摘要
目的:构建预防重症监护室(ICU)成年病人经口气管插管非计划拔管的最佳证据,将其应用于临床实践并评估效果。方法:采用PIPOST分析确定循证实践问题。制定检索策略及检索式,完成证据检索、汇总及临床适宜性评价,确定最佳实践证据;进而制定审查指标并开展基线审查,分析实施障碍后制定变革策略。比较最佳证据应用前后ICU成年病人经口气管插管非计划拔管率、ICU护理人员对各项审查指标执行情况及ICU护理人员对预防成年病人经口气管插管非计划拔管知信行水平的变化情况。结果:证据应用后,ICU成年病人经口气管插管非计划拔管率由0.92%下降至0.25%,但差异无统计学意义(P>0.05);除指标11外,其余指标执行率在循证实践后均有改善;护理人员对预防ICU成年病人经口气管插管非计划拔管知信行总分有所提升,差异均有统计学意义(P<0.05)。结论:基于循证的预防管理策略可有效改善ICU护理人员的临床实践执行能力与知信行水平,虽然非计划拔管率的改善未达统计学意义,但整体对提升护理质量具有积极作用。
Objective:To establish optimal evidence for preventing unplanned endotracheal extubation in adult patients undergoing endotracheal intubation in the intensive care unit(ICU),apply it to clinical practice,and evaluate its effectiveness.Methods:The PIPOST framework was used to define evidence‐based practice questions.A search strategy and search terms were developed to retrieve,synthesize,and assess the clinical appropriateness of evidence,thereby identifying optimal practice evidence.Review indicators were then established,baseline reviews conducted,implementation barriers analyzed,and change strategies formulated.Compare the rate of unplanned extubation through oral tracheal intubation in adult ICU patients before and after the application of the best evidence,the implementation of various review indicators by ICU nursing staff,and the changes in the knowledge,attitude and practice level of ICU nursing staff in prevention of accidental oral intubation dislodgement in adult patients.Results:After evidence implementation,the rate of unintentional endotracheal tube dislodgenment among ICU patients decreased from 0.92%to 0.25%,but the difference was not statistically significant(P>0.05).Implementation rates of all indicators except Indicator 11 improved following evidence‐based practice.Nurses'total scores for knowledge,attitude,and practice regarding preventing unplanned endotracheal extubation in adult ICU patients receiving endotracheal intubation increased,with all differences statistically significant(P<0.05).Conclusion:Evidence‐based preventive management strategies effectively enhance ICU nurses'clinical practice implementation capabilities and knowledge‐attitude‐practice levels.Although the improvement in unplanned endotracheal extubation rates did not reach statistical significance,the overall approach positively contributes to enhancing nursing quality.
作者
潘世琴
孙晓林
马琴
韩进海
孙丽娟
路艳萍
童雅倩
罗尹聪
PAN Shiqin;SUN Xiaolin;MA Qin;HAN Jinhai;SUN Lijuan;LU Yanping;TONG Yaqian;LUO Yincong(Qinghai Provincial People's Hospital,Qinghai 810000 China)
出处
《循证护理》
2026年第4期701-709,共9页
Chinese Evidence-Based Nursing
基金
青海省人民医院院内科研课题,编号:2023-qhsrmyy-45
中华医学会杂志社护理学科研究课题,编号:CMAPH-NRI2022030。
关键词
经口气管插管
非计划性拔管
障碍因素
基线审查
知信行
循证护理
oral endotracheal intubation
unplanned extubation
barriers factors
baseline review
knowledge,attitude,and practice
evidence‐based nursing
