护理人员对术中压力性损伤风险评估现状及临床需求的研究

A study on the application status and clinical needs of risk assessment tools for intraoperative pressure injury in nursing staff

目的:了解护理人员对术中压力性损伤风险评估工具的临床应用现状、临床的实际需求以及护理人员对术中压力性损伤风险因素的认知。方法:自行设计调查问卷,内容包括一般资料、临床应用现状、临床实际需求三部分,采取问卷星形式对天津市二、三级医院手术室护理人员进行抽样调查。结果:临床应用最多的评估工具分别为Waterlow量表(37.5%)、Braden量表(25%)、Norton量表(22.5%),满意率为78.8%,存在实用性不强、评估不便捷、连续性欠缺等问题;护理人员需求显示评估工具应具有专科性(98.01%);能够包括患者因素(94.42%)、手术因素(96.81%);能够进行术前(95.92%)、术中(91.02%)、术后(89.80%)围术期的动态评估;危险因素的认知调查结果:“手术时长、手术体位、术中施加外力、低温麻醉、术中体温变化”的重要性判断最高,“术中血压变化、术中体温变化”的可操作性最低。结论:术中压力性损伤风险评估工具的临床选择呈现多样性,但普遍存在不足之处,这与手术相关因素对患者的影响相关,因此,术中压力性损伤风险评估工具的形成更应结合临床实际需求,向手术专科性、结构化的方向发展。

Objective:To understand the current clinical application and actual needs of risk assessment tools for intraoperative pressure injury,and the cognition of risk factors for intraoperative pressure injury in nursing staff.Methods:An online sampling survey was carried out in nursing staff of the operating room of secondary and tertiary hospitals in Tianjin.It chooses a professional platform what is named‘Wenjuanxing’for data collection using self-designed questionnaires,including general information,current clinical application and actual clinical needs.Results:The results showed that most clinically used assessment tools were Waterlow scale(37.5%),Braden scale(25%)and Norton scale(22.5%),and the satisfaction rate was only 78.8%,theexisting problems were poor practicability,inconvenient assessment and lack of continuity.Nursing staff hoped that clinical assessment tools could meet the following requirements:high specialty(98.01%),inclusion of patient factors(94.42%)and surgical factors(96.81%),and perioperative dynamic assessment before surgery(95.92%),during surgery(91.02%)and after surgery(89.80%).Survey on the cognition of risk factors revealed that the importance of surgical duration,surgical position,intraoperative external force exertion,hypothermic anesthesia and intraoperative body temperature change was the highest in judgement,and the operability of intraoperative blood pressure change and intraoperative body temperature change was the lowest.Conclusion:Clinical risk assessment tools for intraoperative pressure injuries are diverse,but they all have shortcomings,which is related to the impact of surgery-related factors on patients.Therefore,the formation of risk assessment tools for intraoperative pressure injuries should be combined with actual clinical needs,and develop towards surgical specialization and structuralization.