| ObjectiveTo establish a cluster nursing plan for prevention of ventilatorassociated pneumonia,and discuss its application effect in neonatal mechanical ventilation.MethodsA cluster nursing plan for prevention of ventilator-associated pneumonia in NICU was established via literature review,case review,expert panel discussion and Delphi method.80 children with mechanical ventilation admitted in a tertiary children’s hospital in Heilongjiang Province from February 2021 to December 2021 were selected as research objects in this study.According to the order of admission,they were randomly divided into control group and experimental group by using the random number table,with 40 cases in each group.Conventional treatment and nursing for mechanical ventilation were given in the control group,while cluster nursing plan was performed in the experimental group.The general data,occurrence of ventilator-associated pneumonia,duration of mechanical ventilation,length of stay and occurrence of other complications were collected in the two groups,and the effect of the cluster nursing plan was evaluated according to the final result.All data were processed and analyzed with SPSS25.0 statistical software after being entered by two persons two times,significant level α=0.05 was set,and P<0.05 was considered statistically significant.Results1.Results of expert consultation in the Delphi method:(1)Active degree of experts:the recovery rate of expert consultation was 100%in the two rounds.(2)Authoritative degree of experts:the authoritative degree of experts Cr was 0.81 and 0.87 in the first and second rounds,respectively.(3)Coordination and concentration degree of expert opinions:a total of 3 first-level indicators,13 second-level indicators and 30 third-level indicators were involved in the first round of expert consultation,and their Kendall coefficient of concordance was 0.217,0.355 and 0.329(P<0.05),respectively;their coefficient of variation was between 0 and 0.20(P<0.05);and their mean of significance assignment was between 3.93 and 5.00(P<0.05).A total of 3 first-level indicators,15 second-level indicators and 23 third-level indicators were involved in the second round of expert consultation,and their Kendall coefficient of concordance was 0.420,0.432 and 0.433(P<0.05),respectively;their coefficient of variation was between 0 and 0.13(P<0.05);and their mean of significance assignment was between 4.00 and 4.93(P<0.05).2.Results of clinical application:(1)Comparison of the general data between the two groups:there was no statistical significance,indicating that the data were comparable between the two groups.(2)Comparison of the occurrence rate of ventilator-associated pneumonia between the two groups:13 children were infected with ventilator-associated pneumonia in the control group,with the occurrence rate of 32.5%;and 5 children were infected with ventilator-associated pneumonia in the experimental group,with the occurrence rate of 12.8%.Therefore,the occurrence rate of ventilator-associated pneumonia in the experimental group was lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).(3)Comparison of the duration of mechanical ventilation and length of stay between the two groups:the duration of mechanical ventilation was 11.55±3.37 days in the control group;the length of stay was 18.05±2.49 days.The duration of mechanical ventilation was 8.79±1.44 days in the experimental group;the length of stay was 14.87±1.22 days.Therefore,both the duration of mechanical ventilation and length of stay in the experimental group were shorter than those in the control group,and the differences between the two groups were statistically significant(P<0.05).(4)The other complications that occurred during hospitalization in the two groups were atelectasis,hypoventilation or hyperventilation and lung leakage.In the control group,there were 4,2 and 2 cases,respectively;and in the experimental group,there were 1,1 and 0 cases,respectively.Therefore,the number of cases with the complications in the experimental group was obviously fewer than that in the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusions1.A cluster nursing plan for prevention of ventilator-associated pneumonia is established,and the plan has certain scientificity,feasibility and practicability,which provides a reference for wide application of cluster nursing concept clinically.2.The cluster nursing plan established in this study has been applied to the children in NICU,and it can shorten duration of mechanical ventilation and length of stay,and reduce the occurrence rate of ventilator-associated pneumonia and other complications. |
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