ECMO treatment for critically ill patients mostly requires family members to make surrogate decisions. However, the process and experience of family members’ participation in decision making have not been well described. To explore the experience of family members of critically ill patients who were asked to consent to ECMO treatment and to gain insight into the factors that promote and hinder their decision-making. A descriptive qualitative study. Data were collected using a semi-structured interview method and analysed using traditional content analysis approaches. The cohort included nineteen family members of critically ill ICU patients from a general hospital in China. Eleven family members consented to ECMO treatment, and 8 refused. 4 themes and 10 subthemes emerged: (1) tough choices: the dilemma in the emergency situation, the guilt and remorse after giving up; (2) rationalisation of decision-making: ethics and morality guide decision-making, expected efficacy influences decision making, and past experience promotes decision making; (3) decision-making methods: independent decision-making, group decision-making, decision making based on patient preferences; (4) influencing factors of decision making: information and communication, social support. The findings provide insights and a basis for promoting efficient ECMO decision-making in clinical practice. It may be difficult to improve the time it takes to make the decision without sacrificing the quality of the decision. Healthcare professionals should provide timely emotional support, informational support, and comprehensive social support to assist them in making efficient decisions while respecting the treatment preferences of the decision-makers.

Background The success of hair transplantation surgeries for androgenetic alopecia is evaluated by postoperative long-term outcomes. Patients' self-management during the long recovery period affects this outcome. Objective This study aimed to explore patients' self-management status, facilitators, and impediments in the postoperative period and to provide a reference for developing a postoperative self-management intervention program. Methods Patients who underwent hair transplantation for androgenetic alopecia were selected using purposive sampling. They were interviewed using one-to-one semi-structured interviews at a general tertiary hospital in Hangzhou from March to April 2022. Qualitative research analysis software Nvivo 12.0 was used to analyze the collected data. Results The self-management of postoperative patients with androgenetic alopecia during the recovery period encompasses six areas: more problems with postoperative medication (e.g., not being able to take medication on time) and wound care (e.g., not daring to shampoo, etc.), not being able to review their postoperative condition on time (due to busy schedules at work and at home), more hindrances to the establishment of good living habits (affected by overtime work, socialising, and bad habits of the people around them), and seeking positive ways of relieving bad emotions (stress, anxiety, depression, etc.), worrying about one's image during recovery and taking the initiative to obtain and use resources to promote recovery (through the Internet, books, etc.) Conclusions Various factors impact the postoperative self-management abilities of patients, including medication, shampooing, and emotions. It is essential to design support programs to enhance these abilities and improve long-term hair transplantation outcomes.

Deep venipuncture catheterization is a routine and basic operation in the treatment of critically ill patients, and it is the most effective way to quickly correct the shock. Clinical B-ultrasound guided deep vein catheters can improve the success rate of puncture, but in the process of operation, the short axis needs to be replaced by the long axis. In the replacement process, the stability of the novice is insufficient, the positioning is difficult, and the operation time is too long. If only short axis puncture is used, it is impossible to know whether the current position of the puncture needle, and the puncture may be too deep and stray into the artery. The accuracy of the 45 degree angle of the injection point requires a very experienced operator. In view of the above shortcomings, doctors in the department of critical care medicine of Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a B-ultrasound puncture equipment, which has obtained the National Invention Patent of China (ZL 2016 1 0571557.X). The device is composed of B-ultrasound probe fixing frame, sliding scale plate, simulation slide rule, puncture needle, sliding device. By sliding device the angle of the pinhole channel, it is conducive to the accurate positioning of the puncture target, optimizing the operation procedure, improving the puncture speed and accuracy, effectively reducing the occurrence of puncture complications, ensuring patient safety, reducing unnecessary waste of human and material resources. It can reduce the workload of medical staff and is worthy of clinical practice.

