Effect of a multidisciplinary nutrition management model in patients with critical illness: A randomized trial.

BACKGROUND: Managing nutrition in critically ill patients involves many medical fields. However, the nutrition management of critically ill patients has not been comprehensive enough to achieve multidisciplinary team cooperation in China and many other countries. Furthermore, there is no standardized management model or process. AIM: To explore the multidisciplinary cooperative nutrition management model for critically ill patients in the ICUs in China, verify its clinical effect and provide a clinical practice reference for the nutrition management of critically ill patients. STUDY DESIGN: A multidisciplinary cooperative nutrition management team, including ICU doctors, ICU nurses, clinical nutritionists, clinical pharmacists and radiologists, was established for critically ill patients. According to a literature review and domestic guidelines, the standardized process of nutritional management for critically ill patients was constructed through the Delphi expert consultation method. One hundred thirty-two patients in the ICU were randomly divided into an experimental group and a control group. A routine nutrition management mode, which was the nutrition management plan mainly formulated by the ICU doctor in charge only and the ICU nurses responsible for the implementation and monitoring of nutrition support, was implemented in the control group. And a multidisciplinary nutrition management mode, which was the nutrition management implemented by the multidisciplinary teams with the standardized nutrition management process for critically ill patients, was adopted in the experimental group. The early nutritional support rate, nutritional indexes (serum albumin, preprotein, haemoglobin and hs-CPR), mechanical ventilation time, ICU hospitalization days and hospitalization expenses of the two groups were compared. RESULTS: The early nutritional support rates of the experimental group and the control group were 89.39% and 69.7%, respectively (χ2 = .002, p = .031). Serum albumin (35.4 vs. 33.1 g/L), preprotein (153.2 vs. 125.9 mg/L) and haemoglobin (97.5 vs. 90.6 g/L) in the experimental group were significantly higher than in the control group (p = .000, .016, .033). The days of hospitalization in the ICU of the experimental group were shorter than in the control group (5.1 vs. 7.1, p = .039). High-sensitivity C-reactive protein, the days of mechanical ventilation and ICU hospitalization expenses of the experimental group were lower than in the control group; however, the difference was not statistically significant (p = .713, .068, .489). CONCLUSIONS: Because of the severity and complexity of patients' diseases, it is necessary to implement multidisciplinary nutrition management for critically ill patients. Research shows that the multidisciplinary nutrition management standardized process for critically ill patients that was constructed in this study can effectively improve nutritional indexes such as serum albumin, preprotein and haemoglobin, shorten the length of stay in the ICU and promote the rehabilitation of patients, and this process be widely used in the clinic. RELEVANCE TO CLINICAL PRACTICE: Structured multidisciplinary nutrition management operational processes can guide clinical practice. They could be widely used in the clinical nutrition management of critically ill patients in critical care units or other departments.

Effects of internet plus continuous rehabilitation nursing on older patients after lumbar fusion / 中国康复理论与实践

ObjectiveTo observe the effects of Internet plus continuous rehabilitation nursing on older patients after lumbar fusion. MethodsFrom January, 2018 to August, 2021, 157 older patients after transforaminal lumbar interbody fusion (TLIF) in Department of Orthopedics, Chongqing General Hospital were retrospectively studied. A total of 66 patients accepting routine continuous rehabilitation nursing care were as control group, and 91 patients accepting internet plus continuous rehabilitation nursing care were as intervention group. They were assessed with Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), Huaxi Emotional-distress Index (HEI) and Adult Health Self-management Skill Rating Scale (AHSMSRS) before, and one and three months after intervention. The compliance and nursing satisfaction were investigated with self-made questionnaire three months after intervention, and the postoperative complications were recorded. ResultsA total of 148 patients finished follow-up of three months, including 61 patients for the control group and 87 patients for the intervention group. The VAS, ODI, HEI and AHSMSRS scores improved in both groups one and three months after intervention (F > 85.4, P < 0.001), and improved more in the intervention group than in the control group (|t| > 3.645, P < 0.001). Both the compliance and nursing satisfaction were better in the intervention group than in the control group (χ2 > 5.478, P < 0.05), and no postoperative complication was observed in both groups. ConclusionInternet plus continuous rehabilitation nursing can promote the recovery of function, pain and psychological emotion, ability of self-management, compliance, and nursing satisfaction.

