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Objective:In order to analyze the current research status of handover shift in nursing management, summarize, analyze and judge the existing literature, in order to provide reference for clinical nursing practice.Methods:Through literature review, it is planned to review the current situation, shortcomings and future development of nursing handover classes.Results:The handover process was generally divided into four stages, of which SBAR was the best practice tool for handing over key information. For the performance of handover shifts, NASR, PVNC-BR, HES and Handoff CEX were often used to evaluate the performance of shifts, and for the results of shifts, evaluations were mostly conducted at the levels of patient safety, process elements, and organizational management. At present, the use of electronic information systems, benign organizational culture and patient and family-centered clinical practice could effectively improve the efficiency and effectiveness of handover.Conclusions:The process and elements of the current shift mode are relatively complete, and the communication strategy is reasonable, but there are still many shortcomings and defects. This suggests that nursing managers should adopt scientific intervention methods and evaluation tools when paying attention to and reforming nursing handover in the future to continuously improve the quality of handover.
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Regular assessment is a key to early detect and treat delirium. However, studies showed poor compliance and accuracy of delirium assessment by nurses. Moreover, delirium was characterized by acute onset and fluctuation of cognition. Therefore, delirium was frequently unrecognized. Postoperative delirium incidence in the intensive care unit was high and associated with poor outcome. Studies demonstrate delirium was preventable. Delirium prediction models were warranted to identify high-risk critically ill patients in order to apply preventive strategies. This article was to provide an overview of postoperative delirium and review postoperative delirium prediction models for surgical patients in the intensive care unit, thereby providing reference for development, validation as well as application of models in China.
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The role of interprofessional collaboration in the health care system has been increasingly proven and has led to a shift in the way work is done in the health care industry. Following the trend of this development, interprofessional education has also been developed accordingly. As the main content of interprofessional education, inerprofessional collaboration compentence plays an important role in improving the practice level of interprofessional collaboration among medical personnel. In this paper, the research status of interprofessional collaboration compentence is summarized, and the theoretical research of interprofessional collaboration compentence and the practical research in clinical nursing are reviewed, and the thinking of interprofessional collaboration compentence of critical care nurses is put forward, in order to provide reference for the education and management of critical care clinical nurses
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Objective:To explore the clinical application of a new type of medical drainage device designed to measure the intra-abdominal pressure of ICU patients.Methods:The 65 patients with severe acute pancreatitis treated in our hospital from April to September 2018 were selected as the experimental group; the 54 patients with severe acute pancreatitis treated from October 2017 to March 2018 were selected as the control group. Patients in the control group used traditional drainage bags to measure intra-abdominal pressure, while patients in the experimental group used a new-designed medical drainage device to measure intra-abdominal pressure. Compare the cost of consumables used for the first time in the experimental group with the control group, the incidence of acupuncture injuries, the incidence of urethral leakage, the incidence of rupture of the catheter balloon, and the satisfaction of the nurses. The 32 patients admitted from January to March 2018 in the control group were measured again using a new drainage device after the abdominal pressure measurement operation was stopped in order to compare the accuracy of the two methods.Results:The per capita consumable cost of the experimental group was 5.71 yuan, 0 cases of needle stick injury, 0 case of catheter leakage, which were lower than the control group (22.36 yuan, 1 case, 7 cases), the difference was significant ( P<0.05). The nurse operation satisfaction score was 13.85±0.93, which was higher than the control group (10.00±1.05). The difference was statistically significant ( t value was -20.323, P<0.05). Conclusion:In the operation of intra-abdominal pressure measurement, the use of a new type of medical drainage device can ensure the accuracy of the measurement, reduce the cost of consumables, needle stick injuries and the incidence of urinary catheter leakage, and improve nurse operation satisfaction.
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The change of nursing management is of great significance to improve the service quality and management level of the hospital. The authors summarized the research progress of shared governance model in hospital nursing management, including the development and connotation of the model, related influencing factors, evaluation tools and application results. The authors proposed the enlightenment of participating in shared governance to China′s nursing management, as well as related problems and suggestions for its implementation, so as to provide new ideas and scientific references for the transformation of nursing management in China.
