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Objective@#To establish an evidence-based nursing bundle to prevent pressure injury related with operation and observe the clinical application of the bundle.@*Methods@#Clinical practice guidelines, systematic reviews/Meta-analysis, and randomized controlled trials (RCT) about prevention of pressure injuries related operation were acquired by searching databases, websites, manual retrieval and retrospective review. Two researchers independently screened and evaluated the literature, and experts′ advice were combined to form the prevention bundle of pressure injury related operation. A convenient sampling method was used to select 70 patients who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University. The pre-test for the clinical application of preventing the bundle was carried out to observe the incidence of pressure injury in patients and the implementation rate of each measure.@*Results@#This study included 22 RCTs, 6 systematic reviews/Meta analysis, and 6 clinical practice guidelines. The bundle for preventing pressure injury related operation included: preoperative pressure injury risk assessment, use of decompression flat car transporter, using a pressure reducing device to relieve local pressure, protection of dressing, placing the body position reasonably, adjusting intraoperative position, maintaining normal body temperature and skin cleansing. The frequency of implementation of the four measures of "use of decompression flat car transporter" , "protection of dressing" , "adjusting intraoperative position" , and "maintaining intraoperative skin cleansing" were 0, 17.1% (12/70) , 87.1% (61/70) , 5.7% (4/70) , respectively. The remaining measures were executed at a frequency of 100%. No pressure injury occurred from the beginning of operation to 6 days after operation among 70 patients.@*Conclusions@#The prevention bundle of pressure injury related operation can effectively prevent the occurrence of pressure injury related operation. Each of the measures included in the bundle is evidence-based and the interrelations of the various care measures are more focused, comprehensive, and systematic than the clinical practice guidelines.
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Objective To ascertain the pressure ulcer prevalence among secondary and tertiary general hospitals in different areas of Guangdong Province, and describe pressure ulcer related nursing measures in hospitalized patients. Methods A cross-sectional descriptive design was used in the present study. 5 secondary and tertiary general hospitals including 25164 hospitalized patients from different regions in Guangdong Province were recruited. There were 267 pressure ulcer patients among them. Minimum Data Set (MDS) was used to measure prevention measures of hospitalized patients. Pressure ulcer patients′questionnaire was used to measure medical treatment of pressure ulcer patients. Results The overall prevalence rates of pressure ulcers in the 25 hospitals range from 0 to 3.49%, with an average of 1.26%. The prevalence rate in the secondary general hospitals was 1.8%(41/2266), which was significant higher than that of in the tertiary general hospitals(1.0%, 226/22998), χ2=13.48, P<0.01. For the hospitalized patients at risk, 42.0%(1408/3353) of patients didn′t use any systemic support surface, 45.8%(1537/3353) of patients didn′t use any local support surface. In the pressure ulcer patients, 35.2%(94/267) of patients didn′t use any systemic support surface, 14.2% (38/267)of patients didn′t use any local support surface, and 61.4%(164/267) of pressure ulcer patients didn′t use any skin care products. Conclusion The prevention measures of pressure ulcer in Guangdong province were not effective, further improvements are still required.
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Objective To investigate behaviors of nurses on pressure ulcer prevention,exploring the related factors of pressure ulcer prevention behaviors. Methods With cross-sectional survey,a self-made questionnaire of nurse′s pressure ulcer prevention behaviors was used to investigate nurses′behaviors. Results The overall score of behavior was(43.97±8.95)points,standard score from high to low were risk assessment (6.98 ± 1.69) points, incontinence care (6.66 ± 1.51) points, Health education (9.61 ± 2.50) points, position and reposition (9.21 ± 2.19) points, supporting surface (11.51 ± 3.20) points. Different department (Z=-2.379, P<0.05), job title (χ2=11.601, P<0.01), past experiences of learning pressure ulcer knowledge(Z=2.474,P<0.05),latest learning time(Z=-2.399,P<0.05),caring number of pressure ulcer patients (χ2=17.338, P<0.01) had different scores. Multiple linear regression analysis of behavior indicated that recent education time from now was the influential factor, which can explain 15.5% of the variation in prevention behavior. Conclusions Nurses′ pressure ulcer prevention behaviors need to be improved, with nurse whose recent studying time was less than one year showing better preventive behavior. Nurse′s behaviors got worse when they didn′t get education for a long time, which indicated that the frequency of training should be enhanced.
