Cardiovascular medical nursing papers

Cardiology, that is, cardiovascular medicine, is a clinical department established by general departments of hospitals at all levels to diagnose and treat cardiovascular diseases, including angina pectoris, hypertension, sudden death, arrhythmia, heart failure, premature beats, arrhythmia, myocardial infarction, cardiomyopathy, myocarditis, acute myocardial infarction and other cardiovascular diseases. The following is the related content of the nursing paper of cardiovascular medicine I brought with me, hoping to help you.

According to the statistics of the World Heart Federation, for every three deaths in the world, 1 person dies of cardiovascular diseases, and the number of people who die of heart disease and stroke in the world every year is as high as17.5 million. Some experts pointed out that cardiovascular and cerebrovascular diseases are the diseases with the highest morbidity, disability and mortality in China. Every 12s, 1 person falls down due to stroke or myocardial infarction. About 3 million people die of cardiovascular and cerebrovascular diseases every year in China, accounting for about 40% of all deaths. In recent five years, the mortality rate of cardiovascular and cerebrovascular diseases is still on the rise. Cardiovascular diseases have become the main diseases that endanger human health. Most cardiovascular diseases are chronic or recurrent. After hospitalization and discharge after acute attack, patients still need continuous treatment and adopt a healthy lifestyle, which can effectively reduce the incidence of cardiovascular diseases and mortality. Therefore, this study used a self-designed questionnaire to investigate 1, 0 1 patients with cardiovascular diseases who were about to leave the hospital, in order to understand their understanding of continuing nursing after returning to society and provide theoretical basis for clinical targeted health education and professional training of nursing staff. The report is as follows.

1 objects and methods

1. 1 Subjects10/person who was about to be discharged from three cardiovascular disease areas in our hospital in August 2009, including 58 males and 43 females, aged 21person. (2) After clinical treatment, it meets the discharge indications; (3) Voluntary participation in this survey; (4) No mental illness or mental retardation. Education level 10 1 patient: undergraduate 10, junior college 18, senior high school/technical secondary school 2 1 0, junior high school 30, primary school 17, illiterate 5; Occupation: 18 workers, 7 farmers, 30 cadres, 12 soldiers, 4 teachers,1/company employees, 19 other occupations; Types of diseases: coronary heart disease, hypertension, myocardial infarction, arrhythmia, angina pectoris, rheumatic heart disease and other diseases. Among them, 62 cases suffered from one cardiovascular disease and 9 cases suffered from two or more cardiovascular diseases. Surgical treatment history: coronary artery bypass grafting in 27 cases, heart valve replacement in 5 cases and interventional therapy in 5 cases.

1.2 Methods A self-designed questionnaire was used to investigate. The questionnaire consists of two parts: (1) the general information of the respondents, including 20 items such as gender, age, education level, occupation, marital status, whether accompanied by other chronic diseases, surgical history and smoking and drinking history; (2) The Questionnaire of Continuing Care Knowledge and Skills for Patients with Cardiovascular Diseases includes four first-level dimensions (including 9 items), treatment-related knowledge (including 13 items), rehabilitation-related knowledge (including 27 items) and social life knowledge (including 13 items) and 62 items. Likert5-level scoring method is used to score: very familiar with 5 points, familiar with 4 points, familiar with 3 points, unfamiliar with 2 points, and completely ignorant 1 point; The higher the score, the better the mastery of knowledge and skills. The questionnaire was revised by two nursing education experts and three clinical nursing management experts. The content validity is 0.84 and Cronbacha coefficient is 0.96. Each ward appoints a special person to distribute and collect questionnaires. Before the investigation, the researchers conducted centralized training for the personnel who distributed the questionnaire, so that they could understand the design principles, investigation purposes and filling requirements of the questionnaire. When the patient was about to leave the hospital, the investigator explained the purpose and significance of the investigation to the patient, and asked the patient to fill out the questionnaire anonymously after obtaining the patient's consent. Patients who cannot fill in the form by themselves due to eyesight and other reasons shall be read and explained by the staff one by one, and filled in according to the patient's choice. A total of questionnaires 10 1 were distributed in this survey, and valid questionnaires 10 1 were recovered, with an effective recovery rate of 100.00%.

