Objective To develop an intelligent early warning and decision support system for the prevention of unplanned endotracheal extubation (UEE) in adults,so as to prevent the occurrence of extubation events and ensure the safety of patients. Methods A system research and development team was set up to build a UEE early warning and decision support system with 3 modules,including evaluation,early warning,and decision-making. It was applied in the ICU of a tertiary A hospital in Tianjin in September 2020. The researchers compared the implementation rate of UEE preventive measures,the incidence rate of UEE,and the satisfaction of ICU nurses with the system before the application (March-August 2020) and after the application (September 2020-March 2021). Results Compared with the system before application,the implementation of UEE preventive measures by ICU nurses was significantly improved,including risk assessment,endotracheal intubation and fixation,analgesia and sedation observation,norms and constraints,and the differences are statistically significant (P<0.05). No UEE occurred before and after system application. The satisfaction score of ICU nurses on the system is (91.20±7.44) points,which is at a high level. Conclusion The UEE early warning and decision support system can assist ICU nurses to scientifically carry out UEE prevention,improve the implementation rate of UEE preventive measures,and ensure patient safety.

Objective To describe the work status of nurses in secondary and tertiary hospitals in Guangdong province in China,and to analyze the differences between secondary and tertiary hospitals. Methods A total of 4,163 nurses from 36 secondary and tertiary hospitals were investigated with questionnaires on the demographic characteristics,nursing work environments,care left undone,burnout,job satisfaction and intention to stay. Results The overall score of nursing work environments was 3.03（2.74,3.61）;the score：for the subscale of staffing and resources adequacy and nurse participating in hospital affairs were the lowest,which were 3.00（2.50,3.50） and 3.00（2.56,3.56）,respectively. Perception of nurses in tertiary hospitals on nursing work environments was significantly worse than that of nurses in secondary hospitals for both overall scale and 5 subscales（all P<0.001）. The average number of care left undone reported by nurses was 6.0（1.0,11.0）,with a significantly higher number of those reported by nurses in tertiary hospitals than those in secondary hospitals （P=0.036）. Nurses in the secondary and tertiary hospitals experienced a moderate level of emotional exhaustion and depersonalization,and a high level of reduced personal accomplishment. Furthermore,61.42% of nurses were satisfied with their work and 79.87% had the intention to stay. Compared to nurses in secondary hospitals,the level of burnout among nurses in tertiary hospitals was at a higher level（P<0.001 both for emotional exhaustion and depersonalization）,and the proportion of nurses who were satisfied with their work and willing to stay was lower（all P<0.050）. Conclusion In Guangdong province,attention should be paid to further improvement of the work environment. Due to heavy workload and low job satisfaction of nurses,this situation was more prominent in tertiary hospitals than it in secondary hospitals.