Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle
Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle
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DOI：
10.1016/j.ajic.2018.02.004
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发表时间：
2018-09-01
影响因子：
4.9
通讯作者：
Ala-Kokko, Tero I.
中科院分区：
文献类型：
--
作者：
Jansson, Miia M.;Syrjala, Hannu P.;Ala-Kokko, Tero I.
背景：虽然以证据为基础的做法是众所周知的，以提高护理质量。使其具有成本效益和提高临床效果，将研究转化为临床实践的障碍阻碍了这一进程。目的：评估重症监护护士对机构特定呼吸机束的知识，依从性和障碍。材料和方法：在2015年，我们进行了一个特定的机构，在芬兰的一个26床的成人混合内科-外科重症监护病房（ICU）中进行的横断面研究，使用知识和自我报告依从性的定量调查以及屏障数据的定性收集。结果：最终应答率为55.5%（n = 86），47.2%（n = 34）的应答者有10年以上ICU工作经验。知识水平和自我报告的依从性分别占总分的71.1%和65.8%。接受过呼吸机束相关在职教育的受访者的知识水平高于未接受过在职教育的受访者（27.0 vs 24.0 [P= .012]）。经验较少的护士报告的依从性显著高于ICU经验较多的护士（29.0 vs 25.0 [P= .034]）。知识和依从性评分之间的相关性较低（rho 0.48 [P< .001]）。最著名和遵守的指南描述了病人的体位，每日洗必泰为基础的口腔护理，严格的手卫生。最不为人所知的指南和最不遵守的指南描述了呼吸设备，镇静和镇痛的管理，以及气管内吸痰前和吸痰过程中的实践。主要障碍与护士受访者有关（例如，缺乏教育[25.9%]），环境（例如，角色模糊[36.4%]和资源不足[21.1%]），以及患者（例如，结论：自我报告的依从性与知识无关，与工作经验无关。循证指南的大部分障碍表明需要进行超出护士个人控制的改变。(C)2018感染控制和流行病学专业人员协会，Inc.爱思唯尔公司出版All rights reserved.
Background: Although evidence-based practices are known to improve the quality of care. making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process.Aims: To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle.Material and methods: In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n =155).Results: The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P= .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P= .034]). The correlation between knowledge and adherence scores was low (rho 0.48 [P< .001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort 14.8%l and fear of adverse effects [4.6%]).Conclusions: Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.