Table of Content

10 August 2024, Volume 5 Issue 8 Previous Issue    Next Issue

Research Paper

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Research on the status quo and influencing factors of decision conflict among family members of ICU patients QIAO Xiaoting, SUI Weijing, WANG Kaili, GONG Xiaoyan, ZHUANG Yiyu 2024, 5 (8):  677-683.  doi: 10.3761/j.issn.2096-7446.2024.08.001 Abstract ( )   PDF (1151KB) ( )   Save Objective To describe the current situation of decision conflict among family members of ICU patients and explore the risk factors. Methods Using convenience sampling method,we employed Decision Conflict Scale to investigate the 252 family members of ICU patients in the adult ICU ward of a tertiary class A hospital in Zhejiang Province from January 2022 to July 2022,and analyzed the occurrence of decision conflict. Influencing factors were analyzed by Chi-square test,independent sample t-test,rank sum test and logistic regression. Results The incidence of decision conflict in the sample population was 52.0%. Univariate analysis showed that,there were significant differences in patients‘ APACHEⅡ score within 24 hours of admission,family members‘ age,education level,marital status,family per capita monthly income,medical burden,relationship with patients,decision preparation,decision fatigue and decision style between the decision conflict group and the non-decision conflict group（P<0.05）. Multivariate analysis showed that patients‘ APACHEⅡ score within 24 hours of admission（OR=1.130,P<0.001）,family members‘ decision fatigue（OR=1.230,P=0.001） and avoidant decision style（OR=1.183,P=0.027） were risk factors for decision conflict,while their decision preparation（OR=0.967,P=0.047） and intuition-spontaneous decision style（OR=0.824,P=0.026） were protective factors. Conclusion The incidence of decision conflict among family members of ICU patients was high. High patients‘ APACHEⅡscore within 24 hours of admission,low decision preparation,high decision fatigue,high avoidant decision style and low intuition-spontaneous decision style might be the influencing factors of family members‘ decision conflict. Through improving family members‘ cognitive preparation,paying attention to their decision-making state and emotional needs,exploring the causes of avoidance behavior and clarifying their decision principles,health care providers can formulate decision conflict intervention programs that are suitable for the ICU context in China. References | Related Articles | Metrics

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The study on the current situation and influencing factors of second victim experience and support among emergency department nurses CHAI Jingjing, ZHANG Yukun, JIA Ruiying, WANG Yuwei, WANG Meiling, WANG Qiru, XU Xianghua, SHEN Lifeng 2024, 5 (8):  683-688.  doi: 10.3761/j.issn.2096-7446.2024.08.002 Abstract ( )   PDF (774KB) ( )   Save Objective To investigate the current situation of second victim experience and support among emergency department（ED） nurses based on the perspective of positive psychology,and explore the influencing factors. Methods General data questionnaire,the Second Victim Experience and Support Tool,Psychological Detachment Scale and Post Traumatic Growth Inventory were used to investigate 355 emergency department nurses from 10 tertiary general hospitals in Zhejiang province. The second victim experience and support situation were analyzed,and multiple linear regression was used to analyze influencing factors. Results In the sample population,the total scores of the Second Victim Experience and Support Tool,Post Traumatic Growth Inventory and Psychological Detachment Scale were（89.63±10.83）,（66.80±16.33） and（13.23±3.63） respectively. There were positive correlations between ED nurses‘ support,psychological detachment,and post-traumatic growth scores（r=0.275,0.434,and 0.212,all P<0.001）. In the univariate analysis,gender,education background,professional title,position,average monthly income,whether as a teacher,duration of personal influence,whether heard of the concept of the second victim were the influencing factors of the experience and support of the second victim（P<0.05）. In the multivariate analysis,gender,education background,duration of personal influence,whether heard of second victim concept,psychological detachment,and post-traumatic growth were the main factors affecting second victim experience and support among ED nurses（P<0.05）. Conclusion Emergency department nurses‘ second victim experience and support scores higher,psychological distress is serious,but the trauma growth level is higher. It is suggested that hospital should perfect support,help nurses to cultivate positive emotions,improve emergency nurses‘ professional benefits. References | Related Articles | Metrics