5M1E analysis method combined with interview method to investigate the factors hindering the management of nursing quality homogeneity in multiple hospital areas / 中国实用护理杂志

Objective:To explore the obstacles of the promotion of nursing quality homogenization management under the mode of multiple hospital areas, and to make the best response strategies and management ideas according to the obstacles, so as to achieve the goal of nursing quality management with the same quality and high efficiency.Methods:Based on the theory framework of 5M1E analysis, this study made an interview outline. Through focus group interview and personal interview, 44 nurses of different positions and levels were interviewed. The interview materials were sorted out and analyzed by Colaizzi seven step analysis method, and the themes were extracted to obtain the obstacles to the promotion of nursing quality homogeneity management.Results:The factors that hinder the management of nursing quality homogeneity included: the lack of understanding and thinking on the management of nursing quality homogeneity, the incomplete integration of quality control organization system in different hospital areas, the lack of comprehensiveness of nursing quality management system and standard unification, the differences in the implementation of quality control system, standard and plan, the difference in information system, the disunity of quality control index extraction, the physics of treatment room, etc. There were six aspects of environmental layout differences.Conclusion:The homogenization of nursing quality management under the mode of "one hospital, multiple districts" is of great significance. Hospitals need to formulate feasible countermeasures and development ideas according to the obstacles of homogenization management, so as to promote the development of nursing quality management and provide patients with the same quality of nursing services.

Literature analysis of researches on interview before transferring to ICU in China / 中国实用护理杂志

Objective To analyze the current research status and problem of ICU visiting before patient transfer in.To supply the reference for the future research in the field. Methods China National Knowledge Infrastructure,Wanfang database and VIP database were searched for literatures on the field. Note Express and Excel 2007 were used to statistical analysis the tendency of the literature publication trend, distribution,region, article type and research topic. Results Totally 86 articles were retrieved. The first was published in 2004,the related articles increased gradually yearly.18 articles were published in core journals and 16 kinds of nursing journals.There were 6 funds-supported articles,3 degree papers. The top three provinces where the first author came from were Jiangsu,Hubei and Shanghai.The primary study types(74.42%) were experimental study and quasi-experimental study. The primary study topic (90.7%)were intervention comparing and problem resolving. Conclusions Research on ICU pre-visiting is focused by the domestic researchers.However,the object of the pre-visiting,visiting content and form should be improved. The tool of visiting should be structured. The research method and topic should be increased.

Development of family relocation stress scale during patient transferred from intensive care units / 中国实用护理杂志

Objective To develop an instrument for measuring family relocation stress scale during patient transferred from ICU. And to provide evidence for ICU health care personnel to assess and deal with the family member′s relocation stress. Methods A draft scale was developed based on the result of related scale abroad, literature review and semi-structured interviews. Delphi method and Classical test theory were used in item selection. Results The degree of experts′ authority in two rounds′consultation were 0.83. The Kendall′s coordination coefficients of importance were 0.36, 0.36 (P<0.05) in dimension and 0.35, 0.37 (P<0.05) in item. Five items were deleted by the statistical analysis with pilot investigation. 6 dimensions (transfer anxiety, environmental changes, disease severity, nursing model changes, the safety of transfer, self-efficacy of care ability) and 20 items consisted the scale. The Cronbach α coefficient was 0.882. Exploratory factor analysis extracted 6 items, accumulated variance contribution rate was 72.226%. Confirmative factor analysis showed χ2/df=1.677, comparative fit index=0.936, Tucker-Lewis index=0.921, root mean square error of approximation=0.061. Conclusions The scale is based on abundant theoretical evidence and reasonable design, with satisfactory reliability and validity. It can be used as the evaluation tool for family relocation stress during patient transferred from ICU.