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The authors introduced the practice of shared governance in ICU nursing management. According to the standard of magnetic hospital, a shared governance committee was established to guide and motivate the clinical front-line nurses in ICU to participate in nursing affairs management and decision-making. After three years of practice, ICU nursing management mode has achieved the goal of participating in shared governance, enhancing nurses′ perception of patient safety culture and improving the level of work engagement.
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0bjective To translate and revise the Assessment of Interprofessional Team Collaboration Scale (AITCS) into Chinese, then to evaluate the reliability and validity of the Chinese version of AITCS. Methods The Chinese version of AITCS was translated from the original one, back-translated and adjusted for cultural adaptation. The reliability and validity were tested among 288 nurses, 81 physicians, 25 respiratory therapists, 10 physical therapists and 3 nutritionists from a tertiary hospital in Hangzhou using convenience sampling. Results The average of scale-level content validity index was 0.98, unanimity of scale-level content validity index was 0.84 and item-level content validity index was 0.89-1.00. Exploratory factor analysis extracted three common factors,which explained 61.427% of the total variance,and each item had high factor loading quality (>0.4). The correlations coefficients between each dimension score and the total score ranged from 0.801 to 0.898 (P<0.05),and the correlations coefficients between each dimension score ranged from 0.607 to 0.698 (P<0.05). The Cronbach α of AITCS was 0.909, split-half reliability was 0.835 and test-retest reliability was 0.763. Conclusion The Chinese version of the AITCS has been proved to be reliable and valid. It is a valuable tool for evaluating interprofessional team collaboration among the health professional providers in mainland China.
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Objective@#To evaluate the effects on reduction of peripherally inserted central catheter-related venous thrombosis by hand grip exercise.@*Methods@#A detailed search was performed to identify literature about the impact of handgrip exercise on peripherally inserted central catheter-related venous thrombosis, using the Cochrane Library and the databases of PubMed, CINAHL, Embase, CNKI, WanFang and CBM. The meta-analysis or descriptive review were performed after two authors in-dependently searching databases,extracting data and assessing quality of included studies.@*Results@#Seven RCTs were included in a total of 789 patients. Meta-analysis showed the effectiveness of handgrip exercise on reduction of peripherally inserted central catheter-related venous thrombosis (RR=0.27, 95% CI 0.17-0.42, P<0.01); and improving vein maximum velocity (WMD=6.53, 95%CI 3.34-9.73, P<0.01) and time-mean flow velocity (WMD=6.05, 95%CI 3.24-8.87, P<0.01).@*Conclusions@#Handgrip exercise can improve axillary vein blood flow parameters and reduce peripherally inserted central catheter-related venous thrombosis. Due to a small number of included studies and heterogeneity of indicators, multi-centered, high-quality RCTs with large sample size are needed in the future to assess the effect of handgrip exercise in PICC patients.
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Objective@#To investigate the effect of an information module for delirium assessment in ICU.@*Methods@#The information module for delirium assessment was designed according to the route chart of the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU) information assessment. Totally 70 nurses Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in the application of the information module. The compliance and accuracy of the delirium assessment and acceptance of nurses' assessment of information module were compared.@*Results@#The information module for delirium assessment was implanted into the clinical critical information system. The rate of compliance and accuracy of delirium assessed was 55.9%(2 728/4 877), 64.2%(231/360) before the application of information module, and 92.0%(4 360/4 740), 92.5%(333/360) after the application of information module. The difference between two groups were statistically significant (χ2=1 611.531, 85.139, P<0.01). The score of nurses′ acceptance of the input method before and after the application of information module were 69.00±4.00, 100.56±3.50, and the difference were statistically significant (t=-49.70, P<0.01).@*Conclusions@#The information module for delirium assessment can simplify the assessment process, improve nurses′ compliance and accuracy to assess delirium, optimize critical care management and worth spreading.
