【作者】 张晓燕；

【导师】 李萍；

【作者基本信息】 新疆医科大学 ， 护理学， 2018， 硕士

【摘要】 目的:了解乌鲁木齐综合三甲医院ICU护士呼吸机相关性肺炎(VAP)预防措施认知行为及各预防措施临床依从性现状,采用习惯形成理论方法对ICU护士进行干预并评价干预效果。方法:运用《ICU护士VAP预防措施认知行为及影响因素调查问卷》对680名符合纳入标准的ICU护士进行调查。运用《ICU呼吸机相关性肺炎预防措施监测表》对1个ICU的护士进行1个月的VAP预防措施临床依从性监测。对符合纳入标准的两组ICU护士分别进行常规和习惯形成理论干预,比较两组研究对象干预后VAP预防措施认知行为和临床依从性改变情况。结果:(1)ICU护士VAP预防措施的知识、态度、行为及总分的标准化得分为(50.34±10.10)分、(69.45±4.42)分、(85.54±11.32)分、(72.91±5.03)分,知识、态度和行为得分三者呈正相关。(2)ICU护士呼吸机管路/交换器更换、按需吸痰依从率最高,达97%以上;口腔护理、手卫生、镇静效果依从性为50%-67%;每日唤醒和自主呼吸试验、早期康复治疗、床头抬高、气囊压力监测、冷凝水倾倒依从性较低,不及30%。(3)习惯形成理论干预后,两组研究对象VAP预防措施知识、态度、行为得分及总得分组内、组间及差值比较,差别均有统计学意义(P<0.01),试验组VAP预防措施知识、态度、行为得分及总得分均高于对照组。(4)干预后两组研究对象不同时段VAP预防措施依从性组内比较,镇静效果、每日唤醒和自主呼吸试验、早期康复、冷凝水倾倒、床头抬高、口腔护理、手卫生、气囊压力监测依从性差别均有统计学意义(P<0.05);组间比较,镇静效果、呼吸机管路/交换器更换、每日唤醒和自主呼吸试验、早期康复、冷凝水倾倒、床头抬高、气囊压力监测依从性差别均有统计学意义(P<0.05)。干预后两组研究对象VAP各预防措施依从性呈增长趋势(除呼吸机管路/交换器更换、按需吸痰)。试验组干预后7天、14天、21天、1个月,镇静效果、每日唤醒和自主呼吸试验、早期康复、冷凝水倾倒、床头抬高、口腔护理、手卫生、气囊压力监测依从性比较差别有统计学意义(P<0.05);干预后2个月、3个月,呼吸机管路/交换器更换、吸痰护理、镇静效果、每日唤醒和自主呼吸试验、早期康复、冷凝水倾倒、床头抬高、手卫生依从性比较差别无统计学意义(P>0.05),各预防措施依从性和总依从性增长趋于平稳。结论:(1)乌鲁木齐综合三甲医院ICU护士VAP预防措施知识水平较低、态度和行为水平有待提高。(2)ICU护士VAP各预防措施临床依从性不乐观。(3)常规干预和习惯形成理论干预均能不同程度提高ICU护士VAP预防措施认知行为水平和各预防措施临床依从性,习惯形成理论干预效果明显优于常规干预。更多还原

【Abstract】 Objective: To understand the ICU nurses,status of cognitive implementation and clinical compliance about ventilator-associated pneumonia(VAP)preventive measures in the general tertiary hospital of Urumqi,we used habit formation theory to intervene and evaluate the intervention effect of ICU nurses.Methods: 680 ICU nurses were chosen,in conformity with the inclusion criteria by the questionnaire of VAP prevention measures on cognitive behavior and influencing factors,for investigation.The clinical compliance of one ICU nurses were monitored for one month by the monitoring table of the prevention measures in ICU.The two groups of ICU nurses who met the inclusion criteria were given conventional and customary formation theory intervention respectively.The changes of cognition behavior and clinical compliance of the two groups after intervention were compared.Results:(1)The standardized scores of knowledge,attitude,behavior and total score of VAP prevention measures for ICU nurses were(50.34±10.10),(69.45±4.42),(85.54±11.32)and(72.91±5.03)respectively.The three scores of knowledge,attitude and behavior were positive relevant.(2)The compliance rate of ventilator / exchanger replacement,on-demand suction of ICU nurses were the highest,amounting to more than 97%;the compliance rate of oral care,hand hygiene compliance and sedative effects were 50%-67%;the compliance rate of daily wake and spontaneous breathing test,early rehabilitation,head elevation,air condensed water pressure monitoring and the dumping were low,less than 30%.(3)After the intervention of habit formation theory,the scores of knowledge,attitude and behavior within,between and the difference of the two groups were statistically significant(P<0.01),the scores of knowledge,attitude,behavior and the total score were higher than the control group.(4)Comparison of the compliance within the group in different periods after the intervention,the compliance rate of sedative effect,daily wake and spontaneous breathing test,early rehabilitation,head elevation,condensed water dumping,oral care,hand hygiene,air pressure monitoring had significant difference(P<0.05);comparison between groups,the compliance rate of sedative effect,ventilator / exchanger replacement,daily wake and spontaneous breathing test,early rehabilitation,condensed water dumping,head elevation,air pressure monitoring had significant difference(P<0.05).With the prolongation of the time of the intervention,the compliance of the two groups showed a growing trend(except for ventilator / exchanger replacement and sputum sucking on demand).After the intervention for 7 days,14 days,21 days,1 months of the experimental group,the compliance rate of sedative effect,daily arousal,early rehabilitation,head elevation,condensed water dumping,oral care,hand hygiene and aerocyst pressure monitoring compliance had significant difference(P<0.05);after 2 and 3 months,the compliance rate of ventilator / exchanger replacement,sputum suction nursing,sedative effect,daily wake and spontaneous breathing test,early rehabilitation,condensed water dumping,head,hand hygiene had no significant difference(P>0.05),after 2-3 months of intervention,the compliance of VAP preventive measures and the total compliance in the test group grew stably.Conclusion:(1)The knowledge level of VAP prevention measures among ICU nurses in Urumqi large general tertiary hospital was low,and attitude and behavior need to be improved.(2)The clinical compliance of ICU nurses of VAP prevention measures was not optimistic.(3)Routine intervention and habit formation theory intervention can improve the level of cognitive behavior and clinical compliance of VAP prevention measures of ICU nurses in different ways,and the effect of habit formation theory intervention was better than that of routine intervention.更多还原