目的 比较肝素稀释封管液和生理盐水封管液对预防成人患者植入式静脉输液港堵管的效果.方法 回顾性分析2019 年 12 月―2020 年5 月于我院静疗门诊进行输液港维护患者的临床资料,根据纳排标准最终纳入有效患者287 例,分为两组,包括使用肝素稀释封管液者 141 例(肝素稀释液组),使用生理盐水封管液者 146 例(生理盐水组),为获得组间协变量均衡的样本,采用1∶1最邻近匹配法对两组患者进行倾向性评分匹配,比较两组患者的输液港堵管发生率及维护费用情况.结果 通过倾向评分匹配后,两组最终各纳入 130 例患者,临床资料指标的均衡性得到了提高,匹配后两组患者的输液港堵管发生率均为 0.8％(P>0.05),差异无统计学意义;维护费用方面,肝素稀释液组人均耗费 165.08 元,生理盐水组人均耗费 156.99 元.生理盐水组人均维护费用显著低于肝素稀释液组(t=15.788,P<0.001).结论 在输液间歇期间,生理盐水封管液和肝素稀释封管液在预防成人患者植入式静脉输液港堵管方面效果一致,且从经济角度出发,生理盐水封管液可有效降低医疗成本,更具有临床应用价值.

目的 分析认知护理干预措施对宫颈癌化疗患者心理状态的影响.方法 选取2021年11月至2022年10月期间于本院治疗的87例宫颈癌化疗患者作为研究对象.随机将患者分为对照组(43例)和观察组(44例).对照组实施常规护理;观察组实施认知护理.分析比较两组的护理满意度、生活质量以及负性情绪.结果 观察组的护理满意度显著高于对照组(P<0.05).观察组的生理职能、生理机能、躯体疼痛、健康状况、精力、社会功能、情感职能以及精神状况各项生活质量评分均显著高于对照组(P<0.05).护理干预前,两组焦虑抑郁评分对

Objective: To summarize the evidence on the prevention of device related pressure ulcers in critically ill patients with prone position in the domestic and overseas. Methods: Relevant literatures from domestic and foreign guideline websites, professional association and databases were systematically retrieved until Nov 1, 2022. The qualified studies were included and evaluated for quality, and evidence was scientifically extracted, summarized and graded. Results: A total of 24 literatures were included with 6 guidelines, 6 expert consensus, 8 systematic reviews, and 4 evidence summaries. The summary included 26 pieces of evidence in 7 topics, including risk assessment, skin assessment, selection and use of devices, surface management, position changes, moisture management and information provision. Conclusion: Clinical staff should carry out evidence-based prevention of device related pressure ulcers in critically ill patients with prone position based on adequate risk assessment in the early stage, attach importance to the management of patients’ pressed skin, take a variety of decompression measures to ensure the prevention strategies are scientific and systematic.

目的 构建老年机械通气患者谵妄管理护理质量敏感性指标体系.方法 2022年10-11月,以Donabedian的"结构—过程—结果"三维质量评价模型为理论框架,在循证的基础上,通过Delphi法及层次分析法,确定老年机械通气患者谵妄管理护理质量评价指标体系的内容及各指标权重.结果 2轮专家函询问卷的有效回收率均为100％,专家权威系数均为0.875,变异系数为0～0.24和0～0.24,第1轮函询一、二、三级指标肯德尔和谐系数分别为0.333、0.459、0.262,第2轮函询一、二、三级指标肯德尔和谐系数分别为0.457、0.620、0.483.最终构建的老年机械通气患者谵妄管理护理质量敏感性评价指标体系包括一级指标3项、二级指标6项、三级指标51项.结论 构建的老年机械通气患者谵妄管理护理质量敏感性指标体系具有较高的科学性和特异性,可为老年机械通气患者谵妄管理护理质量评价提供参考.

目的:总结预防成人植入式静脉输液港堵管的最佳证据,并评价其应用效果.方法:运用循证护理方法总结预防成人植入式静脉输液港堵管的最佳证据.选取2019年12月9日—2020年3月1日静脉输液治疗(静疗)门诊输液港维护病人2012例设为对照组,实施输液港常规维护方法;选取2020年3月2日—2020年5月24日静疗门诊输液港维护病人2045例设为试验组,实施预防成人植入式静脉输液港堵管最佳证据的维护方法.比较干预后两组病人堵管率、维护费用、血小板计数及维护时间,比较干预前后静疗护士对最佳证据的执行情况及相关知识的掌握情况.结果:干预后试验组堵管率略低于对照组,两组比较差异无统计学意义(P>0.05);试验组维护费用明显低于对照组(P<0.001);试验组输液港维护时间明显短于对照组(P<0.001);干预后静疗护士4条最佳证据审查指标的执行率较干预前明显提升,干预后静疗护士最佳证据相关知识得分明显高于干预前(P<0.001).结论:预防成人植入式静脉输液港堵管的最佳证据应用可以改善病人的临床结局,优化系统操作流程.