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Objective To evaluate the effects on reduction of peripherally inserted central catheter-related venous thrombosis by hand grip exercise. Methods A detailed search was performed to identify literature about the impact of handgrip exercise on peripherally inserted central catheter-related venous thrombosis, using the Cochrane Library and the databases of PubMed, CINAHL, Embase, CNKI, WanFang and CBM. The meta-analysis or descriptive review were performed after two authors in-dependently searching databases,extracting data and assessing quality of included studies. Results Seven RCTs were included in a total of 789 patients. Meta-analysis showed the effectiveness of handgrip exercise on reduction of peripherally inserted central catheter-related venous thrombosis ( RR=0.27, 95% CI 0.17-0.42, P＜0.01); and improving vein maximum velocity ( WMD=6.53, 95% CI 3.34-9.73, P＜0.01) and time-mean flow velocity ( WMD=6.05, 95% CI 3.24-8.87, P＜0.01). Conclusions Handgrip exercise can improve axillary vein blood flow parameters and reduce peripherally inserted central catheter-related venous thrombosis. Due to a small number of included studies and heterogeneity of indicators,multi-centered,high-quality RCTs with large sample size are needed in the future to assess the effect of handgrip exercise in PICC patients.
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Objective To investigate the effects of a multidisciplinary round electronic checklist in ICU. Methods From October 2016 to September 2017,a total of 1 172 patients were provided with a multidisciplinary round electronic checklist. Another 886 patients with routine rounds between October 2015 to September 2016 were retrospectively analyzed. The duration of mechanical ventilation and ICU stay,the rate of nosocomial infection, the percentages of catheter days(central line catheter days,artificial airway days and urinary catheter days) and clinical staffs' satisfaction with the multidisciplinary collaboration were compared. Results The duration of mechanical ventilation and ICU stay in the intervention group were 1.42(0.68,3.63)days and 3.19(2.48,5.40)days respectively,in the control group were 2.16(1.40, 4.77) days and 4.14(3.46, 6.92) days respectively. The differences between two groups were statistically significant(t=2.084, 2.247, P <0.05). The application of a multidisciplinary round electronic checklist shortened the duration of mechanical ventilation and ICU stay. The percentages of catheter days and the rate of catheter-associated urinary tract infection were 0(0/6 269),60.34%(6 269/10 389)respectively,in the control group were 0.93‰(6/6 485),67.02%(6 485/9 676)respectively.The differences between two groups were statistically significant(χ2=96.187,Fisher's exact test=0.031,P<0.05).Besides,the level of multidisciplinary collaboration in ICU was greatly improved in the intervention group, 3.03 ± 0.11 vs. 4.13 ± 0.39 (t=24.587, P < 0.05). Conclusions A multidisciplinary round electronic checklist in ICU can improve the care quality and multidisciplinary collaboration.
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For ICU patients, a structured dental assessment and recording system can effectively prevent adverse nursing events caused by tooth loss, and eliminate the potential risk of patients' safety. In addition, the structured recording system can effectively speed up nursing document input, facilitate compliance and acceptance of dental assessment improve work efficiency and quality, and eventually improve the informationization management of nursing.
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The hospital optimized the lab order administration algorithm in ICU along with full-range IT-based monitoring.The new algorithm can effectively prevent preanalytical errors and improve nurse 's satisfaction in carrying out such orders.Nurse managers should closely monitor the compliance of personal digital assistant usage and analyze the causes of error for higher compliance.With such measures, we can maximize the function to intercept potential errors of the information system, and avoid preanalytical errors ultimately.
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Objective To develop and apply an ICU orientation program based on the Miller pyramid competency model. Methods 45 new ICU nurses in 2013 and 2014 were selected as the experimental group. The experimental group was oriented by the new program,including the orientation of preceptors, workshop-centered orientation courses, checklists-precepting and comprehensive competency evaluation methods. 39 new ICU nurses in 2011 and 2012 were selected as the control group. The control group was oriented by the conventional program,including focused theory classes and traditional precepting.New nurses′ satisfaction with the orientation and the competency were analyzed before and after intervention in two groups. Results Satisfaction with the orientation, self-evaluated competency and peer-evaluated competency in the experimental group were(16.71±1.19) scores, (126.52±3.31) scores and (90.00±2.68) scores respectively,which were much better than the control group and had statistically significant difference in two groups. Conclusions The ICU new nurse orientation program based on the Miller pyramid competency model can improve the new nurses′ satisfaction with the orientation and the competency after the orientation.
