ICU护士呼吸机相关性肺炎预防措施知信行及影响因素调查

黄其东; 郑雷雷; 张其霞; 卫庆; 陈瑜

doi:10.16766/j.cnki.issn.1674-4152.003521

ICU护士呼吸机相关性肺炎预防措施知信行及影响因素调查

doi: 10.16766/j.cnki.issn.1674-4152.003521

1.
温州医科大学附属第一医院330病区重症医学科，浙江温州 325000
2.
温州医科大学附属第一医院呼吸与危重症医学科
3.
温州医科大学附属第一医院护理部

基金项目:

浙江省卫生健康科技计划项目 2024KY1247

温州市科学技术局项目 Y20210596

详细信息

通讯作者:
陈瑜，E-mail：chenxiaolongwy@126.com

中图分类号: R192.6 R563.1
计量
- 文章访问数: 28
- HTML全文浏览量: 14
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-15
- 网络出版日期: 2024-07-20

Investigation of knowledge, attitudes, and behaviors regarding ventilator-associated pneumonia prevention measures and influencing factors among ICU nurses

1.
Section 330, Department of Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的了解浙江省某三级甲等医学重症监护病房护士呼吸机相关性肺炎的知识、态度、行为现状及其影响因素，为提高重症监护病房护士对呼吸机相关性肺炎的护理技能提升提供理论依据。方法于2023年5月，采用自制调查问卷整群抽取浙江省某三级甲等医院重症监护病房全部护士148名进行调查。结果浙江省某三级甲等医院ICU护士VAP知识在知识维度得分为(16.16±1.82)分，在态度维度得分为(100.01±13.86)分，在行为维度得分为(31.33±4.28)分。多元线性回归分析结果显示，在知识维度方面，管理岗相较于责任岗与知识得分呈正相关关系(P＜0.05)，文化程度和从事ICU护理工作的年限(年)与知识得分均呈负相关关系(P＜0.05)；在态度维度方面，从事ICU护理工作的年限(年)与态度评分呈正相关关系(P＜0.05)；在行为维度方面，管理岗和教学岗相较于责任岗，与行为评分均呈负相关关系(P＜0.05)。结论浙江省某三级甲等医院重症监护病房护士呼吸机相关性肺炎的知识处于较高水平，但态度和行为水平仍有待提升。建议增加呼吸机相关性肺炎预防措施相关知识的教育工作。
- 呼吸机相关性肺炎 /
- ICU护士 /
- 认知行为
Abstract: Objective To understand the knowledge, attitude, behavior status, and influencing factors of ventilator-associated pneumonia among nurses in a tertiary A medical intensive care unit in Zhejiang Province, and to provide a theoretical basis for improving the nursing skills of nurses in intensive care units for ventilator-associated pneumonia. Methods In May 2023, a self-made survey questionnaire was used to cluster select 148 nurses from the intensive care unit of a tertiary A hospital in Zhejiang Province for investigation. Results ICU nurses from a tertiary A hospital in Zhejiang Province scored 16.16±1.82 in terms of VAP knowledge in the knowledge dimension, 100.01±13.86 in the attitude dimension, and 31.33±4.28 in the behavior dimension. The results of multiple linear regression analysis showed that in terms of knowledge dimension, management positions showed a positive correlation trend with knowledge scores compared to responsibility positions (P<0.05), while education level and years of working in ICU nursing showed a negative correlation trend with knowledge scores (P<0.05); In terms of attitude dimension, there is a positive correlation between years of experience in ICU nursing work and attitude scores (P<0.05); In terms of behavioral dimensions, management and teaching positions show a negative correlation with behavioral scores compared to responsibility positions (P<0.05). Conclusion The knowledge of ventilator-associated pneumonia among nurses in the intensive care unit of a tertiary A hospital in Zhejiang Province is at a high level, but their attitudes and behavioral levels still need to be improved. Suggest increasing education on the prevention measures for ventilator-associated pneumonia.
- Ventilator-associated pneumonia /
- ICU nurses /
- Cognitive behavior

HTML全文

表 1 不同特征浙江省某三级甲等医院ICU护士VAP知识知信行各维度得分情况比较(分)

