上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

先天性心脏病患儿术后镇静护理的实践调查

唐珊珊1，徐丽华1,2   

  1. 1.上海交通大学护理学院， 上海 200025； 2.世界健康基金会， 上海 200127
  • 出版日期:2014-08-28 发布日期:2014-09-02
  • 作者简介:唐珊珊（1988—）， 女， 硕士生; 电子信箱: tangshanshan2010@163.com。

Survey of nurses' sedation practices on postoperative children with congenital heart disease

TANG Shan-shan1, HSU Lily1,2   

  1. 1.School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; 2.Project HOPE, Shanghai 200127, China
  • Online:2014-08-28 Published:2014-09-02

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摘要：

目的 探讨儿童心脏外科重症监护室（CICU）护士在先天性心脏病（先心病）患儿术后机械通气期间的镇静护理实践现况，并了解与镇静实践相关的因素。方法 采取横断面调查研究方法，通过方便抽样，对275名在上海、北京、武汉三地的6所儿童CICU工作的临床护士使用护士镇静实践量表（中文版）开展调查。结果 接受调查的6所CICU中仅2所CICU（33.3%）使用镇静评估工具评估患儿镇静水平。217名护士中，59.4%~81.6%的护士认为患儿的行为状态（如有无咳嗽反应、躯体运动等）反映了不同的镇静深度。98.2%的护士认为镇静治疗是促进先心病患儿术后机械通气舒适感的重要方法。仅48.8%的护士愿意对所有机械通气的患儿使用镇静剂。62.1%~68.8%的护士认为身边护理同行的镇静药物知识和观点影响其镇静用药实践，并且87.1%的护士认为自身所提供的看法会影响医师镇静用药的决策。分别有62.9%、60.2%和50.7%的护士认为护患沟通障碍、护患比及工作量会影响他们是否对患儿使用镇静剂。镇静态度、主观规范和知觉行为控制与镇静意向及镇静实践行为间呈显著正相关（P<0.01）。结论 儿科CICU护士对先心病术后机械通气时期的患儿给予镇静治疗的态度积极。护士的镇静实践与多种因素有关，如护士对镇静的态度、身边同伴对镇静的看法和护士的人口学特征等。一些非患者因素，如临床工作量，可能影响护士的镇静实践行为。医护人员间对于镇静治疗的看法会相互影响各自的镇静用药决策。

关键词: 先天性心脏病, 重症护理, 镇静, 调查

Abstract:

Objective To investigate and explore the current status and relevant factors of nurses' sedation practice in cardiac intensive care units (CICU) for mechanically ventilated children with congenital heart diseases. Methods A cross-sectional survey was adopted and 275 CICU nurses of six pediatric CICU in Shanghai, Beijing, and Wuhan were investigated by the Nurse Sedation Practice Scale (Chinese version). Results Only in two CICUs (33.3%), sedation assessment tools were used for evaluating the sedation level of children. And 59.4%-81.6% of 217 nurses agreed that children's behavior (such as cough response, body movement, etc.) reflected their sedation level; 98.2% of nurses agreed that sedating mechanically ventilated patients was important for their comfort after heart operation; and only 48.8% of the nurses intended to sedate all intubated patients. About 62.1%-68.8% of nurses agreed that the knowledge and practice of colleagues influenced their sedation practice; 87.1% of the nurses agreed that their attitudes would influence the prescription of physicians. Then 62.9%, 60.2%, and 50.7% of nurses agreed that communication difficulty, nurse to patient ratio, and workload influenced the sedative administration. Nurses' attitude toward sedation, subjective norm, and perceived behavior control were significantly and positively correlated with their intent and actual practice of sedation (P<0.01). Conclusion CICU nurses were positive towards sedative administration for mechanically ventilated children with congenital heart disease after surgeries. Many factors were relevant to nurses sedation practice, such as nurses' attitude towards sedation, opinions of colleagues, and nurses' demographic characteristics. Some factors which are irrelevant to patients, such as clinical workload, might influence the nurses' sedation practice. The opinions of medical and nursing staffs towards sedation practice could influence their decision on sedation administration.

Key words: congenital heart disease, critical care nursing, sedation, survey