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Objective To explore and evaluate the feasibility and accuracy of applying decision tree methods to predict the risk of hospital-acquired pressure ulcers (HAPUs) in intensive care upit (ICU) patients,and provide a theoretical basis for the prevention of HAPUs in clinical practice.Methods A retrospective design was used to collect 468 patients' records,and all of the patients were hospitalized in ICUs including medical intensive care unit and coronary care unit between October 2011 and October 2013 in a 3 A grade hospital in Guangzhou.The CART algorithm was used to construct the decision tree risk prediction model.The area under the receiver operating curve (AUC),sensitivity and specificity were used to evaluate the predictive validity of the decision tree model compared with the Braden Scale.Results The decision tree model had four stratums and eleven nodes.Six classification rules and three styles of high-risk populations were screened out:(1)age ＞81;(2)age ≤81 combined with fecal incontinence;(3)age ≤81 combined with total Braden score ≤ 13 and diastolic blood pressure ＜ 60mmHg (1 mmHg=0.133 kPa).The AUC of the decision tree model was significantly higher than the Braden Score (Z=2.31,P ＜ 0.05).The sensitivity and specificity of the decision tree model (0.809 and 0.703) were higher than the Braden Score (0.777 and 0.587).Conclusions The decision tree model is an easy and feasible tool to predict the risk of HAPUs in ICU patients,and it can be used to screen high-risk populations.
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Objective To identify the risk factors associated with incontinence-associated dermatitis (IAD) in ICU patients with enteral nutrition associated diarrhea (ENAD), and to provide information for taking evidence-based preventive measures. Methods We used a case-control study to collect data. Information of the patients (n=55) and controls (n=55) were retrieved from the medical records of 2 intensive care units (ICUs). The patients with IAD and the controls without IAD were matched with age, gender and ward. Information on disease-related information, perineal environment, drug use and nutritional status were collected. Results The simple factor analysis showed that the risks of IAD were related to coronary heart disease (CHD )(χ2=3.96), composite variable for perfusion (χ2=7.33), APACHE II score (χ2=9.87), FiO2 (Z=-2.96), artificial airway (χ2=93.91), ENAD days (Z=-5.45), stool property (χ2=8.46), antibacterial drug use (χ2=5.55), steroid medicine (χ2=11.34) and enteral nutrition days(Z=-3.33), P<0.05. Logistic regression analysis showed that FiO2(P<0.05,OR=1.03, OR95%CI=1.01-1.06), APACHE Ⅱscore(P<0.05,OR=3.12, OR95%CI=1.01-9.64)and ENAD days(P<0.01,OR=1.64, OR95%CI=1.29-2.10)was independent risk factors for IAD. Conclusions The higher of FiO2, APACHE II score over 15 points and the longer of ENAD days, patients are more likely to occur IAD. Early monitoring and prevention of IAD are recommended to promote skin health.
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Objective To investigate the current status of the willingness of organ donation among floating population in Guangdong Province and explore its influence factors.Methods The questionnaire survey was conducted to investigate general information of the floating population and their willingness of organ donation,knowledge of organ donation,attitude towards organ donation and death as well as the willingness of family discussion (organ donation),etc.The correlation analysis of variables and the willingness of organ donation in floating population was conducted by Spearman rank correlation,and the multivariate analysis was conducted by multiple linear regression model.Results Among the floating population,the people who were female,from city,owned an average monthly household income per capita of RMB 4 001 -5 000 yuan,got acquaintance with the organ donors or their families,got acquaintance with accepted the organ donors or their families had higher willingness of organ donation (all in P <0.05 ).Scores of the willingness of organ donation,knowledge of organ donation,attitude towards organ donation and the willingness of family discussion were 1.95 ± 0.91 ,5.02 ±2.40,92.00 ±1 6.78 and 3.98 ±1 .28 respectively.The willingness of family discussion,knowledge of organ donation and recognition of the value of organ donation showed positive correlation with the willingness of organ donation (P <0.05-0.01 ).The cause hindering organ donation and fear of death showed negative correlation with the willingness of organ donation (all in P <0.01 ).Five variables were integrated into the multiple linear regression analysis model,including willingness of family discussion,knowledge of organ donation,recognition of the value of organ donation, cause hindering organ donation and fear of death.Conclusions The willingness of organ donation among the floating population in Guangdong Province is on or below the medium level,and its influence factors include willingness of family discussion,knowledge of organ donation,recognition of the value of organ donation,cause hindering organ donation and fear of death.