Table 1. Comparison of scores in various dimensions of VAP knowledge, attitudes, and practices among icu nurses at a tertiary Grade-A hospital in Zhejiang Province

特征	例(%)	知识评分	统计量	P值	态度评分	统计量	P值	行为评分	统计量	P值
性别			-1.497^a	0.134		-1.675^a	0.094		-0.471^a	0.638
男性	15(10.1)	16.00(14.00, 16.00)			91.00(86.00, 106.00)			33.00(22.00, 36.00)
女性	133(89.9)	17.00(15.00, 18.00)			101.00(94.00, 106.00)			31.00(30.00, 33.00)
年龄(岁)			1.911^b	0.063		0.903^a	0.637		1.014^b	0.451
＜25	41(27.7)	16.07±1.82			102.00(94.00, 106.00)			30.24±3.84
25~30	55(37.2)	16.16±1.81			99.00(90.00, 104.00)			31.67±4.03
30~40	38(25.7)	16.16±1.87			100.00(94.00，107.00)			32.26±5.02
≥40	14(9.5)	16.43±1.91			107.00(92.00, 113.00)			30.64±3.88
文化程度			32.703^c	＜0.001		0.513^c	0.774		6.827^c	0.033
中专	12(8.1)	18.00(17.00, 18.00)			104.00(91.00, 109.00)			30.00(29.00, 31.00)
大专	45(30.4)	18.00(17.00, 18.00)			102.00(96.00, 106.00)			30.00(29.00, 33.00)
本科及以上	91(61.5)	16.00(15.00, 17.00)			99.00(91.00, 107.00)			31.00(30.00, 334.00)
ICU护士准入资格证书级别			2.896^b	0.005		0.564^c	0.754		1.513^b	0.088
院级	58(39.2)	15.71±1.71			99.00(91.00, 106.00)			31.72±4.67
省级	73(49.3)	16.40±1.75			102.00(94.00, 106.00)			31.41±4.27
国家级	17(11.5)	16.71±2.26			103.00(91.00, 109.00)			29.65±2.15
目前岗位类别			17.737^c	＜0.001		3.193^c	0.203		11.307^c	0.004
责任岗	112(75.7)	16.00(15.00-18.00)			100.00(92.00, 106.00)			32.00(30.00, 33.00)
管理岗	23(15.5)	18.00(17.00, 18.00)			106.00(95.00, 108.00)			30.00(28.00, 31.00)
教学岗	13(8.8)	18.00(17.00, 18.00)			98.00(91.00, 106.00)			30.00(29.00, 30.00)
婚姻状态			8.604^c	0.014		0.110^c	0.578		0.530^c	0.071
未婚	62(41.9)	16.00(15.00, 18.00)			99.00(94.00, 105.00)			31.00(30.00, 33.00)
已婚	78(52.7)	16.00(15.00, 18.00)			102.00(92.00, 108.00)			31.00(30.00, 33.00)
离异	8(5.4)	18.00(17.00, 18.00)			101.00(89.00, 104.00)			30.00(29.00, 30.00)
工作年限(年)			1.386^b	0.208		0.793^b	0.526		9.412^c	0.024
＜5	65(43.9)	16.32±1.71			97.65±15.22			31.00(29.00, 33.00)
5~10	41(27.7)	15.73±1.88			101.61±12.64			33.00(31.00, 33.00)
10~15	24(16.2)	16.13±2.07			98.46±10.92			31.00(28.00, 34.00)
≥15	18(12.2)	16.61±1.69			107.00±13.03			31.00(30.00, 35.00)
从事ICU护理工作的年限(年)			2.274^b	0.026		8.146^c	0.043		5.037^c	0.169
＜5	80(54.1)	16.19±1.74			99.00(91.00, 105.00)			31.00(29.00, 33.00)
5~10	41(27.7)	16.27±1.78			102.00(93.00, 107.00)			33.00(30.00, 33.00)
10~15	18(12.2)	15.89±2.32			103.00(91.00, 111.00)			30.00(28.00, 36.00)
≥15	9(6.1)	16.00±1.94			108.00(104.00, 126.00)			31.00(31.00, 37.00)
所在ICU性质			-1.495^c	0.135		-0.396^a	0.692		-1.201^a	0.230
综合ICU	96(64.9)	17.00(15.00, 18.00)			100.00(92.00, 107.00)			31.00(29.00, 33.00)
专科ICU	52(35.1)	16.00(15.00, 18.00)			102.00(93.00, 106.00)			31.00(30.00, 34.00)
职称			1.568^b	0.140		0.768^b	0.829		8.080^c	0.044
护士	40(27.0)	16.43±2.04			99.80±7.78			30.00(29.00, 33.00)
护师	61(41.2)	15.92±1.65			98.39±17.09			32.00(30.00, 33.00)
主管护师	39(26.4)	16.21±1.84			102.38±12.74			31.00(28.00, 36.00)
副主任护师及以上	8(5.4)	16.50±2.00			101.88±15.99			31.00(29.00, 33.00)
近3个月内受到关于VAP相关知识的次数(次)			4.327^c	0.115		4.897^c	0.086		1.207^c	0.547
＜3	96(64.9)	16.00(15.00, 18.00)			103.00(93.00, 107.00)			31.00(30.00, 33.00)
3~5	44(29.7)	17.00(15.00, 18.00)			99.00(92.00, 104.00)			31.00(29.00, 33.00)
≥5	8(5.4)	15.00(13.00, 17.00)			91.00(81.00, 105.00)			33.00(25.00, 37.00)
注：^a为Z值，^b为F值，^c为H值。

