ABSTRACT
Objective:To explore the effect of supervised early warning nursing in the prevention of pulmonary infection in severe coma patients with tracheotomy in neurosurgery department, so as to provide reference for improving the clinical practice management level of severe coma patients in neurosurgery department.Methods:A clinical controlled trial was conducted. From March to October, 2022, 58 severe coma patients with tracheotomy and non mechanical ventilation who were admitted to the neurosurgery department of the First Affiliated Hospital of Zhejiang University School of Medicine were selected by convenient sampling method. The patients were randomly divided into control group (29 cases) and experimental group (29 cases). The control group received routine nursing. The experimental group implemented supervised early warning nursing based on routine nursing. The pulmonary infection, airway mucosal injury, sputum characteristics of the two groups were observed and compared.Results:After intervention the incidence of pulmonary infection in the experimental group was 34.5% (10/29), which was lower than 62.1% (18/29) in the control group; the incidence of airway mucosal injury in the experimental group was 10.3%(3/29), which was lower than 34.5%(10/29) in the control group. The differences were statistically significant ( χ2=4.86, 4.42, both P<0.05). After intervention, there were 4, 23, and 2 cases with sputum characteristics of Ⅰdegree, Ⅱ degree, and Ⅲ degree in the experimental group, and 2, 10, and 17 cases in the control group, respectively. The difference was statistically significant ( Z=-2.85, P<0.05). Conclusions:The application of supervised early warning nursing in airway management of severe coma patients with tracheotomy and non mechanical ventilation can effectively control the occurrence of pulmonary infection, improve sputum characteristics, which possesses important significance on the prognosis of patients.
ABSTRACT
Objective The effects of dynamic prediction table in ICU were discussed based on the theory visualization management. Methods A self-designed dynamic prediction table of critical patients is used to record the monitoring points and precautions of patient's situation, and evaluating the application effect after 6 months. Results The incidence of unclear shift, missed shift, misplaced shift and accumulated defective shift of observation group was 7.64％(11/144), 3.47％ (5/144), 3.47％ (5/144) and 14.58％(21/144), which was lower than 21.53％(31/144), 12.50％(18/144), 9.72％(14/144)and 43.75％(63/144) of control group(χ2=11.150, 7.986, 7.564, 29.647, P<0.05);nurses on the mastery condition of critically ill patients of observation group was (91.17±3.96), which was higher than(27.83±3.66)of control group(t=-4.813, P<0.01);the satisfaction of doctors with nurses of observation group was(32.22±2.71), which was higher than(23.86 ± 2.76) of control group(t=-12.98, P<0.01); the satisfaction of family members of patients with nurses of observation group was(33.77 ± 2.31), which was higher than(25.42 ± 4.43) of control group(t=-18.326,P<0.01); nurses have a good experience with the new methods. Conclusions Application of dynamic prediction table in ICU can promptly remind nurses work priorities, enhance their awareness of risk warning, strengthen the information communication of department and help to improve the quality of nursing care.