Abstract Background Effective oral care can eliminate bacteria from the oral cavity, enhance oral hygiene, and decrease the occurrence of ventilator-associated pneumonia in mechanically ventilated patients with orotracheal intubation. However, proper implementation of oral care for mechanically ventilated adult patients undergoing orotracheal intubation has not been achieved in clinical practice. The aim was to examine the effectiveness of implementing the evidence in oral care for adult mechanically ventilated patients with orotracheal intubation using the framework of evidence-based continued quality improvement and to take actions to improve nursing quality.Methods Pre- and post-implementation studies were carried out employing a framework of evidence-based continuous quality improvement at the comprehensive intensive care unit of Henan Provincial People’s Hospital in Zhengzhou, China from January to December 2022. A baseline survey was conducted to analyse barriers and facilitators to evidence implementation, informing the development of support strategies such as training nursing staff and creating resources, system flow improvements, and tools. After the evidence implementation, changes in nurses, patients, and the system were assessed. The statistical analysis of the data was performed using SPSS 26.0.Results Nurses' knowledge scores and compliance with evidence significantly improved. The modified Beck Oral Assessment Score decreased from (16.28 ± 1.02) to (8.52 ± 0.45). The detection rate of oral sputum pathogens decreased from 50.0–24.0%. Standardized oral care and workflows for mechanically ventilated adult patients undergoing orotracheal intubation were successfully established.Conclusion The framework of evidence-based continuous quality improvement facilitated the successful implementation of evidence in oral care for adult mechanically ventilated patients with orotracheal intubation. This resulted in improved knowledge among nurses and enhanced oral hygiene for patients, ultimately contributing to the ongoing improvement of nursing quality.

Extracorporeal membrane oxygenation (ECMO) provides continuous extracorporeal respiratory and circulatory support for patients with severe heart and lung failure, in order to maintain their lives. Currently, ECMO is an advanced organ support technology and its application in the clinical field of critical care is becoming increasingly common. When ECMO is implemented via percutaneous cannulation at the bilateral femoral artery and vein, the traditional patient pants cannot be used, which leads to exposure of privacy, easy catching of cold, and easy contamination of bed sheets and covers during defecation, making the patient uncomfortable and increasing the risk of infection. Changing bed sheets and covers not only increases the workload of nurses, but also easily causes pipeline displacement or slipping. It is inconvenient to observe the patient's bleeding, displacement, or dislodgement of the pipeline at any time when wearing patient pants. To solve the problems, nursing staff in the emergency intensive care unit of Henan Provincial People's Hospital have designed a protective skirt specifically designed for patients undergoing ECMO, which has obtained a National Utility Model Patent of China (patent number: ZL 2020 2 08120022.9). The special protective skirt for patients with ECMO mainly consists of a skirt body, a transparent observation window, a hip support part, and a fecal collection part. The transparent observation window is convenient for the puncture site and pipeline observation. After the hip support part is inflated, the patient can separate the perianal skin and urine and feces to avoid the occurrence of incontinence dermatitis. The fecal collection part can collect urine and feces to keep the bed unit clean. The protective skirt has a simple structure and is easy to wear and take off. While protecting patient privacy and ensuring patient comfort, it can also observe the condition of the pipeline at any time. It is suitable for patients with lower limb catheterization or urinary and fecal incontinence, and has certain clinical application and promotion value.

BackgroundPrehospital emergency care is a critical but often understudied aspect of healthcare. Patient vulnerability in this setting can significantly impact outcomes. The aim of this study was to investigate the vulnerability status and to determine associated affect factors among prehospital emergency patients in China.MethodsIn this cross-sectional study conducted in China, from April 2023 to July 2023, we assessed the vulnerability of prehospital emergency patients using the Safety in Prehospital Emergency Care Index (SPECI) scale. We conducted a detailed questionnaire-based survey to gather demographic and disease-related information. We employed the SPECI scale, consisting of two subscales, to evaluate patient vulnerability. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were used to identify factors associated with vulnerability.ResultsThe study included a total of 973 prehospital emergency patients, with a response rate of 81.9%. These patients exhibited a low-to-moderate level of vulnerability, with an average SPECI score of 14.46 out of 40. Vulnerability was significantly associated with age (particularly those aged 60 and above), disease severity (severe conditions increased vulnerability), disease type (circulatory diseases correlated with higher vulnerability), alterations in consciousness, and chronic diseases. Unexpectedly, digestive system diseases were negatively correlated with vulnerability.ConclusionAddressing patient vulnerability in prehospital care is essential. Tailored interventions, EMS provider training, and interdisciplinary collaboration can mitigate vulnerability, especially in older patients and those with severe conditions.