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Objective To analyze the characteristic of auditory brainstem responses (ABR) evoked by chirp in normal hearing subjects .Methods Fifteen cases (30 ears) with normal hearing young people were recorded ABR by stimulation with two kinds of sounds :chirp and click .The data were compared .Results The response threshold of chirp-ABR were lower than that of click -ABR .The average difference was 8 .59 dB .At 90 dB nHL ,the wave V amplitude yield no significant difference between chirp -ABR and click-ABR .The wave V amplitude had a signifi-cant difference between chirp -ABR and click-ABR at 60 dB nHL .At 90 and 60 dB nHL ,the wave V amplitude of chirp-ABR had not a significant difference .The occurence rate was 40% for the wave I of chirp -ABR ,obvi-ously less than that of click -ABR .At 90 dB nHL ,the wave V latency of chirp -ABR was shorter than that of click-ABR .Conclusion The wave V response threshold of chirp -ABR is less than that of the click -ABR .The chirp-ABR is more advantageous than the click -ABR for assessing hearing threshold .
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Objective To investigate the correlation between plasma lysophosphatidic acid (LPA),matrix metalloproteinase 9 (MMP-9) and stability of carotid artery plaque in silent cerebral infarction (SCI).Methods According to the results of the ultrasound examination of carotid,128 patients with SCI were divided into intima-media thickness (IMT) normal group (35 cases),IMT thickening group (50 cases),stable plaque group (24 cases) and unstable plaque group (19 cases),and 40 healthy cases were selected as control group.The levels of plasma LPA and MMP-9 were determined and compared.Results The levels of plasma MMP-9 and LPA in IMT normal group,IMT thickening group,stable plaque group and unstable plaque group were higher than those in control group [(162.31 ±21.79),(219.62 ±32.51),(279.11 ±36.83),(382.43 ±41.92) μg/L vs.(96.54 ±21.34) μg/L and (1.91 ±0.42),(2.15 ±0.39),(2.69 ±0.51),(3.27 ± 0.48) μ mol/L vs.(1.69 ± 0.26) μ mol/L],and there were significant differences (P ＜ 0.01).In IMT normal group,IMT thickening group,stable plaque group and unstable plaque group,the levels of plasma MMP-9 and LPA gradually increased,and the differences among the groups were statistically significant (P ＜ 0.01).The correlation analysis showed that the levels of plasma MMP-9,LPA and IMT of carotid had positive correlation (r =0.713,P ＜ 0.01 ; r =0.679,P ＜ 0.01).Conclusion The levels of plasma MMP-9 and LPA can reflect IMT of carotid and plaque stability in some extent,which can provide the clinical basis for condition assessment,prevention and treatment of SCI patients.
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Objective To study the outcomes of two intervention strategies on the language development of young children with hearing loss greater than moderate degree by universal newborn hearing screening (UNHS) system.Methods Infants and young children,born from Jan 2002 to Dec 2007 in Shanghai and failed UNHS,were included in this study.They received audiometric evaluations at the Shanghai Children's Hearing and Speech Center.Among those diagnosed with hearing loss greater than moderate degrees,65 were intervened at 6 months and followed up subsequently.According to hearing loss degree and intervention strategies,20 of 65 were included in the hearing aid group(M_(HA)),19 was in the severe hearing aid group(S_(HA)),9 in the profound hearing aid group(P_(HA)),and 17 in the profound cochlear implamation group(P_(CI)).Other 36 were not intervened at 6 months old but followed up also.The control group was 36 normal hearing young children.The hearing losse and speech development were analyzed for statistical study.Results Between the group without intervention and the control group,between the group intervened and without intervention,statistically significant differences were noted (P＜0.05) in the average hearing threshold and the developmental scores.Between the control group and anyone group among M_(HA),S_(HA) and P_(CI),no statistically significant differences (P＞0.05) were noted in the developmental scores.For the same hearing level between the group P_(HA) and P_(CI),statistically significant differences (P＜0.05) were noted in the developmental scores.The developmental scores of P_(HA) was lower than that of P_(CI).Conclusion Early intervention is effective for infants and young children with hearing loss greater than moderate degree.Their speech development is noticeably faster than that of those without any intervention.According to hearing loss degree,it was very important for acquiring the best speech development that selected the most proper intervention mode.
