursing of children with acute liver failure caused by neuroblastoma amplified sequence gene mutations ZHOU Hongqin, ZHU Jihua, CHEN Xiuping, LOU Xiaofang, FU Cangcang, SHAN Xiaomin 2024, 5 (2):  150-153.  doi: 10.3761/j.issn.2096-7446.2024.02.011 Abstract ( )   PDF (772KB) ( )   Save To summarize the nursing experience of 3 children with acute liver failure caused by neuroblastoma amplified sequence gene mutations. In view of the problems of hepatic encephalopathy caused by hyperammonemia,high fever and increased catabolism caused by infection,and post-discharge care in this group of children,we adopted strict monitoring of awareness to evaluate the development of hepatic encephalopathy,and appropriate blood purification methods in a timely manner to quickly lower blood ammonia;prevention and control of infection,especially body temperature management;strengthening nutritional support;regular follow-up to avoid recurrence of acute liver failure. After rapid treatment and careful care,the three children were discharged from the hospital in stable condition and recovered well during 3 months of follow-up after discharge. References | Related Articles | Metrics

Critical Care Research

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Nursing care of a patient with malignant hyperthermia after correction of idiopathic scoliosis REN Ershuai, ZENG Fei, LIANG Jiangshuyuan 2024, 5 (2):  153-155.  doi: 10.3761/j.issn.2096-7446.2024.02.012 Abstract ( )   PDF (521KB) ( )   Save To summarize the nursing experience of one case of idiopathic scoliosis complicated with malignant hyperthermia after operation. It aimed at the problems of how to recognize and treat malignant hyperthermia,how to manage body temperature and end-expiratory carbon dioxide partial pressure,how to use dantrolene sodium correctly and avoid the development of rhabdomyolysis. We controlled body temperature as early as possible,continuously monitored core body temperature and end-expiratory carbon dioxide pressure,used dantrolene sodium rationally,monitored creatine kinase and implemented alkalization of urine and other measures. After 11 days of treatment and nursing,the patients were successfully removed from the ventilator and transferred back to the ward for treatment. He was discharged successfully 20 days after the operation. He was followed up for 3 months after discharge and his condition was good. References | Related Articles | Metrics

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Perioperative care of a patient with simultaneous multiple primary carcinoma of the hypopharynx-esophagus with third-degree laryngeal obstruction SUN Chunrong, ZHANG Ping, WEI Jianhua 2024, 5 (2):  156-158.  doi: 10.3761/j.issn.2096-7446.2024.02.013 Abstract ( )   PDF (556KB) ( )   Save We summarized the perioperative care experience of a patient with simultaneous hypopharyngeal-esophageal multiple primary carcinoma with third-degree laryngeal obstruction. Aiming at the patient's high risk of airway obstruction,rapid disease progression,pulmonary infection,poor general nutritional status,and weakened motor function,measures such as early warning and emergency management of airway obstruction risk,phased implementation of lung protective strategies,goal-oriented preoperative prehabilitation nutritional management,and low load and small intensity individualized antiobstruction exercises were taken to improve weakness and promote patient recovery. After 34 d of active treatment and care,the patient was discharged in a stable condition,and the patient was in good condition at 1-month follow-up after discharge. References | Related Articles | Metrics

