重症监护病房护士实施预防呼吸机相关性肺炎的认知调查研究

目的通过对重症监护病房(ICU)护士预防呼吸机相关性肺炎(VAP)护理的认知和行为状况进行调查,评估目前ICU护士预防VAP的护理情况,并分析影响其认知、行为的因素及相互关系。方法收集在该院进行危重症护理人员专科知识培训班的学员100名,主要采用自行设计的调查问卷,调查学员对预防VAP的认知和行为,并分析其影响因素。结果理论及临床培训之前,100名调查对象对于VAP的相关知识掌握情况不佳,12条项目中仅有6项的掌握率达50%以上,对及时吸痰、医护人员无菌观念及手卫生、生理盐水棉球做口腔护理的掌握率较高。培训后,调查对象对VAP的相关知识掌握情况明显优于培训前,差异有统计学意义(P0.05)。培训后,ICU护士预防VAP的护理行为情况优于培训前,差异有统计学意义(P0.05);科室无预防VAP的教育墙报或操作图片强化学习和提醒等是阻碍ICU护士认识预防VAP护理的影响因素;科室、学历和ICU工作年限等是影响ICU护士认识预防VAP护理的相关因素。结论加强ICU专科培训和继续教育,完善操作规范及护理指南,确立预防VAP的护理质量评价标准,从而促进ICU护士行为的稳定,提高ICU护理质量。     

强化ICU护士导管相关性感染循证护理培训的效果

目的评价开展ICU预防导管相关性感染循证护理培训教育的成效。方法以2007年中华医学会重症医学分会血管内导管相关性感染的预防与治疗指南为培训教材,并以此为导向设置课程,对18名ICU护士进行培训,采用自行设计的评价量表评价培训前后护士的认知和行为变化。结果培训后护士的认知和行为水平较培训前明显改善,差异有统计学意义（P〈0．05）。结论ICU预防导管相关性感染的循证护理培训能有效提高护士的认知和行为水平,使护理质量内涵得到大幅提高。     

ICU护士预防呼吸机相关性肺炎循证知识掌握现状及其影响因素

目的了解ICU护士对预防呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)循证知识的掌握现状及其影响因素。方法 2015年1-6月,采用便利抽样法抽取某市3所医院ICU护士及参加重症医学专科护士培训班的学员共164名,对其进行一般资料、预防VAP循证知识及相关影响因素的调查。结果 ICU护士预防VAP循证知识得分为(6.16±1.80)分;不同学历、等级医院的ICU护士预防VAP循证知识得分差异有统计学意义(P0.05);影响护士执行预防VAP措施的主要因素为"科室护理人力资源不足"、"患者病情复杂危重造成护理工作量大"、"缺少相关预防护理措施的相关提醒和强化学习"等。结论 ICU护士预防VAP循证知识掌握情况不佳,应加强ICU护理人才队伍的培养,重视循证护理的发展动态与实践应用,落实VAP循证知识的系统培训,提高VAP预防的有效性,以保证患者安全,提高护理质量。     

ICU护士预防呼吸机相关肺炎知信行现况及其影响因素调查

目的 调查分析重症监护病房(ICU)护士预防呼吸机相关肺炎(VAP)护理知识、信念和行为现状及其影响因素.方法 采取方便抽样法选取我市三级甲等医院的150名ICU临床护士作为研究对象,应用自行设计的ICU护士预防VAP护理知信行量表考察护士知信行现状,采用一般资料调查表对影响ICU护士预防VAP知信行进行单因素分析、多元线性回归分析.结果 本研究ICU护士预防VAP知、信和行得分依次为(10.47±3.01)分、(24.13±6.57)分和(36.89±8.14)分;影响ICU护士预防VAP知识得分的主要因素为ICU工作年限和参加培训,影响其信念得分的主要因素为ICU工作年限和婚姻状况,影响其行为得分的主要因素为年龄和职称,结果具有统计学意义(P＜0.05).结论 ICU护士预防VAP知识欠缺,信念和行为有待进一步提高,需要树立正确的循证护理,加强培训和学习,提高ICU护士预防VAP依从性.     

