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Part 1: Nursing Case Discussion Model
key word nursing case ； discuss ； experience
With the improvement of people's living standards, health problems are also getting more and more attention. Therefore, only by constantly updating their knowledge and skills, can nursing staff meet the growing needs of society for nursing. Our hospital is a "Grade II Grade B" county-level comprehensive hospital. Since the hospital management year activity was launched in 2005, our nursing department has taken the implementation of the nursing case discussion system as one of the measures to improve the professional level of nursing staff. Through nursing case discussion, collaboration, exchange and communication between doctors and nurses and between departments were strengthened, and the purpose of knowledge interaction and resource sharing was achieved. At the same time, the nursing staff were urged to keep learning and learn valuable experience and lessons, so that nursing professional knowledge and technical level were effectively improved.
1 Object and method
1.1 Object
Since 2006, our hospital has carried out six discussions on nursing medical records, with 286 people participating in the discussion, including 96 nurses in charge, 106 nurses, 66 nurses, 12 interns, 4 doctors, 1 laboratory staff and 1 electrocardiogram room staff.
1.2 Methods
1.2.1 Time arrangement
Organize nursing case discussion quarterly
1.2.2 Form and participants
Nursing case discussion is hosted by the Nursing Department, and organized by the head nurse of the clinical department in turn. All nurses in each department except those on duty participate in the discussion. According to the characteristics of the case, clinicians, laboratory, ECG room and other department personnel are specially invited to participate in the discussion.
1.2.3 Case selection
Difficult nursing cases, special cases, new examinations, surgery cases, new nursing technology operation cases, and cases with more nursing problems.
1.2.4 Content
The nursing diagnosis, nursing measures, nursing effects, deficiencies and difficult problems in the nursing process, and advanced achievements and methods in the treatment and nursing of this disease at home and abroad were discussed.
1.2.5 Methods
Two weeks before the discussion, the nursing department will distribute the case data to the clinical departments in advance, and the nursing staff of each department will collect relevant data in advance according to the medical history. During the discussion, the nurse in charge first reported the medical history and general information of the death case, the nursing problems, measures and results of the death case during hospitalization, and summarized the dynamic nursing of the disease. Then the nurses participating in the discussion expressed their opinions on the patient's nursing, analyzed the shortcomings in the work, and proposed improvement measures. The specially invited medical technicians introduced the precautions of sample collection, the guiding significance of test results for nursing work, and the key points of observation in the process of ECG monitoring on the characteristics of cases. Finally, the director of the nursing department summarized the discussion opinions and put forward guiding opinions and requirements.
2 Effect
Nursing staff's evaluation on the effect of carrying out nursing record discussion (see Table 1)
3 Discussion
3.1 Improve the ability of nursing staff to apply nursing procedures
The discussion atmosphere of each nursing case was very warm, and everyone carefully analyzed whether the nursing diagnosis was clear and complete; Whether the nursing measures are specific and effective; Whether the due effect is achieved; Whether there are deficiencies in the nursing process, and discuss how to avoid similar problems. Through discussion, the common problems can be abstracted into a unified understanding, or used as experience to promote learning, or as a lesson to learn from. The discussion of nursing cases in accordance with the nursing procedures has played a role in guiding and promoting the application of nursing procedures by nurses.
3.2 Breaking the limitations of specialized nursing
With the development of medical technology, hospital divisions are gradually refined, while the average age and severity of hospitalized patients are increasing, and the number of complications is increasing. When patients have problems not related to their specialty, or organ dysfunction, or use drugs, instruments and equipment not related to their specialty, or carry out new operations or treatments, the nursing effect is often not best guaranteed. During the discussion of nursing cases, each department gave full play to its advantages according to its own characteristics, provided effective nursing methods and techniques, and gave full play to the role of specialized nursing talents and equipment. It promoted the mutual penetration and exchange of knowledge, overcame the limitations of specialized nursing knowledge and skills, improved the utilization rate of nursing resources, and achieved complementary advantages and resource sharing. At the same time, the opportunities for technical exchange and cooperation between departments have also been increased, and cross department cooperation has been achieved, which has enhanced the team cooperation awareness of nursing staff.
3.3 Promote academic exchanges and the promotion and application of new businesses and technologies
Nursing case discussion also involves the promotion and application of new nursing technology and new business. During the discussion, the nursing staff should collect relevant information on the cases discussed, introduce the medical development trends at home and abroad, and introduce the advanced achievements and methods in the treatment and nursing of the disease at home and abroad. The nursing department should analyze the feasibility of implementing some new nursing methods in our hospital and the precautions when implementing them in combination with the actual situation of our hospital. Nurses who attended the meeting also spoke freely, talking about their experience, experience and suggestions on individual cases: analyzing the value of new technology promotion. The heated discussion not only promoted the exchange of different academic concepts, but also inadvertently promoted new businesses and new technologies.
3.4 Improve the learning enthusiasm and professional level of nursing staff
Part 2: Nursing Case Discussion Model
Key words: liver cancer nursing clinic
1、 Psychological nursing
The psychological care of liver patients is very important, because as long as you have the confidence to overcome the disease, there may be miracles. The following describes the psychological problems of liver cancer patients and nursing measures.
1. Suspicious psychology: once the patient learns that he has cancer, he is restless, asks for evidence in many ways, and is nervous and suspicious. Therefore, medical personnel should be cautious in their words and deeds. They should find out the purpose of the patient's inquiry, answer the patient's questions scientifically and tactfully, and not speak frankly, so as to reduce the degree of the patient's shock and prevent the patient from losing confidence in the treatment.
2. Fear: patients know that they have cancer, and they often express fear, despair, loss of hope for life, and concern for their relatives. Nurses should sympathize with patients, give comfort, encourage patients to actively accept treatment, so as not to delay the condition, emphasize the role of psychology on the condition, and encourage patients to accept treatment with a positive attitude.
3. Pessimism: When patients prove that they have cancer, they will have pessimism and disappointment, showing more disappointment than expectation, depression and unhappiness. At this time, nurses should give care, indicating that the disease is being treated, and emphasizing that good mood is conducive to the prognosis of the disease.
4. Recognition psychology: after a period of time, the patient began to accept the fact that he suffered from this disease. His mood gradually stabilized, he was willing to receive treatment and placed hope on treatment. Nurses should timely apply "hint" therapy, publicize the significance of treatment, and eliminate adverse factors for treatment, such as social factors, family factors, etc.