BACKGROUND:Return to work (RTW) is a critical component of rehabilitation for most young and middle-aged patients after an acute myocardial infarction (AMI). Its success is related to the quality of life and social psychological function of patients, and their social economic growth. However, healthcare professionals often do not deeply understand the patients' experience and their difficulties and coping methods during this process, which limits their ability to institute effective management and support. OBJECTIVE:In this study, we aimed to explore the lived experiences and change processes of young and middle-aged patients with AMI at the different stages of RTW. METHODS:A descriptive qualitative approach was used. Patients aged 20 to 59 years with AMI were recruited from the Department of Cardiology of 3 general hospitals. Data were collected via semistructured interviews. Data analysis was performed by conventional content analysis methods. RESULTS:In total, 18 participants were included. Five main themes emerged: (1) "chaos," (2) "rebuilding," (3) "conflict," (4) "coping," and (5) "benefits." Patients may be more concerned about physical recovery during the initial clinical event. They then begin to plan and adjust for an RTW. Patients in the maintenance phase need strategies to prevent, identify, and respond to conflicts and challenges to maintain long-term stable work. CONCLUSION:We identified several post-AMI stages spanning from the initial illness event to the maintenance of stable work. We described their perceived barriers, coping strategies, and support needs at these various stages. These data are crucial for healthcare professionals to develop improved vocational rehabilitation strategies for patients with AMI.

PICC 是经外周静脉穿刺,将导管尾端送至上/下腔静脉,当前被广泛应用于肿瘤患者治疗中[1-2].目前,临床上常用固定装置是思乐扣和普通 3M敷贴.在使用过程中思乐扣常出现穿刺部位红肿、淤血、压力性损伤等问题[3];普通 3M敷贴容易出现固定不牢固、松脱等问题[4].为解决上述问题,保障输液安全,减少不良事件发生率,研究者设计了双"Y"型 PICC 导管固定贴(专利号:ZL 201820667211.4).经临床使用,效果较好,现报告如下.

"创新"已经成为新时期中国素质教育的基础,成为科教兴国战略推进、竞争力提升的重大措施之一.护理科研作为护理学的一个重要组成部分,在推进和促进护理学科发展、护理质量改进方面起着举足轻重的作用[1].目前主要的创新思维方式是思维导图,其已在教育实践中得到印证[2],曼陀罗思考法是思维导图的一种视觉式思考方式,从多个角度来产生创意,尤其适合用收集多方灵感并进行创新性思考.薛园媛等[3]将该方法应用于课外阅读以提升学生的课外阅读质量,该方法的使用能否帮助护理本科实习生开发创新思维,提升创新能力,有待进一步的实证研究.作者在专利申请思维开发教学中应用曼陀罗思考法,以期探索一种可以激发护理本科实习生创新思维、提升护理科研创新能力的方法,现报道如下.

目的 探讨自制防滑脱计数握力器在ICU机械通气患者握力锻炼中的应用效果.方法 防滑脱计数握力器由握力球、手套、闪关灯、计数器、凸球、导电胶杆、凸粒等组成.选取2022年6月—8月杭州市某三级甲等医院重症医学科50例机械通气患者作为应用对象,采用随机数字表法随机分成试验组和对照组,各25例,试验组使用防滑脱计数握力器,对照组使用传统握力球.比较两组患者机械通气期间握力锻炼依从性、握力和双上肢肌力、握力球平均滑脱次数及患者满意度的差异.结果 试验组患者握力锻炼依从率为96%,优于对照组48%,差异有统计学意义(Z=-4.65,P＜0.05);试验组握力、双上肢肌力、患者满意度均显著高于对照组(P＜0.05),对照组握力球机械通气握力锻炼期间平均滑脱2.48次,试验组无滑脱.结论 防滑脱计数握力器能够提高ICU机械通气患者握力锻炼依从性,从而增加患者握力、肌力,患者满意度高.

