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Objective:To explore the different types and characteristics of rehabilitation exercise compliance of patients with first stroke at 2 weeks of onset, and analyze its influencing factors, so as to provide reference for the formulation of targeted health education.Methods:A cross-sectional investigation was conducted in Neurology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June, 2021. 276 patients with first-episode stroke were investigated by the Questionnaire of Exercise Adherence at 2 weeks of the onset. The potential profile analysis was conducted to explore characteristics classification of the rehabilitation exercise compliance. And the chi-square test was used to compare demographic differences among different categories and ordered multi classification Logistic regression was used to explore the influencing factors of rehabilitation exercise compliance.Results:The patients were divided into 109 cases with high rehabilitation exercise compliance (39.5%), 114 cases with moderate rehabilitation exercise compliance (41.3%), and 53 cases with low rehabilitation exercise compliance (19.2%). There were statistically significant differences in education level, consciousness level at admission, complications and limb muscle strength among the three types of patients ( χ2 values were 6.17-31.50, all P<0.05). Ordered multi classification Logistic regression showed that the patient′s education level, the patient′s consciousness level at admission, whether there were complications and limb muscle strength would affect the rehabilitation exercise compliance of stroke patients ( P<0.05). Conclusions:There are three potential categories of rehabilitation exercise compliance in patients with first stroke. Patients with illiteracy, drowsiness, complications and poor limb muscle strength have poor rehabilitation exercise compliance.
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Under the background of efficiency medical reform, the authors introduced the nursing efficiency management system of a large public hospital, which was divided into two dimensions: nursing resource allocation efficiency and nursing service efficiency. The specific four measures included the establishment of multi-campus unified management organization structure based on nursing management committee, nursing performance reform based on structured big data information platform, the construction of nurse-led patient whole process management model and the accelerated rehabilitation nursing practice from surgery to the whole hospital, so as to provide reference for the nursing efficiency management of large general public hospitals under the medical reform.
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Objective:To observe the effect of evidence-based early activity training on postoperative delirium in patients with brain tumor resection.Methods:This study used non-contemporary comparison method, a total of 238 patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in 2019, were included. 121 patients who met the inclusion criteria and signed informed consent after craniotomy during January 1st,2019 to June 31th,2019 were included in the control group, and 117 patients who met the criteria and obtained informed consent after craniotomy during July 1 to December 31,2019, were included in the experimental group. Neurosurgical postoperative routine nursing care were given to the control group. The experimental group received evidence-based early activity training. The incidence of delirium, duration of delirium, Barthel Index (BI), delirium-related adverse events and other indicators of postoperative hospitalization were compared between two groups.Results:The incidence of delirium, duration of delirium and postoperative hospital stay in the experimental group were 9.5%, 2.0 (1,3) days and 7 (5,10) days, lower than 23.3%, 3.0 (1,5) days and 8 (6,11) days in control group, and the differences were statistically significant ( χ2 value was 8.17, Z value were 2.96 and -2.01, P<0.05). BI index 1 week and 1 month after discharge in the experimental group was 90 (85, 90), 100 (100, 100), higher than the control group of 90 (86, 90) and 100 (100,100), with statistically significant difference ( Z values were -2.41 and -2.46, P<0.05), the comparison of adverse events, 0 case in experimental group, 1 case in control group, there was no statistically significant difference ( χ2 value was 0.97, P>0.05). Conclusions:Early evidence-based activities in patients with brain tumor resection can reduce the incidence of postoperative delirium, shorten the duration of postoperative delirium and postoperative hospital stay, and improve the ability of patients to take care of themselves after surgery, which is safe and effective.
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With the aging of the population and the change of disease spectrum in China, the number of emergency department patients at the elderly, chronic end-stage, advanced tumor and cerebrovascular accident is increasing gradually, and the quality of life in emergency end of life patients is getting more and more attention. This paper reviews the relevant literature of "do not resuscitate" (DNR) in emergency department at home and abroad, introduces the current status of DNR application and the influencing factors of decision-making in emergency department at home and abroad, in order to provide reference for the application and practice of DNR in emergency department in China.
