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Citation |
Fei G, Wang F, Sun D, Ren YW, Zhu LH, Hua J, Zhu YP, Lyu GZ. Zhonghua Shao Shang Za Zhi 2019; 35(5): 384-387. |
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Affiliation |
Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China. |
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Copyright |
(Copyright © 2019, Zhonghua yi xue hui) |
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DOI |
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PMID |
31154738 |
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Abstract |
Objective: To explore the application experience of integrated nursing mode in the treatment of extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 35 extremely severe burn patients involved in the August 2nd Kunshan factory aluminum dust explosion accident were admitted to Wuxi Third People's Hospital, including 18 males and 17 females, aged 21-50 years. According to the characteristics of the wounded, the situation of the nursing staff, and the characteristics of the nursing work, the integrated nursing mode was constructed and implemented to improve overall nursing quality. The standardized management measures such as cluster management of facilities and equipments in wards, improving and unifying nursing system, standardized training, drawing up " Nurses Compulsory Reading" , optimizing nursing shift handover and so on were taken. Professional quality control groups such as continuous renal replacement therapy (CRRT) group, static therapy group, airway group, and burn group were established, and standardized writing nursing group, wound nursing group, psychological nursing group, and enteral nutrition nursing group were set up under burn group. The treatment outcomes of patients and effects of nursing management, nursing methods, and specialty nursing were recorded. Results: Twenty-seven patients survived the shock period, infection period, and recovery period smoothly. The success rate of rescue was 77.14%. During the treatment, the ward was in good order. The implementation rate of disinfection and isolation system, the completion rate of shift handover, the standard rate of intravenous therapy, the implementation rate of bed head elevation, the correct rate of posture placement, and the success rate of CRRT were all 100%. Successful turn over of rotating bed without interruption of CRRT for 24 hours was implemented in two patients. In many cases, the single filter for hemodialysis continuously run for more than 72 hours. The airway mucosa of patients healed around 20 days after injury. No adverse nursing events such as tracheal cannula detachment/blockage, respiratory distress, atelectasis, lung consolidation, aspiration by mistake, rotating bed rollover, ear chondritis, nasal septal pressure ulcer, vacuum sealing drainage (VSD) catheter blockage, VSD dressing leakage, severe abdominal distension/diarrhea, non-planned extubation/blockage of various intravenous treatment catheters implanted into deep veins and arteries were observed. Conclusions: The integrated nursing mode significantly optimizes the nursing work process in the treatment of extremely severe mass burns, clarifies the duties of nursing staff, and improves the quality of nursing. This mode is worthy of taking reference by other burn treatment units. Language: zh 目的： 探讨一体化护理模式在"八二"昆山工厂铝粉尘爆炸事故特重度烧伤伤员救治中的应用经验。 方法： 2014年8月2日，无锡市第三人民医院收治"八二"昆山工厂铝粉尘爆炸事故特重度烧伤伤员35例，其中男18例、女17例，年龄21～50岁。根据伤员伤情特点、护理人员情况及护理工作特点，构建并实施了一体化护理模式，包括采取集束化管理病区设施设备、完善统一护理制度、规范化培训、制订"护士必读"和优化交接班等规范化管理措施，建立气道组、静疗组、连续性肾脏替代治疗(CRRT)组和烧伤组等专业化质控小组，烧伤组又下设规范化书写护理小组、创面护理小组、心理护理小组和肠内营养护理小组，以提升整体护理质量。统计患者治疗结局以及护理管理、护理方法、专科护理方面的效果。 结果： 27例伤员平稳度过了休克期、感染期、恢复期，抢救成功率达77.14%。救治期间，病房井然有序，消毒隔离制度落实率、交接班完好率、静脉治疗操作规范达标率、床头抬高落实率、体位摆放正确率、CRRT上机成功率均达100%，顺利完成伤员卧翻身床24 h不间断CRRT治疗2例，多例患者血液透析单滤芯连续运转超72 h。气道黏膜于伤后20 d左右愈合，未见气管套管脱管/堵管、呼吸窘迫、肺不张、肺实变、误吸、翻身床侧滑、耳软骨炎、鼻中隔压疮、负压封闭引流(VSD)管道堵管、VSD敷料漏气、严重腹胀/腹泻、深静脉及动脉等处置入的各类静脉治疗导管非计划性拔管/堵管等护理不良事件发生。 结论： 一体化护理模式在群体特重度烧伤伤员救治中显著优化了护理工作流程，明确了护理人员的职责，提升了护理质量，该模式值得其他烧伤救治单位借鉴。. Language: zh |
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Keywords |
Accidents; Burns; Integrated nursing mode; Nursing administration research; Nursing shift handover |