Special Planning—Intelligence Construction of Emergency andCritical Care

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The experience and needs of clinical alarm management among ICU medical staff：a qualitative study YANG Chunqing, LUO Duolin, GAO Ping, CHEN Hao, HE Chunlei, XU Xiaoqun 2024, 5 (8):  689-694.  doi: 10.3761/j.issn.2096-7446.2024.08.003 Abstract ( )   PDF (1216KB) ( )   Save Objective Based on the system engineering initiative to patients safety model（SEIPS）,the experience and needs of ICU medical staff in clinical alarm management were analyzed to provide reference for formulating relevant strategies of clinical alarm management. Methods A phenomenological research method was adopted to conduct semi-structured interviews with 12 ICU medical staff in a tertiary Grade A general hospital in Wenzhou from September to November 2023. Colaizzi 7-step analysis method was adopted to analyze data,summarize and extract topics,and SEIPS model was used as the analysis framework. Results Five topics were summarized,including the adverse effects of improper alarm management on both medical staff and patients,the help and hindrance of alarm for work tasks,the interaction between alarm and internal and external environment,the status quo and difficulties of alarm management at the organizational level,and the need to improve and optimize the alarm system. Conclusion Clinical alarm management is affected by multiple factors. In clinical practice,we should improve the efficiency and safety of alarm management in an all-round way by monitoring alert-related adverse events,carrying out diversified training and education,and applying intelligent tools and technologies,so as to reduce the workload of ICU medical staff and effectively ensure patient safety. References | Related Articles | Metrics

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Construction and application of analgesia pump whole-process management system led by pain specialist nurses CHEN Jie, FANG Lili, RUAN Xiaofen, YU Xiaoling, LÜ Bifang, CHEN Shuyi 2024, 5 (8):  695-700.  doi: 10.3761/j.issn.2096-7446.2024.08.004 Abstract ( )   PDF (1049KB) ( )   Save Objective To design a whole-process management system of analgesic pumps led by pain specialist nurses,and to evaluate its application effects. Methods We constructed the whole-process management system of intelligent analgesia pumps that integrated specialized nurse workstation modules and ward nurse workstation modules,led by pain specialist nurses,and with ward nurses as the main body. Meanwhile,a system trial was conducted in a tertiary Grade A general hospital from July 2021 to October 2021 to compare the differences of the inadequate analgesia rate within postoperative 24 hours,positive detection rate of adverse reactions related to analgesia,patient satisfaction,and nurse work time before and after the application of the system. Results After the application of whole-process management system of analgesic pumps,the rate of inadequate analgesia at 20：00 on the same day decreased from 12.09% to 5.9%（χ2=21.749,P<0.001),the rate of inadequate analgesia at 9:00 on the second day decreased from 20.1% to 15.1%（χ2=6.759,P=0.009）,the rate of inadequate analgesia at 16：00 on the second day had no statistically difference. The positive detection rate of analgesic related adverse reactions increased,the positive detection rate of nausea and vomiting increased from 9.2% to 31.5%（χ2=119.469,P<0.001) and the positive detection rate of dizziness increased from 3.6% to 8.1%（χ2=13.96,P<0.001). The patient satisfaction also increased from （4.90 ± 0.40） to （4.96 ± 0.25）,the average work time per day of specialized pain nurses decrea-sed from （93.85 ± 11.14） min/d to less than 20 minutes,and the average evaluation time for the analgesic pumps by ward nurses decreased from （29.72±8.80） s/time to 2 s/time,and the differences were statistically significant（P<0.05）. Conclusion Analgesia pump whole-process management system led by pain specialist nurses can not only effectively improve the quality of postoperative pain management and patient satisfaction,but also optimize the workflow and efficiency of pain management. References | Related Articles | Metrics