目的 探讨老年结直肠癌化疗患者先后置入经外周静脉中心静脉置管(Peripherally Inserted Central Catheter,PICC)和植入式中心静脉输液港(Totally Implantable Venous Access Ports,TIVAP)2种导管的真实体验.方法 采用现象学研究方法,对12例先后置入TIVAP和PICC 2种中心静脉导管的老年结直肠癌化疗患者进行半结构访谈,应用Colaizzi现象学资料七步分析法分析资料.结果 通过访谈归纳出3个主题,分别为:老年结直肠癌化疗患者置入PICC和TIVAP后的体验,导致老年结直肠癌化疗患者二次置管的原因,老年结直肠癌化疗患者对PICC和TIVAP的评价.结论 医护人员置管前应实施充分的评估及规划,协助患者选择合适的输液工具,通过积极干预降低导管相关并发症,减少非计划拔管.关注患者不同阶段的心理变化,给予针对性的心理支持.各级部门应加强培训力度,优化导管使用过程;同时应注重对患者健康教育,提供多渠道、多形式、正规、适时、适度的宣教,以提升患者带管过程中的真实体验.

目的:构建有创机械通气患者俯卧位实施方案.方法:采用文献研究的方法进行系统文献检索并进行证据的筛选、质量评价和证据提取及汇总;通过专家论证法对原始证据进行筛选,纳入具有临床可行性及适用性的证据,初步形成有创机械通气患者俯卧位实施方案;采用德尔菲函询法进一步修订完善方案,以保证该方案的可实施性及临床有效性.结果:构建了有创机械通气患者俯卧位实施方案,共包含33个条目.结论:基于文献研究及德尔菲专家函询法构建的有创机械通气患者俯卧位实施方案具备科学性、可行性、适用性,使俯卧位通气治疗过程更加规范化,可为临床医护人员提供参考.

Objective:To describe the status and influencing factors of nurse-related empowerment perception in inpatients with chronic diseases.Methods:Totally 586 inpatients with chronic diseases from 6 class A hospitals in Shanghai from November 2019 to September 2020 were investigated by the Chinese version of Patient Perception of Patient-empowering Nurses Behaviors (PPPNBS), Self-Efficacy of Chronic Diseases (SECD6), Nurse-patient Trust Scale (NPTS), Chinese version of Chronic Illness Resource Survey (CV-CIRS) and a general information questionnaire which was designed by researchers.Results:The total score of PPPNBS was (134.98 ± 59.60) points, and the average score for each item was (6.14 ± 2.71) points. The total score of SECD6 was (38.81 ± 9.28) points. The total score of NPTS was (141.94 ± 11.42) points, and the total score of CV-CIRS was (57.90 ± 15.24) points, which were positively correlated with empowerment perception through Pearson correlation analysis. Multiple Linear Regression showed that the degree of education, the number of forms and compliance of health education, the times of admission, participation intention in medical decision-making, the dimension of Symptom Management in Self-efficacy, three dimensions of consistency, respect, and confidence in knowledge and technology in Nurse-Patient Trust degree and four dimensions of medical staff support, organization support, family and friends support, media and government support in Chronic Illness Resource were influencing factors of patients ′ empowerment perception (adjusted R 2 value was 0.636, F value was 79.441, P<0.01). Conclusions:Compared with the foreign level, the perception of nurses ′ empowerment of inpatients with chronic diseases is at a lower level, and self-efficacy, nurse-patient trust and chronic disease resource support are all at a medium level, which still need to be improved. Nurses should allow them to participate in their treatment, improve the control of life and reduce their anxiety.

完全植入式静脉输液港(totally implantable-access port,TIAP)自 20 世纪 80 年代就已广泛应用于临床.其类型众多,如 Port-a-Cath、BardPort、PowerPort、Infuse-a-Port、Mediport等,共同特点是在皮下植入注射座或储液囊,连接置入中心静脉的导管,建立长期血管通路,以发挥类似港口的作用,故称"输液港"[1].因其使用方便、感染风险低、维护简单、使用期限长且美观,近年来广泛应用于需要长期或多次重复给药以及化疗药物输注的患者.

