ICU护士舒适化浅镇静策略理念知信行调查问卷的构建及信效度分析

许建秋; 陈晓蕾; 占雷; 蔡晓丹; 陈洁

doi:10.16766/j.cnki.issn.1674-4152.001844

ICU护士舒适化浅镇静策略理念知信行调查问卷的构建及信效度分析

doi: 10.16766/j.cnki.issn.1674-4152.001844

温州医科大学附属第一医院重症医学科，浙江温州 325000

基金项目:

浙江省自然科学基金 LY16H160020

详细信息

通讯作者:
许建秋，E-mail：doctor_nurse120@126.com

中图分类号: R395.6
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- 文章访问数: 136
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- 被引次数: 0
出版历程
- 收稿日期: 2020-02-23
- 网络出版日期: 2022-02-19

The construction and reliability and validity analysis of the questionnaire on knowledge-belief-behavior of eCASH concept for ICU nurses

Department of Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的通过应用德尔菲专家函询法构建ICU护士eCASH理念知信行调查问卷，并检验其信效度，为构建本土化的舒适化浅镇静策略(eCASH理念)培训体系，促进ICU护士镇静镇痛专科护理水平提供依据。方法基于知信行理论，通过文献分析法和半结构式访谈法建立问卷框架，选取了17位浙江省3所三级甲等医院ICU护理专家进行2轮专家函询形成问卷初稿，并通过浙江省3所三级甲等医院187名ICU护士进行问卷信效度评价，最终形成问卷终稿。结果两轮专家函询结果：两轮专家函询回收率分别为82.35%和100.00%，专家协调系数分别为0.32和0.45，权威系数分别为0.845和0.913。4个维度重要性平均得分3.56~3.77，满分比44.12%~65.24%；22个条目重要性平均得分3.43~3.77，满分比43.52%~65.72%，最终形成了包括eCASH基本知识、eCASH技能、eCASH信念、eCASH行为共4个维度，22个条目的eCASH理念知信行调查问卷。信效度评价结果：问卷4个维度的贡献率分别为21.91%、17.81%、13.32%、15.45%，累计贡献率为68.49%(＞40%)；总问卷的内容效度S-CVI为0.982，Cronbach's α系数为0.931，重测信度在0.814~0.923。结论 ICU护士eCASH理念知信行问卷信效度良好，能准确反映ICU护士对eCASH理念的知识水平、执行意愿和临床实施现状，可作为测评ICU护士eCASH理念知信行水平的适用工具。
- 重症监护室 /
- 护士 /
- eCASH理念 /
- 知信行 /
- 信度 /
- 效度
Abstract: Objective To construct the questionnaire of knowledge-belief-behavior of ICU nurses' eCASH concept by means of Delphi expert letter consultation method, and to test its reliability and validity, so as to provide a basis for the construction of localized eCASH concept training system and the promotion of ICU nurses' nursing level of sedation and analgesia. Methods Based on the theory of knowledge-belief-behavior, the questionnaire framework was established by literature analysis and semi-structured interview. Total 17 ICU nursing experts from 3 Class A tertiary hospitals in Zhejiang Province were selected for 2 rounds of expert consultation to form the first draft of the questionnaire. Finally, the final draft of the questionnaire was formed by evaluating the reliability and validity of the questionnaire among 187 ICU nurses in 3 Class A tertiary hospitals in Zhejiang Province. Results Results of the two rounds of expert consultation: the recovery rates were 82.35% and 100%, the expert coordination coefficient was 0.32 and 0.45, and the authority coefficient was 0.845 and 0.913, respectively. The average score of the importance of the four dimensions was 3.56-3.77, with the full score ranging from 44.12% to 65.24%. The average score of the importance of 22 items was 3.43-3.77, and the full score was 43.52%-65.72%. Finally, a questionnaire on knowledge-belief-behavior of eCASH concept was formed, which included four dimensions of eCASH basic knowledge, eCASH skills, eCASH beliefs and eCASH behaviors, and 22 items. Results of reliability and validity evaluation: the contribution rate of the four dimensions was 21.91%, 17.81%, 13.32% and 15.45%, respectively, and the cumulative contribution rate was 68.49% (> 40%). The content validity S-CVI of the total questionnaire was 0.982, Cronbach's coefficient was 0.931, and the retest reliability ranged from 0.814 to 0.923. Conclusion The questionnaire on knowledge-belief-behavior of ICU nurses' eCASH concept has good reliability and validity, which can accurately reflect the knowledge level, executive intention and clinical implementation status of ICU nurses' eCASH concept, and can be used as an applicable tool to evaluate the level of ICU nurses' eCASH concept epistemic practice.
- Intensive care unit /
- Nurse /
- eCASH concept /
- Knowledge-belief-behavior /
- Reliability /
- Validity

