【作者】 杨琳；

【导师】 张志刚； 燕芳红；

【作者基本信息】 兰州大学 ， 护理（专业学位）， 2021， 硕士

【摘要】 目的:基于知-信-行理论(Knowledge,Attitude,Practice,KAP),编制ICU护士对气管插管患者拔管后吞咽障碍(Post-Extubation Dysphagia,PED)的知-信-行问卷,利用该问卷调查甘肃省部分三级甲等医院的ICU护士,了解其关于PED的知-信-行现状,分析探讨影响其知-信-行水平产生差异的相关因素。方法:1.运用文献检索法和Delphi专家函询法编制ICU护士对气管插管患者PED的初始知-信-行问卷。2.用初始问卷对甘肃省部分三级甲等医院的276名ICU护士开展预调查,选取55名调查对象于10天后重测,并通过项目分析、信度检验(内部一致性信度及重测信度)和效度检验(内容效度及结构效度)筛选条目,确定最终的正式调查问卷。3.运用正式问卷调查甘肃省部分三级甲等医院的ICU护士。对其一般资料、知识、态度、行为及问卷总分情况采取描述性统计。对探讨知识、态度、行为得分之间的关系则采用Pearson相关性分析。单因素分析采用独立样本t检验、单因素方差分析或Welch检验法。运用多重线性回归分析法进行多因素分析。结果:1.Delphi专家函询结果:初步形成的问卷条目池共计31个二级条目,其中知识部分有11个条目,态度部分有10个条目,行为部分有10个条目。第一轮专家函询后删除知识条目1个;增加知识条目5个;修改知识条目10个、态度条目3个、行为条目10个。第二轮专家函询共计35个条目,修改态度条目5个。经两轮专家函询后ICU护士对气管插管患者PED知-信-行的初始问卷共包含35个条目,15个知识条目,10个态度条目,10个行为条目。第一、二轮函询的专家对各条目重要性评分的平均值范围分别在4.00～4.78和4.29～5.00之间,变异系数分别在0.09～0.24和0～0.11之间,积极系数分别是90.00%、94.44%,专家意见权威程度系数分别是0.817、0.805,专家意见协调程度系数分别是0.189、0.198(P<0.001),第二轮函询较第一轮有一定改善。2.项目分析及信效度检验结果:项目分析后删除知识条目4个,问卷难度较为适中。经信效度检验,删除知识条目1个。问卷整体Cronbach’sα系数为0.901,知识、态度和行为部分的Cronbach’sα系数分别为0.864、0.944和0.974;知识、态度、行为各部分和总问卷的重测信度分别为0.987、0.978、0.996和0.990。问卷的量表水平内容效度指数为0.90,平均内容效度指数为0.99;此外,结构效度可反映预期概念。3.现状调查结果:参与此次调查的ICU护士共647名,有效问卷为627份,以女性为主,496人(79.11%);平均年龄为(30.87±6.71)。ICU护士对气管插管患者PED知-信-行问卷的知识、态度、行为及总问卷的平均得分分别是(6.46±3.09)、(7.53±1.69)、(4.89±2.00)和(18.88±5.18)。Pearson相关性分析结果表明,ICU护士的知识与态度、知识与行为、态度与行为得分之间的关系均呈正相关,相关系数r分别为0.430、0.293和0.341(P<0.01)。多因素分析结果发现,影响ICU护士对气管插管患者PED问卷总分的因素有年龄、民族、职称等级、工作满意度和聘用方式;影响知识维度得分的因素有性别、年龄、民族和工作满意度;影响态度维度得分的因素有性别、年龄、民族、所在科室、职称等级、工作满意度和聘用方式;影响行为维度得分的因素有职称等级和工作满意度。结论:1.自行编制的调查问卷信效度较好,可作为测量ICU护士对气管插管患者PED知-信-行水平的调查工具。2.ICU护士对气管插管患者PED的知-信-行现状整体处于中等偏下水平,知-信-行水平有待进一步提高。3.ICU护士对气管插管患者PED的知识、态度和行为间彼此均呈正相关,知识与行为间的相关性最差。4.年龄、民族、职称等级、工作满意度和聘用方式是ICU护士对气管插管患者PED知-信-行问卷总分的影响因素。科室及医院管理者应从不同影响因素切入,多角度地采取有针对性的培训方式及干预措施,以提高ICU护士对气管插管患者PED的知-信-行水平,促进患者康复,提高预后质量。更多还原

