ICU伤口造口专科护士基于自然照护理念实施体位管理的质性研究

Qualitative study on ICU wound ostomy specialist nurses implementing postural management based on nature care concept

目的:深入了解伤口造口专科护士在重症监护室(ICU)实施体位管理预防压力性损伤的真实体验与想法,促进自然照护理念和临床实践相结合,为非专科ICU护士体位管理培训提供依据。方法:采用目的抽样法,选取2023年9月—11月河南省某三级甲等综合医院ICU伤口造口专科护士作为研究对象进行半结构式访谈,运用内容分析法、NVivo 12plus软件分析、提炼访谈资料。结果:ICU伤口造口专科护士体位管理的体验与想法归纳为3个主题,7个亚主题。1)缺乏跟进体位管理新理念新技术的意识,包括缺乏辅具选择与应用的知识、缺乏皮肤微环境的认知与监测工具、结构化复位与压力分散;2)科学实施提高体位管理效果,包括合理摆放肢体避免关节挛缩、实践结合指南构建个性化翻身方案;3)团队协作促进病人获益,包括家属及团队合作能力的影响、医护人员管理体位的冲突与平衡。结论:ICU伤口造口专科护士和非专科ICU护士应持续跟进新理念新技术的发展、注重团队合作及家属需求,以改善ICU病人的照护体验,提高体位管理预防压力性损伤的效果。

Objective:To understand the real experience and ideas of wound ostomy specialist nurses in implementing position management to prevent stress injuries in intensive care unit(ICU),promote the combination of natural care concept and clinical practice,and provide basis for non-specialist ICU nurses′position management training.Methods:Objective sampling method was used to select the wound ostomy specialist nurses in the ICU in a Grade A general hospital in Henan Province from September to November 2023 as the research objects for semi-structured interviews.Content analysis method and NVivo 12plus software were used to analyze and extract the interview data.Results:The experience and ideas of position management of wound ostomy specialist nurses in ICU can be summarized into 3 themes and 7 sub-themes.1)Lack of awareness to follow up new ideas and technologies for position management,including lack of knowledge on the selection and application of assistive devices,lack of cognitive and monitoring tools for skin microenvironment,structured reduction and pressure dispersion.2)Scientific implementation to improve the effect of position management,including reasonable placement of limbs to avoid joint contracture,practice combined with guidelines to build personalized turning plans.3)Teamwork promoting the benefit of patients,including the influence of family members and teamwork ability,and the conflict and balance of medical staff′s management positions.Conclusions:Wound ostomy specialist nurses and non-specialist ICU nurses should continue to follow up the development of new concepts and technologies,pay attention to teamwork and family needs,in order to improve the care experience of ICU patients and enhance the effect of position management on preventing stress injuries.