【作者】 王燕；

【导师】 季红；

【作者基本信息】 山东大学 ， 护理学， 2024， 硕士

【摘要】 目的:本研究旨在了解急诊科护士呼吸机相关性肺炎防控措施执行现状并探讨其影响因素,为提升急诊科护士呼吸机相关性肺炎防控措施执行现状提供基础参考资料。方法:本研究采用聚敛式混合研究方法,同时开展量性研究和质性研究,最后整合两部分研究结果。(1)量性研究:该部分研究采用横断面调查研究设计,采用便利抽样方法,于2023年6月至2023年10月抽取山东省4所三甲医院急诊科护士 222名,采用一般资料调查表、护士 VAP防控现状调查问卷、一般自我效能量表、护士工作倦怠量表、护理工作环境量表实施调查。采用SPSS29.0、AMOS 24.0软件进行数据分析,统计学分析方法包括:计量数据用均数、标准差表示,计数数据用频数、构成比描述,符合正态分布的数据采用独立样本t检验或单因素方差分析,Pearson相关分析及多元线性回归分析,构建结构方程模型以及采用Bootstrap方法进行中介效应检验,检验水准α=0.05。(2)质性研究:该部分研究采用现象学研究方法,采用目的抽样法,于2023年6月至2023年10月在山东省4所三甲医院抽取急诊科护士 15名和急诊护理管理者5名,进行半结构式访谈。本研究采用Colaizzi七步分析法对访谈资料进行分析整理,提炼急诊科护士呼吸机相关性肺炎防控措施执行现状影响因素的主题。结果:(1)急诊科护士 VAP防控措施执行现状得分(66.26±8.65)分,VAP防控认知得分(11.66±3.44)分,职业倦怠得分(78.87±20.93)分,自我能效得分(21.98±6.06)分,护理工作环境得分(85.5±9.5)分。(2)单因素分析结果:不同职称、工作年限、监护室工作经历和近6个月接受VAP相关培训的急诊科护士 VAP防控措施执行现状有统计学差异(P<0.05)。(3)相关分析结果:急诊科护士 VAP防控措施执行现状与防控认知呈正相关(r=0.475,P<0.05)、防控措施执行现状与自我效能呈正相关(r=0.247,P<0.05)、防控措施执行现状与高质量护理服务的基础呈正相关(r=0.362,P<0.05)、防控措施执行现状与充足的人力和物力呈正相关(r=0.361,P<0.05)、防控措施执行现状与医护合作呈正相关(r=0.342,P<0.05);VAP防控措施执行现状与职业倦怠呈负相关(r=-0.238,P<0.05)。(4)多元线性回归分析结果:监护室工作经历大于3年、VAP防控认知、职业倦怠、自我效能、高质量护理服务的基础、充足的人力和物力以及医护合作对急诊科护士 VAP防控措施执行现状产生影响,共解释急诊科护士 VAP防控措施执行现状总变异的48.1%。(5)急诊科护士 VAP防控措施执行现状影响因素的结构方程模型结果:护理工作环境直接正向影响VAP防控措施执行现状(β=0.450,P<0.001);自我效能直接正向影响VAP防控措施执行现状(β=0.242,P<0.001);VAP防控认知直接正向影响VAP防控措施执行现状(β=0.176,P=0.010);职业倦怠直接负向影响VAP防控措施执行现状(β=-0.193,P=0.002);护理工作环境直接正向影响VAP防控认知(β=0.356,P=0.001);VAP防控认知直接正向影响自我效能(β=0.162,P=0.015);护理工作环境直接负向影响职业倦怠(β=-0.256,P=0.010)。护理工作环境对急诊科护士 VAP防控措施执行现状的直接效应和总效应最大,效应量分别为0.450、0.576(P<0.05)(6)Bootstrap中介效应检验结果:护理工作环境对急诊科护士 VAP防控措施执行现状3条间接效应的95%CI均不包含0,中介效应存在,护理工作环境对急诊科护士 VAP防控措施执行现状直接效应的95%CI也不包含0,说明急诊科护士 VAP防控认知、职业倦怠、自我效能起部分中介作用,其中急诊科护士 VAP防控认知在护理工作环境和急诊科护士 VAP防控措施执行现状之间起部分中介效应的占比最大为10.94%。(7)质性研究结果:急诊科护士 VAP防控措施执行现状的影响因素包括2个主题为个体因素(护士认知、自我肯定、工作经验、慎独意识)和护理工作环境因素(人力资源、物质支持、质量控制、主观规范)(8)混合方法研究整合结果:VAP防控认知与护士认知、自我效能与自我肯定、监护室工作经历与工作经验、充足的人力和物力与人力资源及物质支持、高质量护理服务的基础与质量控制一致;医护合作、慎独意识、主观规范互为补充。结论:(1)急诊科护士 VAP防控措施执行现状不理想,有待于进一步提高。(2)急诊科护士VAP防控措施执行现状的影响因素包括监护室工作经历、VAP防控认知、职业倦怠、自我效能、高质量护理服务的基础、充足的人力和物力、医护合作、慎独意识、主观规范。(3)护理工作环境的改善和急诊科护士 VAP防控认知水平的提高应是提升急诊科护士VAP防控措施执行现状的重点。更多还原