5. Disappointment or optimism: because individual physique and adaptability are different, the treatment effect is also different. Some patients have been under control and are good at adjusting their mood. At the same time, they live in a harmonious emotional environment and are in an optimistic state for a long time. Some are getting worse gradually, with large treatment response, heavy financial burden, physical difficulty, mental exhaustion, and passively waiting for death. Nurses should analyze the causes of negative patients, do a good job in psychological comfort, timely adjust the patient's mentality, and do a good job in life guidance; For optimistic patients, rehabilitation guidance should be done well. Pay attention to the psychological changes, so as to find problems and solve them in time. In addition, nurses should also have skilled nursing skills and good psychological quality to make patients feel satisfied and happy. Nurses should be compassionate, calm, enthusiastic, patient, decisive, and observant. They should be equal, fair and just to patients of different ages, personalities, and positions. They should gain patients' trust and establish a good nurse patient relationship. They should be good at understanding patients' mistakes, not contradict patients, and be generous. In terms of language, they should be kind, patient, caring and considerate, and have a mild tone. When talking, they should listen carefully and not interrupt at will. They should also pay attention to observing the patient's condition, understanding their thoughts, and accepting reasonable suggestions. In the process of conversation, we should pay attention to the protective language. The diagnosis, treatment and prognosis of patients should be rigorous and scientific. We must not be arbitrary or guess.
2、 Clinical nursing
Clinical nursing is the most important part of liver disease nursing, and the quality of nursing measures will directly affect the recovery of patients.
（1） General care
1. Enthusiastically receive patients, do a good job of admission publicity and education, eliminate patients' fear, make patients have a sense of trust, and actively cooperate with treatment.
2. Pay attention to rest and reduce activity to reduce liver load.
3. Ensure protein intake, and eat appropriate amount of fat and high vitamin.
4. For those with ascites, the intake of salt should be limited to 3-5 g per day; For those with omen of liver coma and liver coma, protein intake should be temporarily stopped, and sugar intake should be the main intake.
5. Keep the bed unit clean and level, roll over regularly, and the emaciated people use safflower ethanol to massage the bone process every day to prevent bedsores.
6. Oral care should be provided to patients with liver coma and those who cannot eat.
（2） Disease observation
1. Observe the changes of vital signs and state of consciousness, and find out the changes of illness in a timely manner.
2. Observe the nature, duration and radiation of pain in the liver area.
3. After the liver intervention treatment, observe the patient's dorsalis pedis artery pulse and whether there is bleeding in the wound, and observe the change of blood pressure. 4. After radiotherapy and chemotherapy, the occurrence of various side effects should be closely observed and symptomatic treatment should be done well.
（3） Symptomatic nursing
1. Patients with pain in the liver area shall be given analgesics according to the three-stage analgesic method, and psychological care shall be done well, and psychological education for pain relief shall be done well.
2. Those with anorexia should often change their diet patterns and eat less and more meals. Those with upper gastrointestinal bleeding should fast during the active period.
3. For those with abdominal distention and ascites, they should take a semi recumbent position, keep the bed clean, turn over regularly, and prevent bedsores.
4. Nursing of various complications.
（4） Health coaching
1. Actively quit smoking and drinking. There are many carcinogens in tobacco; Long term excessive drinking will increase the burden on the liver, which is harmful to disease recovery.
2. Remove the mental burden of patients, encourage patients to actively participate in recreational activities, and live a regular life. After the disease is relieved, we should take part in the work within our power to eliminate the impact of "incurable disease" and maintain the normal function of the body. However, in the case of decompensation and infection, absolute bed rest is necessary.
3. Pay attention to personal hygiene, replace contaminated clothing in time, keep the environment clean and well ventilated, trim nails frequently, and prevent skin from being scratched and causing infection. Avoid bumping and squeezing the skin in the edema area.
4. To actively prevent bedsores, bedridden patients should be replaced every 2 hours. For patients with ascites and limb edema, the methods of recording the volume of entry and exit and measuring the abdominal circumference should be correctly mastered.
5. Diet regulation, especially in the postoperative rehabilitation period and during chemotherapy, must pay attention to diet regulation to facilitate recovery. Eat a diet of high calorie, high protein, high vitamin and low fat. People with edema should not eat bacon or pickles. People with cirrhosis should not eat hard, hot or irritating food.
6. For chemotherapy patients, the side effects of drugs should be observed. For example, mouth ulcers can be rinsed with saline or boric acid water, and gentian violet should be applied locally; Hair loss patients wear wigs; Regular reexamination of white blood cells. If the white blood cells are lower than 4 * 109/L, chemotherapy should be suspended, because chemotherapy drugs are easy to inhibit the hematopoietic system complicated with infection; Pay attention to the air circulation in the ward, disinfect the room regularly, and restrict visiting.
7. Liver function and coagulation function of patients undergoing liver cancer surgery shall be comprehensively checked before surgery. Intestinal preparation shall be carried out three days before surgery. Oral streptomycin shall be taken twice. Clean enema shall be performed the night before surgery. Vitamin K1 shall be intramuscularly injected three days before surgery.
As an excellent nurse, we should be flexible in dealing with all the situations of patients. Therefore, we should not deal with any symptoms of patients dogmatically and methodically, but should be flexible in dealing with them. This will not only improve the quality of care, but also bring great confidence to patients. Therefore, in specific nursing, nurses should also pay attention to improving their overall quality to bring the best physical effect to patients.
reference:
[1] Lu Zhiguo; Niu Jiuxin; Comprehensive treatment of pain in liver cancer. Journal of Clinical Oncology, 2000
Part 3: Nursing Case Discussion Model
1 Blood borne disease
Blood borne disease refers to the disease or syndrome that can be transmitted by pathogenic factors through blood to cause infection of susceptible persons. Many pathogenic factors can be transmitted through blood. There are more than 10 potential infectious pathogenic factors in blood, the most important of which are hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV. HBV, HCV and HIV are abundant in peripheral blood of patients and carriers. Therefore, great attention must be paid to the harm of the transmission of blood borne diseases to nursing staff who are exposed to blood borne diseases.
1.1 Hepatitis B Hepatitis B is the blood borne disease that nurses face the greatest risk of transmission. China is one of the high incidence areas of hepatitis B. So far, there are 120 million people infected with hepatitis B virus (HBV) in China, accounting for 9.09% of the total population in China. One quarter of them are chronic hepatitis B, about 30 million. It not only brings heavy economic burden to the country and patients, but also becomes the main source of infection in society. The main route of transmission of hepatitis B is the transmission of blood and blood products. The concentration of HBV in the blood of chronic infection and virus carriers is very high. Clinical nurses are infected with HBV a lot. In addition, daily contact, sexual contact and mother to child transmission are also important ways of hepatitis B transmission.
1.2 People with hepatitis C are generally susceptible to hepatitis C. The infection rate of hepatitis C in China is generally 3%, and the infection rate of blood recipients or patients receiving blood products, hemodialysis patients, and medical staff contacting blood is as high as 50%~60%. In recent years, hepatitis C caused by blood transfusion occurs occasionally, even the slightest blood contact can be infected. The chances of nurses being infected in the specific environment of the hospital are greatly increased. About half of the cases can form chronic hepatitis after infection.
