ICU护士儿童谵妄评估认知的质性研究

目的了解重症监护室(Intensive Care Unit,ICU)护士应用康奈尔儿童谵妄评估量表(Cornell Assessment of Pediatric Delirium,CAPD)进行谵妄评估后的真实体验及感受,为完善儿童ICU谵妄评估提供参考和依据。方法采用目的抽样法,选取2020年2—4月上海市某三级甲等儿童专科医院11名应用CAPD评估儿童谵妄的ICU护士作为研究对象,采用质性研究中的现象学研究方法,对研究对象进行面对面、半结构式深入访谈,采用Colaizzi 7步分析法收集整理资料,分析提炼主题。结果分析得出ICU护士对儿童谵妄评估认知的4个主题,分别为ICU护士对儿童谵妄评估认识的转变、儿童谵妄评估的阻碍因素、儿童谵妄评估的促进因素、ICU护士关心谵妄评估阳性后的医护团队协作性干预。结论本研究中ICU护士主要表现为对谵妄评估认识的不足、评估过程中遇到的阻碍因素、医护团队协作缺乏等。为提高ICU护士谵妄评估的便捷性及准确性,建议加强对医护人员谵妄的培训,逐步优化评估执行的障碍因素,鼓励医护团队合作,根据监护室工作情境及模式,制定符合儿童ICU的谵妄评估流程。

A qualitative research on cognition of ICU nurses in pediatric delirium assessment

Objective To understand the real experience and feeling of Intensive Care Unit(ICU)nurses after delirium assessment using Cornell Assessment of Pediatric Delirium(CAPD),so as to provide reference and evidence for improving pediatric ICU delirium assessment.Methods Using the purposive sampling method,a total of 11 ICU nurses who used CAPD for pediatric delirium assessment in a ClassⅢGrade A children's specialized hospital in Shanghai from February to April 2020 were selected as the research objects.Phenomenological research method in qualitative research was used to conduct face-to-face and semi-structured in-depth interviews with the research subjects.Colaizzi 7-step analysis method was used to collect and sort the data and analyze and refine the topics.Results ICU nurses'cognition in pediatric delirium assessment could be classified into four themes,including changes of ICU nurses'cognition of pediatric delirium assessment,obstacles to pediatric delirium assessment,promoting factors for pediatric delirium assessment,and ICU nurses'concern about the collaborative intervention of medical team after the positive delirium assessment.Conclusions The main manifestations of ICU nurses in this study are the lack of understanding of the evaluation of delirium,the obstacles encountered in the evaluation process,and the lack of collaboration between the medical and nursing team.In order to improve the convenience and accuracy of ICU nurses'assessment of delirium,it is recommended to strengthen the training of medical staff for delirium,gradually optimize the obstacles to the implementation of the assessment,encourage the cooperation of medical teams and develop a delirium assessment process in line with children's ICU according to the working situation and mode of ICU.