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Objective@#To study and analyze the risk factors of deep Venous Thrombosis of Lower limbs in patients with Orthopaedic bed rest.@*Methods@#273 cases of patients with bed rest who were treated by Orthopaedic operation from November 2015 to March 2016 and from November 2016 to March 2017 in our hospital were.collected and divided into 2 groups according to whether there were deep venous thrombosis after operation, and A group had 232 patients who did not have deep venous thrombosis of lower limbs after Operation. B Group had 41 patients who had deep venous thrombosis of lower limbs after Operation. The two groups of patients were treated with orthopedic treatment, the researchers recorded the basic data of two groups of patients, and analyzed the risk factors of lower extremity deep venous thrombosis in patients with orthopedic Bed rest.@*Results@#In group B, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μgP/L, operating time over 4 h were 54.10% (23/41), 58.54% (24/41), 75.61% (31/41), 60.98% (25/41), 58.50% (24/41), 63.41% (26 /41), 48.78% (20/41), respectively.In group A, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500ugP/L, operating time over 4 h were 24.14%(56/232), 23.28% (54/232), 13.36% (31/232), 23.28% (54/232), 21.12% (49/232), 10.78% (25/232), 9.91% (23/232), respectively, The difference between the two groups was statistically significant (χ2=3.602~11.623, all P < 0.05); Related risk factors for deep venous thrombosis in lower limbs logistic regression analysis showed that age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μg/L, operating time over 4 h were the related risk factors for deep venous thrombosis in patients with bed rest after operation.@*Conclusion@#the risk factors for deep venous thrombosis of lower limbs in the elderly patients with bed rest after orthopedic operation are mainly age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases (such as hypertension, diabetes, etc.), bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/L D-dimer ≥ 500 μg/L, operating time over 4 h, nursing staff should carry out nursing intervention according to the risk factors related to deep venous thrombosis of lower limbs to avoid the formation of deep vein thrombosis of lower limbs as far as possible.
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Objective To study and analyze the risk factors of deep Venous Thrombosis of Lower limbs in patients with Orthopaedic bed rest. Methods 273 cases of patients with bed rest who were treated by Orthopaedic operation from November 2015 to March 2016 and from November 2016 to March 2017 in our hospital were.collected and divided into 2 groups according to whether there were deep venous thrombosis after operation, and A group had 232 patients who did not have deep venous thrombosis of lower limbs after Operation. B Group had 41 patients who had deep venous thrombosis of lower limbs after Operation. The two groups of patients were treated with orthopedic treatment, the researchers recorded the basic data of two groups of patients, and analyzed the risk factors of lower extremity deep venous thrombosis in patients with orthopedic Bed rest. Results In group B, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index≥1.7 mmol/L D-dimer≥500 μgP/L, operating time over 4 h were 54.10% (23/41), 58.54% (24/41), 75.61% (31/41), 60.98% (25/41), 58.50% (24/41), 63.41% (26/41), 48.78% (20/41), respectively.In group A, patient ratio of age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/ m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index≥1.7 mmol/L D-dimer≥500ugP/L, operating time over 4 h were 24.14%(56/232), 23.28%(54/232), 13.36%(31/232), 23.28%(54/232), 21.12%(49/232), 10.78%(25/232), 9.91%(23/232), respectively, The difference between the two groups was statistically significant (χ2=3.602～11.623, all P < 0.05); Related risk factors for deep venous thrombosis in lower limbs logistic regression analysis showed that age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/ m2, with chronic diseases, bed rest for more than 5 days after operation, triglyceride index ≥ 1.7 mmol/ L D-dimer ≥ 500 μg/L, operating time over 4 h were the related risk factors for deep venous thrombosis in patients with bed rest after operation. Conclusion the risk factors for deep venous thrombosis of lower limbs in the elderly patients with bed rest after orthopedic operation are mainly age greater than 65 years old, with a body mass index (BMI) of more than 25 kg/m2, with chronic diseases (such as hypertension, diabetes, etc.), bed rest for more than 5 days after operation, triglyceride index≥1.7 mmol/L D-dimer≥500 μg/L, operating time over 4 h, nursing staff should carry out nursing intervention according to the risk factors related to deep venous thrombosis of lower limbs to avoid the formation of deep vein thrombosis of lower limbs as far as possible.