Background: The impact of intraosseous (IO) access on resuscitation outcomes, as compared to intravenous (IV) administration, is subject to ongoing debate. This review aims to provide a comprehensive evaluation of the methodological, reporting, and evidence quality of existing Systematic Reviews/Meta-Analyses (SRs/MAs) on IO use during resuscitation. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a strategic literature search to identify pertinent SRs/MAs published up until May 6th, 2023. After an extensive screening process, 4 SRs/MAs were included for review. We used the A Measurement Tool to Assess Systematic Reviews-2 tool for assessing methodological quality, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for evaluating reporting quality, and the Grading of Recommendations Assessment, Development, and Evaluation framework for examining the quality of evidence. Results: The assessment revealed high methodological quality across all the included SRs/MAs but showed significant variability in the quality of evidence. The studies offered conflicting findings on the impact of IO access on resuscitation outcomes such as return of spontaneous circulation, survival rates at hospital discharge, and favorable neurological outcomes. Some studies suggested an association of IO access with poorer outcomes, while others indicated no significant difference between IO and IV routes. Conclusions: Despite the perceived utility of IO access when IV access is unachievable, the impact of IO on survival, return of spontaneous circulation, and neurological outcomes remains ambiguous due to the inconsistency in the existing evidence. This review underscores the critical need for more rigorous and consistent primary research in this area to strengthen clinical guidelines and improve patient outcomes.

目的 构建基于案例库的新入职护士危急症护理培训方案,为临床新入职护士的危急症护理核心能力培养提供参考.方法 通过案例收集与编写、案例审核与修订、案例编码入库形成包括8个病种、38个危急症案例的案例库.在文献分析和访谈的基础上设计基于案例库的危急症护理培训方案初稿,采用专家小组会议法对8名专家进行2轮修改论证,形成新入职护士危急症护理培训方案.结果 最终确定包括培训目标、培训活动实施策略、培训内容及考核评价4个方面的新入职护士危急症护理培训方案,专家权威系数为0.938.结论 基于案例库的新入职护士危急症护理培训方案具有较好的科学性与可靠性,可用于三级甲等医院新入职护士的危急症护理培训,但有待通过实践进行完善.

目的 调查首次经皮冠脉介入(PCI)术后患者的电子健康素养现状,并分析其影响因素.方法 2021年10月-2022年2月,便利抽取河南省某三级甲等医院心内科住院的272例首次PCI术后患者作为研究对象,采用一般资料调查表、电子健康素养量表进行调查,并采用单因素分析和多重线性回归分析首次PCI术后患者电子健康素养的影响因素.结果 首次PCI术后患者的电子健康素养得分为(24.06±3.67)分.多重线性回归分析结果显示,年龄、是否愿意使用网络查找相关健康信息、获取健康信息的途径、网络健康信息自我感知可信度、获取网络健康信息的重要性是电子健康素养的影响因素(P＜0.05),共解释变异率的38.6％.结论 首次PCI术后患者的电子健康素养水平有待提高,医护人员应采取电子健康素养技能培训及专业健康网站使用培训等针对性干预措施,以提高首次PCI术后患者的电子健康素养水平.

