新生儿病房护士对新生儿医源性皮肤损伤及其高危因素认知的现状调查

A study on the knowledge of neonatal iatrogenic skin injury and its risk factors among nurses in neonatal ward

目的:分析新生儿病房护士对新生儿医源性皮肤损伤(NISI)及其高危风险因素的认识情况,并了解护士对NISI风险评估相关量表的认知现状,为编制科学实用的NISI风险评估量表提供依据。方法:采用便利抽样法,于2021年11月采用自行编制的问卷对天津市205名新生儿病房护士进行问卷调查。结果:新生儿病房护士认为临床最为常见的NISI类型依次为医用粘胶相关性皮肤损伤(MARSI)、药物外渗性皮肤损伤和医疗器械相关压力性损伤(MDRPI)。帕累托图和拟合优度检验结果显示,新生儿科病房护士认为MARSI高危因素主要为皮肤状况、粘胶粘贴时间、粘胶剂类型、胎龄及体质量,累计比率为78.53%;药物外渗性皮肤损伤高危因素主要为输注药物性质、置管位置、早产和低体质量及置管类型,累计比率77.62%;MDRPI高危因素主要为胎龄、体质量、活动度、营养及皮肤浸渍,累计比率为79.44%。卡方检验显示,是否在临床使用过NISI风险评估量表对于护士应用NISI风险评估量表的意愿、应用量表对临床工作量的影响评价及应用量表对护理质量的影响评价差异具有统计学意义(χ^(2)=31.886、12.641、8.863,P均<0.01)。结论:新生儿医源性皮肤损伤临床常见类型包括MARSI、药物外渗性皮肤损伤和MDRPI,新生儿科病房护士认为胎龄、体质量是其共同高危因素,但损伤类型不同,其特异性高危风险因素存在差异。NISI风险评估量表在临床的应用可在一定程度上减轻护理工作量、提高护理质量,有必要编制出科学实用的NISI风险评估量表以满足临床需求。

Objective:To analyze the knowledge of neonatal iatrogenic skin injury(NISI)and its high-risk factors among nurses in neonatal ward,and to provide the basis for preparing a scientific and practical risk assessment scale for NISI.Methods:A total of 205 nurses were included from the neonatal units and a self-compiled questionnaire survey were conducted in Tianjin in November 2021.Results:The most common clinical types of NISI were medical adhesive-related skin injury(MARSI),drug extravasation skin injury,and medical device-related pressure injury(MDRPI).Pareto plot and goodness-of-fit test results showed that skin condition,adhesive bonding time,type of adhesive,gestational age and body weight were main risk factors for MARSI,and their cumulative ratio was 78.53%.The main risk factors for drug extravasation injury were the nature of infusion drug,placement,preterm birth and low body weight and type of placement,and their cumulative ratio was 77.62%.The main risk factors for MDRPI were gestational age,weight,mobility,nutrition and skin immersion,and their cumulative ratio was 79.44%.Chi-square test showed that whether nurses have used risk assessment scale related NISI in clinical practice influenced their willingness to apply related scale and their opinion about the effect of application scale on clinical workload and quality of nursing(P<0.01).Conclusion:MARSI,drug extravasation injury and MDRPI were the most common types of NISI in the clinic.Different types have different kinds of high-risk factors,while gestational age and body weight are their common high-risk factors.Nurses in neonatal ward believe that the clinical application of injury risk assessment scale can reduce the nursing workload and improve the quality of nursing care to some extent,and they have a willingness to use such scale in clinical practice.Therefore,it is necessary to compiling a scientifically practical scale to predicting the risk of developing neonatal iatrogenic skin injury.