1.3 AIDS is an acquired immunodeficiency syndrome, and its incidence has increased year by year in recent years. Since the first AIDS patient was found in China in 1985, as of December 2006, according to the Chinese Academy of Preventive Medical Sciences, the number of HIV infected people in China has reached 1 million! The number of nurses infected by patients has also increased, and the majority of nurses are facing the risk of occupational infection. The main route of transmission of AIDS is blood transmission, followed by sexual transmission and mother to child transmission. However, asymptomatic HIV infected persons pose a more personal threat to nursing staff. Such infected persons have no conscious symptoms, no positive signs, and can live and work normally. However, every HIV infected person is a dangerous source of infection for spreading AIDS.
2 Risk factors of blood borne diseases among nursing staff
2.1 Indifferent self-protection awareness At present, hospital staff in China generally lack systematic education on infection control knowledge, and the corresponding lack of awareness of self-protection knowledge on hospital infection is an important reason for blood borne diseases among nurses. In addition, unskilled nursing skills and failure to take necessary preventive measures during operation can lead to an increase in the infection rate of blood borne diseases among nursing staff.
2.2 The skin and mucous membrane of the nursing staff are damaged. The skin and mucous membrane are damaged, and the natural barrier disappears. Contact with the blood and body fluid with virus may lead to infection. According to relevant reports in the United States, 4.2% of nurses who have been exposed to HIV blood stain are HIV antibody positive.
2.3 Injuries to instruments contaminated with virus blood Nurses may be injured by various sharp instruments such as knives, scissors, needles and so on when performing operations such as surgical cooperation, injection, puncture, and cleaning of instruments, so that the virus can enter the blood directly and be infected, which is the main reason for the spread of blood borne diseases and poses a great threat to the health of nurses. This is also an important reason why the prevalence of hepatitis among nursing staff is higher than that of other groups.
3 Occupational protection of nursing staff
Nurses' infection with blood borne diseases is mostly caused by accidental contact with infectious blood. In nursing services and operations, some accidents are difficult to stop. At the same time, both fatal and non fatal diseases will seriously threaten the life and health of nurses. Therefore, nursing staff should take effective measures to prevent the spread of blood borne diseases caused by occupational relationships.
3.1 Strengthening the self-protection awareness of nursing staff, training nursing staff on common blood borne diseases, fully understanding the hazards of blood borne diseases, understanding their transmission routes and risk factors, and arousing great attention in ideology are the primary measures for nursing staff to prevent the transmission of blood borne diseases. In addition, nurses must be proficient in various technical operations and take necessary protective measures to reduce the incidence of blood borne diseases.
3.2 Establish the concept of comprehensive barrier isolation and standard prevention. This concept of comprehensive barrier isolation is mainly proposed to protect medical personnel. The isolation object is all patients. It emphasizes that medical personnel wear gloves and carry out necessary vaccination for medical personnel. The standard prevention is that the patient's blood, body fluids and secretions are infectious and must be isolated. Anyone who contacts the above substances must take protective measures, regardless of whether there is obvious blood stain pollution or contact with incomplete skin and mucosa [1]. Standard prevention not only prevents the spread of blood borne diseases, but also prevents the spread of non blood borne diseases; It also emphasizes two-way protection, which not only prevents diseases from spreading from patients to medical staff, but also prevents diseases from spreading from medical staff to patients. It is an effective and important means to prevent the spread of blood borne diseases.
3.3 Prevention of instrument damage To prevent the occurrence of instrument damage, all nursing procedures must be strictly implemented. In the process of disinfection, cleaning, transportation and treatment of infectious pollutants, special care should be taken to avoid accidental damage. When injecting and collecting blood for patients, it is necessary to prevent accidental puncture of the needle with blood. Sharp instruments such as needles used by patients must be properly handled, put into puncture resistant collection containers, sterilize and destroy the shape, and reduce the chance of needle stab injuries. Positive protective measures should be taken when the operator's skin and mucous membrane are damaged. For HBV, HCV, HIV and other positive patients, disposable medical devices or supplies should be used to reduce the spread of blood borne diseases caused by secondary contact, and the articles used should be handled in strict accordance with the requirements of special infection management.
3.4 Immune enhancement When nurses are accidentally stabbed or contaminated with blood, they should detect antibodies as soon as possible, and take corresponding treatment measures according to their immune status and antibody level, such as inoculation of hepatitis B vaccine. For diseases that can not be prevented by vaccines, medical observation can be carried out according to the characteristics of etiology, such as HCV and HIV. Nurses who often contact with corresponding pathogenic factors should be immunized and antibody levels should be regularly tested to ensure that the body is immune to blood borne pathogenic factors.
Chapter 4: Nursing Case Discussion Model
[Abstract] With the rapid progress of the research on coronary intervention, percutaneous transluminal coronary angioplasty (PTCA) and coronary stent implantation have been widely used in clinical practice. PTCA uses the principle of balloon extrusion to tear the intima and atheromatous plaque of coronary artery stenosis, compress the atheromatous plaque and lengthen the middle layer, so as to expand the vascular cavity. The implantation of intravascular metal stent can support the vascular wall and prevent the acute occlusion, dissection and chronic restenosis of blood vessels after PTCA. However, long-term studies have shown that the restenosis rate of PTCA combined with intracoronary metal stent implantation is still as high as about 20%. The development and application of drug-eluting stents can effectively reduce the incidence of restenosis. From November 2004 to December 2005, our hospital used rapamycin drug-eluting stents to treat 27 patients with coronary heart disease. After 6 months of follow-up, no patient had restenosis, and the effect was satisfactory. The nursing experience before and after the operation is summarized as follows.
1、 Data and methods
1.1 General information Among the 27 cases in this group, there are 19 males and 8 females. The average age was 56 years, ranging from 36 to 83 years old. All patients underwent selective coronary angiography, including 6 cases of single vessel disease, 12 cases of two vessel disease, 6 cases of three vessel disease, and 3 cases of multi vessel disease. After improving the preoperative preparation, drug eluting stents were implanted in coronary arteries, with a maximum of 5 stents.
1.2 Methods According to Seldingers method, the right femoral artery was punctured and sent into the 7F or 6F sheath, and then into the guide tube through the outer sheath. From the guide tube, the guide wire and balloon catheter were sent to the lesion location, and the pressure pump was used to pressurize and expand until the narrowed or blocked vessels were unblocked. Then, the drug eluting stent was sent to the lesion through the guide wire, and the stent was expanded by balloon to fix it at the stenosis site, and then the guide wire was withdrawn. The angiogram showed that the blood flow of the blood vessel was unobstructed, and then the guiding catheter was withdrawn, the arterial sheath was retained, and the wound was covered with a 9cm × 15cm sterile dressing. After the sheath was fixed, it was sent to CCU for monitoring.