目的 探讨职业尊重感、工作投入在体面劳动感知对急诊科护士创新行为影响机制中的多重中介作用.方法 便利抽取河南省 6 所三级甲等医院的急诊科护士为研究对象.采用一般资料调查表、体面劳动感知量表、护士职业尊重感量表、工作投入量表和护士创新行为量表对 342 名急诊科护士进行调查,构建链式中介模型.结果 本组 342名急诊科护士创新行为总分为(30.93±6.39)分,体面劳动感知总分为(48.77±9.84)分,职业尊重感总分为(90.94±15.71)分,工作投入总分为(51.11±10.95)分.急诊科护士体面劳动感知对创新行为的间接效应成立,总的间接效应值为 0.208;职业尊重感的特定中介效应占总间接效应的 66.3%;工作投入的特定中介效应占总间接效应的 26.0%;职业尊重感和工作投入在急诊科护士体面劳动感知和创新行为间的链式中介效应占总间接效应的 7.7%.结论 职业尊重感、工作投入在体面劳动感知与创新行为间的多重中介效应成立.建议护理管理者多关注体面劳动感知水平较低的急诊科护士,提高其职业尊重感与工作投入水平,进而提高其创新行为水平.

目的:探讨应激系统理论下的心脏康复运动在急性心肌梗死患者中的应用效果.方法:选取 2021 年 2 月 1 日～2022 年2 月 1 日收治的 104 例急性心肌梗死患者为研究对象,采用随机数字表法分为观察组和对照组各 52 例,对照组采用常规护理,观察组在此基础上给予应激系统理论下的心脏康复运动干预;比较两组干预前后下肢运动功能[采用简式Fugl-Meyer评估量表(FMA)]、治疗干预效果[采用创伤后成长评定量表(PTGI)]及主要心血管不良事件(MACE)发生情况.结果:观察组MACE总发生率低于对照组(P<0.05);观察组FMA、PTGI评分均高于对照组(P<0.01).结论:将应激系统理论下的心脏康复运动应用于急性心肌梗死患者,可提高患者下肢运动功能,对自我调节能力具有促进作用,降低患者不良心血管事件发生率.

目的 探讨D型人格对中青年PCI术后患者自我管理的影响,以及社会支持、自我效能在其中的中介作用.方法 采用一般资料调查表、D型人格量表、冠心病自我管理量表、社会支持评定量表、冠心病自我效能量表对河南省某三级甲等医院265例中青年PCI术后患者进行调查.结果 D型人格患者自我管理、社会支持、自我效能得分分别为(60.78±10.94)分、(28.68±6.22)分、(29.52±9.02)分.D型人格与非D型人格患者的自我管理、社会支持与自我效能得分比较,差异具有统计学意义(均P＜0.001);D型人格可以直接影响自我管理行为,还可以通过社会支持、自我效能及社会支持和自我效能的链式中介作用对自我管理行为产生影响,间接效应分别占总效应的24.2％、15.3％和7.4％,总间接效应占总效应的46.9％.结论 D型人格中青年PCI术后患者的自我管理、社会支持与自我效能水平均偏低.D型人格是一种稳定的人格特质,医护人员应采取针对性措施,加强社会支持力度、提高其自我效能感,以便提高其自我管理能力,改善其生活质量.

Objective To understand the current situation of delayed medical decision in patients with acute myocardial infarction（AMI）, and to explore the relationship of type D personality and coping style with delayed medical decision. Methods A total of 232 patients with AMI were investigated with the General Information Questionnaire, D-type Personality Inventory（DS-14） and Medical Coping Modes Questionnaire（MCMQ）, and the questionnaires and medical records were randomly selected to ensure the consistency of collection time. Results The median delay time of medical decision in 232 patients was 128 min, and 133 patients were delayed with an incidence of 57.3%. The total score of DS-14 and the avoidance coping in coping style were positively correlated with the delay time of medical decision（all P＜0.01）, while face coping was negatively correlated with the delay time of medical decision（P＜0.05）. Avoidance coping played a partial mediating role in the relationship of the type D personality with the delay time of medical decision, and the mediating effect accounted for 34.5% of the total effect. Conclusions Type D personality and coping style are related to the delay of medical decision-making in the patients with AMI. Medical staff should pay attention to the influence of type D personality on the time of medical decision-making, focus on the high-risk groups of AMI, early screening and identification, so as to take targeted intervention measures as soon as possible, promote their active response, and finally shorten the delay time of medical decision-making.

