成年人ICU早期活动护理实施阻碍因素的系统评价与汇总分析

Barriers to implement early mobilization by nursing in adult ICUs:A systematic review and summary analysis

目的对护理人员在成年人ICU中实施早期活动遇到的阻碍因素进行系统综述。方法系统检索中国知网、万方数据库、维普、CBM、PubMed、Web of Science、Cochrane Library、Embase中含成年人ICU早期活动护理实施阻碍因素的研究,对最终纳入文献进行整合性分析。结果共纳入26篇文献,整合5大类59个阻碍因素,包括技术层面6种、组织文化层面13种、人员层面7种、结构层面4种、患者层面6小类29种。出现频次最高的是心血管系统或血流动力学不稳定占42.31%(11/26)、人员配置不足占34.62%(9/26)、呼吸不稳定占26.92%(7/26)、神经不稳定占26.92%(7/26)、镇静占26.92%(7/26)、意识障碍占23.08%(6/26)、设备不足占23.08%(6/26)、患者参与依从性低占19.23%(5/26)、早期活动标准或流程缺乏占19.23%(5/26)。结论护理人员在指导和协助ICU成年人患者进行早期活动时面临较多阻碍因素,应进一步针对可改变阻碍因素制订改进策略,以促进ICU早期活动的实施。

Objective To systematically review the barriers encountered by nursing staff in the implementation of early activities in adult ICU units.Methods A systematic search was conducted on CNKI,Wanfang Database,VIP Database,China Biomedical Database,PumMed,Web of Science,Cochrane Library and EMBASE for the research on the obstacles of early activity nursing implementation in adult ICU from the establishment of the database to July 2020,and the final integrated analysis of the included literature was carried out.Results A total of 26 articles were included,and 59 obstacles in 5 categories were integrated,including 6 kinds of technical level,13 kinds of organizational culture level,7 kinds of personnel level,4 kinds of structural level,and 29 kinds of 6 sub categories of patients level.The most frequent obstacles were unstable condition of patients,sedation or continuous deep sedation,low staffing level,disturbance of consciousness of patients,insufficient equipment related to early activities,and low willingness or compliance of patients to participate.Conclusion The nursing staff are facing with many obstacles in guiding and assisting ICU adult patients to cany out early activities.It is necessary to formulate modified policies aiming at changeable factors in order to promote the application of early activities in adult ICU units.