【Abstract】 Objective: Based on Knowledge-Attitude-Practice(KAP)theory,developing the questionnaire of the ICU nurses towards tracheal intubation patients’ Post-Extubation Dysphagia(PED),which was used to investigate current situation on KAP of ICU nurses in the Class A tertiary comprehensive hospitals of Gansu province,and analyze the relative factors that influence the difference of knowledge,attitude and practice.Methods: 1.Establish the original questionnaire by using the methods of literature retrieving and Delphi expert inquiries.2.Investigate 276 ICU nurses in the Class A tertiary comprehensive hospitals of Gansu province with the original questionnaire,and select 55 ICU nurses from these participants to retest after 10 days.Then,form the final questionnaire through item analysis,reliability test(internal consistency reliability and test-retest reliability)and validity test(content validity and structure validity).3.Use final questionnaire to investigate ICU nurses in the Class A tertiary comprehensive hospitals in Gansu province.Descriptive analysis was used to analyze the ICU nurses’ general information,the score of knowledge,attitude and practice.Pearson correlation analysis was used to explore correlation between the score of knowledge,attitude and practice.For univariate analysis,intergroup comparation used Independent-Sample t test,one-way analysis of variance or Welch.For multivariate analysis,multiple linear regression was used to analyze the influencing factors.Results: 1.Results of Delphi expert inquiries: The original questionnaire items pool included 11 items in the knowledge section,10 items in the attitude section,and 10 items in the practice section,totally 31 second-level items.Through the first round of expert inquiries,1 item of the knowledge section was deleted,and 5 items were increased and 10 items were modified.3 items of the attitude section were modified,and 10 items of the practice section were modified.There were totally 35 second-level items in the second round of expert inquiries.5 items were modified in the attitude section.Through two rounds of expert inquiries,the preliminary “Questionnaire on the KAP of ICU nurses about post-extubation dysphagia of tracheal intubation patients” containing 35 items was formed.Among them,the knowledge section included 15 items,the attitude section included 10 items,and the practice section included 10 items.The range of items’ mean score was between 4.00 to 4.78 in first round expert inquiries,and the range of coefficient of variation was between 0.09 to0.24.The range of items’ mean score was between 4.29 to 5.00 in second round expert inquiries,and the range of coefficient of variation was between 0.00 to 0.11.The positive coefficient of experts in the two rounds were 90.00% and 94.44%respectively.The authoritative coefficients of experts were 0.817 and 0.805,and the Kendall’ s W were 0.189 and 0.198(P<0.001).Compared with the results of first round expert inquiries,the results of second round were improved.2.Results of item analysis,reliability and validity test: Through item analysis and reliability test,5 items in the knowledge section were deleted,and the difficulty was moderate.The results of reliability test showed that the total Cronbach’ s α of the questionnaire was 0.901,and the Cronbach’ s α of knowledge,attitude and practice section were 0.864,0.944 and0.974 respectively.The overall retest reliability coefficient of the questionnaire was0.990.In addition,the retest reliability coefficients of each section were 0.987,0.978 and 0.996 respectively.S-CVI/UA was 0.90 and S-CVI/Ave was 0.99.Structural validity could reflect the expected concepts.3.Results of investigation on the current situation: The number of ICU nurses participating in this investigation was 647,and the number of validated questionnaires was 627.Female,496(79.11%);the average age was(30.87±6.71).The KAP average score of ICU nurses towards tracheal intubation patients’ post-extubation dysphagia was(18.88±5.18).The average score of knowledge dimension,attitude dimension and practice dimension was(6.46±3.09),(7.53±1.69)and(4.89±2.00)respectively.The knowledge,attitude and practice scores were positively correlated,and the correlation coefficients respectively were 0.430,0.293 and 0.341(P<0.01).Results of the multiple liner regression analysis showed that the influencing factors of KAP total score of ICU nurses towards tracheal intubation patients’ post-extubation dysphagia were age,nationality,professional qualification,work satisfaction and employment way.The influencing factors of knowledge dimension score were gender,age,nationality and work satisfaction.The score of attitude dimension was affected by gender,age,nationality,department,professional qualification,work satisfaction and employment way.The score of practice dimension was affected by professional qualification and work satisfaction.Conclusions: 1.The self-compiled questionnaire had a great reliability and validity,which could be used as a survey tool to assess the KAP current level of ICU nurses towards tracheal intubation patients’ post-extubation dysphagia.2.The current KAP situation of ICU nurses towards tracheal intubation patients’ post-extubation dysphagia was in the middle to low level.It showed that the overall KAP level of ICU nurses need to be further improved.3.There were respectively positive correlation between knowledge,attitude and practice scores of ICU nurses KAP level towards tracheal intubation post-extubation dysphagia.The relation of knowledge and practice was the weakest.4.Age,nationality,professional qualification,work satisfaction and employment way were the influencing factors of ICU nurses’ KAP current situation towards tracheal intubation patients’ post-extubation dysphagia.Therefore,based on the different influencing factors mentioned above,administrators should adopt pointed training methods and intervention measures to improve the ICU nurses’ KAP level towards tracheal intubation patients’ post-extubation dysphagia.更多还原