目的 分析中青年急性心肌梗死(acute myocardial infarction,AMI)致心脏骤停(cardiac arrest,CA)发病特征及急救措施,探讨提高患者抢救成功率的方案.方法 收集并整理郑州某院 2019-2022 年中青年 AMI致CA患者 329 例的急救中心记录、院外急救人员记录及本院记录资料,分析其性别、年龄、急救响应时间、发病特点、病因及心电图等流行病学特征以及急救、并发症、转归情况,讨论急救措施的抢救效果.结果 329 例患者经抢救恢复自主循环 174 例(52.89％).36～55 岁年龄段死亡率高于其他年龄段(P=0.017),急救响应时间≤10 min患者死亡率低于急救响应时间＞10 min的患者(P=0.005).有 144 例患者(43.77％)于 00:00-08:00 发病,且有 237 例患者(72.04％)发病时目击者未给予任何急救措施;146 例患者(44.38％)的病因为冠状动脉硬化性心脏病,且有 242 例患者(73.56％)心电图表现为超急性 T 波改变;入院后,171 例患者(51.98％)接受了肾上腺素推注,有 19 例患者(5.78％)发生用药后出血.结论 中青年 AMI 致 CA 的急救成功率还有待提高,建议相关部门对大众进行院前急救知识的培训,并构筑全民急救体系.

目的 探究"互联网+"的延续性护理模式下急性心肌梗死(acute myocardial infarction,AMI)患者远期预后情况.方法 选择2019年3月一2020年3月于河南省人民医院急诊科就诊的AMI患者420例,采用随机数字表法将上述患者随机分为两组,其中研究组患者210例,对照组患者210例.对照组患者采用常规延续性护理的方法进行护理和随访,研究组患者采用"互联网+"结合延续性护理的方法进行护理和随访.收集两组出院和2年随访结束时WHOQOL—BREF生活质量评分以及随访期间并发症情况,并采用Kaplan-Meier生存分析两组生存状况,并进行Log Rank验证.结果 两组患者出院时WHOQOL—BREF量表中环境、生理、社会关系和心理评分无明显差异(P＞0.05);随访结束时两组患者WHOQOL—BREF量表中的环境、生理、社会关系和心理评分均高于出院时,且研究组随访结束时的各项评分均高于对照组,差异均有统计学意义(P＜0.05);通过Kaplan-Meier生存法对两组AMI患者进行2年总生存率分析,结果显示研究组的生存状况显著高于对照组,经Log Rank检验,P＜0.05;随访期间研究组的并发症发生率(8.09％)显著低于对照组(14.29％),差异有统计学意义(x2=4.049,P＜0.05).结论 "互联网+"的延续性护理模式下可以进一步改善AMI患者远期生活质量,提高AMI患者生存率,降低并发症.

目的:了解首发急性心肌梗死病人就医决策延迟现状,并探讨述情障碍与首发急性心肌梗死病人就医决策延迟的相关性,为制订针对性干预措施提供理论依据.方法:采用一般资料调查表与多伦多述情障碍量表(TAS-20)对河南省某三级甲等医院心内科住院的232例首发急性心肌梗死病人进行调查.结果:共149例首发急性心肌梗死病人发生就医决策延迟,发生率为64.2％,病人就医决策延迟时间为136(47,181.5)min.以决策时间1h为界限进行分组,延迟组述情障碍得分为(59.95±5.03)分,非延迟组述情障碍得分为(53.75±4.27)分,延迟组述情障碍及各维度得分均高于非延迟组,差异具有统计学意义(P<0.05).Spearman相关性分析结果显示,首发急性心肌梗死病人就医决策延迟时间与述情障碍总分及各维度得分呈正相关(均P<0.001);Logistic回归分析结果显示,女性、专科及以上学历、非体力活动及述情障碍是首发急性心肌梗死病人就医决策延迟的影响因素(P<0.05).结论:首发急性心肌梗死病人就医决策延迟现状不容乐观,其述情障碍处于中等水平,且述情障碍总分及各维度得分与就医决策延迟时间呈正相关.提示应重点关注存在述情障碍的首发急性心肌梗死病人,采取针对性措施,降低其述情障碍水平,从而缩短其就医决策延迟时间.

The evaluation of acute alcohol impairment is an important basis for evaluating the physiological and psychological status of patients and judging their treatment and nursing measures.There is a large number of research on acute alcohol impairment by foreign researchers,but there are few relevant research reports in China.This article reviews the origin,development and the evaluation tools of acute alcohol impairment in the context of emergency treatment,and summarizing its advantages and disadvantages by comparing the content,evaluation methods,applicable population,reliability and validity of each evaluation tool,in order to provide scientific references for the evaluation,treatment and nursing care of acute alcohol impairment for emergency departments in China.

