【576,577 has been changed, tomorrow's answer】

【Happy Nurses’ Day】

The number of new confirmed cases and deaths in the world has increased rapidly again. There are many pictures and videos of treating severe patients on the Internet. Most of them follow the respirators and their chests are undulating. Some are also flipped and lying on the hospital bed.

The prone position is a posture that has been used for a long time and is very beneficial to patients with respiratory diseases. The World Health Organization (WHO) clearly recommends that those who are infected with the new coronavirus and have acute respiratory distress syndrome (ARDS) should lie on prone for 12-16 hours a day, which can help lung dilate and increase oxygen volume.

ARDS patients used prone positions, which were first reported in 1976. The medical community believes that this is one of the greatest inventions of intensive care medicine.

"Whose idea is this?" Eileen Sullivan-Marx, president of the American Academy of Nursing and dean of the New York University School of Nursing, recently published an article in Scientific American magazine, calling out her name: registered nurse, Margaret Piehl.

At that time, Margaret Peel worked in the intensive care unit (ICU) of a small community hospital in southeastern Michigan. His daily work included wiping the body of critically ill patients and turning over.

Margaret Peel found that even if they were briefly prone, the respiratory status of ARDS patients seemed to improve. So she invited doctor Robert S. Brown to study together. They verified the positive impact of prone position on the oxygenation index in five ARDS patients. In 1976, the two published this pioneering discovery in the journal Intensive Care Medicine. Margaret Peel was the first author of the article.

In the decades after the article was published, many big shots in the ICU field have been constantly researching and have successively confirmed the most favorable time for prone, the best duration and the applicable population.

In 2013, the New England Journal of Medicine published a major article saying that the prone position, as an early intervention method for patients with severe ARDS, can significantly reduce the mortality rate of 28 and 90 days. "Compared with other ARDS treatments, such as lung protection, low tidal ventilation and continuous intravenous infusion of neuromuscular blockers, the prone position has a greater impact on survival."

"When the COVID-19 outbreak first started, the virus claimed countless lives, and there was no magic pill in the medical community. But we can at least use the prone position to maximize the survival chances of patients." Luciano Gattinoni, a professor of anesthesia and first aid at the National University of Milan, Italy, told the BBC.

"Severe patients around the world should thank her (Margaret Peel)." Erin Sullivan-Max said that the pandemic highlights the irreplaceable role of nurses. "Existing research shows that nurses are fighting day and night on the front line of the fight against the epidemic during the outbreak of infectious diseases, saving lives and protecting the entire public. At the same time, they have to deal with the health challenges brought by the aging population and the increasing number of non-communicable diseases. They also need to conduct special scientific research in combination with their own career experience and clinical observations to improve and improve the survival status and survival rate of patients."

In any field of medical care, there are unremitting efforts of nurses.

When nurses do research, they can trace back to Florence Nightingale, the "mother of modern nursing". In 1858, she innovatively used the "Rose Statistics Chart" similar to the pie chart to list the number of soldiers with different causes of death in the Crimean War by month. The clear chart successfully convinced senior military officials who were too lazy to read or did not understand statistical analysis, prompting their decision-making, and timely increase field nurses and reinforcements of medical equipment.

Based on the survey data, she also put forward detailed arguments on the hospital's environmental sanitation management, ward construction, furnishings, number of beds, cleaning equipment and management layout, etc. The relevant measures have reduced the mortality rate of wounded and sick people from 42% to 2%.

During the pandemic, nurses' "scientific literacy" continues to be online. Erin Sullivan-Max introduced that when the COVID-19 pandemic in New York City was at its worst, ICU registered nurse Adam Hadas read a large number of latest journals and articles about ****, to understand how the virus affects the lungs, and to explore the setting of ventilator parameters in nursing work. He collected and shared the data of patients involved in cardiopulmonary resuscitation treatment, and worked with doctors in other disciplines to explore resuscitation programs that "provided the highest survival rate".

The "invention" of nurses is also reflected in humanistic care. Reuters reported in mid-April that in Brazil, the elderly infected with the epidemic in the COVID-19 area were in great pain when receiving treatment. They often ask nurses to hold their hands to get spiritual comfort and warm their arms. In order to try to meet the "handshake requirements" of more patients, nurses Seha and Vanessa Formenton tied two rubber gloves to form two upper and lower layers, then poured warm water into the gloves and put them on the patient's hands. Brazilian media called it "love's little hand."