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Study on the construction and application of standardized terminology database for the chief complaint of patients in emergency triage CHEN Chen, YAN Danping, WANG Sa, ZHOU Shuaishuai, HUANG Chang, WANG Yuwei 2024, 5 (8):  701-705.  doi: 10.3761/j.issn.2096-7446.2024.08.005 Abstract ( )   PDF (876KB) ( )   Save Objective To establish the standardized terminology database of patient complaint and observe its application effect in emergency triage. Methods Based on the list of chief complaints in the Canadian emergency information system,the information of chief complaints in the major disease systems and the emergency triage system of our hospital in the past five years was added. According to the standard medical terminology set,the chief complaint list（chief complaint module） was determined by expert inquiry,supplemented by disease duration （sub-chief complaint module） and International Classification of Diseases（ICD） 10 diagnosis list（auxiliary chief complaint module）,the standardized chief complaint terminology database was formed. Then the standardized chief complaint terminology database was applied to the emergency triage system by jointing with information department. Emergency patients in September 2023 who were triaged using the standardized terminology database of chief complaint were selected as the experimental group,and emergency patients who were recorded in the form of routine free text in the same period of 2022 were selected as the control group. The triage time,triage coincidence rate and 72-h unplanned return rate were compared between the two groups. Results After applying the standardized terminology database of chief complaint,triage time was reduced from（327.33±44.32） seconds to （174.23±49.02） seconds,and the triage coincidence rate increased from 95.27% to 98.34%,which was statistically significant （P<0.001）. The 72-hour unplanned return rate was zero in both groups. Conclusion The application of the standardized terminology database of chief complaint to the emergency triage has played a role in promoting the standardization of chief complaint,the timeliness of triage and the efficiency of emergency care,contributing to the statistics of medical data and the quality control of triage,and improving the efficiency of emergency care. References | Related Articles | Metrics

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The construction and application of ICU intelligent electronic handover system SHUAI Qinyan, LIU Tianci, ZHANG Mei 2024, 5 (8):  706-712.  doi: 10.3761/j.issn.2096-7446.2024.08.006 Abstract ( )   PDF (1397KB) ( )   Save Objective To construct an intelligent electronic handover system for intensive care unit（ICU） and evaluate its application effects. Methods Through literature search,questionnaire survey,semi-structured interview and expert reasoning,ICU intelligent electronic handover system was constructed. The trial was carried out in the intensive care unit of a Class Ⅲ Grade A hospital in Zhejiang Province from January 1,2023 to June 30,2023. The operation effect was evaluated by comparing the time of nurses‘ preparation for shift handover,supplement rate of bedside shift handover and the shift assessment scale before and after the application of the system. Results After the application of ICU intelligent electronic handover system,the time of nurses‘ preparation for shift handover was decreased from（39.12±1.80） min to（27.26±1.29） min,there was significant difference（t=5.365,P<0.001）. Supplement rate of bedside shift handover was lower than that before the application,and the difference was statistically significant（χ2=4.481,P=0.034）. The total score of the nurses‘ shift assessment scale was significantly increased（Z=-6.343,P<0.001）,and there was no statistically significant difference in the score of the dimension of promoting patient participation before and after application（t=-1.793,P=0.075）. Conclusion The ICU intelligent electronic handover system can save the time of nurses‘ preparation for shift report,reduce the rate of bedside shift handover supplement,improve the efficiency and quality of nurses‘ handover,and improve nurses‘ satisfaction. References | Related Articles | Metrics

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The current status and challenges of robot application in critical nursing care JIN Jin, CUI Yifan, HAN Binru, WANG Xinran 2024, 5 (8):  713-717.  doi: 10.3761/j.issn.2096-7446.2024.08.007 Abstract ( )   PDF (864KB) ( )   Save Currently,the robotics industry is booming,changing the way of human production and life,and injecting strong kinetic energy for economic and social development. The specificity of critical care nursing makes it one of the fields where robots play an important role. This paper aims to provide a reference for the intelligent construction of critical care by reviewing the current status of robots in critical care,presenting an overview of the research on robots in remote rounding,assisting in early activities,medication allocation,and emotional support,and analyzing the challenges in terms of practicality,economy and ethics,career development,and nursing talents. References | Related Articles | Metrics

