预防无创正压通气患者鼻面部压力性损伤的循证护理实践

Evidence-based nursing practice for the prevention of nasal and facial pressure injuries in patients with non-invasive positive pressure ventilation

目的运用知识转化理论模式(KTA)开展无创正压通气(NPPV)患者鼻面部压力性损伤预防与护理的循证实践,并探讨其效果。方法运用循证护理的方法,成立循证实践小组,提出临床问题,从国内外数据库中检索文献获取相关证据,并将证据引入临床情景,制定循证实践方案,通过对医护人员和NPPV患者进行基线审查、分析障碍因素与促进因素,并从组织层面、实践者层面、患者层面进行临床实践变革,构建最佳证据应用策略。采用目的抽样法,选择山东第一医科大学附属省立医院心外重症监护病房(CSICU)医护人员,以及2023年10月1日至11月15日(循证实践前)和11月16日至12月31日(循证实践后)收治的NPPV患者作为研究对象。通过调查问卷分析,比较循证实践前后患者NPPV鼻面部压力性损伤发生率、医护人员审查指标执行率和知信行得分,以及患者的依从性与舒适度。结果共纳入52名医护人员,年龄(28.54±6.50)岁,工作年限3.00(1.00,12.75)年;博士学历2名(占3.85%),硕士学历4名(占7.69%),本科学历46名(占88.46%);高级职称2名(占3.85%),中级职称17名(占32.69%),初级职称33名(占63.46%)。循证护理实践前后各收集患者问卷50份;循证实践前后患者性别、年龄、体质量、呼吸机使用时间、24 h出血量及总出血量差异均无统计学意义,具有可比性。与循证实践前比较,开展相应循证护理实践后,患者NPPV鼻面部压力性损伤发生率由16.00%(8/50)下降至4.00%(2/50,P<0.05),医护人员审查指标总体执行率从79.73%提高到94.08%(P<0.01),且知信行总分明显提高(分:141.96±13.88比114.65±19.72,P<0.05),患者依从性和舒适度均明显改善〔依从性评分(分):4.60±0.99比5.82±1.42,舒适度评分(分):4.10±1.63比6.92±2.33,均P<0.05〕。结论应用循证护理方法获得预防NPPV患者鼻面部压力性损伤相关证据可指导临床实践,明显降低了此类患者鼻面部压力性损伤发生率,提高了医务人员对审查指标的执行率和知信行得分,并提升了患者对NPPV的依从性与舒适度。

Objective To investigate the evidence-based practice of prevention and care of nasal and facial pressure injuries in patients with non-invasive positive pressure ventilation(NPPV)using the knowledge to action framework(KTA),and to explore its effectiveness.Methods Using an evidence-based nursing approach,an evidence-based practice group was established to formulate a clinical problem,the literature from domestic and international databases were researched for relevant evidence,the evidence was introduced into clinical scenarios,an evidence-based practice plan was developed,and a strategy for applying the best evidence was constructed by conducting a baseline review of healthcare professionals and patients with NPPV,analyzing barriers and promoting factors,and making changes in clinical practice at the organizational level,the practitioner level,and the patient level.Purposive sampling method was used to select the healthcare staff of the cardiac surgical intensive care unit(CSICU)of the Shandong Provincial Hospital Affiliated to Shandong First Medical University,as well as the patients with NPPV admitted from October 1 to November 15,2023(pre-evidence-based practice)and November 16 to December 31(post-evidence-based practice),as the subjects of the study.Through questionnaire analysis,the incidence of nasal and facial pressure injury of NPPV patients,the implementation rate of review indicators of medical staff,the score of the knowledge,belief and conduct of medical staff,and the compliance and comfort of patients before and after evidence-based practice were compared.Results A total of 52 medical staff were included,aged(28.54±6.50)years old,with 3.00(1.00,12.75)years of working experience;2 doctoral degree holders(3.85%),4 master degree holders(7.69%),46 bachelor degree holders(88.46%);2 with senior title(3.85%),17 with intermediate title(32.69%),and 33 junior titles(63.46%).Fifty patient questionnaires were collected before and after evidence-based nursing practice;the differences between before and after evidence-based practice in terms of gender,age,body weight,duration of ventilator usage,24-hour bleeding and total bleeding were not statistically significant and were comparable.Compared with the pre-evidence-based practice,after carrying out the corresponding evidence-based nursing practice,the incidence of nasal and facial pressure injuries of NPPV patients decreased from 16.00%(8/50)to 4.00%(2/50,P<0.05),the total implementation rate of review indicators of medical staff increased from 79.73%to 94.08%(P<0.01),and the total scores of knowledge,belief and conduct were significantly improved(141.96±13.88 vs.114.65±19.72,P<0.05),and compliance and comfort of patients were significantly improved(compliance score:4.60±0.99 vs.5.82±1.42,comfort score:4.10±1.63 vs.6.92±2.33,both P<0.05).Conclusion The application of an evidence-based nursing approach to obtain evidence related to the prevention of nasal and facial pressure injuries in patients with NPPV can be used to guide clinical practice,significantly reducing the incidence of nasal and facial pressure injuries in such patients,improving the implementation rate of review indicators and the knowledge,belief,and conduct scores of medical staff,and enhancing compliance and comfort of NPPV patients.