ABSTRACT
BACKGROUND: In the intensive care unit (ICU), internal jugular vein puncture and catheterization are basic rescue operations that physicians need to complete quickly and independently. It is necessary to improve the first-attempt success rate of internal jugular vein catheterization, shorten the catheterization duration and reduce the incidence of complications for standardized training residents (STRs). OBJECTIVE: To improve first-attempt insertion success rates of internal jugular vein catheterization for STRs. METHODS: Based on the PDCA cycle management method and current situation investigation, the PDCA management objectives were set, and the implementation content, monitoring items and continuous improvement plan were formulated. The data of residents who were trained in the ICU of Fangcun Hospital, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2016 to April 2016 and managed by the PDCA cycle (PDCA group), were compared with the data of residents trained in the same department from August 2015 to November 2015 before the implementation of PDCA (historic control group), the first-attempt success rate of puncture and catheterization, the duration of puncture and catheterization, and the incidence of complications were analysed. RESULTS: Thirty-six cases of internal jugular vein catheterization were performed by the PDCA group, 21 cases (58%) were performed by residents in the third year of standardized training, and 15 cases (42%) were performed by residents in the second year of standardized training. Compared with the historic control group, there was no significant difference in the seniority of residents (X2 = 0.240, P = 0.625) or the 'majors of the residents (X2 = 1.306, P = 0.835). The first-attempt success rate of puncture in the PDCA group was 94% (34/36), which was significantly higher than that of the historic control group (55% (11/20) (P = 0.001). In the PDCA group, the first-attempt success rate of puncture among third-year standardized training residents was 95% (20/21), and the first-attempt success rate in the second-year was 93% (14/15), which were significantly higher than the corresponding rates of 62% (8/13) and 43% (3/7) respectively, in the historic control group (all P = 0.021). The duration of catheterization was [4 (3,5)] min after PDCA, which was significantly shorter than that in the historic control group [9 (6.25,13.00)] min (Z = - 5.214, P < 0.001). The incidence rate of complications in the PDCA group was 0% (0 /36), which was significantly lower than the rate of 20% (4 / 20) in the historic control group (P < 0.013). CONCLUSION: PDCA cycle management can help improve the first-attempt success rate of internal jugular vein puncture and catheterization, shorten the duration of puncture and catheterization, and reduce the incidence of complications. The idea and method of PDCA cycle management can be applied to other training and management protocols for STRs.
Subject(s)
Catheterization, Central Venous , Jugular Veins , Catheterization, Central Venous/adverse effects , Humans , Incidence , Intensive Care UnitsABSTRACT
Objective To analyze the status of psychological stress of trainees in the standardized cooperation training base for municipal hospital residents, and to discuss their mental health problems. Methods Cluster random sampling method was used to select the standardized training trainees of resident physicians in a municipal cooperative base as the research object. Self-made psychological stress evaluation scale was divided into two dimensions: psychological stress and emotion . The emotional dimension was given 1 to 10 points respectively. Descriptive statistics and analysis of variance were used to evaluate the general situation and stress status of residents in standardized training . Results The psychological stress of trainees is prominent, and the employment pressure is the biggest source of stress (4.583±2.939). Other source are work pressure (4.269±2.791), study pressure (3.398±2.782), economic pressure (3.167 ±2.715), interpersonal pressure (1.222 ±2.088), environmental pressure (1.065 ±1.906), and emotional pressure (0.824±1.723). There are significant differences between different types of stress (F=44.68, P=0.000). Trainees' mental health problems are quite serious. 59.26％ of the standardized training students occasionally feel pressure, 35.19％ often feel pressure, and 4.63％ always feel pressure. The detection rate of anxiety, depression and inferiority is 64％, 26％ and 26％, respectively. There are significant differences in the average scores of various emotions (F=24.19, P=0.000). Conclusion The psychological stress and mental health problems of residents in standardized training are prominent. Positive measures should be taken to deal with the mental health problems in prospective doctors groups in their transformation stage of development.
ABSTRACT
Objective To investigate the influence of social support on the depression and anxiety of standardized training residents.Methods Three hundred and eighteen standardized training residents selected by random sampling method from 4 training bases in Shanghai participated in this survey.ResultsThe average score of PHQ-9 was(7.24±5.20), and 67.30%(n=214)of participants had different degrees of depression;the average score of GAD-7 was(5.57±4.55), and 55.03%(n=175)of participants had different degrees of anxiety.One-way analysis of variances showed that standardized training residents who had work experience, longer training years and less salary satisfaction got higher scores in PHQ-9 and GAD-7.Male physicians had higher scores in GAD-7 than female ones.The scores of PHQ-9 (r=-0.390, P<0.01) and GAD-7 (r=-0.376, P<0.01) were both negatively correlated with social support.Regression analysis showed that training years,salary satisfaction,objective social support and the availability of support were significant for predicting the scores of PHQ-9(adjusted R2=0.242,F=17.893), work experience, salary satisfaction,objective social support and the availability of support were significant for predicting the scores of GAD-7(adjusted R2=0.228,F=14.390).After controlled the demographic variables, social support explained the variation rate of 0.119 to the score of PHQ-9 and 0.126 to the score of GAD-7.Conclusion The depression and anxiety of standardized training residents in this study is in a serious situation.Providing the objective social support and the availability of support as well as improving the salary satisfaction of standardized training residents may relieve the depression and anxiety and enhance their mental health.