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表 1 eCASH知信行问卷因子分析结果

条目	载荷量				共同度
条目	因子1	因子2	因子3	因子4	共同度
K1. eCASH的概念及内涵	0.924				0.675
K2. 推荐使用患者调控镇痛(PCA)治疗模式	0.913				0.578
K5. 建议使用多种形式的镇痛药，从而减少阿片类药物的用量	0.895				0.675
K7. 使用不同给药途径的药物可能会改善疼痛管理，同时可避免高剂量镇痛药导致的不良反应	0.893				0.876
K6. 患者在ICU期间，需定期评估镇痛效果	0.865				0.744
K9. 寻找患者躁动的原因，而不是通过增加镇静药剂量来控制躁动	0.834				0.824
K12. 不再提倡每日镇静唤醒，而是建议增加床旁镇静程度评估频次	0.823				0.726
K10. 可通过加强ICU患者自身、医护人员与患者家属的合作和联系来实施人文关怀，以促使患者达到最佳舒适的状态。	0.786				0.675
K15. 运用Pichmond躁动镇静评分(RASS)评估eCASH的镇静目标		0.845			0.567
K13. 运用数字评分量表(NRS)、疼痛行为学量表(BPS)或重症疼痛观察工具(CPOT)进行量化疼痛评估		0.768			0.785
K14. 运用ICU意识模糊评估法(CAM-ICU)进行谵妄评估评估		0.736			0.745
A3. 系统接收eCASH培训的意愿			0.998		0.765
A7. 对患者进行早期的干预			0.897		0.856
A1. 对患者家属进行健康教育，鼓励家属参与			0.868		0.743
A4. 掌握eCASH知识，义满足临床工作需要			0.745		0.671
A6. 实施eCASH以改善护理结局			0.612		0.611
A2. 持续评估患者的镇静、镇痛状态			0.558		0.564
P3. 持续关注eCASH的最新动态				0.976	0.831
P4. 与家属交流患者的镇静、镇痛状态				0.867	0.754
P1. 与医生交流患者的镇静、镇痛状态				0.776	0.786
P6. 主动实施eCASH的护理				0.612	0.546
P2. 持续随访eCASH护理后患者的状态				0.517	0.677

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参考文献(18)

[1]	苗晓, 马靓, 徐萍, 等. ICU镇静镇痛新概念eCASH的研究进展[J]. 解放军护理杂志, 2018, 35(23): 47-50. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201823013.htm
[2]	VINCENT J L. Optimizing sedation in the ICU: the eCASH concept[J]. Signa Vitae, 2017, 13(3): 10-13.
[3]	VINCENT J L, SHEHABI Y, WALSH T S, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept[J]. Inten Care Med, 2016, 42(6): 962-971. doi: 10.1007/s00134-016-4297-4
[4]	BARR J, FRASER G L, PUNTILLO K, et al. Clinical practice guidelines for the managment of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2018, 41(1): 263-306.
[5]	ACEVEDO-NUEVO M, GONZALEZ-GIL M T, RO-MERA-ORTEGA M A, et al. The early diagnosis and management of mixed delirium in a patient placed on ECMO and with difficult sedation: a case report[J]. Intens Crit Care Nur, 2018, 44: 110-114. doi: 10.1016/j.iccn.2017.07.013
[6]	孙俊丽, 葛建琳, 陈叶柔, 等. eCASH理念对ICU胸外科术后患者的影响[J]. 西藏医药, 2018(3): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-XZYY201803020.htm
[7]	赵先美, 叶曼, 李知音, 等. eCASH理念运用于ICU机械通气患者镇静镇痛管理的效果评价[J]. 中国护理管理, 2018, 18(4): 533-537. doi: 10.3969/j.issn.1672-1756.2018.04.022
[8]	郭晓夏, 安友仲. ICU后综合征在镇痛镇静谵妄指南、镇痛镇静集束化措施及eCASH中的干预建议[J]. 中华重症医学电子杂志, 2017, 3(4): 250-253. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYD201704003.htm
[9]	李春玉. 社区护理[M]. 北京: 人民卫生出版社, 2012: 62-64.
[10]	LOCKWOOD C, MUNN Z, PORRITT K. Qualitative research synthesis: methodological guidance for systematic reviewer sutilizing meta-aggregation[J]. Int J Evid Based Healthc, 2015, 13(3): 179-187. doi: 10.1097/XEB.0000000000000062
[11]	AROMATARIS E, FERNANDEZ R, GODFREY C, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an Umbrella review approach[J]. Int J Evid Based Healthc, 2015, 13(3): 132-140. doi: 10.1097/XEB.0000000000000055
[12]	周英凤, 顾莺, 胡雁, 等. JBI循证卫生保健中心对关于不同类型研究的质量评价工具——患病率及分析性横断面研究的质量评价[J]. 护士进修杂志, 2018, 33(3): 219-221. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201803007.htm
[13]	周英凤, 顾莺, 胡雁, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价[J]. 护士进修杂志, 2018, 33(1): 24-26. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201801007.htm
[14]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8): 701-703. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201808008.htm
[15]	GERRISH K, LATHLEAN J, CORMACK D. The research process in nursing[M]. New Jerseg: Wiley Blackwel, 2018: 632.
[16]	吴明隆. SPSS统计应用实务[M]. 北京: 科学出版社, 2003: 11-12.
[17]	陈燕雅, 齐蒙蒙, 李泽楷. 护理本科生职业相关社会支持量表的编制及信效度检[J]. 护理管理杂志, 2017, 17(10): 723-726.
[18]	HAYS R D, ANDERSON R, REVIEKI D. Psychometric considerations in evaluating health-related quality life measures[J]. Qual Life Res, 1993, 2(6): 441-449. http://ard.bmj.com/external-ref?access_num=10.1007/BF00422218&link_type=DOI