1.3 statistical processing SPSS 15.0 statistical software is used to analyze and process the data, and the measurement data is expressed in X form.

Two results

2. 1 patients' overall cognition of knowledge and skills of continuous nursing. The 62 scores of 10 1 patients were concentrated at about 3 points, which indicated that patients were basically familiar with and understood the knowledge and skills of continuous nursing. Among them, the lowest score is "Know the precautions after installing a pacemaker", with a score of (2.481.70); The highest score is "I feel my life is very meaningful", and the score is (3.57 1. 12), both of which belong to the dimension of "rehabilitation-related knowledge".

2.2 Patients' scores on knowledge and skills of continuous nursing. Among the nine diseases related knowledge, patients have a good knowledge of cardiovascular diseases, such as treatment methods at onset, preparation before return visit and return visit time, but they have a poor grasp of more professional knowledge, such as return visit indications, detection and recovery status, and cardiac function evaluation.

2.2.2 Patients' knowledge about treatment. 13 items of treatment-related knowledge, patients have good knowledge of medication and poor knowledge of wound care. 2.2.3 Patients' cognition of rehabilitation-related knowledge. Among the 27 rehabilitation related knowledge, patients have a good grasp of psychology, diet, sleep and other aspects, but their understanding of rehabilitation exercise and precautions in pacemaker use is not ideal.

2.2.4 Patients' knowledge of social life. Among 13 items of social life knowledge, patients have a good grasp of hospice care and social communication knowledge, but lack of insurance and legal knowledge.

3 discussion

3. 1 The cognitive status of patients with cardiovascular diseases on continuous nursing is not optimistic. The results of this study show that patients with cardiovascular diseases who are about to leave the hospital after hospitalization are basically familiar with the cognitive level of continuous nursing that they need to master after returning to society, with the score ranging from 2.48 to 3.57, with an average of (2.70 0.81). Among them, the score of 12 is below 3.00, which indicates that patients with cardiovascular diseases generally lack the knowledge and skills related to continuous care, and they have not fully possessed the ability to implement effective self-care after returning to society, which is not conducive to their rehabilitation and improvement of their quality of life. The reason may be that continuous nursing started late in China and has not been popularized in communities and primary medical institutions. Large hospitals and community medical institutions have not formed smooth channels for patient handover and information transmission. Patients did not form the consciousness of continuing to complete follow-up treatment and self-care after discharge, nor did they take the initiative to acquire relevant knowledge of disease treatment and rehabilitation. In addition, the coverage of health education for patients during hospitalization in China is narrow, and the current health education mainly focuses on the prevention and care of the disease itself, and there is a lack of comprehensive understanding of health education for chronic diseases from nursing managers to clinical nurses. Therefore, it is urgent to establish a relatively perfect systematic health education model that runs through "prevention-treatment-rehabilitation" of diseases.

3.2 Dimension analysis of continuous nursing cognition of patients with cardiovascular diseases

3.2. 1 Patients with cardiovascular diseases have an ideal grasp of the basic knowledge of diseases. As can be seen from the table 1, the scores of 9 diseases-related knowledge of patients with cardiovascular diseases are all higher than 3.00, reaching the familiar level, but there is still a gap from the familiar level. It may be because most cardiovascular diseases are chronic diseases, and some patients suffer from multiple diseases at the same time. Long-term treatment has enabled patients to have a certain understanding of their own diseases, especially important knowledge such as treatment methods, preparation for follow-up visits, and time for follow-up, suggesting that patients' cognitive level is related to their willingness to acquire knowledge.