Emergency Care Research

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Nursing care of a patient with severe obesity and acute respiratory distress syndrome CHEN Fang, YANG Minfei, HUANG Keer, YU Li, YAO Xiaoyue 2024, 5 (8):  718-720.  doi: 10.3761/j.issn.2096-7446.2024.08.008 Abstract ( )   PDF (598KB) ( )   Save To summarize the nursing experience of a patient with severe obesity and acute respiratory distress syndrome. The patient developed acute respiratory distress syndrome after taking online weight loss medication,which presented with difficult airway,severe oxygenation disorders,the risk of infection aggravation and malnutrition,we adopted nursing interventions,including emergency opening of difficult airway and implementation of lung ventilation protection strategy,personalized ECMO combined with prone position ventilation,implementing infection control strategy to reduce the risk of aggravation of infection,personalized nutrition supply to enhance the immune function,step-by-step exercise rehabilitation training to improve respiratory function,strengthening health education to establish healthy living habits. After active treatment and nursing,the patient was discharged smoothly on the ninth day after admission. References | Related Articles | Metrics

Critical Care Research

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Practice of family integrated perioperative care for patients with implanted left ventricular assist devices HE Xiaodi, LAN Meijuan, CHEN Yuan‘er, SHEN Hang, ZHU Xian 2024, 5 (8):  721-724.  doi: 10.3761/j.issn.2096-7446.2024.08.009 Abstract ( )   PDF (776KB) ( )   Save To summarize the perioperative care experience of 6 patients with left ventricular assist device implantation based on family integrated care. The main points of care were implemented. We formed a project team to select appropriate family caregivers to participate in preoperative state optimization and psychological support,and encourage family members to participate in ICU delirium prevention. During the discharge planning period,the focus was on the training of family caregivers,and the training content of five modules were completed in phases,including the management of mechanical assistive devices,anticoagulation management,symptom management,infection prevention and control and the management of daily life. All patients successfully completed the surgery,and family caregivers were fully involved in perioperative care and mastered the target knowledge and skills before discharge,and were satisfied with family care after discharge,with no instrument and equipment failures and other complications during the follow-up at home,and no unplanned secondary admissions. References | Related Articles | Metrics

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Nursing care of prone position ventilation in a patient with acute respiratory distress syndrome after multiple fractures ZHANG Hui, WANG Li, HE Xuehua 2024, 5 (8):  724-727.  doi: 10.3761/j.issn.2096-7446.2024.08.010 Abstract ( )   PDF (706KB) ( )   Save To summarize the nursing experience of prone position ventilation in a patient with acute respiratory distress syndrome（ARDS） after multiple fractures. In view of the patient with multiple fractures complicated with ARDS,rapid disease progression,high risk of traditional prone position and etc,key points of care included establishing a multidisciplinary team for prone position ventilation after multiple fractures,implementing a modified prone position turning process,combining the prone position with airway clearance technology to promote lung rehabilitation,providing comfort analgesia and sedation to improve the patient‘s tolerance of the prone position,and actively encouraging family members to participate in the patient‘s mental symptom management. After 7 days of treatment and care,the patient was transferred from the ICU to the general ward,recovered on the 26th day after surgery and was discharged. References | Related Articles | Metrics

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Nursing care of complications of percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy ZHOU Lili, GUO Ge, YANG Lili, WU Weier 2024, 5 (8):  728-730.  doi: 10.3761/j.issn.2096-7446.2024.08.011 Abstract ( )   PDF (564KB) ( )   Save To summarize the nursing care of 41 patients with hypertrophic obstructive cardiomyopathy treated by percutaneous intramyocardial septal radiofrequency ablation（PIMSRA）. From March 2021 to March 2022,41 patients underwent PIMSRA,and 9 patients（21.95%） developed related complications. In view of the complications of pericardial effusion,ventricular septal perforation and pleural effusion in this group of patients,close hemodynamics monitoring,rapid identification,timely and effective rescue were taken. Fine nursing was carried out in an all-round way to promote disease rehabilitation. Strengthening discharge guidance,improve patient self-management were implemented. All the 41 patients finished the operation and were discharged after careful treatment and nursing. With one year of follow-up,the New York‘s heart function grade was evaluated,97.56% of patients were grade 1 or 2. References | Related Articles | Metrics