2、 Results
All cases had no serious postoperative complications, and the operations were successful. No restenosis occurred after 6 months of follow-up.
3、 Care
3.1 Preoperative care
3.1.1 The health education responsible nurse understands the patient's physiological and psychological problems purposefully and pertinently after admission, analyzes the collected data, formulates the patient's health education plan and implements holistic nursing. Through health education, enhance patients' awareness of self health care, control risk factors, change bad lifestyle, quit smoking and drinking, control weight, blood sugar, blood lipids, pay attention to life rules, and strengthen self psychological adjustment. To introduce the technical advantages and specialties of interventional therapy in our hospital, the advancement and effectiveness of drug stents, so that patients can receive treatment in the best psychological state.
3.1.2 Improve the examination to assist in improving the preoperative examinations, including ECG, X-ray examination, heart color ultrasound, blood routine, blood type, blood biochemistry, bleeding and coagulation time, and the first four items of blood transfusion, especially to observe the changes of myocardial zymogram and troponin.
3.1.3 Prepare routine skin preparation before operation to avoid skin damage, keep local skin clean, conduct iodine allergy test, and give anti platelet aggregation drugs such as aspirin and clopidogrel according to the doctor's advice before operation. Generally, aspirin 100mg, once a day, was taken at admission, and clopidogrel 75mg, once a day, three days before surgery; Or the anticoagulation method of taking 300mg daily before operation. Take food and urinate on the exercise bed, change clothes in the morning, give 10mg of diazepam intramuscular injection 30 minutes before operation, establish venous channels, and empty the urine and stool before going to the catheter room.
3.2 Postoperative care
3.2.1 Closely observe the changes of the patient's condition and return to CCU after surgery. After the patient is placed, do a 12 lead ECG immediately, fix the exact position of each chest lead, and then do an ECG at the same chest lead according to the patient's condition to improve the comparability of the figure. Venous blood was drawn regularly to observe the changes of myocardial enzymes. ECG, blood pressure and blood oxygen saturation were monitored for 48 hours, and body temperature was measured 4 times a day for 3 consecutive days. Closely observe the dynamic changes of the above indicators, listen to the patient's chief complaints, record the changes of the condition, such as chest pain, suffocation, pericardial tamponade, etc., and timely find out the complications such as persistent angina, coronary spasm, coronary dissection, acute coronary occlusion, acute myocardial infarction, hypotension, arrhythmia, etc. In case of any abnormality, report to the doctor and handle it in time.
3.2.2 During the implantation of wound care stent, heparin is used to heparinize the blood. Delayed extubation can reduce postoperative bleeding. In addition, emergency PTCA is prepared for use. After the patient returns to CCU for 4h, the wound is in good condition, and the retained sheath can be removed. Before extubation, the nurse should prepare for extubation, prepare first-aid drugs such as dopamine, atropine, adrenaline, lidocaine, sterile gauze, disposable air bag tourniquet and other items, and assist the doctor in extubation to prevent patients from increasing vasovagal tension, bradycardia, decreased blood pressure, nausea, pale face Emergency treatment due to cold sweat, indifferent expression and other symptoms. During extubation, the finger pressure is generally applied at the two transverse fingers above the puncture point for 15 to 30 minutes. The pressure should be able to touch the pulse of the dorsal artery of the foot. After that, the puncture point is covered with sterile gauze, and then the disposable balloon tourniquet is used to compress the bleeding. At the beginning, the balloon pressure is 8 to 12 kPa. After 2 hours, the pressure is reduced to 6 to 8 kPa, and the pressure is pressed for 4 to 6 hours. No case in this group has vascular vagus reflex due to extubation.
3.2.3 Pharmacotherapy nursing The most fatal weakness of intravascular stent implantation is that it is easy to lead to acute thrombosis, so it is important to strictly control the dosage of heparin and medication time after surgery. In general, 5000u of low-molecular-weight heparin calcium was injected subcutaneously into the abdominal wall 2 hours after pulling out the sheath, twice a day. During heparin use, bleeding tendency should be prevented. Continue to take anti platelet aggregation drugs orally, such as aspirin, clopidogrel, etc. Prophylactic use of antibiotics for 3 days after operation, observe the efficacy and side effects of drugs, guide patients to use drugs correctly and timely, and no infection and adverse reactions caused by various drug side effects occurred in this group of patients after operation.
3.2.4 Discharge guidance instructs patients to review and follow up regularly. Continue to take antiplatelet aggregation drugs on time according to the doctor's advice. Take 75 mg of clopidogrel every day, and 100 mg of aspirin every day for 3 to 6 months. If there is no digestive tract ulcer, take it for a long time, and pay attention to taking it after meals. Tell the patient to see a doctor in time if he has chest tightness or chest pain. In addition, we should guide patients to establish a good lifestyle, prevent disease recurrence, and control disease progress. Control the risk factors of primary diseases and avoid the inducements of disease recurrence, such as smoking and drinking cessation, fat reduction, weight loss, treatment of hypertension, diabetes and other concomitant diseases, and avoid inducing factors such as excessive fatigue, excitement, cold, satiety, constipation and so on. And tell the family members to actively cooperate and support the patients to create a good physical and mental recuperation environment.
4、 Experience
With the development of interventional therapy, how to effectively reduce restenosis after PTCA has always been the focus of relevant disciplines. The emergence and clinical application of stents have epoch-making significance, reducing the restenosis rate to 20%, but this percentage has become a bottleneck that cardiac intervention cannot overcome. Rapamycin, as an immunosuppressive drug, mainly acts on the G1 anaphase of mitosis of smooth muscle cells to make cells return to the quiescent phase, but does not kill cells, which has good safety. Large scale clinical trials have confirmed that the stent carrying rapamycin can significantly reduce the incidence of restenosis of bare metal stent. We use rapamycin eluting stent to apply it to patients after PTCA, Good results have also been achieved. As an emerging technology, we deeply understand that good nursing cooperation is essential to reduce complications and ensure the success of the operation.
[References]
[1] Hu Dayi, Ma Changsheng. Practice of cardiology [M]. Beijing: People's Medical Publishing House, 2001:441
Chapter 5: Nursing Case Discussion Model
1. Preoperative nursing
1.1 Introduce the new medical progress, surgical methods, postoperative precautions, etc. to the children and their families, especially the importance of lying flat for 12 hours after surgery to reduce the tension of lower limb blood vessels and prevent bleeding at the puncture site, and obtain the cooperation of parents. And let them watch the surgical video, so that they have some perceptual knowledge about the treatment, and at the same time, they should contact with the children more, explain some understandable knowledge, and gain the trust and cooperation of the children and their families.
1.2 Children living in a single room should pay attention to disinfection, isolation and warmth to prevent upper respiratory tract infection. Ensure adequate sleep and keep it in the best operating condition.
