Care for unplanned extubation prevention: analysis of the validity of an instrument's content

An Empirical Study of Feedforward Control in Unplanned Extubation of Nasogastric Tube

Objective

To explore the effect of feedforward control on reducing the incidence of unplanned extubation and improving the quality of catheter nursing.

Methods

A total of 186 patients with nasogastric tube after gastrointestinal surgery in the eastern region of our hospital from September 2020 to September 2021 were selected as the control group; 186 patients with nasogastric tube after gastrointestinal surgery in the western region of our hospital at the same period were selected as the experimental group. The influencing factors of unplanned extubation in patients with long-term postoperative nasogastric tube were analyzed, and effective preoperative and postoperative health education was conducted. The ratio of unplanned extubation of nasogastric tube and nursing satisfaction of patients in the two groups were compared.

Results

Patient constraint, perceived pressure score, anxiety score, nasal gastrointestinal canal health education feedback score and indwell tube comfort score were independent risk factors for unplanned extubation. The restraint rate and the incidence of unplanned extubation in the experimental group were lower than those in the control group after intervention, with statistical significance (P < 0.05). The nursing satisfaction of the experimental group was significantly higher than that of the control group after feedforward cognitive intervention. After intervention, serum albumin and gastric PH in the experimental group were significantly higher than those in the control group (P < 0.05).

Conclusion

The safe nursing management method of feed forward control can effectively reduce the incidence of unplanned extubation in inpatients, which is worth further promoting in nursing work.

Validation of a Risk Assessment Tool for Unplanned Endotracheal Extubation: An Observational Study

The purpose of this study was to validate and determine the sensitivity and specificity of the risk assessment tool for unplanned endotracheal extubation. Unplanned endotracheal extubation is a common adverse event. The rate of unplanned endotracheal extubation is an indicator to measure patient safety and medical quality. This study was conducted in five intensive care units in a tertiary-A hospital. A total of 227 samples encounters were obtained from 147 unique patients. The content validity was 0.91, and the item content validity ranged from 0.80 to 1.00. Cronbach's α was .58, the interrater reliability was .93. The area under the curve was 0.89 (95% CI [0.84, 0.94], p < 0.01), the sensitivity was 87.80%, and the specificity was 74.20%. This tool presented good reliability and validity and can be used to assess the risk of unplanned endotracheal extubation in patients with artificial airways.

The Clinical Nursing Pathway on Prevention of Catheter Slippage with Intensive Care Unit Patients: A Systematic Review and Meta-Analysis

Objective

To evaluate the prevention effect of the clinical nursing pathway (CNP) of catheter slippage with intensive care unit (ICU) patients.

Methods

Primary databases were electronically searched from the inception up to June 25, 2021. Randomized clinical trials of CNP versus routine nursing for prevention of catheter slippage with ICU patients were included. The risk of bias was assessed using the Cochrane risk of bias tool and the quality of included studies using the Jadad rating scale. A meta-analysis was conducted using the Cochrane collaboration's RevMan5.3 software.

Results

Eight studies met the inclusion criteria. The findings of the meta-analysis revealed that the comparison of CNP and routine nursing was applied in ICU patients, the catheter slippage incidence rate odds ratio (OR) was 0.11, with 95% confidence interval (CI) (0.05, 0.24), and the difference was statistically significant (P < 0.00001). The catheter infection rate OR was 0.15, with 95% CI (0.06, 0.37), and the difference was statistically significant (P < 0.0001). The nursing satisfaction OR was 14.06, with 95% CI (5.71, 34.63), and the difference was statistically significant (P < 0.00001).

Conclusion

Compared with routine nursing, the application of CNP in ICU patients can effectively reduce the incidence of catheter slippage, reduce the infection rate of the catheter, and improve the nursing satisfaction.