儿科ICU护士肠内营养相关决策行为的现况调查

目的 调查儿科ICU护士肠内营养相关决策行为的现状,为推进儿科ICU肠内营养管理的发展提供参考。方法 采用便利抽样法,于2020年1月抽取南京市儿童医院NICU、PICU、CCU、SICU的护士作为研究对象,采用“儿科ICU护士肠内营养相关决策行为问卷”对其进行调查。结果 共发放177份问卷,有效回收142份。仅有57.0%的护士熟知本科室的肠内营养护理流程;胃管留置长度和位置核实方法方面,高达54.2%~94.4%的护士依旧采用传统方法;喂养不耐受监测方面,91.5%的护士每次喂养前都评估胃残留量,当问及如何处理胃残留时,高达60.6%的护士将胃残留全部丢弃;本调查还发现仅有7.0%的护士总是主动采取非药物方式预防或减少喂养不耐受的发生与发展。结论 儿科ICU护士肠内营养的实施与护理措施大多沿用传统方法,欠缺对新方法的学习与探索。建议加强儿科ICU肠内营养相关指南和新理念的培训,制定科学严谨的肠内营养实施与操作流程,规范护理行为,加强营养专科护理人才的培养,营造良好的工作氛围以提高儿科ICU护士工作主动性,从而优化危重患儿肠内营养的管理。

Enteral Nutrition-related Decision-making Behavior of Pediatric ICU Nurses

Objective To investigate the status quo of enteral nutrition-related behaviors in pediatric ICU nurses, and to provide reference for the development of enteral nutrition management. Methods With convenient sampling, nurses from NICU, PICU, CCU and SICU were selected and surveyed by a self-designed questionnaire on enteral nutrition-related decision-making behavior of pediatric ICU nurses in January 2020. Results We obtained 142 out of 177 questionnaires and only 57.0% of the nurses were familiar with the nursing process of enteral nutrition in the department. In terms of measuring the length and verifying the position of gastric tube, 54.2%~94.4% of the nurses still adopted traditional method and 91.5% of the nurses assessed gastric residual volume before each feeding. When asked how to deal with gastric residual volume, 60.6% of the nurses discarded all of them. Our investigation also found that only 7.0% of the nurses always took the initiative to prevent or reduce the occurrence and development of feeding intolerance. Conclusion Generally, traditional approaches to enteral nutrition were adopted in pediatric ICU, and there are insufficient learning and exploration about new methods. More training of guidelines and new concepts, scientific enteral nutrition implementation procedures, standardized nursing behaviors, cultivation of nutrition specialist nurses, and good work atmosphere are beneficial to improving the initiative of nurses, thus to optimize the management of enteral nutrition in critically ill children.