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Objective To evaluate the effect of Otago exercise program on the elderly′s falls. Methods The relevant randomized controlled trials were searched from PubMed, Web of science, Scopus,CINAHL,Chinese Biomedical Literature Database,China National Knowledge Infrastructure and Wanfang database. According to the inclusion and exclusion criteria two reviewers screened literature, extracted data and assessed the quality of included studies, using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 independently. Meta-analysis was conducted using RevMan5.3. Results Totally 16 randomized controlled trials were included. Meta-analysis showed that Otago exercise program can reduce the incidence of falls(ratio ratio was 0.85,P=0.000 6),improve falls efficacy (standardized mean number difference was 0.67, 0.43, all P<0.05), enhance elderly′ s balance (standardized mean number difference was 0.65,P<0.01)and mobility(mean number difference was-5.46, P=0.000 1),but can′t effectively reduce the incidence of falls related injury(ratio ratio was 0.98,P=0.78). Conclusions Otago exercise program is effective to improve falls efficacy, enhance balance and mobility,reduce the incidence of falls.It is suggested to promote clinical use.
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This article summarized the evidence-based nursing program of rewarming in 41 adult patients with traumatic hypothermia.According to the principle of PICO,the clinical problems were clarified.The related literatures were collected through searching the databases of Cochrane Library,EMBASE,CINAHL,PubMed,CBM,CNKI,VIP Resource Library and Wanfang Database,and were evaluated.The evidence-based nursing program of rewarming was formulated,including the establishment and implementation of rewarming standards,clinical application of rewarming,and continuous monitoring of rewarming process.A total of 41 adult patients with traumatic hypothermia were applied with evidence-based nursing program,and achieved satisfactory results.The evidence-based nursing program of rewarming improved standards of clinical nursing practice,and promoted nurses' professional capacity as well as quality of clinical specialty nursing.
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Objective To investigate nurses' scientific research competency and training demand in Chinese tertiary hospital.Methods It was a multi-stage large-scale survey.A total of 27 335 nurses from 22 provinces/autonomous regions/municipalities were recruited to complete the self-designed questionnaire,including demographic data(7 items),scientific research competency(objective index of 4 items,and subjective index of 6 subscales with 40 items),and training demand evaluation(6 subscales with 16 items).Results There were 1 130(4.14％) nurses who had managed or were managing the research projects as principal investigators(PIs),2 147(7.85％)nurses who had attended or were attending research programs,1 463(5.35％) nurses had published papers,and 557(2.04％) nurses obtained patents.The self-evaluated competency score was 25.00 (12.50,37.50)(rangedfrom 0 to 100)and training demand score was 53.13(37.50,75.00)(ranged from 0 to 100).Conclusion The nurses' scientific research competency should be improved and they had strong training demands.In order to improve nurses' research competency and quality,nursing administrators should pay more attention to post-graduate training focusing on research competency.