3.2.2 Cardiovascular patients' knowledge of medication is better than that of wound care.

The first three are knowledge of medication, and the last three are knowledge of wound care. It may be because taking medicine is the main treatment for cardiovascular diseases, and patients with such diseases often need long-term combined medication to make the relevant detection indicators meet the requirements; Compared with invasive treatment methods such as interventional therapy and surgery, drug therapy is more welcomed and accepted by patients and their families, and persists as a long-term treatment method, constantly exploring and summarizing the medication scheme suitable for them. At the same time, medication guidance, as an important part of hospital health education, has formed a more standardized and scientific education model in long-term practice and exploration. However, the professional nursing of stoma and wound started late and has not yet formed a mature education model. Moreover, most patients only receive one operation and other treatment methods, and they have neither experience nor psychological preparation for long-term treatment with this method. Therefore, the willingness to acquire this kind of knowledge is not strong, leading to

3.2.3 Cardiovascular patients' mastery of rehabilitation knowledge is uneven. Table 3 shows that among the 62 items, the items with the highest and lowest scores belong to the dimension of rehabilitation knowledge. Patients with cardiovascular diseases are full of confidence in rehabilitation and know more about life knowledge such as diet and sleep, but they don't know much about the rehabilitation knowledge of their diseases, and they can't properly grasp the nodes of various activities, so it is difficult to carry out rehabilitation exercise step by step, especially the special requirements and precautions of staying away from magnetic fields after installing pacemakers and coronary stents. It may be because most of the above contents are problems faced by patients after discharge, which were not involved during hospitalization. Therefore, nurses did not carry out systematic and comprehensive health education for the above contents, but focused on the treatment and nursing of the disease itself and the patient's hospitalization stage. This phenomenon shows that the concept of continuous nursing has not been popularized among nurses. At present, clinical nurses only provide phased health education for patients, and the continuity of nursing is often interrupted because patients are discharged from hospital. It is still not ideal to emphasize the disease management based on patient self-management, that is, national medical intervention and communication activities.

3.2.4 The knowledge of social life of cardiovascular patients needs to be improved. As can be seen from Table 4, patients with cardiovascular diseases have a high understanding of hospice care knowledge such as the right to choose hospice medical institutions, but they have insufficient understanding of insurance knowledge, types, rights protection and other insurance and legal knowledge. The reason may be that with the improvement of the comprehensive quality of our citizens, the status quo of stepping into an aging society and frequent media reports, the public no longer rejects hospice care, but adopts a direct attitude and gradually agrees; However, the wide variety of insurance and the narrow popularization of laws and regulations to protect medical consumers have caused cardiovascular patients to be at a loss when choosing insurance types and using laws to safeguard their legitimate rights and interests, which is still the weak point of effective connection between hospital health education and community continuous nursing.

3.3 Management Countermeasures Health education is a basic measure that should be persistently implemented for patients with cardiovascular diseases, and it is also a way to correct unhealthy lifestyles. Healthy lifestyle is the main cause of cardiovascular diseases. 16 1. As long as a healthy lifestyle is adopted, the morbidity and mortality of cardiovascular diseases can be fundamentally reduced 1.7. Therefore, strengthening and standardizing health education is an effective way to improve the cognitive level of continuous care for patients with cardiovascular diseases. Select high-quality nurses to carry out health education, guide patients to establish a healthy lifestyle through effective health education, and effectively reduce the incidence and mortality of cardiovascular diseases. You can also go directly to the community, or cooperate with the community to carry out rehabilitation knowledge lectures and popularize legal and insurance common sense, and realize continuous evaluation of patients while following up. Pay attention to the effective combination of theoretical knowledge and practical skills, pay attention to practicality and operability, change the boring oral education form of nurses into diversified health education methods, and adopt the way of sharing patients' statements and other experiences to deliver comprehensive education content to patients. Pay attention to the effect evaluation in the process of health education, and position the best effect of health education as whether it can meet the health needs of patients, so as to ensure the practicality and effectiveness of health education and truly benefit patients.

To sum up, at present, the cognitive level of patients with cardiovascular diseases on continuous nursing needs to be improved urgently, and it is very important to strengthen the health education of patients during hospitalization. In view of the unbalanced development of community nursing and the limited resources of community nursing, community rehabilitation nursing guidance can not be effectively promoted. It is an effective way to meet patients' continuous nursing needs, improve nursing effect and improve patients' quality of life by educating patients on standardized continuous nursing knowledge, enabling them to realize self-care through standardized health education, cultivating healthy lifestyles and effectively guiding patients to establish the concept of continuous nursing.

