機械通氣病人急性胃腸損傷分級護理方案的循證護理實踐準備度評估

Evaluation of evidence-based nursing practice readiness of graded nursing scheme for acute gastrointestinal injury in patients with mechanical ventilation

ZHANG Zijing，ZHENG JianhuangSchool of Nursing，Fujian Medical University，Fujian 350108 ChinaCorresponding Author ZHENG Jianhuang，E-mail：xiahuai312@126.com

Abstract Objective：To investigate the readiness of evidence-based practice of graded nursing program for acute gastrointestinal injury in patients with mechanical ventilation，identify the promoting factors and obstacles to evidence-based practice，and promote the successful change of evidence to practice.Methods：A total of 68 clinical nurses from the intensive care department of a Grade A hospital who participated in the graded nursing plan for acute gastrointestinal injury in patients with mechanical ventilation were selected by continuous sampling method.The self-made basic data questionnaire and evidence-based nursing practice readiness assessment scale were used to investigate，and the scores of the total scale and each subscale were calculated.The relevant factors affecting the score of total scale and subscale are analyzed.Results：The total score of evidence-based nursing practice readiness scale in each subscale was（128.45±18.47），evidence subscale was（52.65±7.17），organizational environment subscale was（37.12±5.87），and facilitation subscale was（38.68±7.45）.Entries 25，26，and 27 had low scores（alllt;4）.The results of univariate analysis showed that research experience affected the total score of the scale and the score of the evidence subscale（Plt;0.05），and evidence-based practice experience affected the score of the evidence subscale （Plt;0.05）.Conclusion：Evidence readiness and organizational environment readiness are good，but there are problems such as lack of decision-making power，evidence-based practice training in place and imperfect incentive mechanism in facilitating factor readiness.The research team should formulate coping strategies in time to reduce or eliminate the obstacles of these factors to evidence transformation.

Keywords evidence-based practice;readiness;evidence-based nursing;evidence transformation

摘要 目的：調查機械通氣病人急性胃腸損傷分級護理方案的循證實踐準備度，識別開展循證實踐的促進因素及障礙因素，促進證據向實踐的成功變革。方法：采用連續性抽樣法，選取某三級甲等醫院重癥醫學科參與機械通氣病人急性胃腸損傷分級護理方案的臨床護理人員68名，采用自制的基本資料調查表和循證護理實踐準備度評估量表進行調查，計算總量表及各分量表得分，并分析影響總量表及分量表得分的相關因素。結果：循證護理實踐準備度量表總得分為（128.45±18.47）分，證據分量表得分為（52.65±7.17）分，組織環境分量表得分為（37.12±5.87）分，促進因素分量表得分為（38.68±7.45）分。條目25、條目26、條目27得分較低（均＜4分）。單因素分析結果顯示，科研經歷影響量表總得分及證據分量表得分（P＜0.05），循證實踐經歷影響證據分量表得分（P＜0.05）。結論：證據準備度及組織環境準備度水平較好，但在促進因素準備度中存在決策權缺失、循證實踐培訓到位及激勵機制不完善的問題，研究團隊應及時制定應對策略，降低或消除上述因素對證據轉化的阻礙。

關鍵詞 循證實踐;準備度；循證護理；證據轉化

doi：10.12102/j.issn.2095-8668.2024.15.006

多項研究已證明，長時間的機械通氣是發生胃腸道功能損傷的獨立危險因素［1-2］，機械通氣時間越久，胃腸道低灌注狀態持續時間就越長，發生胃腸功能損傷的風險也就越高，重癥病人死亡率與胃腸道功能損傷明顯相關［3］。但目前缺乏急性胃腸損傷相關的護理指南，其護理措施主要以醫院自行制定的護理常規的形式呈現，存在無法早期識別胃腸道并發癥風險及根據胃腸道功能的動態變化提供個性化護理措施等問題?！?br>