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目的了解ICU护士抬高机械通气患者床头依从性认知、态度、执行现状,并分析低依从性原因。方法从问卷调查、直接观察和小组长访谈3方面,对新疆某三级甲等医院91名ICU护士进行机械通气患者床头抬高依从性现状及影响原因调查。结果本组ICU护士中,94%认为机械通气患者的推荐卧位是30°~45°半坐卧位;72%认为所有机械通气患者常规执行指南推荐体位;12%选“不同意”和“非常不同意”执行指南推荐体位;约50%认为,对病情允许的机械通气患者实施标准指南推荐体位,且对机械通气患者使用角度指示卡或量角器等工具评估床头角度。本组ICU护士对床头抬高自评依从性均高于临床观察依从性。科室在ICU护士抬高床头执行上存在质量监管、质控部分缺失,小组长职能未充分发挥。结论 ICU护士对相关指南中的机械通气患者床头抬高信息认知好,但是理解不透彻;其临床执行的依从性不高,自评依从结果高于临床实际监测结果。提示需加强认知培训,促进床头抬高依从性的知-行转化;完善科室监管质控体系,并发挥小组长工作职能。
Objective To understand the cognition, attitude and executive status of bedside compliance of ICU nurses in elevating patients with mechanical ventilation and to analyze the causes of low adherence. Methods From questionnaires, direct observation and interview with team leader, we investigated the status of bedside elevation compliance of 91 ICU nurses in a third class Hospitals in Xinjiang and their causes. Results Among the ICU nurses in this group, 94% believed that the recommended supine position of patients with mechanical ventilation was 30 ° ~ 45 ° semi-recumbent lying position; 72% suggested that all patients with mechanical ventilation routinely performed recommended guidelines; 12% chose “Do not agree” And “strongly disagree” with the guidelines recommended by the guidelines; about 50% consider standard guidelines recommended for patients with mechanically ventilated conditions and bedside angles using tools such as angle gauges or protractor for mechanically ventilated patients. The ICU nurses on the bed elevation self-assessment compliance are higher than the clinical observation of compliance. Department of nurses in ICU to raise the bed there is the implementation of quality control, quality control part is missing, the role of team leader did not give full play. Conclusion ICU nurses are good at understanding the bedside elevation information of patients with mechanical ventilation in the related guidelines, but they do not understand thoroughly. The compliance of clinical practice is not high, and the results of self-evaluation compliance are higher than the clinical monitoring results. Prompts need to strengthen cognitive training, promote bed-based compliance improvement knowledge-line transformation; improve departmental supervision and control system, and play a small team work functions.