ICU护士遵循集束化镇静镇痛策略现状及其影响因素研究
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摘要
目的:探讨ICU护士遵循集束化镇静镇痛策略的行为现状,并分析其影响因素。方法:采用自行设计的一般资料问卷、集束化镇静镇痛策略认知问卷、一般自我效能感量表、集束化镇静镇痛策略行为问卷,对200名ICU护士进行调查。结果:ICU护士遵循集束化镇静镇痛策略行为总得分为(99.17±17.94)分,得分较低的项目包括疼痛和镇静量表的使用、谵妄评估与管理、家属参与。多元线性回归分析显示,自我效能感、文化程度、ICU类型是ICU护士遵循集束化镇静镇痛策略的影响因素(P<0.05～P<0.01),可解释集束化镇静镇痛策略行为26%的变异量。结论:ICU护士遵循集束化镇静镇痛策略的依从性不高,其现状与相关循证策略要求存在差距,应引起ICU管理者重视,注重提高ICU护士的自我效能感,对文化程度较低的ICU护士着重关注,加强各学科交流、学习与协作,促进集束化镇静镇痛策略的临床推广。
Objective:To investigate the current status of ICU nurses abiding by the cluster sedation and analgesia strategies,and analyze its influencing factors.Methods:A total of 200 ICU nurses were investigated using general questionnaire,cognitive questionnaire of cluster sedation and analgesia strategies,self-efficacy scale and behavior questionnaire of cluster sedation and analgesia strategies.Results:The behavior score of ICU nurses abiding by the cluster sedation and analgesia strategies was(99.17±17.94),and the items with low scores included the use of the pain and sedation scale,delirium evaluation and management,and family involvement.The results of multiple regression analysis showed that the self-efficacy,education level and ICU type were the influencing factors of ICU nurses abiding by the cluster sedation and analgesia strategies(P<0.05 to P<0.01),and which could explain 26% of the variance.Conclusions:The compliance of ICU nurses abiding by the cluster sedation and analgesia strategies is not high,there is a gap between current situation and requirements of relevant evidence-based strategies,and the ICU managers should pay more attention to improve the self-efficacy sense of ICU nurses,focus on ICU nurses with low education level,strengthen the communication,learning and collaboration among different disciplines,and promote the clinical promotion of the cluster sedation and analgesia strategies.
Objective:To investigate the current status of ICU nurses abiding by the cluster sedation and analgesia strategies,and analyze its influencing factors.Methods:A total of 200 ICU nurses were investigated using general questionnaire,cognitive questionnaire of cluster sedation and analgesia strategies,self-efficacy scale and behavior questionnaire of cluster sedation and analgesia strategies.Results:The behavior score of ICU nurses abiding by the cluster sedation and analgesia strategies was(99.17±17.94),and the items with low scores included the use of the pain and sedation scale,delirium evaluation and management,and family involvement.The results of multiple regression analysis showed that the self-efficacy,education level and ICU type were the influencing factors of ICU nurses abiding by the cluster sedation and analgesia strategies(P<0.05 to P<0.01),and which could explain 26% of the variance.Conclusions:The compliance of ICU nurses abiding by the cluster sedation and analgesia strategies is not high,there is a gap between current situation and requirements of relevant evidence-based strategies,and the ICU managers should pay more attention to improve the self-efficacy sense of ICU nurses,focus on ICU nurses with low education level,strengthen the communication,learning and collaboration among different disciplines,and promote the clinical promotion of the cluster sedation and analgesia strategies.
引文
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[3] 汪玲,尹皓,张俊,等.集束化干预策略预防ICU机械通气患者谵妄的研究进展[J].牡丹江医学院学报,2018,39(4):108.
[4] STANIK-HUTT JA,SOEKEN KL,BELCHER AE,et al.Pain experiences of traumatically injured patients in a critical care setting[J].Am J Crit Care,2001,10(4):252.
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[8] 汤阿毛,李益民,陆骏,等.杭州300名临床一线高年资护士自我效能现状及影响因素分析[J].护理学报,2016,23(18):44.
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[10] ELLIOTT SR.ICU delirium:A survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit [J].Intensive Crit Care Nurs,2014,30(6):333.