Quality and Safety

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Construction and application of risk evaluation index system of nursing interruptions in medication process DONG Xiaoqian, DING Siqing, CAO Huan, WANG Xingxing, GAN Gang, LIU Min, XIE Jianfei, WANG Sha, ZHENG Shuji 2024, 5 (8):  731-736.  doi: 10.3761/j.issn.2096-7446.2024.08.012 Abstract ( )   PDF (843KB) ( )   Save Objective To construct and apply the risk evaluation index system of nursing interruptions in medication process. Methods From January to October 2023,with "safety information flow-based accident causative conceptual model" for the theoretical framework,literature analysis,qualitative research,Delphi method and analytic hierarchy process were used to determine the contents and each index weight of risk evaluation index system for nursing interruptions in medication nursing. It was used to evaluate 440 nurses from a tertiary Class A hospital in Hunan Province. Results Effective recovery rates of two rounds of consultation were 100%,expert authority coefficients were 0.922 and 0.894,coefficient of variation were 0~0.240 and 0~0.188,and Kendall concordant coefficients were 0.151 and 0.171. Finally,6 first-level indicators,17 second-level indicators and 56 third-level indicators were determined. The Cronbach‘s α coefficient of the system was 0.746,and the average content validity index was 0.969. The rank sum test showed that the total score of nurses in different departments had no statistical significance（P>0.05）,but there were differences in management and environmental factors（P<0.05). Conclusion Reliability and validity of the risk evaluation index system for medication nursing interruptions were good. Constructed indexes are scientific,reasonable,comprehensive and professional,which can provide basis for management strategy in medication nursing. References | Related Articles | Metrics

Career Development of Nurses

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The status and influencing factors of competency of nurses in transitional intensive care units ZHANG Qiaoling, XU He 2024, 5 (8):  737-741.  doi: 10.3761/j.issn.2096-7446.2024.08.013 Abstract ( )   PDF (859KB) ( )   Save Objective To investigate the current situation of competency of nurses in transitional intensive care units and analyze the influencing factors,so as to provide basis for competency training of nurses in transitional intensive care units. Methods Using convenient sampling method,a questionnaire survey was conducted among 171 nurses in the transitional care units of four Grade 3A hospitals in Zhejiang Province from April 2023 to May 2023. Results The total average score of competency of nurses in transitional intensive care units was（7.27±1.41）,which was in the middle to high level. There were significant differences in competency scores among nurses in transitional intensive care unit with different age,professional title,post grade,working years,marital status and with or without further study（P<0.05）. Conclusion The competence of nurses in transitional intensive care units is generally at a high level,in which the score of personal trait is higher and the score of professional skills is relatively low. It is suggested that management departments should strengthen the professional skills training for nurses in transitional intensive care units. References | Related Articles | Metrics

Evidence Synthsis Research

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The safety and effectiveness of early enteral nutrition in patients with extracorporeal membrane oxygenation：a systematic review AI Shanshan, NIU Pengli, WANG Yue, XIAO Wenjun, XU Guojun 2024, 5 (8):  741-746.  doi: 10.3761/j.issn.2096-7446.2024.08.014 Abstract ( )   PDF (825KB) ( )   Save Objective To systematically evaluate the safety and effectiveness of early enteral nutrition in patients with extracorporeal membrane oxygenation（ECMO）,and to provide reference for clinical decision of early enteral nutrition in ECMO patients. Methods CNKI,WanFang Database,VIP Database,Chinese Biomedical Literature Database,Cochrane Library,PubMed,Embase,Web of Science were searched,the retrieval limit was from inception to December 30,2023. Two researchers who received evidence based training screened the literature according to the inclusion and exclusion criteria,extracted data,assessed the quality of included studies and integrated the data independently. Results Finally,11 articles were included,with a total of 2 455 patients with early enteral nutrition in ECMO patients. Early enteral nutrition in ECMO patients did not increase the incidence of gastric remnants,intestinal intolerance,and severe abdominal complications,it could achieve target feeding rates and reduce mortality. Conclusion Early enteral nutrition in ECMO patients is safe and effective,it has a positive impact on prognosis. References | Related Articles | Metrics

