| Objective To apply the postural management technology of natural light nursing concept to high-risk patients with pressure ulcers,and to explore its influence on the pressure of patients’ body compression parts,the incidence of stress injury,comfort and pain in the process of postural management.And through the study to understand the general situation of lumbar function of hospital nurses,to verify the influence of new ideas and new technologies on low back pain of nurses participating in the care.Method The subjects of this study were high-risk patients with stress injury and nurses participating in the nursing.From January to December in 2019,181 high-risk patients and 117 nurses were selected.According to the departments with 80% of the incidence of stress injury in nursing management system in 2019,four departments were selected,including neurology department,neurosurgery department,respiratory and critical medicine department,and geriatric medical center.In order to avoid bias in the experimental process,the subjects were divided into groups by simple sampling method.A total of 93 patients in the experimental group were selected by stratified sampling,including 20 in neurosurgery a,28 in neurology B,26 in respiratory and critical care medicine B,and 19 in Geriatric Center II.The control group consisted of 88 patients,including 18 in neurosurgery B,27 in neurology a,25 in respiratory and critical care medicine a,and 18 in geriatric center I.By cluster sampling,61 nurses in the experimental group were selected,including 6 in neurosurgery a,25 in neurology B,16 in respiratory and critical care medicine B,and 14 in Geriatric Center II.The control group consisted of 56 patients,including 4 in neurosurgery B,25 in neurology a,14 in respiratory and critical care medicine a and 13 in geriatric center I.The patients in the control group were treated with posture management according to the hospital’s "pressure injury diagnosis and treatment and nursing standards",while the patients in the experimental group were treated with posture management technology based on the control group’s posture management method.After the implementation of posture management,the pressure of the compressed parts of the patient’s body was measured,including the occipital posterior part,scapular part,sacrococcygeal part and heel part in the supine position,the shoulder,hip joint and lateral side of the left knee in the 30 ° left lateral position,and the sacrococcygeal part in the 30 ° semi sitting position.The pressure of 8 parts was recorded in the "posture management pressure measurement record form".The measurement requirement was to measure the pressure of 8 parts according to the patient’s position every day for 7 consecutive days.The comfort state scale and Wong Baker facial expression scale were filled in on the third and seventh day after admission,and the nurses filled in the lumbar dysfunction scale before and after the experiment.The main outcome indicators of this study were the pressure of the compressed part of the body and the incidence of stress injury.The secondary outcome indicators were the comfort score,pain score of the patients and the lumbar function of the nurses.Result 1.The pressure of body pressure parts in supine position,30 ° left lateral position and 30 ° semi sitting position.After 7 days of continuous measurement,the occipital posterior pressure of the experimental group was 19.6(17.3~22.7)mm Hg,scapular 24.5(21.5~27.6)mm Hg,sacrococcygeal 51.8(47.5~56.7)mm Hg,heel 16.3(13.5~19.7)mm Hg in supine position The occipital posterior pressure in the control group was 35.35(25.3~45.72)mm Hg,scapular pressure was 31.9(26.83~36.4)mm Hg,sacrococcygeal pressure was 74.6(63.63~85.3)mm Hg,heel pressure was 25.2(19.93~30.78)mm Hg,the differences were statistically significant(all P < 0.05).In the 30 ° left lateral position,the shoulder pressure of the experimental group was 27.3(24.3~31.6)mm Hg,the hip joint was 58.7(56.9~60.9)mm Hg,the lateral left knee was 18.6(16.6~19.9)mm Hg,the shoulder pressure of the control group was 55.15(47.1.3~63.5)mm Hg,the hip joint was 79.85(68.13~90.6)mm Hg,the lateral left knee was 22.2(18.7~26.4)mm Hg,the differences were statistically significant(all P < 0.05).The sacrococcygeal pressure of the experimental group was 59.25 ± 4.22 mm Hg,while that of the control group was 84.52 ± 16.01 mm Hg,the difference was statistically significant(P < 0.05).The maximum pressure of sacrococcygeal joint in supine position and supine position was 58.7~30.7 mm Hg(P < 0.05))mm Hg。 There were significant differences in sacrococcygeal pressure in the control group(P < 0.05),which were 85.95(71.03~97.1)mm Hg in 30 ° semi sitting position,79.85(68.13~90.6)mm Hg in 30 ° left lying position and 74.6(63.63~85.3)mm Hg in supine position.2.The incidence of pressure ulcers in the two groups The incidence of stress injury in the experimental group and the control group was 1.1% and 4.5% respectively,and there was no significant difference between the two groups(P > 0.05).In the experimental group,there was one patient in stage II,which occurred in the sacrococcygeal region.In the control group,there were two patients in stage I,two patients in stage II,three patients in the sacrococcygeal region,and one patient in the heel region.3.GCQ and FPS-R scores of the two groups On the third day of intervention,the scores of physical dimension 14(12~15),psychological dimension 28(27~30),social dimension 17(16~19)and total score 77(76~80)in the experimental group were significantly higher than those in the control group(11.25~14),psychological dimension 27(26~29),social dimension 16(15~17)and total score 75(73~78)(all P < 0.05)There was no statistically significant difference between 19(17~21)and 19(17.25~20)(P > 0.05).On the seventh day of intervention,the scores of physical dimension 13(11.5~14),social dimension 18(17~20)and total score 78(74~82)in the experimental group were significantly higher than those of physical dimension 12.5(11~13),social dimension 17(16~19)and total score 76(73~79)in the control group(all P < 0.05)There was no significant difference between the two groups(P > 0.05).There was significant difference in pain score between the two groups on the third and seventh day of intervention(P < 0.05).4.General condition of lumbar function of nurses In this study,female nurses accounted for 98.3%.Age 20~25 years old accounted for 12%,26~30 years old accounted for 41%,31~35 years old accounted for 22.2%,36~40 years old accounted for 16.2%,41~45 years old accounted for 8.5%.Among the nursing levels,N2 accounted for 47%.Among the working years,1~5 years accounted for 32.5%,6~10 years accounted for 31.6%,more than 10 years accounted for 34.2%.The number of nurses involved in turning over was mainly one or two,accounting for 35.9% and 63.2% respectively.The highest frequency of each turn was 2~5 times,accounting for 41%.In the history of low back pain,the positive rate was 95.7%,the degree of pain was mainly moderate,60.7%,the frequency of pain was 1~2 times / day accounted for 29%,1~2 times / week accounted for 36.8%,and 1~2 times / month accounted for 33.3%.About training,only 11.1% of them had received training on low back pain.Only 6.8% of the people asked for leave because of low back pain,and only 7.7% asked for leave for 1~7 days.Most people choose to do nothing or rest 47% for the treatment of low back pain.5.RMDQ score of nurses in two groups There was no significant difference in rmdq score between the two groups before intervention(P > 0.05).The rmdq scores of nurses in the experimental group before and after the intervention were 1(1~12)and 2(1~3),respectively,and the differences were statistically significant(P < 0.05).The rmdq scores of nurses in the control group before and after intervention were 5(2~9)and 6(5~8.75),respectively,with no significant difference(P > 0.05).The difference of rmdq score between the two groups before and after intervention was statistically significant(P < 0.05).Conclusion In this study,the postural management technology of natural nursing can reduce the pressure of high-risk patients with stress injury,reduce the pain induced by turning over,and promote the comfort of patients.According to the preliminary investigation,the general situation of low back pain of hospital nurses is not optimistic,but compared with the traditional position management technology,the position management technology of natural nursing can reduce the damage to the lumbar function of nurses in the process of position management. |
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