Objective To formulate an evidence-based position program for a ventilation patient with acute respiratory distress syndrome (ARDS). Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to January 2011), DARE (March 2011), CCTR (March 2011), MEDLINE (1996 to January 2011) and CNKI (1979 to January 2011) were retrieved to collect high quality clinical evidence, and then the optimum nursing program was designed in line with patient’s conditions and relatives’ willingness. Results Three meta-analyses, three randomized controlled trials, one systematic review and one anterior-posterior self-control study were included. The available clinical evidence displayed that: a) the prone position adopting earlier, especially for patients with bilateral lungs or left lung functional disorder, was propitious to effectively improve the oxygenation condition and reduce the incidence of ventilator induced lung injury (VILI); b) The long-term prone position could increase the risk of pressure sore; c) The prone position could prolong the survival time, but there was no enough evidence to prove that it could obviously decrease the mortality rate of ARDS. So finally a nursing plan was made in combination with literature evidence and patient’s condition: adopting the prone position after onset within 24 to 36 hours, and enhancing the skin nursing to prevent pressure sore at the same time. After 4-week comprehensive therapy and prone position ventilation, the patient got obvious alleviated in oxygenation, with SpO 2 up to 90% to 100%, stable vital signs, and no more VILI and pressure sore. And then the patient was stopped applying ventilator, and transferred to a general ward for further treatment. Conclusion The earlier adoption of prone position ventilation for severe ARDS can improve oxygenation and reduce ventilator associated pneumonia (VAP) and VILI, but whether it can prolong survival time and reduce mortality for mild ARDS or not still has to be proved with more high quality evidence in the future.
Objective To formulate an evidence-based adjuvant therapeutic plan for a patient with large area pressure ulcers. Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2008), DARE (Issue 3, 2008), CCRT (Issue 1, 2008), MEDLINE (1980~ March 2008) and Chinese Journal Full-text Database CNKI (1979~2008) for the best available clinical evidence on adjuvant therapy of large area pressure ulcers with infrared rays, nutrition support and some special overlays. Results Two systematic reviews and three randomized controlled trials were included. According to the current evidence, as well as the patient’s clinical condition and preference, a comprehensive therapeutic plan was given to the patient. And in the next three months with the therapeutic plan, the patient’s large area pressure ulcers had already recovered. Conclusion Evidence based approaches can help us develop the best comprehensive therapeutic plan for the patient and will help improve the therapeutic results for patients with large area pressure ulcers.
Objective To explore the delay in help-seeking by breast cancer patients in Sichuan province. Methods A cross-sectional survey was performed in 327 patients with breast cancer from 7 first-level hospitals in Sichuan province, from July 2006 to January 2007. The following items were assessed: the time of symptom onset, the time of help-seeking, the time of definitive diagnosis, and the time of cancer treatment. The median times of patient delay, medical delay and total delay were computed. Results A total of 327 patients were surveyed and 312 questionnaires were distributed, with a response rate of 95%; 308 were retrieved, with a retrieval rate of 99%; and 283 were identified as valid, with a valid retrieval rate of 92%. The median time of total delay was 94 days, with an incidence of 50.2%; the median time of patient delay was 50 days, with an incidence of 35.7%; the median time of medical delay was 10 days, with an incidence of 16.7%.Conclusion Help-seeking delay by breast cancer patients is common in Sichuan province. Since patient delay contributes most to the total delay, it is important to control this portion.
Objective To construct a framework and relevant evaluation items for evaluating the core competence of clinical nursing teachers. Methods We explored the whole frame of competence structure and established behavior items for evaluating competences with corresponding level-marking standards through theory analysis, literature study, expert consultation and a small sample test. We also investigated 237 nursing managers, teachers, and students from six medical schools in China using a 5-point Likert-type scale. Item analysis and factor analysis were performed to reveal competence construction and connotation, and the evaluation model for core competence of clinical nursing teachers were constructed. Results Content, structure and internal consistency coefficient were checked for validity. Cronbach＇s alpha of the total system was 0. 9109 and of each domain ranged from 0. 6064 to 0. 8474. Results of Split-half Reliability demonstrated that of total system was 0. 8765 and of each domain ranged from 0. 634 2 to 0. 8369. Conclusions The evaluation model for core competence of clinical nursing teachers is composed of three parts： competence domains, behavior items and their corresponding grade standards. Core competence of clinical nursing teachers consist of four domains：leadership ability, problem-solving ability, teaching ability and nursing ability, each of which contains several behavior items and corresponding four grades standards reflecting different abilities.
Objective To evaluate the effect of visual and audiovisual distraction on anxiety and acceptance levels among patients undergoing colonoscopy. Methods A total of 180 consecutive patients undergoing colonoscopy were randomly divided into three groups: group A received visual distraction; group B received audiovisual distraction; and group C received routine care alone. Levels of anxiety and willingness to accept the same intervention if the procedure needed to be repeated were compared among the three groups. Results The reduction of anxiety score after colonoscopy in group A and group B was greater than that in group C, but the difference was not statistically significant. The rate of willingness to accept the same intervention if the procedure needed to be repeated was significantly different among the three groups: the rates for group A and group B were higher than for group C (Plt;0.05). Conclusions Both visual distraction and audiovisual distraction can significantly improve patients’ acceptance of colonoscopy. Visual distraction and audiovisual distraction have no significant effect on reducing anxiety.
Objectives To describe the attitude , subjective norm and behavioral intention of ICU nurses toward mechanically ventilated patients in Chengdu. Methods The modified version of Attitude, Subjective Norm and Behavioral Intention of Nurses Toward Mechanically Ventilated Patients (ASIMP) was used to investigate ICU nurses in three tertiary-level hospitals in Chengdu. Results The attitude, subjective norm and behavioral intention among ICT nurses respectively toward mechanically ventilated patients were 69.1%, 91.3%, and 95.9%. Conclusion The attitude, subjective norm and behavioral intention of most ICT nurses toward mechanically ventilated patients were positive.
目的 了解高校护理本科生（下称护生）在临床实习阶段对带教教师的具体期望，为临床带教老师的培养提供依据。 方法 以杜威的反思思维理论为基础，使用Van Manen的诠释现象学研究方法暨反思日记分析，于2011年1月对67名护生的临床反思日记进行分析；同时采用自行设计的问卷就护生对临床教学的评价进行调查。 结果 护生对临床带教教师的反思主要集中于5个主题，即期望带教老师制定合理的、有针对性的带教计划并采用灵活多样的教学手段，期望得到带教老师的肯定和鼓励，期望得到独立实践护理角色的机会，期望带教老师注重培养护生的临床思维能力，期望带教老师拥有良好的综合素质；护生对临床教学评价总平均分为（4.51 ± 0.06）分，得分率为87.3%。 结论 临床带教老师在不断提升自身综合素质的同时，应根据护理本科人才能力培养目标制定合理的实习计划，选择恰当的教学方式，提供良好的临床学习环境，以进一步提高临床教学质量。