目的 评价俯卧位通气患者使用平躺式移位机的安全性及有效性.方法 选取2022年12月—2023年2月杭州市某三级甲等医院ICU收治的100例采用俯卧位通气治疗的重度急性呼吸窘迫综合征患者为研究对象,按照随机数字表法分为试验组50例和对照组50例.试验组采用平躺式移位机实施俯卧位通气,共计实施500次;对照组采用传统方法实施俯卧位通气,共计实施510次.比较两组实施俯卧位所需用时、所需医护人员数、不良事件(导管移位、导管滑脱、导管阻塞、关节脱臼)的发生率和医护人员满意度.结果 试验组使用平躺式移位机实施俯卧位通气的用时为(300.24±11.88)s,少于对照组使用传统方法实施俯卧位通气所需用时(357.50±20.36)s,差异有统计学意义(P<0.001);使用平躺式移位机实施俯卧位通气所需医护人员中位数为3(3,3)名,使用传统方法需医护人员中位数为5(4,6)名,差异有统计学意义(Z=-28.450,P<0.001);使用平躺式移位机实施俯卧位通气可提高医护人员的满意度,满意度总分中位数从7(7,8)分升高至8(8,9)分,差异有统计学意义(Z=-6.177,P<0.001);两组应用期间均未发生不良事件.结论 在不增加医疗风险的前提下,使用平躺式移位机不仅可提高俯卧位通气治疗的实施效率,还可减轻医护人员劳动强度,进而提高医护人员满意度.

Patients in the intensive care unit (ICU) often need to have various catheters placed on their bodies due to their severe condition. In order to prevent the occurrence of unplanned extubation, patients' hands should be restrained appropriately. The current restraint gloves used in clinical practice have problems such as improper restraint, easy falling off of oxygen saturation monitoring probes, and pressure injury of hands. Therefore, department of critical care medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a wrist restraint glove suitable for restless patients, and obtained the national utility model patent (ZL 2020 2 1612453.7). The device is composed of restraint gloves and restraint rings, which can not only restrain patients, but also continuously monitor the changes of blood oxygen saturation in patients with restfulness. This device is convenient to use, low cost, comfortable to wear, and can prevent the occurrence of device-related pressure injuries, which is suitable for clinical application.

Objective To establish a project team to assess and manage the risk of out-of-town transport of extracorporeal membrane oxygenation(ECMO)patients using the healthcare failure mode and effects analysis(HFMEA),analyze the effectiveness of its application,and develop targeted improvement measures and processes.Methods Patients with ECMO who were treated in the department of intensive care unit(ICU)of Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine March 2020 to September 2021 were selected as the study subjects.By comparing the differences in the accuracy of ECMO transport risk assessment,the rate of fixation against catheter slippage,the incidence of adverse transport events between the two groups before and after HFMEA,and the application effect of this model in ECMO transport adverse event risk management was evaluated.Results A total of 48 ECMO patients were enrolled,and 42 times of out-of-home transfers were performed,including 22 before HFMEA and 20 after HFMEA.Compared with pre-HFMEA,the accuracy of ECMO transport risk assessment[95.00%(19/20)vs.54.55%(12/22),P＜0.05]and the compliance rate of catheter slip fixation[100.00%(20/20)vs.68.18%(15/22),P＜0.05]in patients after HFMEA were significantly increased,the incidence of adverse events in transport was significantly lower[5.00%(1/20)vs.40.91%(9/22),P＜0.05].Conclusion The application of HFMEA in the risk management of ECMO transshipment adverse events is beneficial to standardize the prevention of ECMO transshipment accidents,effectively reduce the incidence of transshipment adverse events,and ensure patient safety.

目的 分析国内外压力性损伤支撑面研究领域的热点及趋势,为未来相关研究提供参考.方法 检索Web of Science核心数据库、中国知网、万方数据库、维普网中收录的压力性损伤支撑面的相关文献,检索时限为2010年1月1日—2023年2月28日,应用CiteSpace软件进行可视化分析.结果 最终纳入中文文献307篇、英文文献434篇.美国是发文量最多的国家;南京军区南京总医院是国内发文量最多的机构;《中华现代护理杂志》是国内发文量最多期刊,Journal of Tissue Viability是国外发文量最多期刊;蒋琪霞是发文量最多的作者,Gefen是国外发文量最多的作者.中文文献共形成12个聚类,英文文献共形成17个聚类,最终各总结出8个有意义的类别(人群、部位、研究类型、危险因素、静态支撑面、动态支撑面、智能监测、效果评价),其中智能监测是未来研究的趋势.结论 压力性损伤支撑面是近年来国内外的研究热点,建议通过拓宽研究的应用人群范围、联合计算机和人工智能等学科研发利于推广的智能支撑面设备、开展大样本的高质量原始研究和相应的质量改进项目等方法推动国内压力性损伤预防护理研究的发展.

