预防成人经口气管插管非计划性拔管护理专家共识

Development and analysis of Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation

目的形成预防成人经口气管插管非计划性拔管护理实践专家共识。方法系统查阅国内外文献资料并以天津市护理质控中心2016年制定的预防气管插管非计划性拔管集束化护理套餐为基础,结合专家临床经验,列出具体问题并设计专家函询表,邀请北京市、天津市、上海市、广东省、四川省、湖南省、河北省等地40名相关领域专家,进行3轮德尔菲专家函询和2轮专家论证会议,对各个条目进行调整、修改、完善。结果3轮函询专家积极系数均为100%,专家权威程度均为0.87,专家对指标重要性赋值均数分别为(4.86±0.35)、(4.94±0.27)、(4.97±0.16),专家协调系数分别为0.135、0.174、0.262(均P<0.001)。最终对预防成人经口气管插管非计划性拔管护理实践的6个方面、共23个条目达成共识。结论该共识严格遵循文献查证—雏形构建—德尔菲函询—现场论证的标准化流程进行制定,融合多省市护理质控中心资源以及多学科专家建议,具有专业代表性、科学性、严谨性和权威性。该共识不仅能够为临床护理实践提供指引,还为该领域指南、标准的制定奠定了基础,但仍需要进一步的理论和实证研究验证。

To establish expert consensus on nursing standard for prevention of adult oral tracheal intubation unplanned extubation.Methods Studies from domestic and foreign were retrieved and the ‘Prevention of Tracheal Intubation Unplanned Extubation Cluster Care Package’ drawn up by Tianjin Nursing Quality Control Center as well as professional experience were taken into consideration.Expert Delphi mail questionnaire was developed according to the key issues of nursing care.Forty experts from Beijing,Tianjin,Shanghai,Guangdong,Sichuan,Hunan and Hebei were invited to complete 3 rounds of Delphi expert consultation and 2 rounds of expert meeting.Each item was revised and adjusted considering objective evidence and expert opinions.Results The positive coefficients of experts in three rounds of Delphi expert consultation were all 100%,and the degrees of expert authority were all 0.87.The average assignment values of experts to the importance of items were 4.86±0.35,4.94±0.27,and 4.97±0.16,and the Kwbdall's W were 0.135,0.174,and 0.262,respectively(all P<0.001).At last,experts agreed on 23 items under 6 dimensions of nursing care.Conclusion The consensus strictly follows the standardized process of literature study--draft construction--Delphi inquiry--onsite meeting,and integrates the resources of nursing quality control centers from several provinces and cities,and multi-disciplinary experts' suggestions.It is professional,scientific,rigorous and authoritative.The consensus can not only provide guidance for clinical nursing practice,but also lay a foundation for the formulation of guidelines and standards in this field.However,further theoretical and empirical studies are needed to verify the consensus.