摘要
目的:审查成人呼吸重症患者气管插管拔管前的护理现状并分析临床实践的障碍与促进因素,为推进证据转化提供依据。方法:基于整合的证据建立审查指标,于2024年4月—9月在循证实践试点科室行基线调查,并对11名医护人员进行焦点小组访谈,分析障碍和促进因素。结果:共纳入28条证据,制定18条审查指标,其中护士审查中11条指标执行率<60%,系统审查中2条指标执行率为0,患者结局指标中48 h拔管成功率为85.7%,拔管前谵妄和疼痛的发生率高,分别为33.3%和76.2%。成人呼吸重症患者气管插管拔管前护理管理实施的主要障碍因素为证据内容复杂;护士知识、态度、行为均不足;医护技团队间协作不足;缺乏拔管前管理相关培训与考核、流程与标准、评估工具;主要促进因素为管理者的重视、医护技团队的认可与支持、护士有提升专业能力的意识等。结论:成人呼吸重症患者气管插管拔管前护理管理的临床实践与证据存在一定差距,应针对其障碍和促进因素进一步优化证据,制定可行的实施方案,为推进证据的临床转化提供保障。
Objective:To examine the current status of nursing care for adult patients with critically ill respiratory conditions pre-extubation,and analyze the barriers to clinical practice,providing a basis for advancing evidence translation.Methods:Based on evidence integration,we established audit indicators and conducted a baseline investigation from April to September 2024,and through focus group interviews,analyzed the barriers and facilitating factors.Results:This study included a total of 28 pieces of evidence summaries and formulated 18 audit indicators.Among them,the implementation rate of 11 indicators in the nurse audits was less than 60%,and the implementation rate of 2 indicators in system audits was 0.The 48-hour extubation success rate was 85.7%in the patient outcome indicators.The incidence of pre-extubation delirium and pain was high,at 33.3%and 76.2%respectively.The main obstacles were the complexity of evidence content;inadequate knowledge,attitude,and behavior of nurses;insufficient collaboration among medical,nursing,and technical teams;and a lack of training,assessment,procedures,standards,evaluation tools,and observation scales related to extubation management.The main facilitating factors included the attention of managers,recognition and support from medical,nursing,and technical teams,and nurses'awareness of improving their professional abilities.Conclusion:There is a significant gap between the clinical practice and evidence for the pre-extubation care management of critically ill adult respiratory patients.We should further optimize the barriers and facilitating factors,and develop feasible implementation plans to ensure the clinical translation of evidence.
作者
吴红梅
杨彩蝶
周念
宋彩萍
罗春梅
WU Hongmei;YANG Caidie;ZHOU Nian;SONG Caiping;LUO Chunmei(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Army Medical University,Chongqing,400037,China)
出处
《中国护理管理》
北大核心
2025年第9期1281-1287,共7页
Chinese Nursing Management
基金
重庆市卫生健康委医学科研项目(2025WSJK077)。
关键词
气管插管拔管
护理
审查指标
障碍因素
循证实践
重症
安全
tracheal extubation
care
audit indicators
barriers
evidence-based practice
critically ill
safety