目的:探讨老年急性心肌梗死经皮冠状动脉介入(PCI)术后合并心力衰竭的特征及影响因素.方法:选择2021 年 12 月至 2022 年 12 月河南省人民医院行PCI术的 120 例老年急性心肌梗死患者,按照是否合并心力衰竭分为两组,收集两组一般资料,经单因素、Logistic多因素分析老年急性心肌梗死PCI术后合并心力衰竭的特征与影响因素.结果:120 例老年急性心肌梗死PCI术后合并心力衰竭的有 43 例(35.83%),纳入合并组;将剩下 77 例(64.17%)纳入未合并组.合并组与未合并组的性别、年龄、高脂血症、饮酒史、疾病类型、发病至PCI时间对比,差异无统计学意义(P＞0.05);合并组的糖尿病、高血压、吸烟史、收缩压(SBP)、舒张压(DBP)、N-末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)、血肌酐(SCr)高水平表达占比均高于未合并组(P＜0.05).经非条件Logistic回归分析结果得出,糖尿病、高血压、吸烟史、SBP、DBP、NT-proBNP、CK-MB、cTnⅠ、SCr可能是影响老年急性心肌梗死PCI术后合并心力衰竭的危险因素(OR＞1,P＜0.05).结论:糖尿病、高血压、吸烟史及SBP、DBP、NT-proBNP、CK-MB、cTnⅠ、SCr高水平表达可能是影响老年急性心肌梗死PCI术后合并心力衰竭的危险因素,临床应根据上述因素合理制定相关预防措施,以改善患者预后.

Background The aim of this study was to investigate the current state of disaster preparedness and to determine associated factors among emergency nurses from tertiary hospitals in Henan Province of China. Methods This multicenter descriptive cross-sectional study was conducted with emergency nurses from 48 tertiary hospitals in Henan Province of China between September 7, 2022–September 27, 2022. Data were collected through a self-designeds online questionnaire using the mainland China version of the Disaster Preparedness Evaluation Tool (DPET-MC). Descriptive analysis and multiple linear regression analysis were used to evaluate disaster preparedness and to determine factors affecting disaster preparedness, respectively. Results A total of 265 emergency nurses in this study displayed a moderate level of disaster preparedness with a mean item score of 4.24 out 6.0 on the DPET-MC questionnaire. Among the five dimensions of the DPET-MC, the mean item score for pre-disaster awareness was highest (5.17 ± 0.77), while that for disaster management (3.68 ± 1.36) was the lowest. Female gender (B = −9.638, p = 0.046) and married status (B = −8.618, p = 0.038) were negatively correlated with the levels of disaster preparedness. Five factors positively correlated with the levels of disaster preparedness included having attended in the theoretical knowledge training of disaster nursing since work (B = 8.937, p = 0.043), having experienced the disaster response (B = 8.280, p = 0.036), having participated in the disaster rescue simulation exercise (B = 8.929, p = 0.039), having participated in the disaster relief training (B = 11.515, p = 0.025), as well as having participated in the training of disaster nursing specialist nurse (B = 16.101, p = 0.002). The explanatory power of these factors was 26.5%. Conclusion Emergency nurses in Henan Province of China need more education in all areas of disaster preparedness, especially disaster management, which needs to be incorporated into nursing education, including formal and ongoing education. Besides, blended learning approach with simulation-based training and disaster nursing specialist nurse training should be considered as novel ways to improve disaster preparedness for emergency nurses in mainland China.

