成人ICU患者睡眠质量管理的循证护理实践

Evidence-based nursing practice for sleep quality management of adult ICU patients

目的 基于最佳证据制定成人ICU患者睡眠质量管理循证实践方案,并评价其在临床应用中的有效性和安全性。方法 以循证护理实践模式为理论指导,组建循证团队,通过循证获取改善成人ICU患者睡眠质量的最佳证据并进行应用。通过查看病志、监控回顾和现场查看等方式收集资料,在证据应用前后分别对两组患者及医护人员进行基线调查和质量审查,并对证据临床转化进行障碍因素分析,制订针对性的改进策略。结果 共形成14条审查指标,障碍因素主要为成人ICU患者睡眠质量管理流程缺乏、医护人员对患者的睡眠状况重视度不高、相关知识培训不足及缺乏相应的激励机制、变革带来的工作量增加使医护人员产生抵触心理等。证据应用前后,患者的睡眠质量有统计学差异(P<0.05),医护人员各审查指标落实率有统计学差异(P<0.05)。结论 基于最佳证据制定的成人ICU患者睡眠质量管理循证实践方案可规范成人ICU患者睡眠管理流程,提高患者的睡眠质量以及医护人员对证据应用的落实率。

Objective To develop an evidence-based practice plan for managing sleep quality in adult ICU patients based on the best evidence,and to evaluate its clinical effectiveness and safety.Method Guided by the evidence-based nursing practice model,an evidence-based team was formed to collect the best evidence for improving sleep quality in adult ICU patients and apply it.Data were collected through reviewing medical record,monitoring retrospection,and siting visits.Baseline surveys and quality reviews were conducted for two groups of patients and healthcare professionals before and after evidence application,and barrier analysis was performed for clinical transformation of evidence to formulate targeted improvement measures.Results The study developed 14 review indicators based on the best evidence.The main barriers included a lack of sleep quality management processes for adult ICU patients,insufficient attention to patients'sleep conditions by healthcare professionals,inadequate related knowledge training and lack of corresponding incentive mechanisms,and resistance from healthcare professionals due to increased workload brought by changes.There was statistically significant difference in sleep quality between patients and the implementation rate of each review indicator by healthcare professionals before and after evidence application(P<0.05).Conclusion The evidence-based practice plan for managing sleep quality in adult ICU patients can standardize sleep management process,enhance sleep quality,and increase the implementation rate of evidence by healthcare professionals.