江苏省新生儿科与产科护士新生儿低血糖预防认知及管理现状的调查

Study on the status quo of neonatal hypoglycemia prevention cognition and management among neonatal and obstetric nurses in Jiangsu Province

目的调查江苏省新生儿科与产科护士对新生儿低血糖(NH)预防认知与管理现状,为NH预防护理工作提供参考。方法本研究为横断面研究。采用便利抽样法,于2020年5—6月采用自行设计的问卷对江苏省13个市21所医院的新生儿科与产科护士进行调查,该问卷包括一般资料、护士对NH预防护理的认知、护士对科室NH预防管理制度认知与落实的差异3个部分。本次共发放问卷331份,回收有效问卷318份,有效回收率为96.1%。结果318名新生儿科与产科护士中,新生儿科与产科护士所在医院NH诊断与干预阈值为2.2~2.9 mmol/L,大多数护士认为血糖水平≤2.2、≤2.6 mmol/L为诊断阈值和干预阈值,分别占59.75%(190/318)、58.18%(185/318)。在开放性问题中,颤抖、喂养困难和肌张力减弱是护士所提及的NH最常见的临床表现,60%以上护士知晓妊娠糖尿病、巨大儿是NH的高危因素。新生儿科与产科护士对科室NH管理制度的认同率为72.96%~87.11%,落实率为46.77%~84.48%,所有项目中,认同率均高于落实率。在建立NH风险评估、制订NH筛查人群表、组织预防NH健康宣教、定期分析NH的发生原因方面,护士认知与落实率比较差异均有统计学意义(P<0.05)。结论江苏省各医院的NH管理缺乏统一标准,护士对NH评估、筛查和监测方面的认知存在较大差异,且对NH管理制度的认同率均高于执行率,需要建立规范的NH预防与管理制度并加强科室内具体制度的落实。

Objective To explore the status quo of neonatal hypoglycemia(NH)prevention cognition and management among neonatal and obstetric nurses in Jiangsu Province and provide a reference for NH prevention and nursing.Methods In this cross-sectional study,between May and June 2020,convenience sampling and a self-designed questionnaire were used to investigate neonatal and obstetric nurses from 21 hospitals in 13 cities across Jiangsu Province.The questionnaire encompassed general information,nurses'cognition of NH prevention and care,and differences between nurses'cognition and implementation of departmental NH preventive management system.Totally 331 questionnaires were distributed and 318 were collected,accounting for an effective recovery rate of 91.1%.Results Among the 318 neonatal and obstetric nurses,the NH diagnosis and intervention thresholds in the hospitals where the neonatal and obstetric nurses worked were 2.2-2.9 mmol/L.Most nurses considered blood glucose levels≤2.2 and≤2.6 mmol/L as diagnostic and intervention thresholds,accounting for 59.75%(190/318)and 58.18%(185/318),respectively.Among the open-ended questions,tremor,feeding difficulties,and hypotonia were the most common clinical manifestations of NH mentioned by nurses,and more than 60%of nurese knew that gestational diabetes and macrosomia were high-risk factors for NH.Neonatology and obstetric nurses'approval rate for the department's NH management system was 72.96%-87.11%,and the implementation rate was 46.77%-84.48%.In all projects,the approval rate was higher than the implementation rate.In terms of establishing NH risk assessment,formulating NH screening population table,organizing preventive health education for NH,and regularly analyzing the causes of NH,there were statistically significant differences between nurses'cognition and implementation rate(P<0.05).Conclusions There is a lack of uniform standards for NH management in hospitals in Jiangsu Province.Nurses'cognition of NH assessment,screening and monitoring is quite different,and the recognition rate of NH management systems is higher than the implementation rate.It is necessary to establish a standardized NH prevention and management system and strengthen the implementation of specific systems within the department.