工作坊模式在ICU护理人员预防呼吸机相关性肺炎培训中的运用

目的探讨工作坊模式在ICU护理人员预防呼吸机相关性肺炎(VAP)培训中运用的效果。方法由研究者担任培训的负责人,根据预防呼吸机相关性肺炎要求和要点制定出工作坊培训模式,通过运用"工作坊"形式对本院ICU的36名护理人员进行为期6个月的预防呼吸机相关性肺炎知识和操作技能培训。培训前后,采用自制ICU护士预防VAP护理知识、行为调查问卷对36名护理人员进行测评。结果培训后,36名护理人员预防VAP护理知识、行为调查问卷得分明显高于干预前,差异有统计学意义(P0.05)。结论工作坊模式在ICU护理人员预防呼吸机相关性肺炎(VAP)培训中运用是一种非常有效的医学培训模式,因培训主题鲜明、形式灵活、目标明确,强化了ICU护理人员对预防呼吸机相关性肺炎(VAP)知识的掌握,使其产生良好的信念,在实际操作中采取正确的行为,从而降低ICU机械通气患者VAP发生率。     

ICU护士呼吸机相关性肺炎最佳培训频次和时间初探

[目的]探讨ICU护士呼吸机相关性肺炎(VAP)最佳培训频次和时间。[方法]对646名ICU护士进行呼吸机相关性肺炎预防策略认知行为问卷调查。[结果]ICU护士VAP知识的主要来源是专题讲座(89.0%),其次是看书(59.4%)。近3个月不同VAP培训次数、培训累积学时的ICU护士行为得分、知信行总得分比较差异均有统计学意义(P0.01)。两两比较中,近3个月VAP培训3次～5次的ICU护士知识、行为、知信行总分均优于3次者;近3个月VAP培训累积3学时～5学时、≥6学时ICU护士行为、知信行总分大于≤2学时者,差异均有统计学意义(P0.01)。[结论]科室管理者可将培训次数3次～5次,累积培训学时为3学时～5学时作为ICU护士近3个月VAP最佳培训频次和学时。     

ICU护士预防呼吸机相关性肺炎的循证护理认知调查

目的:调查我院ICU护士对预防呼吸机相关性肺炎的循证护理认知水平,探讨影响其认知水平的可能因素,为制定针对性护理培训计划提供理论基础。方法:采用"ICU护士预防呼吸机相关性肺炎的循证护理认知调查问卷"对我院ICU科室共21名护士进行调查,并对调查结果进行统计描述与数据分析。结果:调查问卷5个维度得分高低水平依次为吸痰护理、气管套囊护理、呼吸机管道护理、肠内营养护理与口腔护理。单因素分析显示,年龄30岁的护理人员、护士长及ICU护龄10年的护理人员认知水平较高,总体认知水平均存在统计学差异(P0.05)。结论:ICU护士预防呼吸机相关性肺炎的循证护理相关知识的认知仍存在一定的问题,尤其在呼吸机管道与口腔护理方面应重点培训,并且认知水平可能与年龄、职称、工作经验有关,与学历无关。     

WORKSHOP联合强化训练方法对提高ICU护士非计划性拔管知信行的影响

目的探讨预防非计划性拔管(UEX)工作坊(WORKSHOP)联合强化训练方法对提高ICU护士UEX知信行的影响。方法对20名ICU护士进行WORKSHOP联合强化训练方法进行培训,采用自制的《ICU护士预防UEX的知信行调查问卷》评价培训前后护士的认知、信念和行为变化。结果护士培训后总体水平较培训前明显改善,差异有统计学意义(P0.05),知识、态度及行为评分较培训前明显改善,差异有统计学意义(P0.001)。结论 WORKSHOP联合强化训练方法能提高ICU护士关于预防UEX知识、态度以及行为水平,使知信行达到了统一,整体上达到了培训的预期效果,提高了护理服务的内涵。     

呼吸机相关性肺炎预防集束护理的认知、行为及影响因素研究

[目的]通过对临床护理人员进行呼吸机相关性肺炎(VAP)预防集束护理的认知调查、行为及影响因素调查,了解其对于预防VAP相关知识的掌握状况和临床工作中的执行情况,明确影响实施的相关因素,以促进VAP预防集束在临床工作中的应用与效果。[方法]使用自行设计的问卷调查82名直接护理机械通气病人的护士,分析VAP集束护理的认知、执行情况及影响因素。[结果]对VAP集束护理的认知总体较好,护士预防VAP集束护理的认知与科室、工作年限、本科室工作年限有关,差异有统计学意义(P0.05),护士执行预防VAP集束护理的状况与科室有关,差异有统计学意义(P0.05),护士预防VAP集束护理的认知与行为总体水平两者之间无显著相关关系(P0.05)。[结论]VAP预防集束仍然需要护理人员的持续关注,不断加强相关知识培训,并将具体护理措施在临床工作中加以落实,共同努力,降低VAP的发生率。     

