ABSTRACT
BACKGROUND: Severe craniocerebral injury (STBI) is a critical physical trauma caused by a sudden external force acting on the head. The condition is complex and changeable, and disability and mortality rates are high. Although the life of STBI patients can be saved through treatment, the sequelae of consciousness, speech, cognitive impairment, stiffness, spasm, pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family. In the past, routine nursing was often used to treat/manage STBI; however, problems, such as improper cooperation and untimely communication, reduced therapeutic effectiveness. AIM: To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI. METHODS: From January 2019 to December 2020, 126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center. These patients were retrospectively selected as the research participants in the current study. The study participants were then divided into a control group (61 cases) and a study group (65 cases). The control group was treated with routine nursing. The study group adopted the proposed care bundle. The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale (GCS) were used to evaluate neurological function before and after emergency treatment. After 3 mo of rehabilitation, experimental outcomes were assessed. These included the GCS, Barthel Index, complication rate, muscle strength grade and satisfaction. RESULTS: There was no significant difference in gender, age, cause of injury and GCS between the two groups. After emergency, the National Institutes of Health Stroke Scale/Score of the study group (10.23 ± 3.26) was lower than that of the control group (14.79 ± 3.14). The GCS score of the study group (12.48 ± 2.38) was higher than that of the control group (9.32 ± 2.01). The arrival time of consultation in the study group was 20.56 ± 19.12, and the retention time in the emergency room was 45.12 ± 10.21, which were significantly shorter than those in the control group. After 3 mo of rehabilitation management, the GCS and Barthel Index of the study group were 14.56 ± 3.75 and 58.14 ± 12.14, respectively, which were significantly higher than those of the control group. The incidence of complications in the study group (15.38%) was significantly lower than that in the control group (32.79%). The proportion of muscle strength ≥ grade III in the study group (89.23%) was significantly higher than that in the control group (50.82%). The satisfaction of patients in the study group was significantly higher than that in the control group. CONCLUSION: Care bundles are used to optimize the nursing process. During first-aid, care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time. In early rehabilitation, they can effectively improve the consciousness of STBI patients, improve the activities of daily living, reduce the risk of complications, accelerate the recovery of muscle strength and improve their satisfaction.
ABSTRACT
OBJECTIVES: The objective of this systematic review and meta-analysis was to estimate the effectiveness of problem-based learning in developing nursing students' critical thinking. DATA SOURCES: Searches of PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Proquest, Cochrane Central Register of Controlled Trials (CENTRAL) and China National Knowledge Infrastructure (CNKI) were undertaken to identify randomized controlled trails from 1965 to December 2012, comparing problem-based learning with traditional lectures on the effectiveness of development of nursing students' critical thinking, with no language limitation. The mesh-terms or key words used in the search were problem-based learning, thinking, critical thinking, nursing, nursing education, nurse education, nurse students, nursing students and pupil nurse. REVIEW METHODS: Two reviewers independently assessed eligibility and extracted data. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. We analyzed critical thinking scores (continuous outcomes) using a standardized mean difference (SMD) or weighted mean difference (WMD) with a 95% confidence intervals (CIs). Heterogeneity was assessed using the Cochran's Q statistic and I(2) statistic. Publication bias was assessed by means of funnel plot and Egger's test of asymmetry. RESULTS: Nine articles representing eight randomized controlled trials were included in the meta-analysis. Most studies were of low risk of bias. The pooled effect size showed problem-based learning was able to improve nursing students' critical thinking (overall critical thinking scores SMD=0.33, 95%CI=0.13-0.52, P=0.0009), compared with traditional lectures. There was low heterogeneity (overall critical thinking scores I(2)=45%, P=0.07) in the meta-analysis. No significant publication bias was observed regarding overall critical thinking scores (P=0.536). Sensitivity analysis showed that the result of our meta-analysis was reliable. Most effect sizes for subscales of the California Critical Thinking Dispositions Inventory (CCTDI) and Bloom's Taxonomy favored problem-based learning, while effect sizes for all subscales of the California Critical Thinking Skills Test (CCTST) and most subscales of the Watson-Glaser Critical Thinking Appraisal (WCGTA) were inconclusive. CONCLUSIONS: The results of the current meta-analysis indicate that problem-based learning might help nursing students to improve their critical thinking. More research with larger sample size and high quality in different nursing educational contexts are required.