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Objective To establish two grade triage safety management mode in outpatient department,and to evaluate its effects of application for outpatient nursing quality management.Methods Two grade triage safety management mode was established:improving management system for two grade triage,establishing nursing position for two grade triage,improving patient triage management software and triage management scheme.The convenience sampling method was adopted to extract the two grade triage safety management model.Satisfaction of outpatients,nursing risk warning evaluation and nursing safety management were evaluated before and after the implementation of two grade triage safety management mode.Results After the implementation of two grade triage safety management mode in outpatient department,the overall satisfaction of outpatients was improved from (4.00±0.89) points to (4.67±0.37) points (P＜0.05).The overall compliance rate of nursing risk warning evaluation index showed significant increases (P＜0.05),and the qualification rate of rescue items was increased from 84.55％ to 95.91％ after the implementation.For nursing safety management program,the utilization rate of prior passages was increased from 5.22％ to 20.45％.The usage rate of self-service blood pressure measurement was increased from 1.94％ to 54.33％.The identification rate of high-risk fall patients was increased from 13.82％ to 43.36％.All differences were statistically significant (P＜0.05).Conclusion The implementation of two grade triage safety management mode is helpful to improve satisfaction of outpatients,and promote outpatient safety quality management.
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Objective To systematically evaluate the optimal dose of early enteral nutrition support in critically ill patients.Methods Systematic search database including PubMed,Web of science,Scopus,CINAHL,CBM,CNKI.RCTs about early enteral nutrition dose selections in critically ill patients were chosen according to include and exclude criteria by two researchers independently.Cochrane system evaluation manual bias risk assessment was used to evaluate quality of literature.RevMan5.3 Meta analysis software was used to analyze the data.Results A total of 1 571 literatures were retrieved and 8 RCT studies were included,2 713 subjects in total.Meta analysis results showed that there were statistically significant differences in mechanical ventilation time,incidence of diarrhea,and utilization rate of gastro dynamic drugs between trophic feeding and full feeding (P＜0.05).There were no statistically significant differences in mortality,length of stay,incidence of nosocomial infections,reflux,vomiting,constipation,etc.(P＞0.05).Conclusions Trophic feeding has familiar effects on mortality,length of hospital stay compared to full feeding,but it can help to shorten ICU mechanical ventilation time,improve the gastrointestinal tolerability.
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Objective To explore the effects of Six-Step standardized communication procedure in improving the communication ability of nurses.Methods C-I-CARE communication procedure was converted into Chinese.The Chinese version of Six-Step standardized communication procedure was Yi Kan,Er Yin,San Gaozhi,Si Wen,Wu Da,Liu Zaijian.The procedure was propagandized by making posters,setting up computer desktop,training nurses by lectures,video and role play.The effects were evaluated by pre and post self-control test among 100 nurses.Results The average score of communication behavior of 100 nurses after applying standardized communication procedure increased from 2.55±0.67 to 4.44±0.59 (t=-23.174,P＜0.001).In 2015,the nursing department received 622 silk banners and commendatory letters for appreciating nursing work,increased by 18.9％ compared to 2014.The discharged patient satisfaction increased from 94.2％ to 96.93％.The satisfaction of doctors to nurses' collaboration was 99.86％.There was no nursing complaint or dispute caused by bad communication.Conclusion The application of procedure and standardized communication method can improve the communication ability of nurses,optimize the relationship between nurses and patients and increase patient satisfaction.
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Objective Investigate the current situation of emergency nurses' perception of hospital safety climate in tertiary hospitals. MethodsA total of 866 emergency nurses from 114 hospitals in 29 provinces,municipalities and autonomous re.gions were randomly selected,and the self-designed general information questionnaire and Chinese version of the hospital safety climate scale were used to investigate. ResultsThe overall hospital safety climatel was(3.97+0.61). Univariate analysis of variance showed that there were statistically significant differences in the hospital safe.ty climate of emergency nurses with educational background and employment form (P<0.05). ConclusionThe e-mergency nurses have a better sense of the overall hospital safety climate,but the obstruction of' the safety work and the cleanliness and neatness of the. working: environment need to be improved. Therefore,il is suggested Lhal the construction of hospital safety climate should be further strengthened in the rational allocation of human re-sources and emergency working environment.