1.3 Routine ECG and vital signs monitoring, echocardiography to determine the size and location of the defect and whether there are other abnormalities. Routine blood test, electrolyte, bleeding and coagulation time, prothrombin time, etc.
1.4 Preoperative preparation (1) The skin preparation range is from below the umbilicus to 1/3 of the upper thigh. (2) The allergy test of iodine contrast medium was performed. (3) Fasting began 6 hours before operation. (4) Urination and intramuscular injection were performed 0.5 h before operation. (5) The cardiac catheterization operating room shall be equipped with various first-aid equipment and medicines.
2. Intraoperative nursing
2.1 During the operation, closely monitor the changes of heart rate, heart rate, blood pressure and respiration.
2.2 Transient bundle branch block and atrioventricular block may occur in some cases during the operation, and most of them do not need treatment. They can recover immediately or within 24 hours after the operation.
3 Postoperative nursing
3.1 After operation, the child shall return to the ward by flat car, keep the punctured limb straight, and check whether the puncture site is well bandaged, and whether there is blood seepage and hematoma.
3.2 The child shall lie on his back for 4~6h without pillow, with his head turned to one side, and he shall fast water to prevent suffocation due to aspiration.
3.3 Keep the lower limbs straight and brake for 6h, compress the femoral vein with sandbags for 4h, and lie absolutely in bed for 12h. Observe the color, temperature and humidity of the skin at the distal end of the lower limb, and the pulse of the dorsalis pedis artery every 15 minutes to judge the blood circulation of the lower limb. Close monitoring of vital signs, once per hour, until the bandage is removed.
3.4 Do a good job of education and life care during braking. For younger children, the methods of comfort, encouragement and induction can be used. If necessary, small doses of sedatives can be given as instructed.
3.5 The child can eat and drink water 4~6h after the operation to prevent hypotension caused by too long fasting time. Avoid eating sour and gas producing foods, such as milk, drinks, bean products, etc; Do not eat fried, spicy and other food that is difficult to digest. Because of the contrast examination during the operation, more water should be drunk after the operation to facilitate the discharge of contrast agent and reduce renal damage.
3.6 In order to prevent mural thrombosis at the occluder site, routine anticoagulation treatment was performed after the operation, with 0.3 gqd of Tamil taken orally for 4-6 months. Parents of children are advised to take it after meals to reduce the irritation to gastric mucosa. The patients and their families are advised not to increase or decrease or stop taking drugs without authorization. Pay attention to observe whether there is bleeding tendency and stool color in the skin mucosa, mouth, gums and other parts of the body.
3.7 Remove the bandage 12 hours after the operation, and the child can get out of bed and move. Water washing is prohibited at the puncture site within 3 days after operation.
3.8 Echocardiography was performed on the second day after operation. Check whether the plugging device is well placed, located and shunted. If there is no abnormality, you can leave the hospital. Ask the child to avoid strenuous exercise, such as running and jumping, within 3 months; Frequently observe the puncture site to prevent the formation of hematoma due to poor healing of the puncture site; Ensure nutrition, give high protein, high calorie, high vitamin, easy to digest diet to strengthen the body. At the same time, appropriate amount of coarse fiber vegetables should be given to keep the stool unobstructed.
3.9 Regularly come to the hospital for reexamination.
reference
Dai Ruping. Current situation and prospect of interventional therapy for congenital heart disease in China. Chinese Journal of Cardiovascular Diseases, 2003, 31 (11): 801-805
Chapter 6: Nursing Case Discussion Model
[Key words] Psychological factors of elderly patients with dental diseases Oral health
Clinical data 200 patients, 93 males and 107 females. The age is 55-73 years old. According to different psychological states, patients are classified as follows:
1 Clinical classification
1.1 Carcinophobic type
The oral and maxillofacial anatomy and physiology of the elderly have changed to varying degrees. Literature analysis shows that 7% - 10% of elderly patients are easy to associate cancer with oral pain and mucosal abnormalities. Emotional tension and pressure increase the psychological burden and delay the effective treatment opportunity.
1.2 Fear and anxiety
Go to the department of stomatology to see a doctor, almost all the elderly will have different degrees of fear and anxiety. Only to a different extent. Because the body of the elderly is less able to bear pain, they worry about whether it is painful to drill and extract teeth. Whether there is distention, pain and infection after the operation, and whether the inlay can resume normal chewing.
1.3 Obsolete views
The thought of "preservation" is a mischief. It thinks that "tooth is one's own thing that cannot be pulled out, and a full mouth will fall out". It thinks that it is natural for people to become old, and toothache and looseness are manifestations of anger and aging. The false theory that toothache is not a disease is deeply rooted. Generally, if you can stand it, you will not go to the hospital or take anti-inflammatory and analgesic drugs by yourself, which will delay the treatment opportunity.
1.4 Loneliness and inferiority
The elderly, especially when they are not accompanied by relatives, worry about whether the treatment time and times are too long, and whether the treatment costs will increase the burden on their children. Some people are forced to give up the treatment of oral diseases due to economic constraints. I always feel that I am old, useless or "powerless", and "powerless", so I am anxious, or I think that I am too old to need treatment.
1.5 Doubtful
Because the elderly have more or less reactions to menopausal syndrome due to endocrine changes, they will have doubts about anything, and they will take a distrust attitude towards doctors' diagnosis and treatment, which is manifested in doubts about whether the charges are too high, doctors' technical level, and whether the equipment is disinfected.
1.6 Excessive self-esteem
This kind of situation is mostly seen in the elderly cadres who are on duty or retired after leaving their jobs. Because they have been valued and respected by others for a long time, they also require special treatment, customary orders and denial of medical staff's work in the process of treatment.
2 Countermeasures
2.1 It is necessary to eliminate the fear and anxiety of the elderly and warmly welcome every elderly person who comes to see the doctor, listen carefully to the elderly's complaints, patiently and carefully explain the occurrence, prognosis and recovery of the disease to the patients, so that they can understand the treatment plan. By prolonging the communication time, patients can gradually get used to the medical environment in the stomatological hospital, lead them to see other patients under treatment, and observe the reaction of other patients to eliminate tension. Let patients communicate more about the process of treatment and the recovery, enhance their confidence in overcoming the disease, let patients eliminate fear, and achieve the goal of cure.
2.2 Eliminate the sense of loneliness and inferiority. Explain patiently and carefully during the treatment, pay attention to the speed and volume of speech, and increase the communication time between doctors and patients. Move gently and handle the equipment gently. Pay attention to the time of diagnosis and treatment during the treatment, and combine work with rest. Increase the rest time and times during the treatment, and talk about more relaxed topics. Explain the precautions during treatment and try to win the cooperation of family members. Make the patient feel that the medical staff pay attention to him and gain the trust of the patient, which will help to reduce the loneliness and pessimism of the patient. In the process of treatment, we should strive for close cooperation of family members, eliminate their pessimistic self abandonment psychology, and glow a positive mood, so as to achieve the goal of doctor-patient cooperation.