Cardiovascular diseases are a series of diseases involving the circulatory system. With the progress of society and the continuous improvement of people's living standards, the risk factors of cardiovascular diseases such as hypertension, dyslipidemia and diabetes in China continue to increase, and the incidence and mortality of cardiovascular diseases remain high. The huge number of patients with cardiovascular diseases brings opportunities and challenges to clinical nursing. How to strengthen the training of nurses, improve the nursing level of cardiovascular diseases and ensure the safety of patients is a problem that we should face together and seriously think about. This paper discusses the present situation of the continuous growth of patients with cardiovascular diseases, the problems faced by nursing work and the coping strategies.

1 Current situation of the onset and treatment of cardiovascular diseases

1. 1 The incidence of cardiovascular diseases is increasing year by year.

According to China Cardiovascular Disease Report 20 10, report 1. It is estimated that there are 230 million patients with cardiovascular diseases in China, and 1 person in every five adults suffers from cardiovascular diseases. In 2009, the crude death rate of coronary heart disease among urban residents in China was 94.9/65438+ 10,000; Every year, 3 million people die of cardiovascular diseases in China, accounting for 4 1% of the total deaths, ranking first among all deaths. In 20 10, 7293 cases of heart surgery were completed in our hospital, an increase of nearly 20% compared with 2009. There were 65438 cases of coronary angiography and 7765438 cases of percutaneous coronary intervention. Due to the increase in the number of patients, the workload of clinical nursing has increased sharply, and the problems such as imbalance between doctors and nurses and insufficient allocation of nursing manpower have become prominent. Overworked work has greatly affected the physical and mental health of nurses and the safety of patients.

1.2 Cardiovascular disease diagnosis and treatment technology is constantly updated.

In recent years, China Institute of Cardiovascular Disease Prevention and Treatment has made important progress. In 2007, 870 hospitals were able to independently carry out PCI, and 299 hospitals completed PCI, with an annual number of cases 100, accounting for 34.37% of the total hospitals. The total number of cardiac operations in Chinese mainland in 2009 was 1 57,444, an increase of 8.7% compared with 2008, of which128,358 were performed with cardiopulmonary bypass. At the same time, the number of operations has greatly increased, and new technologies and services have been widely developed in clinic. For example, the application of hemodynamic monitoring technology, supportive treatment of circulatory function (intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation) and continuous arterial (venous)-venous hemofiltration technology have become active and effective means to treat patients with critical cardiovascular diseases. With the continuous improvement of the diagnosis and treatment technology of cardiovascular diseases, the opportunities for patients with complex and difficult problems to get treatment increase, and the patients tend to be older or younger, and the infants are low in weight. Nurses need to constantly learn new knowledge and skills in order to keep up with the pace of medical development.

2 Cardiovascular disease specialist care highlights problems

2. 1 patient

2. 1.65438+ At the same time, with the increase of the incidence of cardiovascular diseases, the proportion of inpatients with cardiovascular diseases in non-cardiovascular wards increased. The complication of patients' condition and the expansion of the coverage of hospitalized patients make the treatment and nursing of diseases more difficult.

2. 1.2 The demand for nursing services increased. 1999 China has entered an aging society. According to the Statistical Bulletin on the Development of China's Aging Undertaking in 20 10 released by the Office of the National Working Committee on Ageing in August, the population aged 60 and above in China in 20 10 was close to 65,438. With the extension of life span, the proportion of elderly patients increases, which increases the risk of diagnosis, treatment and nursing. At the same time, in addition to their own diseases, there are also old-age problems such as decreased vision, hearing, feeling and motor function, which have great nursing safety hazards. With the popularization of medical information, the public's medical knowledge is getting richer and richer, and the demand for quality nursing services is growing. The high risk of treatment and the uncertainty of disease outcome bring heavy psychological burden to patients, so psychological nursing is particularly important.