Quality and Safety

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Study on the stability management of calcium ion levels in patients undergoing continuous renal replacement therapy with regional citrate anticoagulation DAI Zhenjuan, XU Shenting, ZHOU Jianying, CHEN Jianqin, XUE Fangying, WANG Xuemin, SUN Shifan 2024, 5 (2):  159-164.  doi: 10.3761/j.issn.2096-7446.2024.02.014 Abstract ( )   PDF (922KB) ( )   Save Objective To explore the application of software-hardware-environment-liveware（SHEL） mode in the stability management of calcium ion levels in continuous renal replacement therapy（CRRT） with regional citrate anticoagulation（RCA）. Methods Through preliminary baseline surveys,the SHEL model was applied to analyze the causes,formulate countermeasures,control processes,and evaluate the effectiveness of calcium ion management in the implementation of the digital model for calcium ion and citric acid requirements. Using the convenience sampling method,84 patients who underwent RCA-CRRT in the intensive care unit from July to December 2022 were selected as the experimental group,and 84 patients who underwent RCA-CRRT in the intensive care unit from January to June 2022 were selected as the control group. After treatment,the blood iCa2+ levels,accuracy of sampling sites of radial artery catheters,accuracy of individual venous calcium supplementation pathways,timely adjustment of calcium and citrate parameters,unplanned downturns,and specialized nurses' satisfaction were compared. Results The results showed that there was no statistically significant difference in the blood iCa2+ levels of the experimental group at 2,4,8,and 12 hours after treatment（P=0.534）,there was a statistical difference in the blood iCa2+ levels of the control group at 2,4,8,and 12 hours after treatment（P=0.001）. The probability of unplanned downturns in the experimental group was 9.5%,lower than 10.7% in the control group,but there is no statistically significance（P=0.798）. The accuracy rate of the radial artery catheter sampling sites in the experimental group was 97.6%,higher than 81.0% in the control group. The correct rate of calcium supplementation through individual venous access was 96.4%,higher than 86.9% in the control group. The timely adjustment rate of calcium and citric acid parameters was 95.2%,higher than72.6% in the control group. All had statistical significance（P<0.05）. The satisfaction of specialist nurses increased by15.03% compared to the control group,and the role of SHEL mode in calcium management in RCA-CRRT treatment was affirmed（P<0.001）. Conclusion The use of SHEL mode can improve the calcium ion stability in continuous renal replacement therapy with local citrate anticoagulation,and increase the satisfaction of specialized nurses. References | Related Articles | Metrics

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Development and reliability and validity testing of the ICU Missed Nursing Care Survey LIU Yu'an, LI Lezhi, WANG Huiping 2024, 5 (2):  165-171.  doi: 10.3761/j.issn.2096-7446.2024.02.015 Abstract ( )   PDF (1041KB) ( )   Save Objective To develop the ICU Missed Nursing Care Survey （MNC-ICU survey）,and test the validity and reliability. Methods The development of this survey was based on Missed Nursing Care Model,the draft scale was formulated by referring literature,the results of qualitative interview and expert consultation. 219 ICU nurses from a tertiary hospital in Hunan Province were investigated with the survey during September to October in 2021,and the reliability and validity of the scale were analyzed. 203 ICU nurses from 3 hospitals in Hunan Province were surveyed during November 2021 to January 2022,and the data was used for confirmatory factor analysis. Results The MNC-ICU survey included two parts,the missed nursing care in ICU（part A） and the reasons for missed nursing care in ICU（part B）. Part A included 37 items,which is not suitable for dividing dimensions. Part B included 25 items,which is divided into 5 dimensions：absolute shortage of nursing staff,relative shortage of nursing staff,material resources factor,communication and cooperation factor and organizational management factor. Through the exploratory factor analysis,5 common factors were extracted,which could explain 66.938% of the total variation. The confirmatory factor analysis showed that the model fit of part B of the scale was good（χ2/df=2.029,RMSEA=0.071,IFI=0.923,CFI=0.922）. The content validity of two parts of the survey were 0.89 and 0.84. The Cronbach's α of two parts of the survey were 0.963 and 0.964,and the Cronbach's α of each dimension of Part B was 0.708~0.904. Conclusion The MNC-ICU survey has good reliability and validity,which is suitable to evaluate the situation of missed nursing care in ICU. References | Related Articles | Metrics

