综合ICU护士非必要性导尿管留置的知信行现状的调查分析

A survey of knowledge,attitude and practice of ICU nurses about unnecessary urinary catheteration

目的了解综合ICU护士非必要性导尿管留置的知信行现状。方法2019年7月至9月自制ICU护士非必要性导尿管留置的知信行问卷,并对22个综合ICU共308名护士的知信行留置现状进行调查分析。结果知识方面:近80%及以上的ICU护士认为,急性尿管潴留、尿道梗阻、手术每小时监测尿量、会阴部、下腹部或腰部以下有开放性伤口、尿失禁是导尿管的留置指征。定期更换导尿管(83.12%)和不符合导尿管留置指征(68.83%)是科室拔除导尿管的主要原因。态度方面:67.21%ICU护士认为,有必要每日评估导尿管留置的必要性。52.60%护士认为,患者入科后需常规留置导尿管。“自己评估的正确性”“拔除导尿管后,会增加患者发生护理不良事件的风险”“害怕患者拔除后再次留置导尿管”是阻碍护士提醒医生拔除导尿管的主要原因。行为方面:53.25%护士选择自行评估的方式进行导尿管评估,44.81%采用纸质版导尿管评估表,仅31.17%选用电子版评估表。64.29%护士认为,自己会主动告知医生不符合导尿管留置指征的患者。62.99%护士认为科室存在不符合导尿管留置指征却继续使用的情况。结论ICU护士对导尿管留置指征和评估其必要性的认知较高,但对及时拔除非必要性导尿管留置的态度不积极,及时拔除非必要性导尿的落实率仍较低,提示临床管理者应采取有效措施,强化护士积极拔除非必要性导尿管的态度和行为。

Objective To investigate the knowledge,attitude and practice of nurses in intensive care units(ICU)about unnecessary urinary catheteration.Method A total of 308 ICU nurses were engaged in the interviews using a self-designed questionnaire from 22 ICUs in a province from July 2019 to September 2019.Results Knowledge:nearly 80% nurses thought that acute urinary retention and urinary obstruction,hourly assessment of urine output in patients,open wound of perineum,lower abdomen,or below the waist urinary incontinence were the indications for indwelling urethral catheter use in critical care units.Regular replacement of urinary catheter(83.12%)and non-indication for catheter indwelling(68.83%)were the main causes of the removal of the urinary catheter.Altitude:67.21% of ICU nurses believed that it was necessary to evaluate the need for catheter detention daily.52.60% of nurses thought that patients should be routinely indwelled urinary catheters after admission."suspecting the correctness of assessment of indications for indwelling urethral catheter use""fear of increasing the risk of adverse care events in patients after removal of urinary catheter""worried about indwelling catheter again after removal of urinary catheter"were the main reasons that hindered nurses from reminding doctors to remove urinary catheters.Behaviour:53.25% nurses chose self-accessment for urinary catheters.44.81% used the paper of the catheter evaluation form,while only 31.17% used the electronic form.64.29% nurses believed that they would proactively inform patients without the catheter indwelling indications.62.99% nurses believed that there were cases in the department that did not conform to the indications of catheters but continued using them.Conclusions The ICU nurses have a high awareness of urinary catheteration indications and assessing the necessity.However,the nurse's attitude towards timely removal of the unnecessary urinary catheter is not positive,and the implementation rate is still low.Therefore,hospital authorities should take effective measures to improve the attitude and behavior of nurses to actively remove the unnecessary urinary catheter.