ICU医护人员对ICU病人谵妄认知情况的系统评价

Systematic evaluation of cognition on ICU delirium among medical staff in ICU

[目的]评价ICU医护人员ICU谵妄认知能力。[方法]系统检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方数据库(WanFang Data)、PubMed、Web of Science数据库,检索时间均为建库至2019年10月31日,纳入ICU医护人员对ICU谵妄的认知调查及知信行调查的相关横断面研究文献,采用Stata13进行数据整理和分析,对研究结果进行描述性分析。[结果]共有17篇文献纳入分析。分析结果显示:17篇文献报道了护士对ICU谵妄的认知情况,其中11篇文献报道了对ICU谵妄的认知,6篇文献报道了ICU谵妄的知信行;仅2篇文献研究了医生对ICU谵妄的认知情况。各研究中ICU医护人员对ICU谵妄的认知能力的描述及评判标准不尽相同,无法进行数据合并,但每个研究对于认知能力的结论均一致,认为ICU医护人员对ICU谵妄的认知能力普遍偏低。90.3%受调查者认为在学校学得的ICU谵妄知识不能满足临床需要,62.8%的人未接受过谵妄知识培训。在各研究中对于ICU谵妄知识的来源和需求方面的调查不尽相同,但知识来源普遍涉及在校学习、工作经验积累、学术会议讲座、同事交流、学习班学习5个方面,而知识需求普遍涉及危险因素及病因、检测和诊断、处理3个方面。[结论]现有证据显示,ICU医护人员对ICU谵妄的认知水平普遍比较低,难以满足临床需要;ICU谵妄认知的调查工具各不相同,难以进行定量系统评价,为临床提供高质量的参考存在一定困难;由于纳入文献总体质量不高,同时,研究间使用不同的问卷,调查工具存在较大异质性,因此期待更多高质量研究进一步验证。护理人员自身专业性越强,识别ICU谵妄越高,故建议课程设置和继续教育培训中增加ICU谵妄知识的内容,提高护士的工作能力和专业水平,提高ICU病人的安全管理质量,从而改善疾病预后,提高病人生存质量。

Objective:To evaluate the cognitive ability of ICU delirium among ICU medical staff.Methods:The relevant cross-sectional research literature on cognition of ICU delirium and knowledge-attitude-practice(KAP)survey among ICU medical staff,was retrieved from China National Knowledge Infrastructure(CNKI),Chinese Biomedical Database(CBM),VIP Database,WanFang Database,PubMed,and Web of Science.The retrieval time was from the establishment of the database to October 31,2019.Then,results was used to take a descriptive ana lysis.Results:A total of 17 articles were included.Analysis showed that there were 17 pieces of articles reporting the cognition status of ICU delirium among ICU nurses.Among them,there were 11 pieces of articles reporting the knowledge of ICU delirium;there were 6 pieces of articles reporting the KAP of ICU delirium had 6 pieces.But articles exploring the cognitive situation of ICU delirium among doctors only had 2 pieces.The description and evaluation criteria of cognitive ability of ICU delirium among ICU medical staff in included studies were different.Therefore,the data could not be merged.However,conclusions on cognitive ability in included study were consistent.These conclusions indicated that cognitive ability among ICU medical staff was generally at lower level.Respondents,who believed that the ICU delirium knowledge in school could not meet the clinical needs,accounted for 90.3%.And respondents who had not received delirium knowledge training,accounted for 62.8%.Although investigations on the sources and needs of knowledge related to ICU delirium in included studies,were different.In general,sources of knowledge involved five aspects,as follows study in school,accumulation of work experience,academic conference lectures,communication among colleagues,and study in tutoring class.Needs for knowledge generally involved three aspects:risk factors and pathogenesis,detection and diagnosis,and treatment.Conclusions:Present evidence showed that cognition of ICU delirium among ICU medical staff was genera lly at lower level,which was difficult to meet clinical needs.Tools for investigating cognition of ICU delirium among ICU staff were various,which made it difficult to carry out a quantitative systematic evaluation.Thus,these tools could not provide a high-quality reference for clinical needs.Due to the limitation of overall low quality of the included literature,using different investigation questionnaires,and large heterogeneity among different tools,there still needs to be more high-quality studies to verify above rusults in further.The wore professional nursing staff are,the higher cognitive ability of ICU delirium is,so it′s suggested that increasing ICU-related knowledge when setting the course and training about continuing education,enhancing nurses′working ability and professinoal skills,strengthening safety management quality of ICU patients Thus,to improve the prognosis and patients′quality of life.