| Objective1.Based on the predictive nursing model,relevant contents of swallowing function management for ICU patients undergoing tracheal intubation were summarized through literature retrieval,and an expert group focus forum was convened to revise the preliminary draft of the intervention plan,and the final draft of the predictive nursing intervention plan was formed.2.The predictive nursing intervention plan was applied to the patients undergoing tracheal intubation in ICU,to explore the application effect of this plan in the swallowing function management of patients undergoing tracheal intubation.To provide practical guidance for helping ICU patients undergoing tracheal intubation to prevent and reduce the occurrence of swallowing dysfunction after extubation,improve swallowing function after extubation,reduce state anxiety,improve patient comfort and shorten the duration of gastric tube indwelling.MethodsLiterature retrieval was used to summarize the status of swallowing function management for ICU patients undergoing tracheal intubation,and the first draft of predictive nursing intervention plan was formed.Objective to select 8 clinical experts and nursing experts from ICU of a classⅢa hospital in inner Mongolia autonomous region by sampling and hold group focus discussion meeting.the discussion results of the focus discussion meeting were recorded,analyzed and revised,and the final draft of predictive nursing intervention plan was formed.This study was quasi-experimental,and adopted the convenient sampling method.A total of 58 patients who were admitted to the ICU of a 3A hospital in Hohhot,Inner Mongolia Autonomous Region from March 2022 to December 2022 were selected as the research subjects by random sampling according to the inclusive criteria.Patients were numbered 1–58according to the time of ICU admission.Random grouping was performed using the random number table in the seventh edition of Medical Statistics.Starting from row 5 and column 3,58 random numbers were read from left to right,and patient numbers 1–58 were one-to-one corresponding to the 58 random numbers selected.All groups were then arranged from small to large based on the random number size as the standard(the ones with the same random numbers were numbered in the previous order).The first 1–29 groups after arrangement were defined as intervention groups and 30–58 groups as control group.To avoid contamination,the intervention group was assigned to the north ward and the control group was assigned to the south ward.Patients in the control group received routine nursing care,including basic nursing care,bedside evaluation,bedside patrol,and comfortable nursing after catheter removal.Patients with WST score of 3–5 in frog field drinking water test(WST)required to receive swallowing function training within 24h after catheter removal,on the third day after catheter removal,and one week after catheter removal.On this basis,the intervention group adopted the predictive nursing intervention plan,and before the intervention began,a research group team was established,with members including deputy chief physician,chief nurse practitioner,chief nurse practitioner,rehabilitation specialist and the researcher herself.Before the start of the study,the chief nurse practitioner and the researcher were responsible for organizing the members of the study group to hold three group meetings,conduct homogenization training,master the training methods of the predictive nursing intervention plan,and use a unified guiding language,action content,time arrangement,sequence arrangement,and unified and standardized implementation.According to the predictive process of"assessment、diagnosis、plan、implementation、evaluation",firstly,the high-risk factors of patients during intubation were assessed,patients who met any risk factors were diagnosed as"PED high-risk population",and the list cards of patients and bed cards were indicated and marked.Through risk warning,the prevention for oral mucosa condition of patients during intubation and accidental extubation event was improved,and the predictive nursing intervention plan was implemented after the patients were extubated.The protocol covers one week after the catheter removal and is divided into three stages.(1)The first stage starts within 24 days after the catheter was removed and lasts until the end of the second day after the catheter was removed,and specifically includes muscle relaxation training,palate lifting function training,laryngeal lifting and lip contraction breathing.The functional training in this stage is mainly passive training,which focuses on building trust and strengthening humanistic care.(2)The second stage starts on the 3rd day after the catheter was removed and ends on the4th day after the catheter was removed,and specifically includes abdominal breathing,cough training and pronunciation skills training.In this stage,active training is mainly used for functional training,and faith-building is mainly used to strengthen humanistic care.