危重症监护室护士有创血压监测技能掌握现状及改进对策

Mastery status of invasive blood pressure monitoring skill of intensive care unit nurses and improvement countermeasures

目的：调查危重症监护室护士有创动脉血压（IABP）监测技能掌握现状，分析原因，探讨对策。方法：采用已获认可自行研制 IABP 监测技术与应用调查表调查江苏省6所三级甲等医院13个危重症监护室165名护士 IABP 监测技能掌握情况（条目掌握正确得分反映）、McGhee 标准评定掌握水平，探讨掌握与否原因，进而阐述 IABP 生理及影响因素、技术规范、动力反应性校准及波形识读，以此内容教学1年后变换调查表再次调查并比较。结果：初次调查条目掌握得分0-75分，平均（31．32±13．71）分，水平评定为差。其缘于 IABP 生理及影响因素一知半解、部分监测技术把握不够规范、系统动力反应性校准茫然、波形识读经验不足。通过教学1年的197名危重症监护室护士再次调查掌握得分62．5-100分，平均（86．90±13．10）分，显著高于初次调查（P 〈0．05）。结论：强化 IABP 生理及影响因素学习、全面把握技术规范、厘除系统动力反应性影响、积累波形识读经验，有助于克服危重症监护室护士 IABP 监测技能掌握差现状，提升整体水平。

Objective：To investigate mastery status of invasive arterial blood pressure（IABP）monitoring skill of intensive care unit nurses,analyze causes and discuss countermeasures. Methods：Totally 165 nurses from 13 intensive care units of 6 Class III and Grade I hospitals in Jiangsu Province were investiga-ted with a recognized and independently developed IABP monitoring skill and application questionnaire. These nurses were investigated in terms of mastery status of（IABP）monitoring skill（reflected by their scores in mastery levels of monitoring contents）and mastery level of McGhee standard rating. Then discussed reasons why they mastered or failed to mastered skills,before explaining the following teaching contents,including physiological and influencing factors of IABP,technical specification,dynamic reactive calibration and waveform recognition. These nurses were investigated again with another question-naire after 1 year of teaching,and the mastery status of IABP monitoring skill was compared with that before teaching. Results：As shown in the first investi-gation,scores in contents mastery were between 0 - 75,with a low - level average score of（31. 32 ± 13. 71）. The average score was undesirable because these nurses had little knowledge about monitoring contents,failed to master standard monitoring skills,knew nothing about system dynamic reactive calibra-tion and lacked experience in recognizing waveforms. While in the second investigation after 1 year of teaching,scores of 197 intensive care unit nurses in skill mastery were between 62. 5 - 100,with an average score of（86. 90 ± 13. 10）,which was significantly higher than that in the first investigation（P 〈0. 05）. Conclusion：Enhancing learning about IABP physiological and influencing factors,mastering technical specifications fully,eliminating system dy-namic reactivity influences and accumulating experience in waveform recognition are ways to change bad mastery status of IABP monitoring skill of intensive care unit nurses and improve overall mastery level.