Evidence Synthesis Research

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Summary of best evidence for the management of continuous renal replacement therapy in adults with acute kidney injury LIU Jialong, GUO Wenchao, TENG Jiao, QIN Hanzhi, JIN Kui, ZHANG Zhenwei, JIANG Yan 2024, 5 (2):  172-180.  doi: 10.3761/j.issn.2096-7446.2024.02.016 Abstract ( )   PDF (1300KB) ( )   Save Objective To evaluate and summarize the best evidence for the management of continuous renal replacement therapy in patients with acute kidney injury and to provide evidence for clinical practice. Methods We searched the National Institute for Health and Clinical Excellence website,National Guidelines Network,American Society of Nephrology,Chinese Society of Nephrology,Cochrane Library,Joanna Briggs Institute Evidence-Based Health Care Database,Up To Date,BMJ Best Practice,PubMed,Wanfang,VIP,CNKI,and other professional societies websites and databases for relevant literature on continuous renal replacement therapy in adults with acute kidney injury. The retrieval period was from the establishment of the database to February 2023. Results A total of 15 articles were included,including 2 guidelines,5 expert consensus articles,3 systematic reviews and Meta-analyses,1 evidence summary,and 4 clinical decisions,forming 29 best evidence articles in 5 aspects：patient assessment,indications and timing,continuous renal replacement therapy program,process monitoring and complication prevention,and nutritional support. Conclusion The best evidence for continuous renal replacement therapy in adults with acute kidney injury was summarized in this study,which can provide a reference for clinical practice. The evidence should be combined with patient status and our current medical resources to develop individualized treatment plans to improve clinical outcomes for patients. References | Related Articles | Metrics

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Visualization analysis of research hotpots on post-extubation dysphagia in patients with tracheal intubation HUANG Xiaoxia, TANG Jiaying, GUO Zhiting, CHEN Yao, FENG Xiuqin 2024, 5 (2):  181-187.  doi: 10.3761/j.issn.2096-7446.2024.02.017 Abstract ( )   PDF (1393KB) ( )   Save Objective To analyze the research hotspot and development trend of post-extubation dysphagia in patients with tracheal intubation. Methods The researches on dysphagia after tracheal extubation were systematically searched from CNKI and Web of science database,and the literatures were analyzed by CiteSpace 5.8.R3 visualization software. Results A total of 119 Chinese literature and 408 English literature were included,and the number of published papers showed an increasing trend. Keyword analysis found that research hotspots mainly focused on complications,risk factors,screening and management,etc. Chinese literature formed 6 clusters,namely dysphagia,risk factors,tracheal intubation,aspiration,nutrition and swallowing evaluation. English literature included 7 clusters,namely dysphagia,airway management,management,endotracheal intubation,muscle skeletal,aspiration,cardiac surgery. Keyword emergence analysis showed that complication management and symptom evaluation were the frontiers of the research on post-extubation dysphagia. Conclusion Dysphagia after tracheal extubation is mainly focused on patients with severe disease,cardiac surgery and cervical fracture. There are differences in the research topics and types between Chinese and English literature. Nursing plays an important role in the management of dysphagia after extubation. In the future,Chinese nursing workers can learn from foreign experience to develop specific assessment tools and standardize post-extubation swallowing assessment and management procedures in order to improve the safety of oral eating and promote early recovery from oral eating. References | Related Articles | Metrics

Review

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Research progress on risk prediction models for the circuit lifespan of continuous renal replacement therapy YANG Erming, WANG Qiaohong, MAO Ya, WU Yanming, YANG Hui 2024, 5 (2):  188-192.  doi: 10.3761/j.issn.2096-7446.2024.02.018 Abstract ( )   PDF (752KB) ( )   Save Continuous renal replacement therapy is an important life support technique for critically ill patients,but the premature failure of its circuit significantly reduces the adequacy of patient treatment. This paper reviews the applicable population,predictive factors,outcome measures,prediction performance,and clinical implications of the risk prediction models for the circuit lifespan of continuous renal replacement therapy. The models have different focuses,and their generalizability needs to be validated,so healthcare professionals need to screen the applicability and prediction performance when applying them. References | Related Articles | Metrics