(3)The third stage began on the fifth day after the catheter was removed and lasted until the end of one week after the catheter was removed.It specifically included improving respiratory exercise and getting out of bed,and strengthening humanistic care by strengthening and insisting on exercise beliefs.At the end of the intervention,each score of the patient’s WST,Standard swallowing function evaluation scale(SSA),Comfort status scale(GCQ)of Kolcaba and state anxiety questionnaire(SAI)were summarized and evaluated.SSA and WST were used to compare the swallowing function and the number of people with a WST score of 3-5 between the two groups within 24h after catheter removal,on the third day after catheter removal and one week after catheter removal.The GCQ and SAI scores of the two groups were compared before intervention and one week after catheter removal.The indwelling time of gastric tube in two groups was recorded.The data of this study were entered and analyzed using SPSS 25.0 statistical software.The count data were expressed as frequency and frequency,and the comparison was performed using x~2test or Fisher exact probability method.Measurement data subject to normal distribution were expressed as mean standard deviation((?)±s).Two independent samples t test was used for inter-group comparison,and paired samples t test was used for intra-group comparison.The data whose measurement data did not conform to the normal distribution were expressed as the median(M)and interquartile range(Q).The Mann-Whitney U rank sum test was used for inter-group comparison,and the Wilcoxon signed rank sum test was used for intra-group comparison.P<0.05 indicated statistically significant difference.ResultsIn this study,two groups of subjects have completed the study.There was no statistical difference in general information,comfort status and state anxiety scores of WST,SSA and Kolcaba between the two groups before intervention(P>0.05),indicating that the baseline was comparable.After the intervention of two groups of subjects,the results showed that:1.WST:After intervention,the WST scores of the two groups were significantly lower on the 3rd day after catheter removal and one week after catheter removal than those before intervention(P<0.05).Besides,the WST score of the intervention group was significantly lower than that of the control group(P<0.05).2.WST score of 3-5:On the 3rd day after catheter removal and one week after catheter removal,the number of patients with WST scores of 3-5 in the intervention group was significantly lower than that in the control group,and the differences between the two groups were statistically significant(P<0.05).3.SSA:After intervention,the SSA scores of the two groups were significantly lower on the 3rd day after catheter removal and one week after catheter removal than those before intervention(P<0.05).The SSA total scores on the third day after catheter removal and one week after catheter removal as well as the score of the 60ml water test in the intervention group were significantly lower than those of the control group(P<0.05).The preliminary clinical score of the intervention group one week after catheter removal was significantly lower than that of the control group(P<0.05).There was no difference between the intervention group and the control group in the 5ml water test on the third day after catheter removal and one week after catheter removal(P>0.05).4.GCQ:After intervention,the total scores and scores of each dimension of comfort status in the intervention group were significantly higher than those in the control group and higher than those before intervention(P<0.05).In the control group,the total scores of comfort status and scores of psychological,sociocultural and environmental dimensions were higher than those before intervention(P<0.05),and the scores of physiological dimensions showed no significant difference as compared with those before intervention(P>0.05).5.SAI:After intervention,the total scores of state anxiety and scores of each dimension in the intervention group were significantly better than those in the control group and were better than those before intervention(P<0.05).The total scores of state anxiety,positive emotions and negative emotions in the control group were lower than those before intervention(P<0.05).6.Gastric tube indwelling time:After intervention,the duration of gastric tube indwelling in the intervention group was significantly less than that in the control group,and the difference between the two groups was statistically significant(P<0.05).ConclusionPredictive nursing intervention plan comprehensively evaluated patients during intubation,comprehensively analyzed risk factors,and adopted effective preventive care.Compared with the routine nursing intervention,the predictive nursing intervention scheme prevented and reduced the occurrence of swallowing dysfunction after catheter removal,improved the swallowing function and comfort level of patients after catheter removal,alleviated the anxiety after catheter removal,and shortened the duration of gastric tube indwelling. |
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