目的 设计腰大池引流定位定量报警装置并验证其应用效果.方法 腰大池引流定位定量报警装置由升降调节杆、重量报警装置、激光笔、刻度尺、腰大池引流袋、侧面板、主面板等组成.选取杭州市某三级甲等医院危重症医学科2022年5月—9月的21例卧床留置腰大池引流管患者为试验组,使用腰大池引流定位定量报警装置;2022年1月—4月的21例卧床留置腰大池引流管患者为对照组,使用传统工具定位.比较两组患者定位时间、定位高度差值、护理人员满意度及每日引流量的差异.结果 试验组腰大池引流袋定位时间为(12.32±2.93)s,短于对照组(33.24±8.84)s,差异具有统计学意义(t=38.298,P＜0.001);试验组定位高度差值为(1.25±0.21)mm,小于对照组(7.03±1.92)mm,差异具有统计学意义(t=20.456,P＜0.001);试验组护理人员满意度(100％)高于对照组(28.57％),差异具有统计学意义(P＜0.05).试验组每日引流量为(162±13)ml,对照组为(165±37)ml,目标准确度高于对照组.结论 腰大池引流定位定量报警装置可节约定位测量时间,减小定位高度误差,提高护理人员满意度.

目的 探讨运动想象联合上肢训练器在脑卒中患者上肢功能康复的应用效果.方法 选取2019年9月—2020年10月我科收治的120例脑卒中患者,采取随机数字表法分为常规康复组、上肢训练器组及运动想象联合上肢训练器组,每组各40例,常规康复组予以常规康复锻炼,上肢训练器组在常规康复组基础上予以上肢训练器康复锻炼,运动想象联合上肢训练器组在常规康复组基础上予以运动想象联合上肢训练器康复锻炼,对比3组患者上肢运动功能评分、日常生活活动能力评分.结果 3组患者干预后较干预前的上肢运动功能评分、日常生活活动能力评分均显著升高(P<0.05),且运动想象联合上肢训练器组评分最高,上肢训练器组次之,常规康复组最低,两两比较后各组间差异均有统计学意义(P<0.05).结论 采用运动想象联合上肢训练器进行康复锻炼可促进脑卒中患者上肢功能恢复,促进改善日常生活活动能力.

目的 了解杭州市社区老年2型糖尿病患者认知衰弱的患病现状并分析其相关因素,以期为老年糖尿病患者认知衰弱的预防和干预提供参考.方法 采取便利抽样法选取2020年8-12月杭州市3个社区的252例老年2型糖尿病患者(≥60岁)为研究对象,采用一般资料调查表、衰弱(FRAIL)量表、简易精神状态检查量表(MMSE)、简版老年抑郁量表(GDS-15)、微型营养评定法简版(MNA-SF)进行调查,采用单因素及多因素logistic回归模型分析老年2型糖尿病患者认知衰弱相关影响因素.结果 252例老年2型糖尿病患者中,认知衰弱者22例,占8.73％,单因素分析显示,年龄、家庭人均月收入、居住方式、文化程度、婚姻状况、有无规律运动、每晚睡眠时长、听力障碍、合并慢性种类、营养状况、是否存在抑郁与老年糖尿病患者认知衰弱存在关联(均P＜0.05).Logistic回归分析显示,文化程度(高中:OR=0.191;大专及以上:OR=0.287)、规律运动(OR=0.325)、营养不良(OR=4.081)、抑郁(OR=2.754)是老年2型糖尿病患者认知衰弱的影响因素(均P＜0.05).结论 社区老年2型糖尿病患者认知衰弱发生率较高,医护工作者应加强关注文化水平低、无运动习惯、营养缺失及存在抑郁症状的老年糖尿病患者认知衰弱筛查和干预.