2.3 Respect for patients and the elderly should be respected by the society. Medical staff should care for and sympathize with patients, give them sympathy and understanding, respect them as their own elders, and use honorific titles, such as "Liu Lao", "Wang Lao" or you. Help gently upstairs and downstairs, be considerate, considerate, kind, and speak kindly. The examination and diagnosis and treatment should be conducted gently and patiently to explain the condition and treatment plan. Try to use easy to understand language to avoid using professional terms, and slightly increase the volume so that elderly patients can hear clearly.
2.4 Elaborate treatment plan After a thorough and careful examination, the doctor should help the patient formulate a treatment plan scientifically and reasonably according to the patient's time characteristics, economic conditions and other personality factors. The information we provide must be correct, easy to understand, appropriate and conducive to enhancing patient confidence. When patients fully understand and obtain the information of their own condition, their choice is often consistent with the doctor's advice. Of course, when explaining the plan to the patients, the doctors should not forget to inform the elderly patients in advance of some conditions that will be encountered in the course of diagnosis and treatment, such as pain between visits or cracked teeth, and tell them how to avoid these conditions as much as possible.
2.5 Actively promote oral health care knowledge, update old ideas, let elderly patients understand the importance of oral health and general health, let them understand that physical diseases can be reflected in the oral cavity, and oral diseases can also cause other diseases. In the special period of old age, healthy oral cavity determines the balanced intake of various nutrients, thus affecting the health of the body, increasing the resistance of the body to reduce the occurrence of diseases. During this period, we must actively do oral health education to make them consciously accept oral health care and treatment, so as to achieve the goal of both prevention and treatment. Super Secretary Network
3 Conclusion
The aging of population is the general trend of development worldwide. Human aging is a physiological process, a comprehensive manifestation of degenerative changes in various organs in the process of life, and an irresistible natural law. With the aging of the population, the proportion of elderly dental patients is increasing day by day, and the oral diseases of the elderly have begun to receive attention. The principle of oral disease prevention and treatment for the elderly requires that doctors must master the characteristics of the elderly and conduct safe and effective treatment. Patient and meticulous working attitude and accurate treatment principle will win the patient's trust and cooperation in the treatment scheme. Relieve the mental pressure and concerns of elderly patients, help adjust their mentality, and enable timely and effective treatment and prevention of oral diseases. Although the psychological characteristics of each patient are different, and the disease and pathological stage are also different, as a clinical medical worker, we can meet the needs of patients timely through behavior, language, attitude, expression and responsibility. In addition to the knowledge and experience of geriatric stomatology, the treatment of oral diseases of the elderly should also have psychological knowledge. This reflects the important value of establishing a good medical ethics, and is also the quality that every medical staff should have.
reference
[1] Douglas CW. Analyze and deal with dental fear. Oral Health Report, 2002,12 (1): 11
[2] Zhang Zhenkang, Editor in Chief, Modern Stomatology (Volume II) Beijing: Science Press, 2003:2121
Chapter 7: Nursing Case Discussion Model
Key words: clinical case discussion; Respiratory diseases; Undergraduate nursing students; Clinical probation; Clinical thinking
In recent years, our school has implemented the reform of the teaching mode of adult nursing courses. After learning basic medical and clinical courses, students enter clinical probation early, increasing the opportunities for practice. The discussion of typical clinical cases, an interesting learning form, has also become one of the important teaching activities in clinical practice to cultivate the clinical comprehensive ability of nursing undergraduates to collect medical history, master the clinical manifestations of related diseases and nursing observation points, and formulate practical and targeted nursing diagnosis and nursing measures. The procedure is to select typical cases of related diseases in advance, arrange students to collect medical history, conduct relevant physical examination, summarize, put forward their own nursing observation points, and formulate corresponding nursing diagnosis and nursing measures. The teacher guided according to the teaching purpose, organized students to fully discuss the integrity of medical history collection, relevant positive signs, clinical nursing observation points, nursing diagnosis and basis, and the formulation of nursing measures, and gave targeted guidance. In the clinical probation teaching of respiratory department, the implementation of case discussion method can enable students to consolidate the basic theoretical knowledge they have learned, combine with clinical specific patients, cultivate students' correct clinical thinking, thus improving their ability to observe the condition, analyze and solve clinical problems, and obtain good interactive learning effect. The following is a summary of our experience in carrying out typical case discussion teaching in the respiratory department.
1、 Strengthen basic skill training
In clinical nursing work, perfect skills such as medical history collection, physical examination, condition observation and how to implement effective nursing measures are the basic qualities of a nurse, and also the important content of cultivating students' comprehensive ability. Although undergraduate nursing students have learned diagnostics and adult nursing, due to the lack of practical experience and the lack of formal skills and physical examination, the collection of medical history is simple and sketchy, and the positive signs are not fully mastered, and the specific clinical manifestations of the disease, possible complications, nursing observation focus, etc. cannot be described in detail and correctly. Therefore, in the course of case discussion, we put great emphasis on the training of basic clinical skills, including the collection of medical history, physical examination and the standardization and systematization of its techniques, as well as the correct description of positive signs, and strictly corrected the shortcomings and deficiencies of students.
The discussion and selection of clinical cases in the respiratory department focuses on common diseases and frequently occurring diseases in the respiratory department, such as COPD, pneumonia, spontaneous pneumothorax, etc. Due to the poor specificity of clinical symptoms and strong compensatory ability of respiratory diseases, students are required to master the general method of asking medical history and pay attention to the differences in clinical manifestations of respiratory diseases. For example, most patients with respiratory diseases have three major clinical manifestations: cough, expectoration, and dyspnea. If only the three major clinical manifestations are known, but the specific differences of clinical manifestations related to different respiratory diseases are not known, it is not conducive to mastering the knowledge learned. The length of cough time, the nature of cough is dry or phlegm, the regularity of cough is paroxysmal or persistent, and the relationship with climate and season; The nature of sputum is white foam sputum, or yellow purulent sputum, rust colored sputum; It can be found that although many diseases have three major clinical manifestations of cough, expectoration and dyspnea, the three major clinical manifestations of various diseases have their own specific characteristics. Finding and understanding these differences will enable students to have a deep understanding of the theoretical knowledge they have learned.