"This move not only warms the patient's hands and provides emotional support. It also has practical medical significance, including accelerating blood circulation and avoiding too cold hands affecting blood oxygen monitoring readings." Reuters said.

Chinese nurses have never lagged behind in inventions and innovations during the epidemic.

In March and April 2020, Li Yaqin, a nurse of a medical team member in Shanxi, and her colleague Pan Bo, conceived and invented a "medical anti-droplet tongue-pressing sampling device". This can prevent droplet splashes caused by coughing or vomiting in patients during the detection of the new coronavirus.

During the 2020 "International Nurses' Day", the Yangpu District Central Hospital of Shanghai held the "Nursing Creative Invention Exhibition". Among the 103 nursing creativity exhibited, 16 were "born" on the front line of the anti-epidemic in Wuhan. For example, "Oxygen masks that can drink water" relieve dry mouth and thirst of assisted ventilation. The straw is designed as a "color-changing special tube": when unused, the straw is transparent; the water temperature is normal or high, and the straw is of different colors.

There is also a disposable closed suction tube with quantitative flushing device developed by Ma Lu, chief nurse of the Department of Critical Care Medicine at Zhongda Hospital Affiliated to Southeast University, which reduces the risk of exposure for medical personnel while caring for patients.

In addition, the "a general anesthesia head support device" invented by Hu Ling, head nurse of the General Hospital of the Southern Theater Command of the People's Liberation Army, is of great benefit to improving the prone ventilation of patients with severe illness. This invention won the first prize of the "Chinese Nursing Society Innovation and Invention Award" in 2021.

"Nurses are also scientists, with topics ranging from metabolic diseases to dementia to emerging symptom science (Sye). In every field of medical care, there are unremitting efforts of nurses." Erin Sullivan-Max said that since 2001, American nurses have been rated as "the most trusted professional" in professional ethics and integrity polls for 15 consecutive years. In 2020, according to the annual survey results released by the American Nurses Association, nurses have once again become one of the "most trusted professional groups in the United States."

We have reason to believe that Chinese nurses should also receive this huge social honor and extremely high social status.

May 12, 2021 is the 110th "International Nurses' Day". This day is also a festival for 4.45 million registered nurses in China.

From in-built care to community and home care, you provide high-quality nursing services such as medical care, elderly care, chronic disease management, psychological care, and sedative care to the public.

To borrow from WHO Director-General Tedros Adhanom Ghebreyesus, "Nurses are the backbone of the health systems of all countries." I wish you all a happy holiday!

【Host care (2/2)】

A new cultural concept is also being formed. Wang Yifang proposed the idea of ​​"surround death" in recent years. He said that just like the "surround birth" that integrates pregnant women, childbirth and newborn problems, people should also achieve "surround death": in the stages of dying, clinical death, biological death, and sociological death, different care for patients and families, including hospice care, organ donation, and funeral rituals. This is not only a new medical concept, but also a concept of life culture - death, which can also be filled with warmth, affection and hope.

While applying traditional culture in clinical practice, Lu Guijun also gained a deeper understanding of China's traditional family concepts. He realized that family culture is often entangled with the concept of death, which affects the Chinese people's death decisions.

For example, the family members do not inform the patient of the real condition in the name of good things, and the patient cannot tell his family about his fear of death and be relieved, and then develop anxiety, depression and even delirium. For example, the patient still has concerns in the world, mostly about his family, but in the escape of "don't say such words, he will not die", both parties can never express their love frankly, and they can only leave with regrets. In this regard, Lu Guijun's team will focus on using guidance to let the patient and his family express their affection and make a good decision on the death side.

In China, no matter what the actual effect is achieved, family members' concealment will be understood as a "don't tell her" movie-style lies. In some countries and regions, this practice may touch the red line of the law: the US Patient Rights Act was issued in 1973, and Taiwan, my country, also passed the Patient Autonomous Rights Act in 2015. It is the first special law on patient autonomous rights in Asia, ensuring that patients have the right to know, choose and refuse medical treatment.

Can a mortality rate be allowed

100% of the departments exist?