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Objective To explore the factors influencing emergency staff′ compliance with standard precautions in the tertiary hospitals, in order to provide a theoretical basis for improving the standard precautions. Methods Using qualitative research method, eight focus groups were conducted with emergency staff in the tertiary hospitals in China from October to December in 2015. Interview data were imported into Nvivo10.0 qualitative analysis software, using content analysis method for its collation and analysis. Results Factors that affect the standard precautions compliance were grouped into five themes: availability and practicality of protective equipment, organizational climate, safety awareness, obstructive elements to the behavior, and trigger elements to the behavior. Conclusions Standard precautions compliance of emergency medical staff is affected by many factors, management departments should actively build a good professional environment and reinforce safety awareness of the emergency staff.
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Objective To analyze the effect and the problems of the comprehensive application of quality management tools in order to improve nursing quality and ensure patient safety.Methods To summarize the implementation of Plan,Do,Check,Action(PDCA),quality control circle(QCC),root cause analysis(RCA),healthcare failure mode and effect analysis(HFMEA) in the nursing quality improvement.Aiming at problems arising in application process,the measures such as systematic training of quality management knowledge,case demonstration,standardized evaluation throughout the whole process,holding competition activities,inviting experts to give immediate guidance were applied.Results Among 1 798 PDCA and QCC programs,the result of 1 795 programs reached the target value,3 substandard programs reached the expected outcome finally after cause analysis,procedure break down and adjust of improvement contents.No nursing error or adverse events occurred.The indicators of nursing quality improved and patient satisfaction was 98.58％,which got the third position among all national hospitals.Conclusions The comprehensive application of four quality management tools was helpful in enhancing the effect of nursing quality improvement.
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The QCC campaign at the emergency center was themed as minimizing incidence of risky transport of critically ill patients,which aimed at continued quality improvement by means of conditions review,problem analysis,measures making,and procedure improvement.The incidence of risky transports dropped from 26％ to 0.9％ in six months.Another promising outcome was a sharp betterment of clinical nurse management. It has proved that QCC can effectively downsize risky transports of critically ill patients,making it a functional means to improve nursing quality.
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Objective To explore factors associated with emergency room(ER)length of stay and provide basis for the emergency managers about the development of relevant measures.Methods Data of critically ill patients from the emergency room in a tertiary teaching hospital from January 2010 to June 2011 were retrospectively studied.Binary Logistic regression analysis was used to determine possible factors and further compare the clinical characteristics of the patients.Results(1)From January 2010 to June 2011 a total of 11 468 patients were seen in the emergency department,the median ER length of stay was 11 h,a number of 6 525 patients(56.9％)stayed in ER more than 6 h.(2)Binary Logistic regression analysis showed that the main factors contributing to length of stay more than 6 hours were types of wards,green channel,treatment time,followed by admitted to ICU,traffic,sent by 120,the number of initial diagnosis,destinations of disposition,sex,holiday visit,visit month.While age,occupation,residence were not factors.Conclusions The patients in this hospital has a prolonged length of stay.The associated factors included types of wards,green channel,treatment time deserves a further study.
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Objective To study a quick and effective assessing method used in the emergency trauma patients in order to prevent delaying treatment for patients from overlook or misdiagnosis during triage. Method From 1 January 2006 to 31 September 2006, there were 4023 patients evaluated with trauma assessment method, which was composed of CRAMS scale and trauma assessment program. Results Of 4023 patients, there were 2430 cases with CRAMS below 1( < 7) ,of whom 1979 cases assessed with trauma assessment program were found to be injuried severely to threaten their lives. And more noticeably,of 1593 patients with CRAMS ≥7 there were 46 patients found to have life-threatening injuries assessed with trauma assessment method. Conclutions CRAMS score can be used for triage, and trauma assessment program can be used to evaluate the injuries anatomically. Trauma assessment program and CRAMS employed conjointly can increase the sensitivity and specificity for the stratification of the severity in the injuried patients in order to get a successful triage and lo take advantage of the resources of e-mergency care appropriately.