2.2 Nursing aspects

2.2. 1 nursing education In recent years, the scale of nursing education in China has gradually expanded and the education level has improved significantly. However, judging from the social demand for nursing manpower, there are still some problems to be solved urgently. Ordinary care education is the initial education for secondary vocational schools, junior colleges and undergraduate nursing majors in China, and the primary requirement for graduates is to have the practical working ability of clinical nursing. However, the newly graduated nurses lack professional knowledge of cardiovascular diseases, which is far from the clinical nursing needs. Surveys in Dan Fan and Hu Xiaohong show that junior nurses are in urgent need of professional knowledge training after entering the clinic. 92% of nurses think that training is "very necessary" and "necessary", while the top three are commonly used drugs in cardiac surgery, monitoring skills and basic knowledge of cardiac surgery, which suggests that nursing managers should pay attention to professional training of nurses.

2.2.2 In terms of nursing manpower allocation, according to the statistical yearbook of Ministry of Health 20 10.8, in 2009, the ratio of doctors to nurses in China was only 1.97. To achieve the ideal medical care ratio of 1.2 announced by the Ministry of Health, there was still a shortage of 1.9 million registered nurses at that time, especially after the promulgation of the Nurses' Regulations, the Ministry of Health stipulated in the Working Standards for Implementing Quality Nursing Services in Hospitals (Trial) that nurses should be configured according to the nursing workload of each ward and the patient's condition. The ratio of actual beds to nurses in wards is 65433. With the continuous enrichment of nursing work, the development of new technology and new business, and the increasing number of critical and difficult cases, higher requirements are put forward for the allocation of nursing human resources in cardiovascular wards. Due to the limitation of nursing manpower resources, the increase of patients and the continuous expansion of hospital beds, the shortage of nursing manpower still exists. In addition to normal leave, there are sick leave, marriage leave and maternity leave. The actual number of on-the-job nurses is lower than the matching number, which aggravates the shortage of nursing manpower.

2.2.3 The transformation of traditional Chinese medicine mode in the professional development of nurses requires that nursing work should proceed from the overall concept of biology, psychology and society to meet the nursing needs of people's physical and mental health. The "Demonstration Project of High-quality Nursing Service" also requires the ward to implement the responsibility contract system, and all the nursing work of patients from admission to discharge, such as basic nursing, condition observation, treatment, rehabilitation and discharge guidance, is fully and completely undertaken by their responsible nurses. The condition of patients with cardiovascular diseases is changing rapidly, the clinical diagnosis and treatment technology is becoming more and more complicated, the work tasks of departments are heavy, the work pressure is high, and there are many unexpected situations, which requires nurses' clinical decision-making ability to be very high. Nursing clinical decision-making is a complicated process for nurses to make nursing judgments on patients by combining theoretical knowledge and practical experience, which requires nurses to have the core competence of cardiovascular specialty. In May, 2007, the Ministry of Health issued the Training Outline for Nurses in Specialized Nursing Field, which guides all localities to standardize the training of nurses in specialized nursing field, but there are no regulations on the training objects, training objectives, training time and training contents of cardiovascular nurses. There is still a gap between the current situation of cardiovascular nurses' training and the needs of nurses' professional development.

3. Thoughts and suggestions on the development of specialized nursing for cardiovascular diseases.

3. 1 Rational allocation of nursing human resources

Ma, Vice Minister of Health, pointed out in his speech at the second regular meeting of the national high-quality nursing service demonstration project that the surge in the number of nursing staff is a necessary condition for nursing work to achieve a qualitative leap and an important condition for nursing work to be "close to patients, close to clinic and close to society". The guarantee of nursing manpower is the basis to realize the responsibility to people and the work in place. At present, there is no uniform standard for the allocation of nurses in cardiovascular wards. It is suggested that the nursing manpower demand should be calculated according to the nursing level and self-care ability of patients. He Sun [14] proposed that life nursing can be divided into three levels according to patients' self-care ability, that is, those who are completely dependent are Grade A nursing, those who are partially dependent are Grade B nursing, and those who are completely self-care are Grade C nursing. The patients with different nursing levels were 1: 0.7,: 0.5 and 1: 0.3 respectively. Considering the needs of patients in heart surgery to observe the condition, assist treatment and promote rehabilitation, the allocation of nurses should be appropriately higher than this standard, especially in transplant wards and cardiovascular disease wards.