Perhaps the difference is not only culture and law. Zhang Yunlong from the School of Humanities and Social Sciences of Harbin Medical University remembers that when he participated in the "Second Cross-Strait Pediatrics Summit Forum", Dr. Su Wenhao from Taiwan said: "For palliative care, there is no right model or wrong model. The best model is determined by local resources and needs."

For example, in Taiwan, the palliative care unit does not only refer to one room, but is more like a comprehensive place for patients and their families, with saloons, restaurants, sky gardens, prayer rooms, etc. In mainland China, beds in first-tier cities are tight. In Beijing's tertiary hospitals, it is not easy for Lu Guijun to open a palliative care unit in the Pain Department and win a single room.

In fact, the ward is just one of the models of palliative care. At Peking Union Medical College Hospital, the Department of Geriatric Medicine, Oncology, Internal Medicine and other departments were recruited into the training group to focus on cultivating their concepts and abilities of palliative care, and then the palliative care model was integrated into the clinical practice of various departments. The hospital also conducted relaxation medical consultations to help patients relieve symptoms and help their families release their emotions, "to a certain extent, it plays a great role in relieving the tension between seriously ill patients."

Not only Beijing, in recent years, many provinces and cities across the country have carried out palliative care pilot projects. In 2016, the "Healthy China 2030" Outline issued by the State Council clearly stated that it is necessary to achieve full-process health services and health protection from the fetus to the end of life, and to strengthen the construction of palliative care and other medical institutions. In 2017, the Health Commission issued the "Basic Standards, Management Specifications and Palliative Care Practice Guidelines for Palliative Care Centers", which mentioned that the development of palliative care is conducive to saving medical expenditures and improving medical resource efficiency.

He Miao, a professor at the School of Humanities and Social Sciences of Harbin Medical University, once concluded that the development of palliative care in mainland China has formed three models: palliative care hospitals or wards, home services, and community palliative care. In Lu Guijun's view, from the perspective of medical resources, palliative care should be vigorously developed in grassroots communities. However, carrying out palliative care work not only requires humanistic spirit, but also certain medical technology as the basis, and requires the resource support of some large hospitals.

"We can make full use of the medical alliance that the country is vigorously building, and medical institutions at all levels form an interactive mechanism, coupled with the coordination of social forces such as medical social workers to form a peaceful and tranquil care system with Chinese characteristics." Lu Guijun told the "medical community". Shanghai is actually practicing this model. In 2012, it included the establishment of "supervision and care" wards and "hospice care" in the municipal government's implementation project. Nearly 100 community health service centers in the city have provided palliative and care services combining home and hospitalization for patients with advanced tumors.

However, when the system and model are not yet mature, the development of palliative care still needs to break through some barriers to the medical system.

The first thing to be affected is the performance standards issue. If the traditional medical evaluation system is used to assess the bed turnover rate and mortality rate, then all palliative care institutions will be unqualified: hospice care takes a certain amount of time, the ward bed turnover rate is poor, and the mortality rate is 100%. "Can we form an understanding at the decision-making level and allow a department with a 100% mortality rate to exist?" Lu Guijun asked.

The second is the issue of cost. Palliative care requires a lot of labor costs. There is no charging standard within the current medical system, and related projects are not included in medical insurance in most areas. "Palliative care should be a social welfare undertaking and is of great significance to the development, stability, civilization and human dignity of society. However, since this cause cannot bring profits, in an era of market economy where economic indicators are the weather vane, this cause is easily ignored and it is even more difficult to obtain support from private capital." Wang Yunling said.

While taking advantage of the opportunity of the funeral during my lifetime to reflect on and summarize these problems, Lu Guijun was still recalling the moment of his collapse at the funeral. "I was lying in the coffin and felt scared and crying. It seemed that I was really leaving at this moment, but I have not yet witnessed the beginning of my children's wonderful life. What surged in my heart at this moment was that I couldn't let go of the children, and it was difficult to let go. How could I give up? I regretted it too little..." But this also made him and the guests present understand more deeply. When life came to an end, the most unwilling thing was love.

"Even if people are prepared for death, the psychological defense line of death is loose or even collapsed is almost inevitable... Life and death settlement has no end and no end, only doing their best." Lei Aimin, a friend of Lu Guijun and a research scholar on death issues, sighed.
Chapter completed!