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Risk prediction models for enteral feeding intolerance in critically ill patients：a systematic review YANG Jin, HUANG Jingying, XU Miaomiao, QI Haiou 2024, 5 (8):  747-755.  doi: 10.3761/j.issn.2096-7446.2024.08.015 Abstract ( )   PDF (1166KB) ( )   Save Objective To systematically evaluate the prediction models of enteral feeding intolerance（EFI） in critically ill patients to provide references for subsequent model development. Methods Relative articles on the prediction models of EFI in critically ill patients were retrieved from CNKI,Wanfang,VIP,CBM,PubMed,Embase,Web of Science,Cochrane Library and CINAHL from the establishment of the databases to November 19,2023. Language limited to Chinese and English. Two researchers independently screened,extracted data,and assessed bias risk and applicability by PROBAST. Results 19 studies were included,involving 24 models with an area under the subject working characteristic curve of 0.700 ~ 0.940. The independent predictors repeatedly reported were APACHE Ⅱ score,intra-abdominal pressure and serum albumin levels. 19 studies had good applicability but high risks of bias due to existing data sources,outcome definitions incorporating the predictors,small sample size,inappropriate handling of continuous variables and missing data,incomplete univariate analysis for predictors selection,and incomplete model performance assessment. Conclusion Existing predictive models for EFI in critically ill patients are still in the initial stage,as they have methodological defects. Future research should incorporate more sensitive and reproducible indicators for evaluating gastrointestinal dysfunction and follow the TRIPOD guidelines for reporting the results. References | Related Articles | Metrics

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Evidence summary of assessment and management for perioperative spinal cord injury in adult patients with aortic dissection LI Ce, WANG Yini, WANG Huan, WU Rong 2024, 5 (8):  756-763.  doi: 10.3761/j.issn.2096-7446.2024.08.016 Abstract ( )   PDF (1057KB) ( )   Save Objective To summarize the best evidence on assessment and management of perioperative spinal cord injury in adult patients with aortic dissection. Methods We searched guidelines,expert consensuses,system reviews and original studies from relevant guidance databases,professional associations and databases according to evidence pyramid “6s” Model. The search limit was from database establishment to January 31,2023. Two researchers conducted quality evaluation,extraction,and integration of the literature. Results Twenty articles were included,including 6 guidelines,6 expert consensuses,4 systematic reviews,and 4 original studies. Twenty-seven items of evidence were summarized from five dimensions,including risks assessment,spinal cord monitoring,prevention management,nursing of paraplegia and others. Conclusion Most evidence is from foreign studies and need to be further transformed into localized evidence. High-quality original studies are needed to rich the evidence and guide best practice. References | Related Articles | Metrics

Review

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Research progress on health-related quality of life in adult survivors of extracorporeal membrane oxygenation ZHANG Qiuyang, YU Shaoyun, PANG Xiangying, XIA Hua, ZHAO Xuehong 2024, 5 (8):  764-768.  doi: 10.3761/j.issn.2096-7446.2024.08.017 Abstract ( )   PDF (723KB) ( )   Save Health-related quality of life refers to the extent to which an individual‘s usual or desired physical,mental,and social well-being is affected by an illness or its treatment. This paper reviews the research benefits,assessment tools,current status and key nursing points of health-related quality of life in adult extracorporeal membrane oxygenation survivors,and proposes that healthcare professionals should concern the influence of in-hospital traumatic experience,out-of-hospital adverse symptoms and psychosocial problems on survivors,and make full use of supportive resources such as the family or develop personalized nursing plans. Health-related quality of life is an important prognostic indicator for survivors,but specific assessment tools and interventions need to be further improved. References | Related Articles | Metrics