Research On The Construction And Application Of Comfort Management Plan For Patients With High Flow Nasal Cannua In ICU

objective1.This study is based on comfort theory,guided by the framework of nursing procedures,through literature review and expert consultation,to construct a more scientific and systematic comfort management plan for high flow nasal cannula.This program provides methods and theoretical basis for the comfortable nursing of patients with high flow nasal cannula,and provides guidance for the application and practice of clinical comfortable nursing.It is scientific and standardized.2.In this study,the constructed plan was applied to patients with high flow nasal cannula after tracheal extubation in the intensive care unit,and further explored how this plan can improve patient comfort,reduce concurrency,shorten the length of ICU stay,and reduce reinsertion.To test the effectiveness of management rate and mortality rate,improve patient satisfaction and other aspects.Method1.Construction of a comfortable management plan for high flow nasal cannula:refer to relevant domestic and foreign literature,summarize the review evidence,based on the comfort nursing experience related to high flow nasal cannula and initially construct comfort management plan of high flow nasal cannula.Through expert consultation,combined with pre-tests,modified and improved the content of the intervention plan,and finally formed a simple and easy-to-use high flow nasal cannula comfort care plan.2.Application of a comfort management plan for high flow nasal cannula:Select patients who have applied high flow nasal cannula after tracheal extubation in the intensive care unit of a tertiary hospital in Zhejiang Province in 2020.The patients admitted from January 1 to May 31,2020 are the control group,and the patients from August 1 to December 31,2020 are the experimental group.The experimental group adopted this management plan,and the control group performed routine care around the three operating steps of onboarding,airway and offboard management.The intervention time is from the beginning of the ventilator to the tracheal extubation,after the intervention,collect relevant data and evaluate the effect of the main outcome index overall comfort(VAS)and the secondary outcome index of each dimension comfort(GCQ),complication rate,reintubation rate,fatality rate and patient satisfaction,etc.The SPSS 20.0 software was used for data processing.Measurement data used two independent sample t test or two independent sample rank sum test,count data used x2 test,and P<0.05 was considered statistically significant.Result1.The literature review of this research included a total of 14 literatures,19 experts participated in the consultation,and finally constructed a comfortable management plan for patients with high flow nasal cannula,including 3 first-level indicators,12 second-level indicators,and 32 third-level indicators index.The authority coefficients of the two rounds of expert consultation were 0.915 and 0.931 respectively.The Kendall coefficients of all levels of indicators were 0.221,0.130,0.278(x2 values were 8.000,27.140,163.2824,all P<0.05).2.The test group and the control group included 51 study subjects each.There was no statistically significant difference in gender,BMI,APACHE II score,mechanical ventilation time,underlying diseases and comorbidities between the two groups(P>0.05),the baseline is comparable.Compared with the control group,after 24 and 48 hours of intervention,the overall comfort of the test group patients improved significantly,and the difference was statistically significant(P<0.05).As time progresses,the test group can better maintain its comfort.This study found that after 48 hours of intervention,the patients’ physical comfort,psychological comfort,social and cultural comfort,and environmental comfort were significantly improved(P<0.05).In addition,during ICU hospitalization,patient satisfaction was improved,and the difference was significant(P<0.05).However,there was no significant difference in the complication rate,reintubation rate and mortality rate between the two groups of patients(P>0.05),and the length of ICU stay was not significantly shortened(P>0.05).Conclusion1.The previous literature search found that there is little research evidence related to the comfort management program of high flow nasal cannula,and there is no comfortable management program of high flow nasal cannula at home and abroad.This research method is based on comfort theory and nursing procedure theory,combined with literature review,and established a comprehensive comfort management program for high flow nasal cannula,which is rigorous.The results of the 2 rounds of expert consultation are reliable and credible.The experts are highly motivated and authoritative,and the item importance and operability are well coordinated,providing a theoretical source and practical basis for later application.2.Clinical practice has found that the use of high flow nasal cannula management program can help improve the overall comfort of patients,alleviate the discomfort of patients in treatment,and improve the comfort of the four dimensions of physiology,psychology,social culture and environment.This program can also help improve patient satisfaction and reduce the incidence of related complications.The application effect of ICU length of stay and case fatality rate is not obvious,but there is still some positive significance.The comfortable management program of high flow nasal cannula is practical and suitable for further promotion.