【Abstract】 Objective:This study aims to understand the current situation of the implementation of prevention and control measures for ventilator-associated pneumonia among emergency nurses and explore its influencing factors,so as to provide a basic reference for improving the implementation of prevention and control measures for ventilator-associated pneumonia among emergency nurses.Methods:This research adopts the convergent mixed research method,carries out quantitative research and qualitative research at the same time,finally integrates two parts of research results.(1)Quantitative study:this part of the study adopts a cross-sectional survey research design,adopts the convenience sampling method,and samples 222 nurses in the emergency department of four tertiary hospitals in Shandong Province from June 2023 to October 2023.The general information questionnaire,VAP prevention and control cognition and implementation status questionnaire,General Self-Efficacy Scale,Maslach Burnout Inventory,and Nursing Work Index Revised were used to investigate.Spss29.0 Amos 24.0 software was used for data analysis.The statistical analysis methods included:the measurement data were expressed by means of mean and standard deviation,the counting data were described by frequencies and constituent ratios,the data conforming to normal distribution were analyzed by independent sample t-test or one-way ANOVA,Pearson correlation analysis and multiple linear regression analysis,the structural equation model was constructed,and the bootstrap method was used to test the mediating effect and test the level α=0.05.(2)Qualitative research:This part of the study adopted phenomenological research methods.Purposive sampling was used to select 15 emergency nurses and 5 emergency nursing managers from 4 Class iii Grade A hospitals in Shandong Province from June 2023 to October 2023 for semi-structured interviews.In this study,the Colaizzi seven-step analysis method was used to analyze and sort out the interview data,and to refine the theme of influencing factors of the implementation of prevention and control measures for ventilator-associated pneumonia in emergency nurses.Results:(1)The scores of implementation status of VAP prevention and control measures,cognition of VAP prevention and control,job burnout,self-efficiency and nursing work environment were(66.26±8.65),(11.66±3.44),(78.87±20.93),(21.98±6.06)and(85.5±9.5)respectively.(2)Univariate analysis results:There were statistical differences in the implementation status of VAP prevention and control measures among emergency nurses with different professional titles,working years,working experience in intensive care unit and VAP-related training in the past 6 months(P<0.05).(3)Results of correlation analysis:The implementation status of prevention and control measures of VAP in emergency department nurses was positively correlated with the cognition of prevention and control measures(r=0.475,P<0.05),the implementation status of prevention and control measures was positively correlated with self-efficacy(r=0.247,P<0.05),and the implementation status of prevention and control measures was positively correlated with the basis of high-quality nursing services(r=0.362,P<0.05),the implementation status of prevention and control measures was positively correlated with sufficient human and material resources(r=0.361,P<0.05),and the implementation status of prevention and control measures was positively correlated with doctor-nurse cooperation(r=0.342,P<0.05).The implementation status of VAP prevention and control measures was negatively correlated with job burnout(r=-0.238,P<0.05).(4)Multiple linear regression analysis showed that working experience in intensive care unit more than 3 years,cognition of VAP prevention and control,job burnout self-efficacy,basis of high-quality nursing service,sufficient human and material resources and doctor-nurse cooperation had influence on the implementation status of VAP prevention and control measures of emergency nurses,which explained 48.1%of the total variation of implementation status of VAP prevention and control measures.(5)Structural equation of influencing factors of implementation status of VAP prevention and control measures in emergency department nurses:nursing work environment directly affected implementation status of VAP prevention and control measures(β=0.450,P<0.001);Self-efficacy directly affected the implementation status of VAP prevention and control measures(β=0.242,P<0.001).The cognition of VAP prevention and control directly affected the implementation status of VAP prevention and control measures(β=0.176.P=0.010).Job burnout directly negatively affected the implementation of VAP prevention and control measures(β=-0.193.P=0.002).Nursing work environment directly affected the cognition of VAP prevention and control(β=0.356,P=0.001).The cognition of VAP prevention and control directly affected self-efficacy(β=0.162,P=0.015).Nursing work environment had a direct negative impact on job burnout(β=-0.256,P=0.010).The nursing work environment had the largest direct effect and total effect on the implementation of VAP prevention and control measures in emergency department nurses,with effect sizes of 0.450 and 0.576 respectively(P<0.05).(6)Bootstrap mediation effect test results:The 95%CI of the three indirect effects of nursing work environment on the implementation status of VAP prevention and control measures in emergency department nurses did not include 0,and the mediating effect existed.The 95%CI of the direct effect of nursing work environment on the implementation status of VAP prevention and control measures in emergency department nurses did not include 0,indicating that emergency department nurses’ cognition of VAP prevention and control,job burnout and self-efficacy played a partial mediating role.The cognition of VAP prevention and control of nurses in emergency department had a partial mediating effect between the nursing work environment and the implementation status of VAP prevention and control measures of nurses in emergency department,accounting for 10.94%.(7)Results of qualitative research:The influencing factors of implementation status of VAP prevention and control measures among nurses in emergency department included two themes:individual factors(nurses’ cognition,self-affirmation,work experience,and consciousness of prudence)and nursing work environment factors(human resources,material support,quality control,and subjective norms).(8)Integration results of mixed methods research:cognition of VAP prevention and control was consistent with nurses’ cognition,self-efficacy and self-affirmation,work experience of intensive care unit and work experience,sufficient human and material resources and human resources and material support,basis of high quality nursing service and quality control.Doctor-nurse cooperation,consciousness of prudence and subjective norms are complementary to each other.Conclusions:(1)Implementation of VAP prevention and control measures by emergency nurses is not ideal and needs to be further improved.(2)The influencing factors of implementation status of VAP prevention and control measures of emergency nurses included work experience in ICU,cognition of VAP prevention and control,job burnout,self-efficacy,basis of high-quality nursing service,sufficient manpower and material resources,medical cooperation,consciousness of prudence and subjective norms.(3)The improvement of nursing work environment and the improvement of cognition level of VAP prevention and control of emergency nurses should be the focus of improving the implementation status of VAP prevention and control measures of emergency nurses.更多还原