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Objective@#To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit.@*Methods@#From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients′ medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test.@*Results@#(1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ2=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ2=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ2=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ2=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ2=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ2=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01).@*Conclusions@#Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.
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Objective@#To explore the effect of intensive care on the comfort of patients after pacemaker implantation.@*Methods@#36 patients admitted from January 2016 to May 2017 were selected as routine care group, and 38 patients admitted from June 2017 to October 2018 were selected as cluster care group. Routine care was given in the postoperative routine care group, and intensive care was given in the intensive care group until the day before the postoperative discharge. The changes in comfort score, anxiety score, and lumbar and back pain score of the two groups were recorded and compared on the day before the surgery and the day before discharge.@*Results@#There were no statistically significant differences in comfort score, lumbar and back pain score and SAS score between the intensive care group and the preoperative conventional care group (all P > 0.05). Postoperative comfort score (43.71±3.29, 73.27±4.37), lumbar and back pain score (4.31±1.07, 1.56±1.04) and SAS score (53.49±6.18, 38.29±7.35) in the intensive care group were significantly better than those in the conventional care group, with statistically significant differences (t=8.478, 3.218, 6.293, all P < 0.05).@*Conclusion@#The application of bundles of care after pacemaker implantation can effectively improve patients′ body discomfort, cardiac rehabilitation effect and quality of life, which is worthy of clinical promotion.
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Objective To research the intervention effect of the ABCDE Bundle in mechanically ventilated patients. Methods A prospective randomized controlled trail (RCT) was selected 84 mechanically ventilated patients aged 22-45 years in the ICU of respiratory and severe medical center of the affiliated hospital of Logistics University of PAP from January to December in 2016. The research samples were randomly divided into intervention group (n=42) and control group (n=42). Samples were chosen to compare the difference of basic situation, ICU length of stay, 28-day hospital survival rate and the incidence of delirium between the patients of intervention group and control group. Results The average ICU hospitalization time in the intervention group was (11.76± 5.15) days, while that in the control group was (17.64 ± 8.04) days, and the difference between the 2 groups was statistically significant (t=3.99, P<0.01). The 4-week survival rate and delirium incidence rate in intervention group were 90.48％ (38/42) and 66.67％ (28/42) respectively, while those in control group were 71.43％ (30/42) and 40.48％ (17/42) respectively, and the difference between 2 groups was statistically significant (χ2=4.94, 5.79, P<0.05). Conclusion The application of bundles of care strategy could reduce the incidence of delirium and improve the clinical outcome of mechanically ventilated patients.
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Objective To observe the effect of the decontamination bundle of care for prevention of nosocomial infection after cardiac surgery. Methods Patients who underwent routine perioperative care from January 2012 to December 2013 for cardiac surgery were enrolled as the control group, while patients with bundle of care from May 2014 to April 2016 as the decontamination group. The care bundle included preoperative nasopharyngeal screening for methicillin-resistant Staphylococcus aureus (MRSA), perioperative systematic decontamination, isolation and antibiotic prophylaxis (mupirocin and glycopeptide) for MRSA carriers. The clinical data and nosocomial infection was collected and statistically analyzed. Results There were 712 cases in the control group and the incidence of nosocomial infection was 8.29% (59/712) including 4 MRSA cases. The decontamination group enrolled 791 cases with 5.56% (44/791) nosocomial infection including 2 MRSA cases. The bundles of care inhibited the nosocomial infection significantly (χ2=4.356, P<0.05), and there was a trend of decrease on MRSA infection. A total of 6 cases (0.76%) in the decontamination group were detected as MRSA colonization, but none of them got infected. Conclusions The care bundle of perioperative decontamination is useful to prevent nosocomial infection in cardiac surgery, especially to MRSA infection.
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Objective To observe the effect of the decontamination bundle of care for prevention of nosocomial infection after cardiac surgery. Methods Patients who underwent routine perioperative care from January 2012 to December 2013 for cardiac surgery were enrolled as the control group, while patients with bundle of care from May 2014 to April 2016 as the decontamination group. The care bundle included preoperative nasopharyngeal screening for methicillin-resistant Staphylococcus aureus (MRSA), perioperative systematic decontamination, isolation and antibiotic prophylaxis (mupirocin and glycopeptide) for MRSA carriers. The clinical data and nosocomial infection was collected and statistically analyzed. Results There were 712 cases in the control group and the incidence of nosocomial infection was 8.29% (59/712) including 4 MRSA cases. The decontamination group enrolled 791 cases with 5.56% (44/791) nosocomial infection including 2 MRSA cases. The bundles of care inhibited the nosocomial infection significantly (χ2=4.356, P<0.05), and there was a trend of decrease on MRSA infection. A total of 6 cases (0.76%) in the decontamination group were detected as MRSA colonization, but none of them got infected. Conclusions The care bundle of perioperative decontamination is useful to prevent nosocomial infection in cardiac surgery, especially to MRSA infection.