[11] 李明珍,邓爱辉,龚凤翔,等.ICU护士与患者家属沟通影响因素的质性研究[J].护理学杂志,2015,30(17):54.
[12] JABRE P,BELPOMME V,AZOULAY E,et al.Family presence during cardiopulmonary resuscitation[J].N Engl J Med,2013,368(11):1008.
[13] BANDURA A.Social foundations of thought and action:a social cognitive theory[M].New Jersey:Prentice-Haii,1986:37.
[14] 尚少梅,张磊,金晓燕,等.ICU护士工作倦怠感与自我效能感的调查分析[J].中华护理杂志,2007,42(8):761.
[15] ESTEBAN A,ANZUETO A,ALIA I,et al.How is the mechanical ventilation employed in the intensive care unit[J].Am J Respir Crit Care Med,2000,161(5):145.
[16] 李倩,彭华,周建辉,等.重症监护护士核心能力现状及其影响因素分析[J].中国护理管理,2015,15(4):420.
[17] 张继芝,李秀娥,徐玉芝,等.多学科合作加速康复外科工作模式下的护理管理实践及效果评价[J].中国护理管理,2018,18(4):546.
[18] 陈竞萌,尤黎明,郑晶,等.医院内科、外科和ICU病区护士特征分布以及护理工作环境分析[J].中国护理管理,2012,12(7):20.
[2] 周丹.ICU医护人员镇静镇痛集束化策略认知、临床实践现状调查和对策研究[D].青岛:青岛大学,2015.
[3] 汪玲,尹皓,张俊,等.集束化干预策略预防ICU机械通气患者谵妄的研究进展[J].牡丹江医学院学报,2018,39(4):108.
[4] STANIK-HUTT JA,SOEKEN KL,BELCHER AE,et al.Pain experiences of traumatically injured patients in a critical care setting[J].Am J Crit Care,2001,10(4):252.
[5] 梁蝴蝶,李静,李晓静,等.首发脑卒中病人生活质量现状及其影响因素分析[J].护理研究,2012,26(16):1458.
[6] BARR J,FRASER GL,PUNTILLO K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit:Executive summary[J].Am J Health-Syst Pharm,2013,70(1):53.
[7] MORANDI A,PIVA S,ELY EW,et al.Worldwide survey of the "Assessing Pain,Both Spontaneous Awakening and Breathing Trials,Choice of Drugs,Delirium Monitoring/Management,Early Exercise/Mobility,and Family Empowerment"(ABCDEF) bundle[J].Crit Care Med,2017,45(11):e1111.
[8] 汤阿毛,李益民,陆骏,等.杭州300名临床一线高年资护士自我效能现状及影响因素分析[J].护理学报,2016,23(18):44.
[9] STEIS MR,FICK DM.Are nurses recognizing delirium:A systematic review[J].J Gerontol Nurs,2008,34(9):40.
[10] ELLIOTT SR.ICU delirium:A survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit [J].Intensive Crit Care Nurs,2014,30(6):333.
[11] 李明珍,邓爱辉,龚凤翔,等.ICU护士与患者家属沟通影响因素的质性研究[J].护理学杂志,2015,30(17):54.
[12] JABRE P,BELPOMME V,AZOULAY E,et al.Family presence during cardiopulmonary resuscitation[J].N Engl J Med,2013,368(11):1008.
[13] BANDURA A.Social foundations of thought and action:a social cognitive theory[M].New Jersey:Prentice-Haii,1986:37.
[14] 尚少梅,张磊,金晓燕,等.ICU护士工作倦怠感与自我效能感的调查分析[J].中华护理杂志,2007,42(8):761.
[15] ESTEBAN A,ANZUETO A,ALIA I,et al.How is the mechanical ventilation employed in the intensive care unit[J].Am J Respir Crit Care Med,2000,161(5):145.
[16] 李倩,彭华,周建辉,等.重症监护护士核心能力现状及其影响因素分析[J].中国护理管理,2015,15(4):420.
[17] 张继芝,李秀娥,徐玉芝,等.多学科合作加速康复外科工作模式下的护理管理实践及效果评价[J].中国护理管理,2018,18(4):546.
[18] 陈竞萌,尤黎明,郑晶,等.医院内科、外科和ICU病区护士特征分布以及护理工作环境分析[J].中国护理管理,2012,12(7):20.