2、 Cultivate students' clinical thinking ability
Clinical thinking is a logical method for clinical nurses to use basic medicine and nursing knowledge to conduct comprehensive analysis and logical reasoning on clinical data, so as to find out the main problems and summarize them, and on this basis, establish nursing diagnosis of diseases and implement effective nursing measures. When students enter clinical probation, the following situations often occur: First, when diagnosing, they often only consider one or two symptoms, that is, they use the nursing diagnosis they have learned to cover the patients without detailed analysis. At this time, teachers should guide them, expand their thinking, take the scientific thinking mode as the guidance of teaching work, and at the same time, Make students receive a training in scientific methods. Second, although we have a wide range of ideas, thought more and put forward a lot of nursing measures, they are not targeted, in-depth and specific enough. At this time, teachers should help students carry out in-depth comparative analysis, eliminate the false and retain the true, eliminate the coarse and extract the essence, and enhance students' confidence. In combination with cases, for each analysis step of students, put forward questions, carry out layer by layer analysis, grasp the main contradictions to guide, and cultivate their clinical thinking ability. For example, when discussing COPD, the focus of discussion is on clinical manifestations, related incentives, main treatment, related complications, nursing diagnosis and specific nursing measures. We should guide students to think according to the following ideas: how the patient's life habits What are the clinical manifestations of the patient in the working environment? What treatment measures should be taken to ensure the expected effect of various treatment measures? What interventions should be taken in nursing? What problems may occur to the patient? How to find problems in time through nursing observation? How to deal with problems? How to do a good job in propaganda and education of the patient's related diseases? So as to play a point to area, will learn the role of knowledge. At the same time, it also organically combines theory and practice, and urges students to complete the leap from perceptual knowledge to rational knowledge.
3、 Cultivate students' ability of autonomous learning
Through the teaching process of case discussion, we should not only teach students relevant theories and specific inquiry methods, but also pay attention to training students' ability to acquire and use knowledge, that is, "teach them fish, teach them fish". Before each case discussion, the teacher requires students to prepare carefully. The preparation includes the basic medical knowledge and clinical nursing knowledge related to the case, relevant books published in recent years, and relevant nursing papers queried online. The teacher summarizes the knowledge about specific diseases and puts forward his own opinions. This process of comprehensive inquiry of relevant knowledge is conducive to improving students' understanding of data retrieval The ability of logical analysis can cultivate their independence and creativity, reduce their dependence on teachers, so as to cultivate their strong ability of independent learning, sorting out and summarizing new knowledge and information. In case discussion, we should give full play to students' initiative, let them think first, discuss first, and then the teacher will give analysis, supplement and summary. Only in this way can students better understand the teacher's correction and explanation, master the key content, and be particularly impressed. What students learned from this is not just one move, but learn to draw inferences from one instance. Through accumulation, students will gradually form the habit of independent thinking and improve their ability to solve problems.
Clinical nursing is a practical discipline. Only through the combination of clinical practice and theory, focusing on the cultivation of students' clinical thinking, and broadening their vision, can high-quality nursing talents be cultivated. In this sense, the teaching method of clinical typical case discussion has trained students' basic skills, developed their correct thinking methods, and their ability to observe and actually handle the disease. It can be regarded as an effective way to organically combine the medical foundation with preliminary clinical practice.
reference:
Chapter 8: Nursing Case Discussion Model
1.1 Research objects: 89 students from two administrative classes of nursing specialty in 2013 were randomly selected to carry out teaching research. There were 44 students in the experimental group (CBL teaching group) and 45 students in the control group (traditional teaching group). The teaching materials, teachers, class hours and teaching progress of the two groups of nursing students were the same, but their age and pre experiment scores were not significantly different (P>0.05), which was comparable.
1.2 Methods
1.2.1 Teaching methods The two groups were taught by the same teacher according to the curriculum and standards of mother and infant care.
1.2.1.1 Teachers in the control group complete teaching tasks according to traditional teaching methods.
1.2.1.2 The teachers in the experimental group mainly use the CBL teaching method, supplemented by lecture teaching. The specific procedures are as follows: teachers carefully screen typical clinical cases according to the teaching content; According to the key and difficult points of teaching and learning conditions, several core problems are designed, and the difficulty of the problems is progressive. When learning the nursing of patients with postpartum hemorrhage, can you ask whether the patient has postpartum hemorrhage? If so, what is the main reason for the patient's postpartum hemorrhage? What other factors cause postpartum hemorrhage? As an obstetric nurse, how will you rescue and nurse the puerpera? Teachers will transfer cases and problems to each student's space through the world university town space. The students in the experimental group are divided into five to six groups. Before class, they collect and sort out data, think about and solve problems, and write report materials. In the class, the teacher, based on the relevant cases and questions, arouses the students' interest in learning and discussion. Each group selects a representative to explain the discussion results of this group, and other students can make supplements. The teacher makes suggestions and answers questions according to the students' discussion, and finally focuses on the key contents of this section.
1.2.2 Evaluation method
1.2.2.1 After the examination result evaluation course, the school will organize the final examination for the two classes. The examination questions are randomly selected from the question bank, with a total of 100 points, including two parts: basic theoretical knowledge (50 points) and analytical application questions (50 points). If the total score is greater than or equal to 60, it is qualified; if the total score is less than 60, it is unqualified.
1.2.2.2 After the teaching effect evaluation course, the self-designed questionnaire was used to conduct a return visit survey on the two groups of nursing students to understand their satisfaction and evaluation of teaching. 89 questionnaires were distributed on the spot and 89 were recovered, with an effective recovery rate of 100%.
1.2.3 Statistical method: SPSS13.0 statistical software is used for statistical analysis of data. Sample comparison: the measurement data is subject to t test, the rate is subject to χ 2 test, and P<0.05 is used as the basis for determining statistically significant data.
2. Results
2.1 Student performance comparison The total scores of basic theoretical knowledge, analytical application questions and maternal and infant nursing examinations of nursing students in the experimental group were higher than those in the control group, with a statistically significant difference (P<0.05)
2.2 Comparison of teaching effect evaluation The experimental group was better than the control group in stimulating learning interest, learning initiative, understanding and mastering theoretical knowledge, linking theory with clinical practice, and communication ability, with a statistically significant difference (P<0.05).
3. Discussion
Maternal and Infant Nursing is one of the main disciplines of nursing specialty. It is a clinical medical discipline that studies the anatomy and physiology of the female reproductive system, pregnancy, childbirth, puerperium and the physiological and pathological status of newborns. The traditional teaching method is that teachers pass a large amount of information to nursing students in the prescribed class hours through "spoon feeding". Nursing students often feel boring and difficult to understand during their learning. When most students encounter specific cases during clinical practice, they cannot flexibly use the basic theoretical knowledge they have learned, lack clinical thinking ability, and have poor ability to analyze and solve problems. In the process of teaching reform, CBL teaching method has been applied to the field of medical education. CBL teaching method is that teachers select representative cases, ask questions, guide students to analyze and discuss cases, and finally teachers summarize and promote cases to abstract theory. From the results of this study, the application of CBL teaching method in Maternal and Infant Nursing has greatly improved the learning ability and effectiveness of nursing students.