目的 探讨PDCA视频宣教在咳痰标本质量改进中的应用效果.方法 对2017年3月13日-4月2日某院感染病科住院患者痰标本留取情况进行现状调查(作为改善前);实施PDCA对策(对策1:建立咳痰标本采集流程图;对策2:建立咳痰标本采集的考核标准;对策3:制作咳痰标本采集视频),以2017年5 7月作为改善中资料;2017年8 12月作为改善后资料,比较各阶段痰标本合格情况等.结果 改善前,146例住院患者咳痰标本,其中45例合格,合格率为30.82％.“不能正确理解宣教内容”是痰标本不合格的首要原因,占79.21％(80/101).通过PDCA循环,实施3个对策后,咳痰标本合格率均有提高,由改善前的31.51％ (45/146)提高至67.33％(101/150),改善幅度达54.23％.其中采集视频播放后的咳痰标本,合格率从58.14％ (25/43)提高至81.82％(54/66),升幅达23.68％,效果最明显.改善后连续5个月咳痰标本合格率波动在65％上下,较改善前明显提高,较改善中稍有回落,成效良好.结论 应用视频宣教能有效改进住院患者咳痰标本留取质量,提高咳痰标本合格率,同时节省护理人员的时间和精力,优化工作流程,提高患者对护理服务的满意度.

目的 阐述护士在执行医嘱时的常见问题,并探讨与临床药师的合作模式.方法 结合实例阐述护士在执行医嘱前及执行时的常见问题,以及与临床药师之间开展的合作模式.结果 护士在执行医嘱前必须做好护理评估和护理决策,即所用药物和药物治疗方案是否合理,医嘱如何执行,怎样观察治疗反应和进行用药指导等.护士在药物治疗中不能被动执行医嘱,必须做好核对医嘱、优化医嘱和制定执行计划等重要工作.临床药师通过参与医嘱的审核,与护士一起干预问题医嘱;发现护士执行医嘱中的问题,通过与护士的沟通和宣教来解决问题;与护士团队一起组建多学科治疗团队.结论 临床药师参加治疗团队,与护士携手多方面的合作,促进合理用药.

Objective:To investigate the role of pulse oxygen saturation monitoring in nursing intervention for elderly patients with chronic heart disease.Methods:A total of 100 elderly patients with chronic heart disease treated in Zhongshan Hospital,Fudan University from June to December 2014 were randomly divided into observation group and control group(50 patients in each group).Pulse and respiration were measured by conventional methods in the control group while on the basis of conventional nursing,pulse oxygen saturation was measured by pulse oximeter in the observation group,and different grades of nursing intervention were carried out according to the monitoring results.The incidence rate of acute heart failure and nursing satisfaction were compared between the two groups,and the correlation between pulse oxygen saturation and arterial oxygen saturation was analyzed.Results:The incidence rate of acute heart failure was significantly lower in the observation group than that in the control group,nursing satisfaction was significantly higher than that in the control group,and the differences were statistically significant (P<0.05).Pearson analysis showed that pulse oxygen saturation was highly correlated with arterial oxygen saturation (r= 0.922,P<0.01).Conclusions:Using pulse oximeter to measure pulse blood oxygen saturation can make nursing more standardized and efficient,which is beneficial for the early detection of acute heart failure.

Objective:To explore the scientific,reasonable changing frequency of oxygen humidifier bottles and to optimize the medical resource and reduce the medical cost of patients.Methods:Patients who need 7-day continuous oxygen therapy were selected.Samples of the oxygen humidifier bottlenecks and humidifier liquid at 8∶00 am daily from day 1 to day 7 were taken.And the humidifier liquid was changed.Samples were sent to the lab for bacterial culture.Crossed bacterial plate culture method was used to count the bacteria colony,and checked the result after 48 h.If bacteria grew,bacterial counting and identification of bacterial strain was continued.When there were no pathogenic microorganisms detected,the sample was qualified.SPSS 14.0 statistical software andχ2 test were used to analyze the difference among the bacterial counting result of humidifier liquid and the bottles between day 1(control group)and day 2 to day 7(experimental group).Results:The bacterial counting results of humidifier liquid or the bottlenecks on day 2,day 3,day 4 and day 5 had no significant difference compared with that on day 1.The bacterial counting results of humidifier liquid on day 6 and day 7 were 54.1 %(33/61)and 90.2 %(55/61),which was higher than that on day 1[9.8%(6/61)],the differences were statistically significant(χ2=27.475 and 78.721,P<0.01).The bacterial counting results of the bottlenacks on day 6 and day 7 were 27.9 %(17/61)and 60.7 %(37/61),which was higher than that on day 1[9.8 %(6/61)],the differences were statistically significant(χ2=6.483 and 34.513,P<0.05 and 0.01).Conclusions:Oxygen humidifier bottle should be changed after using for 6 days.