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Objective To Explore of peak latency of direct cochlear never action potential in rabbet with internal auditory artery vasospasm causing ischemia .Methods Twenty rabbits, 10 each group, re-spectively group with phenylephrine ( test group ) , group with physiological saline solution ( control group );On different period of time(0,the 30th,the 60th,the 90th and the 120th minute) took record of direct co-chlear never action potential ( DCNAP) latency.Results Successfully built an animal experiment model of internal auditory artery vasospasm .The group 1 had huge difference with the group 2 ( P 0.05 ) .Conclusion Internal auditory artery vasospasm causes hearing loss .Topically use papaverine will cause certain extent protection on hearing .
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OBJECTIVE@#To evaluate the injuring and rehabilitation of lower cranial nerve after surgery of jugular foramen tumors.@*METHOD@#The lower cranial nerve functions were analyzed retrospectively in 32 cases with jugular foramen tumors in the past six years, including 12 jugular glomus, 10 schwannomas, three meningiomas, one cholesteatoma, two giant cell tumors, one fibromatosis, one chondromyxosarcoma, one adenoid cystic carcinoma and one embryonal rhabdomyosarcoma. All patients received surgical procedures. Total tumor removal was achieved in 30 cases, subtotal and partial resection were performed on one case respectively.@*RESULT@#One case was died of intracranial bleeding after surgery, the other 31 were followed-up with a period from one to six years. Normal lower nerve functions were observed in five cases and new nerve deficits were observed in eight cases. Eighteen cases with poor nerve functions before surgery experienced additional nerve injuring manifestations. Eight cases received tracheotomy in perisurgical period, in which three were transient and five went home with tubes. Twenty cases were compensated well after a short period, and six cases failed to compensate. With a long-term follow-up for these six patients, three cases had well functional rehabilitation, two were partially compensated, and one was decompensated.@*CONCLUSION@#Lower cranial nerve dysfunction was the most common complication after jugular foramen tumor surgery. Preoperative nerve function evaluations, protection of nerve during surgery and early postoperative functional rehabilitation training were the key to better prognosis.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Cranial Nerve Injuries , Cranial Nerve Neoplasms , General Surgery , Cranial Nerves , Pathology , Jugular Veins , Pathology , Neurosurgical Procedures , Retrospective StudiesABSTRACT
OBJECTIVE@#To evaluate the clinical etiopathogenesis, the diagnose and the treatment of laryngotracheal stenosis in children.@*METHOD@#Six patients with laryngotracheal stenosis who had been surgically were reviewed.@*RESULT@#Three cases of congenital laryngeal cyst, among 2 cases were treated by undertaken endoscopic, one case was treated by laryngofissure. One case with congenital laryngeal web was treated by undertaken endoscopic with CO2 laser resection. One case with congenital tongue base cyst was treated by direct laryngoscope with puncture. One case with congenital cricoiddysplasty was treated by laryngotracheotomy with stent. One case of traumatic granuloma of trachea was treated by fence-form tracheotomy and inserting T-shape tube. Four patients were successfully decannulated, one patient was cured, one patient were followed-up.@*CONCLUSION@#The early diagnosis of laryngotracheal stenosis in children was important. The different methods of surgical used here for the laryngotracheal stenosis proved to be effective. The functions of laryngotracheal would been recovered with good voices and satisfactory airway.