3.1 CBL teaching method is a teacher led and student-centered teaching method Table 1 shows that nursing students in the experimental group are significantly better than those in the control group in terms of their ability to master basic theories, clinical thinking, analysis and problem solving. The reason is that CBL teaching method is a teacher led and student centered teaching method, which has well mobilized the teaching enthusiasm of teachers and students:
(1) With the CBL teaching method, teachers must have the following conditions to guide and control the classroom: first, scientific and rigorous design of the teaching process before the class: plan the key points and difficulties of the relevant chapters of maternal and infant care, select typical obstetric clinical cases, reasonably set appropriate questions, which are closely linked to each other, and gradually guide nursing students into the theme of the classroom; Secondly, teachers should not only firmly grasp the basic theoretical knowledge of maternal and infant care, but also have some clinical experience in obstetrics and gynecology. Only by combining theory with practice can teachers better answer questions for nursing students; Thirdly, teachers should continue to expand their knowledge, be good at stimulating students' interest, teaching in fun, controlling the rhythm of the classroom, and standardizing the guidance of nursing students.
(2) Nursing students no longer passively accept knowledge in CBL teaching, they are the main body of the classroom. This requires nursing students: first of all, they should preview the textbook knowledge before class, consult the literature related to maternal and infant care according to the cases and problems assigned by teachers, and sort out the data to accumulate knowledge; Secondly, in class, we discuss in groups, actively express our views, analyze and solve problems. The discussion process is actually a learning and thinking process, and students can learn from each other. Let nursing students learn how to analyze and solve problems, for example, when discussing postpartum hemorrhage, know what factors will lead to postpartum hemorrhage, how to carry out comprehensive nursing evaluation for puerperal women, make correct nursing diagnosis and nursing plan, and how to take appropriate nursing measures, etc. So as to gradually form the clinical thinking ability and the ability to analyze and solve problems. In the process of using CBL teaching, teachers should lead the classroom rather than the lecturer, step by step, actively guide, and promote nursing students to master knowledge; Nursing students actively explore knowledge, express their views through reporting and discussion, better integrate theory with practice, and learn to solve problems. The active classroom atmosphere and the exchange and feedback of information between teachers and students are conducive to stimulating the interest of nursing students in maternal and infant care and improving their ability to understand and analyze. Therefore, the use of CBL teaching method, as long as teachers and students work together, will achieve better results.
3.2 The advantage of applying CBL teaching method to Maternal and Infant Nursing is that "teaching people to fish is better than teaching them to fish". Modern educational circles widely agree that "teaching students to learn and making it a lifelong habit". From the results in Table 2, it can be seen that CBL teaching method is obviously helpful in the teaching of Maternal and Infant Nursing. This is because compared with traditional teaching methods, it has the following advantages:
Chapter 9: Nursing Case Discussion Model
The purpose of modern nursing teaching is to cultivate comprehensive nursing talents, so that nurses can have the ability to solve problems. For clinical cases, theory and practice can be combined to improve the clinical comprehensive ability of interns [1]. The application of clinical cases is to introduce interns into specific nursing scenes, guide interns with case related problems, and enable interns to master independent analysis and problem solving methods. There is a big difference between clinical case teaching and traditional teaching mode, which fully arouses the learning interest of interns. While mastering the key points of theoretical knowledge in clinical teaching, it can also grasp the overall knowledge and improve the ability of practical application of practical nursing [2]. In order to explore the application of clinical cases in the nursing teaching of neurology, in this study, 200 nurses from January 2014 to December 2015 were randomly selected as interns of neurology department in our hospital. The case group applied the clinical case nursing teaching mode and achieved ideal results. The report is as follows.
1 Data and methods
1.1 General information
From January 2014 to December 2015, 200 interns in the department of neurology of our hospital were randomly selected. According to different teaching modes, 200 interns were divided into two groups. One group selected 100 interns who applied the traditional teaching mode of nursing as the traditional group, and the other group selected 100 interns who applied the clinical case nursing teaching mode as the case group. There were 5 males and 95 females in the traditional group; The average age was (22.5 ± 1.1) years old; Among them, 80 are junior college students and 20 are undergraduates; Case group: 6 males and 94 females; The average age was (21.9 ± 1.3) years old; Among them, 82 are junior college students and 18 are undergraduate students; There was no significant difference in general data between the two groups, which was comparable (P>0.05).
1.2 Methods
The traditional group was taught by teachers, centered on the teaching teachers, and guided the practice nurses according to the teaching subjects. The case group applied the clinical case nursing teaching mode, divided 100 interns into 10 groups, and each group had 10 interns. Before explaining, the teaching teacher prepared the cases, related PPT, video materials, etc., to prepare the classic clinical nursing problems related to cases, and guided the learning to combine theoretical views with clinical nursing practice, Implement targeted nursing measures for patients with different types and disease progression. The teaching is case centered, with the practice nurses as the main body to carry out research-based teaching, guiding the practice nurses to do a good job of preview before class, then make classroom explanation, and finally discuss and explain the cases step by step.
1.3 Observation indicators
The theoretical knowledge scores, clinical case nursing scores and nursing evaluation of the teaching mode of the two groups of interns were observed and recorded. Among them, interns' evaluation of teaching mode nursing can be divided into positive, medium and negative. Among them, praise means that the nursing mode is ideal, patients have good mood and nursing compliance; The middle evaluation refers to the selection of reasonable nursing methods, the patients' emotions and nursing compliance are general; Poor evaluation refers to poor emotion and nursing compliance of patients [3].
1.4 Statistical methods
SPSS17.0 software was used for data statistical analysis, chi square test was used for counting data, (x ± s) was used for measuring data, and P
2 Results
2.1 Compare the effect of practice nursing teaching between the two groups
There was no significant difference in theoretical knowledge between the case group and the traditional group (P>0.05); The clinical case nursing score of the case group was better than that of the traditional group, and the difference between the two groups was statistically significant (P
2.2 Compare the praise rate of the two teaching models
There were 82 good comments, 18 medium comments, 0 poor comments in the case group, 52 good comments, 38 medium comments, and 10 poor comments in the traditional group. The evaluation rate of the established nurses in the case group was higher than that in the traditional group. The difference between the two groups was statistically significant (P
3 Discussion
The goal of nursing is to maintain the health of patients and promote their clinical recovery. Improving the nursing service system can provide high-quality nursing services for patients. Nurses need to have a high professional level and comprehensive quality. The cultivation of nursing staff is mainly in the ability to solve nursing problems. Therefore, the clinical teaching of nursing staff needs to reform teaching methods, change from traditional experiential teaching to case based teaching mode, help interns master clinical nursing measures and skills, operate nursing procedures independently, correctly apply clinical nursing evaluation, and cultivate the comprehensive quality and working ability of interns [4].