总结体外膜肺氧合技术在院内"999"急救中的应用及管理体会.完善院内体外膜肺氧合急救护理团队管理;制订"999"急救后启动体外膜肺氧合程序流程与应急预案;改进用物管理,缩短准备时间;强调医护抢救配合,注重心肺复苏质量与体外膜肺氧合置管效率;做好院内转运管理等.对10例"前IC U期"的心搏骤停患者成功建立体外膜肺氧合,从患者第1次发生心搏骤停至体外膜肺氧合成功转机时间38～74 min,平均(49.5±6.2)min;10例均成功行院内转运至IC U,未发生严重不良事件.经过整体治疗与护理,5例成功撤离体外膜肺氧合治疗后康复出院,随访3个月未有脑功能障碍等相关并发症;3例体外膜肺氧合治疗>14 d,心功能无法逆转,家属提出自动出院;2例体外膜肺氧合治疗48 h内,再次出现心搏骤停合并严重的多脏器功能衰竭死亡.

目的 探讨假饲法对卒中后吞咽障碍患者的影响.方法 将72例脑卒中后吞咽障碍患者分为观察组与对照组,观察组采用假饲法,对照组采用常规鼻饲进食,比较两组治疗前后吞咽障碍程度评分(VGF)、吞咽障碍特异性生活质量量表(SWAL-QOL)评分、Beck口腔评分、体重指数(BMI)、血清白蛋白(ALB)水平.结果 治疗后观察组VGF、SWAL-QOL、Beck评分及BMI、ALB水平优于对照组(P<0.05).结论 假饲法对脑卒中后吞咽困难的患者吞咽功能、营养状况、生活质量的改善有较好的作用.

Objective . To explore the efficacy and safety of chlorhexidine oral care in the prevention of ventilator-associated pneumonia (VAP) by means of meta-analysis. Methods . Randomized controlled trials on the effect of chlorhexidine oral care on the incidence of VAP in patients on mechanical ventilation were searched in PubMed, Scopus, Cochrane Library, and Embase from May 1, 2022. Two researchers independently screened and included the study, extracted the data, and evaluated the literature quality. RevMan5.3 software was used for meta-analysis. Results . Meta-analysis of 13 included literature studies involving 1533 patients showed that oral care with chlorhexidine solution could reduce the incidence of VAP in patients with mechanical ventilation and the difference was statistically significant (RR = 0.61, 95% CI (0.46, 0.82), P = 0.04). However, the results showed that the incidence of VAP of low concentration (0.02%, 0.12%, and 0.2%) and high concentration (2%) of chlorhexidine in the intervention group was lower than that in the control group and the difference was statistically significant (RR = 0.70, 95% CI (0.51, 0.96), P = 0.03; RR = 0.41, 95% CI (0.27, 0.62)). There was no significant difference in mortality between the two groups (RR = 1.01, 95% CI (0.85, 1.21), P = 0.87). There was no statistical significance in days ventilated or days in ICU between the two groups (RR = −0.02, 95% CI (−0.19, 0.16), P = 0.84; RR = 0.01, 95% CI (−0.11, 0.14), P = 0.85). Conclusion . Existing evidence shows that chlorhexidine used for oral care of patients with mechanical ventilation can reduce the incidence of VAP, and high concentration of chlorhexidine (2%) or low concentration of chlorhexidine (0.02%, 0.12%, 0.2%) has a significant effect on the prevention of VAP. Considering the safety of clinical application, it is recommended to use 0.02%, 0.12%, and 0.2% chlorhexidine solution for oral care.