3.2 Strengthen nurse training

3.2. 1 Establish a standardized training system for junior nurses. With the development of social economy, people's requirements for health services are constantly improving, clinical diagnosis and treatment technology is becoming increasingly complex, and nursing functions are constantly expanding, which constantly puts forward newer and higher requirements for nurses' ability and quality. Clinical junior nurses are the new force of nursing team, and they are constantly added to clinical nursing work. Cardiovascular disease nursing is professional, and patients' condition tends to be complicated and difficult, so it is urgent to carry out standardized training for junior nurses. In order to solve this problem, our hospital tried to carry out standardized training for nurses from two levels. Nurses who graduated from junior college or undergraduate college for three years and graduated from technical secondary school for five years are divided into three grades according to their working years: N 1, N2 and N3 * * *. N 1 nurses regularly take basic knowledge and skills tests and write reading notes. On this basis, N2 and N3 nurses are required to complete case accumulation, undertake small lectures and give lectures to undergraduates. In the process of case accumulation, nurses' active learning ability, illness observation ability and comprehensive analysis ability are gradually cultivated. The nursing department will incorporate the assessment results into the evaluation, promotion and regularization of contract nurses. While paying attention to professional training, nurses realize the importance of nurse-patient communication through case analysis of nursing complaints and special lectures on humanistic care, learn communication methods, improve services and meet patients' needs.

3.2.2 Carry out various forms of continuing education activities. Continuing education is an effective way for nurses to constantly update their knowledge. Participating in continuing education is not only the right but also the obligation of nurses. As a nursing manager, we should vigorously publicize the importance of continuing nursing education and strengthen the management of continuing education. Nursing departments and departments should formulate different levels of continuing education plans and incorporate them into the assessment indicators of nursing management. Wuzhou international Cardiovascular Disease Seminar and Nursing Academic Exchange Conference, held every two years in our hospital, has been held for six consecutive years, which has built a good professional exchange platform for nursing colleagues. At the same time, the nursing knowledge and skills of cardiovascular diseases, such as cardiopulmonary resuscitation technology, application of defibrillators, ECG characteristics of common arrhythmia, common cardiovascular drugs, etc., are required, and clinical nurses are provided with hierarchical continuing education and training through various forms of continuing education activities such as nursing rounds, case discussions, small lectures, self-study and operation assessment. The curriculum and training form are planned, purposeful and targeted according to the needs and job requirements of nurses at all levels to ensure the training effect.

3.2.3 Combination of academic education and specialist education At present, the proportion of clinical nurses with technical secondary school or junior college education who improve their academic level through on-the-job education is relatively high. From June 2004 to June 2065, 438+February 2000, 729 nurses with junior college education took part in academic education in their spare time. From the survey feedback, it is found that most of the course contents in the education stage of junior college and undergraduate degree overlap, and some contents are rarely used in clinical work. If university courses are closely integrated with the contents of clinical professional study, students can learn more about their major while studying in junior college and undergraduate course, which is more conducive to improving the quality of clinical nurses.

3.3 Explore the training methods of cardiovascular nurses.

The training of cardiovascular nurses in China is still being explored. At present, attending the training of ICU nurses is an alternative way. Zhou Lijuan and others reported the training experience of cardiovascular specialist nurses in the whole army twice, and proposed that the admission criteria should be registered nurses with college education or above, who have been engaged in specialist nursing for more than 2 years or engaged in other specialist nursing for more than 4 years. This is basically consistent with the current admission standards for nurses in ICU, emergency department, operating room and oncology department. However, the training time, methods, teaching materials and assessment standards need further study. In view of the short-term off-the-job training currently adopted, the training period is long and the number of trainees is limited, it is suggested to give full play to the role of ICU specialized nurses, carry out hierarchical training, organize cardiovascular specialized classes in hospitals, and cultivate clinical nursing backbones in the form of off-the-job learning, small class teaching and combination of theory and clinic to meet clinical nursing needs and improve nursing level.

4 abstract

The prevention and treatment of cardiovascular diseases has become an important public health problem. The difficult problems faced by specialized nursing of cardiovascular diseases have aroused widespread concern. How to rationally allocate the human resources of cardiovascular nurses, explore the establishment of a standardized training system for nurses, determine the professional core standards, and carry out specialist nurse training has become a major issue before us.