| Objective:(1)By investigating to understand the gap between the practice and guidelines of bedraising position in patients with mechanical ventilation,and to explore the relevant factors affecting nurses' decision-making on the angle of bed-raising,so as to provide direction for further improving training programs and carrying out relevant research;(2)Comparing the effect of 20°and 30° bed-head elevation on various prognostic indicators,a machine-controlled study was conducted to provide evidence for clinical position practice of nurses and provide evidence for further improving the compliance of bed-head elevation.Methods:(1)In the survey research,the investigators were trained uniformly to measured the bedside angles of invasive mechanical ventilation patients who were admitted to four ICUs of a 3A-level comprehensive hospital in Shanxi Province from June to July 2018 by the same type of protractor and the same measurement method,collect the patient's disease data,and conduct a questionnaire survey on their duty nurses.(2)In a randomized controlled study,87 patients with invasive mechanical ventilation admitted to ICU of neurosurgery and ICU of respiratory medicine of a 3A-level comprehensive hospital of Shanxi Province from August 2018 to January 2019 were randomly divided into two study groups(Group 20° and Group 30°)by random number table method.Except for the different angle of the head of the bed,the other measures in the two groups were carried out according to the routine nursing care in the Department and the common intervention measures..Results:(1)Research results 591 times of bedside angle were measured in 41 patients who met the exclusion criteria.The average angle of bedside elevation was(16.49±7.06)°,10°~20° was the most common,and the compliance of the guideline was low.The nurses surveyed had a moderate level of knowledge about bedside elevation of 30°~45°.Craniocerebral surgery,pressure sore score,enteral nutrition,sedative use,state of consciousness,mean arterial pressure,nurses' cognitive score and observation time were independent influencing factors of bedside elevation angle(P<0.05).It indicated that the actual angle of bed elevation was affected by both nurses' subjective cognitive level and patients' objective disease status.(2)Randomized controlled study resultsThe baseline data of the two groups were comparable.There were no significant differences in VAP incidence,mechanical ventilation time,pressure injury incidence,sacrococcygeal temperature and mean arterial pressure within 2 hours between Group 20° and Group 30°(P>0.05).Conclusion:(1)Nurse's perception of the importance of posture and potential risks and patient's condition are important factors affecting posture decision-making of mechanical ventilation patients.Nurses may be more inclined to choose positions that minimize all kinds of risks according to the patient's condition and their professional judgment in practice.(2)Compared with 20° of bed-head elevation,30° does not increase increase the risk of pressure injury and blood pressure changes.It is a relatively safe position for patients with mechanical ventilation.Compared with 45°,30° is more comfortable and easy to be recognized and adopted by nurses.It can be used as the first choice for nurses' posture decision-making. |
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