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Objective To evaluate the effects of hydrocolloid dressings with conventional care in the prevention of pressure ulcers.Methods Randomised controlled trials and quasi-randomised trials,which assessed the effects of hydrocolloid dressings in preventing pressure ulcers compared to conventional care were sought.Data were pooled using RevMan 5.0.Results 17 eligible trials were identified with a total of 1 371 study participants.Meta-analysis showed that:Compared to conventional care,conventional care and hydrocolloid dressings were effective for preventing pressure ulcers for patients at risk of pressure ulcers [RR =0.29,95％CI (0.18,0.46)] and using noninvasive positive pressure ventilator [RR=0.30,95％CI (0.18,0.52).Conclusions Hydrocolloid drcssings and conventional care can reduce the pressure ulcer incidence of patients at risk of pressure ulcer or using noninvasive positive pressure ventilator.
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Objective ToexploreamethodofusingCaspase-3smallinterferenceribonucleicacid (siRNA)in vitro to decrease the apoptosis in stable cell lines of bone marrow mesenchymal stem cell (MSC)in ordertoestablishMSCcelllineswithstableexpression.Methods VirusparticlescontainingCaspase-3siRNA were generated in 293FT cells by retroviral packaging system,then were transfected into MSC of rats. And the transfected cells were screened and cultured to get the stable MSC lines. According to the characteristics of retrovirus,the stable expression of the cell lines was identified by Western blot and real-time fluorescent quantitative PCR (RT-QPCR). The apoptosis of stable cell lines and normal MSC were detected by terminal dexynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL ) and their differences were compared.Results Comparedwiththenormalcells,thecaspase-3proteinexpressionandmRNAcontentof stable MSC lines were significantly reduced. In the same condition in vitro,the apoptosis quantity of stable MSC linessignificantlydecreasedcomparedwiththenormalcells.Conclusions StablecelllinesofMSCwithstable expression of Caspase-3 siRNA can be obtained by retroviral packaging system. The apoptosis quantity of stable MSC Lines significantly decreased compared with the normal cells.
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Objective To describe the general condition of workplace violence against emergency department nurses in five hospitals of Guangzhou;to investigate the status of the post-traumatic stress disorder in the emergency department nurses after suffering from workplace violence;to analyze the relative factors of post-traumatic stress disorder.Methods 143 emergency department nurses from 5 hospitals in Guangzhou were investigated by general information questionnaire,workplace violence questionnaire,PCLC and SSRS.The investigation data were analyzed.Results 86.7％ of emergency department nurses suffered from workplace violence during the past 1 year;the most popular style was non-physical violence.The emergency department nurses suffered from negative emotional experience,such as grievance,chagrin,low work passion,not focused spirit.The scores of PCL-C of emergency department nurses who had suffered from workplace violence were obviously higher than those who hadn't.21.8％ of the emergency department nurses who suffered from workplace violence in the past one year had certain degree of the signs of PTSD,12.1％ had obvious signs of PTSD.The influencing factors of PTSD:degree of hurt,objective support and availability of social support.Conclusions The situation of workplace violence which the emergency department nurses were faced with was more and more grave.The emergency department nurses who had suffered from workplace violence were in different degree of PTSD.The more social supports the nurses get,the better mental health status they will possess.
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Objective To explore the relationship between quality of life and acceptance of disability of colostomy patients.Methods Using convenience sampling method to investigate 111 colostomy patients.General information questionnaire,QLQ-C30 scale,QLQ-CR38 scale and Acceptance of Disability Scale were used to investigate patients' general condition,quality of life and acceptance of disability.Data was analyzed by SPSS 17.0.Results The general health condition of colostomy patients was better than reference value and the score of ADS was at an average level.There was a relationship between general health condition,functioning dimensions,symptom dimensions and acceptance of disability.Conclusions There was a close relationship between quality of life and acceptance of disability.The acceptance of disability should be improved to help patients to obtain better quality of life.