Objective:A foot cleaning device for bedridden patients in ICU was made, and its application effects in foot cleaning for bedridden patients in ICU was discussed.Methods:A total of 200 inpatients in the department of ICU from April 2021 to October 2021 were selected as the research objects.According to the random number table, the patients were divided into two groups, including 100 patients in the control group and 100 patients in the experimental group.The patients in the control group used an ordinary foot basin and dipped warm water by a towel for foot wiping and cleaning. The patients in the experimental group used a foot cleaning device for bedridden patients developed and designed by our hospital. Both groups received warm water foot bath for 20 minutes after cleaning. The incidence of adverse events, average foot washing time, total foot washing time, the subjective comfort and satisfaction of the patients and the satisfaction of the operator were observed.Results:The incidence of adverse events during foot cleaning in the experimental group was 2.00%(28/1 400) lower than 4.36%(61/1 400) in the control group, the difference was statistically significant ( χ2=11.88, P<0.05). The foot washing time in the observation group [(27.77 ± 1.34) min] was longer than that in the control group [(24.63 ± 2.36) min], the difference was statistically significant ( t=9.30, P<0.05). The total foot washing time in the observation group [(27.77 ± 1.34) min] was shorter than that in the control group [(49.26 ± 4.71)min], the difference was statistically significant ( t=42.51, P<0.05). The subjective comfort of foot cleaning, the satisfaction of foot cleaning of patients and the satisfaction of foot cleaning operators in the experimental group were 91.00 (91/100) , 97.00% (97/100) , 91.67% (55/60) , while the control group were 75.00% (75/100) 、85.00% (85/100) , 75.00% (45/60) , and the differences between the two groups were statistically significant ( Z=-3.04, -4.82, -2.71, all P<0.05). Conclusions:The self made foot cleaning device for bedridden patients in this study can be used in ICU patients. It can effectively reduce the incidence of adverse events in the process of foot washing and shorten the time of foot washing. It can also improve the comfort and satisfaction of patients, and improve the satisfaction of operators.

Ventilator-associated pneumonia (VAP) is one of the most common infectious diseases in patients undergoing mechanical ventilation in intensive care unit (ICU). Although the use of closed sputum suction tube for sputum suction is the most common nursing measure for patients with tracheal intubation in ICU, and it is also an important measure to reduce the occurrence of VAP, the existing clinical technology still needs to use external flushing solution for humidification and flushing. In the process of use, the flushing operation has the risk that the amount of flushing fluid cannot be controlled, resulting in a large amount of flushing fluid entering the patient's airway, causing the patient to suffocate. The sputum attached to the wall of the sputum suction tube cannot be completely flushed, and the prolonged retention of the sputum leads to the proliferation of colonized bacteria, aggravating the infection of patients. Repeated pipe flushing not only increases consumables, but also increases the workload of medical staff. For this reason, the author has designed a fully enclosed sputum suction tube flushing device, which has obtained the National Utility Model Patent of China (patent number: CN 2019 2 1198740.5). This device is an integrated design, and the materials used for sputum suction, humidification and flushing are fully enclosed, without air exposure, and can be operated strictly without bacteria. Pulse flushing with syringe can clean the sputum attached to the inner wall and reduce the incidence of VAP. The volume of flushing fluid can be effectively controlled during use to ensure patient safety and reduce waste. It is worth popularizing and applying in clinical practice to optimize the operation steps and reduce the workload of medical staff.

重症监护室(ICU)是抢救危重患者的场所,其专业特点是病情危重、病种复杂,护士在患者治疗中起到举足轻重的作用[1].开展新入职护士培训是培养合格临床护士的重要途径,是提高临床护理质量、保障医疗安全的有力举措,对于提高护士队伍整体素质和服务能力水平具有重要意义[2].为加快培养合格的临床护理工作者,作者所在综合性三甲医院对新入职护士进行为期2年的规范化培训,于2015年起对本院新入职护士实施"导师制"进行指导、引领.2018年,ICU科室结合护理部要求,根据科室自身特点制定"全程-专科"双导师责任制带教方案,对传统师徒式带教模式进行改革,提高规培护士对危重症护理的临床实践能力,规培护士对临床带教的满意度高,取得一定效果.现报道如下.