ICU护士预防呼吸机相关性肺炎循证护理的认知、行为及影响因素调查

目的 了解ICU护士预防呼吸机相关性肺炎循证护理的认知、实施行为的现状及影响因素. 方法 采用方便抽样方法,应用自行设计的结构式问卷,对江苏省某三甲医院101名ICU护士进行问卷调查,并对 结果 进行统计描述和方差分析. 结果 ICU护士预防呼吸机相关性肺炎循证护理的认知平均值为(4.75±1.42)分(总分10分),行为得分平均值为(3.32±0.32)分(满分4分).影响其认知的因素有不同的科室、ICU工作年限;不同ICU工作年限的护士其行为比较显著不同.阻碍护士实施预防呼吸机相关性肺炎循证护理的因素主要有"因患者病情复杂危重而造成护理工作量大". 结论 医院应加强ICU护士有关呼吸机相关性肺炎专业知识的培训和循证护理教育,完善相关的护理指南和操作规范,并合理配置人员、提供必备的设施用品.相关部门应完善医疗制度,调整医疗费用的结构,以有效落实预防呼吸机相关性肺炎的循证护理.     

ICU护士预防呼吸机相关性肺炎循证护理的认知、行为及影响因素调查

目的了解ICU护士预防呼吸机相关性肺炎循证护理的认知、实施行为的现状及影响因素。方法采用方便抽样方法,应用自行设计的结构式问卷,对江苏省某乏甲医院101名ICU护士进行问卷调查,并对结果进行统计描述和方差分析。结果ICU护士预防呼吸机相关性肺炎循证护理的认知平均值为（4．75±1．42）分（总分10分）,行为得分平均值为（3．32±0．32）分（满分4分）。影响其认知的因素有不同的科室、ICU丁作年限;不同ICU工作年限的护士其行为比较显著不同。阻碍护士实施预防呼吸机相关性肺炎循证护理的因素主要有“因患者病情复杂危重而造成护理工作量大。结论医院应加强ICU护士有关呼吸机相关性肺炎专业知识的培训和循证护理教育,完善相关的护理指南和操作规范,并合理配置人员、提供必备的设施用晶。相关部门应完善医疗制度,调整医疗费用的结构,以有效落实预防呼吸机相关性肺炎的循证护理。     

ICU护理人员对口腔护理预防呼吸机相关性肺炎的知信行现状调查及影响因素

目的调查ICU护理人员对口腔护理预防呼吸机相关性肺炎(VAP)的知信行状况及影响因素。方法选取2018年5月至2019年5月我院65名ICU护理人员为研究对象,调查其对口腔护理预防VAP的知信行现状并探究其影响因素。结果 ICU护理人员对口腔护理预防呼吸机相关性肺炎的认知、信念评分均较好,但部分护理人员仍需提高预防VAP的知识水平。多因素logistic回归分析显示,ICU工作时间、学历、职称、参加培训是影响ICU护理人员对口腔护理预防VAP知信行水平的独立影响因素。结论 ICU护理人员对口腔护理预防VAP的知识水平较为缺乏,需通过加强培训等方式提高其相关知识水平,进而改善其护理措施。     

The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia.

BACKGROUND: Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilise foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. OBJECTIVES: The aim of the study was to determine if an evidence-based practice (EBP) educational programme would improve the quality of oral care delivered to mechanically ventilated patients; thereby, reducing the VAP rate. RESULTS: Improvement in oral health was demonstrated by a decrease in median scores on the Oral Assessment Guide (pre (11.0), post (9.0)). A t-test analysis revealed a statistically significant difference (p=0.0002). The frequency of oral care documentation also improved as demonstrated by a positive shift to the more frequent timeframes. The VAP rates have decreased by 50% following the EBP education intervention. CONCLUSIONS: The implementation of an EBP educational programme focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff.     

Critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire

BACKGROUND: Lack of adherence to recommended evidence-based guidelines for preventing infections associated with use of central venous catheters may be due to nurses' lack of knowledge of the guidelines. OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters. METHODS: A total of 10 nursing-related strategies were identified from current evidence-based guidelines for preventing infections associated with use of central venous catheters. Face and content validation were determined for selected interventions and multiple-choice questions (1 question per intervention). The test results of 762 critical care nurses were evaluated for item difficulty, item discrimination, and quality of the response alternatives or options for answers (possible responses). RESULTS: All 10 items had face and content validity. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0-0.8) indicated widespread misconceptions among the critical care nurses in the sample. CONCLUSION: The questionnaire is reliable and has face and content validity. Findings from surveys in which this questionnaire is used can lead to better educational programs for critical care nurses on infections associated with use of central venous catheters.     

Critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire.

BACKGROUND: Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. METHODS: Ten nursing-related interventions were identified from a review of evidence-based guidelines for preventing ventilator-associated pneumonia. Selected interventions and multiple-choice questions (1 question per intervention) were subjected to face and content validation. Item difficulty, item discrimination, and the quality of the response alternatives or options for answers (possible responses) were evaluated on the test results of 638 critical care nurses. RESULTS: Face and content validity were achieved for 9 items. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.10 to 0.65. The quality of the response alternatives led to the detection of widespread misconceptions among critical care nurses. CONCLUSION: The questionnaire is reliable and has face and content validity. Results of surveys with this questionnaire can be used to focus educational programs on preventing ventilator-associated pneumonia.     

The primary and secondary care interface: the educational needs of nursing staff for the provision of seamless care

AIM: To identify nurses' perceived deficits in the knowledge and skills required to provide effective seamless care, so that appropriate training could be provided. BACKGROUND: A clear understanding of nursing staff roles, skills and resources is paramount to work at the primary/secondary care interface. Nursing staff require an educational model that will provide a clear understanding of how their roles coalesce with other healthcare professionals. There is little evidence that examines the educational needs of nurses related to changing care boundaries. DESIGN/METHODS: The study used methodological triangulation to explore these issues within current practice. Focus groups were used to generate items for inclusion in the questionnaire. Questionnaire design was based on an importance-performance analysis. This procedure has been effective in developing health care marketing strategies. A stratified random sample of nursing staff (n=722) from the participating trusts received the questionnaire, eliciting a response rate of 172 (23.8%). RESULTS: Factor analysis provided a list of seven training categories in order of training need priority: information technology, awareness of roles, communications within seamless care, working across boundaries, professional issues, practice-related issues, delivery of patient/client care issues. There were no differences in nurses' training needs across NHS trusts. However, differences were highlighted for staff located in primary or secondary settings or working across the interface. CONCLUSIONS: Despite there being a vast range of training issues the majority of nurses appear to have a clear idea of their training needs for the provision of seamless care. A training programme required which targets the specific needs of nursing staff working at different positions across the primary/secondary care interface.     

Creating nursing research opportunities in rural healthcare facilities

Advanced practice registered nurses, and clinical nurse specialists in particular, play a critical role in creating an institutional research culture and developing nurses' knowledge about the research process, implementing evidence-based care, and participating in continuous quality improvement initiatives. This article focuses on creating nursing research opportunities in small healthcare facilities located in rural settings.     

临床护士参与循证实践培训体验的质性研究

目的 了解临床护士参与循证实践培训的感受和需求,为完善和开展循证实践培训提供参考。方法 采用现象学方法对13名参加循证实践培训的护士进行半结构式访谈,运用Colaizii七步分析法进行资料分析。结果 临床护士参与培训的感受提炼出5个主题:对循证实践培训的赞同,循证实践认识和技能的提升,临床工作思维的改变,职业发展获益及职业认同感的提升;培训需求提炼3个主题:优化培训课程设置,增加培训方式的多样性和加强培训师资建设。结论 循证实践培训能培养护士的批判性思维能力和科研能力,有效提升其循证实践水平。护理管理者应注重临床护士的不同发展需求,组织和开展多层次、针对性的循证实践培训,丰富培训内容和方式,加强多学科合作师资队伍的建设并提高临床实践导师的水平,以完善和优化循证实践培训体系。