目的 探讨虚拟仿真实验教学平台在急诊低年资护士临床技能培训中的应用效果.方法 选取2017年3月—2020年2月32名急诊科低年资护士作为观察组;选取2014年3月—2017年2月34名急诊科低年资护士作为对照组.对照组采用常规急诊科培训方式,观察组在对照组基础上引入虚拟仿真实验教学平台.分别比较两组急诊低年资护士考核成绩(基础理论成绩、实践技能成绩)以及急救能力(学习主动性、临床思维、临床技能操作、急救意识、团队合作、沟通技巧).结果 观察组急诊低年资护士基础理论和实践技能成绩均高于对照组,差异具有统计学意义(P<0.05);观察组急诊低年资护士在"学习主动性、临床思维、临床技能操作、急救意识、团队合作、沟通技巧"方面的评分高于对照组,差异具有统计学意义(P<0.05).结论 将虚拟仿真实验教学平台引入急诊低年资护士的临床技能培训当中,有助于加深护士对基础理论知识的理解,提高护士的急诊实践操作水平,使护士的急救能力得到有效提升.

目的 探讨在急诊抢救区患者安全管理中实施发展性反馈+激励化管理方案对压力性损伤的预防效果.方法 2020 年 7 月起医院急诊科应用发展性反馈+激励化管理方案预防患者院内压力性损伤,将 2020 年 7-12 月收治的 8101 例患者作为观察组,2020 年 1-6 月收治的患者 6334 例为对照组,实施常规院内压力性损伤预防方案.比较两组压力性损伤发生率、压力性损伤预防护理执行率差异并比较两组护理人员压力性损伤考核结果差异.结果 应用发展性反馈+激励化管理方案后,观察组患者压力性损伤预防措施落实率高于对照组,损伤发生率低于对照组,差异有统计学意义(P<0.05);观察组压力性损伤患者的严重程度明显低于对照组,差异有统计学意义(P<0.05);对照组所有护士理论考核与实践考核得分均提升,差异有统计学意义(P<0.05).结论 急诊抢救区应用发展性反馈+激励化管理方案可降低患者院内压力性损伤风险,提高护理人员压力性损伤防护能力.

Objective:To investigate the occurrence and influencing factors of cerebral microbleeds in patients with acute cerebral infarction.Methods:This study was a prospective cohort trail. A total of 114 patients with acute cerebral infarction treated in Henan Provincial People’s Hospital from January 2020 to January 2023 were selected. According to occurrence of cerebral microbleeds during the visit, the selected patients were divided into occurrence group and non-occurrence group. The baseline data of the two groups were counted and compared. Univariate and multivariate logistic regression analysis was used to test the influencing factors of cerebral microbleeds in patients with acute cerebral infarction.Results:Forty-two of 114 patients developed cerebral microbleeds, with an incidence of 36.84% (42/114). There were statistical significant differences in hypertension, 24-hour systolic blood pressure coefficient of variation (SBP-CV), 24-hour diastolic blood pressure coefficient of variation (DBP-CV), glomerular filtration rate, platelet distribution width and serum 25-hydroxyvitamin D between the two groups ( P<0.05). Results of logistic regression analysis showed that elevated 24 h SBP-CV, elevated 24 h DBP-CV, decreased glomerular filtration rate, decreased serum 25-hydroxyvitamin D, and increased platelet distribution width were related factors affecting the occurrence of cerebral microbleeds in patients with acute cerebral infarction ( P<0.05). Conclusions:The incidence of cerebral microbleeds in patients with acute cerebral infarction is relatively high, which is mainly influenced by 24 h SBP-CV, 24 h DBP-CV, glomerular filtration rate, serum 25-hydroxyvitamin D and platelet distribution width.

目的:调查急诊科护士的职业悲伤现状并分析其影响因素.方法:采用便利抽样法2022年8月—2022年10月选取河南省6所三级甲等医院的366名急诊科护士为研究对象,采用一般资料调查表、修订版悲伤体验量表、中文修订版死亡态度描述量表、临终关怀态度量表、心理脱离量表、社会支持评定量表进行调查.结果:急诊科护士职业悲伤总分为(44.60±5.05)分;多元线性回归分析结果显示,宗教信仰、接触死亡形式、接受死亡教育培训情况、接受临终关怀教育情况、接触死亡频率、自然接受、死亡逃避、临终关怀态度、心理脱离、社会支持是急诊科护士职业悲伤的影响因素(P<0.05),共解释总变异的40.7％.结论:急诊科护士职业悲伤处于轻度水平,提示护理管理者应及时关注急诊科护士的心理健康,采取针对性措施,帮助其降低职业悲伤水平,以促进其悲伤成长.