Objective:To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit (ICU).Methods:Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected. The patients were randomly divided into two groups. The experimental group conducted early off-bed mobility, such as using the shift machine off-bed sitting and walking aids to assist standing and walking, and the off-bed mobility is based on patient tolerance. The control group was given early bed activities, including conducting the joint range activity, limb movement, bed sitting, upper limb elastic belt movement, and lower limb cycling, once a day. Each joint moved 15-20 times, a total of 30 minutes. Both groups were treated with anti-infection, mechanical ventilation, analgesia and sedation, and nutrition therapy. After intervention, confusion assessment method for the ICU (CAM-ICU) was used to assess the onset and duration of delirium, physical restraint rate and duration of physical restraint, mechanical ventilation time, and the length of ICU stay.Results:After excluding patients who died or gave up treatment during the intervention period, 266 patients were included, with 133 patients in the experimental group and 133 patients in the control group. There were no significant differences in gender, age, diagnosis, degree of illness, sedative drugs between the two groups. The incidence of the delirium in intervention group was significantly lower than that in control group [26.3% (35/133) vs. 42.1% (56/133), χ 2 = 7.366, P = 0.007], the duration of delirium was shorter than that in control group (hours: 11.26±4.11 vs. 17.00±3.29, t = -4.157, P = 0.000), the rate of physical restraint was lower than that in control group [19.5% (26/133) vs. 45.1% (60/133), χ 2 = 19.864, P = 0.000], the duration of physical restraint was shorter than that in control group (hours: 9.71±4.07 vs. 13.55±7.40, t = -5.234, P = 0.000), the mechanical ventilation time and the length of ICU stay were shorter than those in control group [mechanical ventilation time (hours) : 106.23±42.25 vs. 133.10±41.88, t = -3.363, P = 0.001; length of ICU stay (days) : 8.35±6.21 vs. 13.25±9.98, t =-4.190, P = 0.000]. Conclusions:Early off-bed mobility can reduce physical restraint rate and the incidence of delirium, and thus can accelerate rehabilitation in critically ill patients. Early off-bed mobility is safe and effective for patients with mechanical ventilation in ICU.

Objective: To explore the application effect of blending-learning model on clinical teaching for practice nursing students in ICU. Methods: Totally 165 nursing students who practiced in ICU from 2016 to 2017 were selected by convenient sampling.82 nursing students in the traditional teaching mode were used as the control group in 2016, while 83 nursing students in the blending-teaching model on the basis of the control group were used as the observation group in 2017. Results: The aspects of theory and skill operation, clinical nursing comprehensive ability, teaching content, teaching method, language expression, interpersonal relationship, learning atmosphere, learning opportunity and overall evaluation in nursing students of the observation group were (83.89±7.01), (93.05±2.60) , (6.61±1.15), (3.64±0.68) , (3.85±0.77) , (3.76±0.73) , (3.84±0.91) , (3.68±0.78) , (3.74±0.81) , (3.73±0.66) points, which were higher than (69.93±10.28) , (87.94±3.11) , (5.51±1.53) , (2.79±0.84) , (2.69±0.63) , (2.39±0.52) , (2.01±0.70) , (2.43±0.57) , (2.50±0.55) , (2.46±0.55) points in the control group, the differences were significant (t=-14.235- -5.176, P<0.05) .There was no significant difference between the two groups in terms of sex, age, educational level, scores of entrance examination, teachers′ quality, teaching attitude, work atmosphere and organizational support (P>0.05). Conclusions The blending-teaching model is beneficial to improve the learning achievement, clinical nursing comprehensive ability and satisfaction in nursing students who practiced in ICU, and promote the continuous improvement of clinical teaching quality.