下载: 导出CSV

表 2 148名不同特征浙江省某三级甲等医院ICU护士VAP知识知信行得分的多元线性回归分析

Table 2. Multivariate linear regression analysis of VAP knowledge, attitudes, and practices scores among 148 ICU nurses with diverse characteristics in a tertiary hospital in Zhejiang Province

变量	B	SE	β'	t值	P值
知识维度
文化程度	-0.917	0.256	-0.324	-3.575	＜0.001
管理岗	1.129	0.519	0.225	2.177	0.031
教学岗	0.847	0.591	0.132	1.433	0.154
从事ICU护理工作的年限(年)	-0.642	0.221	-0.319	-2.906	0.004
态度维度
从事ICU护理工作的年限(年)	3.156	1.238	0.206	2.550	0.012
行为维度
管理岗	-3.898	1.278	-0.331	-3.049	0.003
教学岗	-3.610	1.380	-0.240	-2.616	0.010
职称	1.206	0.584	0.243	2.064	0.041
注：各变量赋值情况如下，性别：男性=1，女性=2；年龄(岁)：＜25=1；25~＜30=2，30~＜40=3，≥40=4；文化程度：中专=1，大专=2，本科及以上=3；ICU护士准入资格证书：院级=1，省级=2，国家级=3；工作年限(年)：＜5=1，5~＜10=2, 10~＜15=3, ≥15=4；从事ICU护理工作的年限(年)：＜5=1，5~＜10=2, 10~＜15=3, ≥15=4；所在ICU性质：综合ICU=1，专科ICU=2；职称：护士=1，护师=2，主管护师=3，副主任护师及以上=4；近3个月内接受到关于VAP相关知识的次数(次)：＜3=1, 3~＜5=2, ≥5=3。对于目前岗位类别及婚姻状态分别设置哑变量，岗位类别中责任岗=(0, 1, 0)，管理岗=(1, 0, 0)，教学岗=(0, 0, 1)；婚姻状态中，未婚=(0, 1, 0)，已婚=(1, 0, 0)，离异=(0, 0, 1)。

下载: 导出CSV

参考文献(20)

[1]	PAPAZIAN L, KLOMPAS M, LUYT C E. Ventilator-associated pneumonia in adults: a narrative review[J]. Intens Care Med, 2020, 46(5): 888-906. doi: 10.1007/s00134-020-05980-0
[2]	FERNANDO S M, TRAN A, CHENG W, et al. Diagnosis of ventilator-associated pneumonia in critically ill adult patients: a systematic review and meta-analysis[J]. Intens Care Med, 2020, 46: 1170-1179. doi: 10.1007/s00134-020-06036-z
[3]	KLOMPAS M, BRANSON R, CAWCUTT K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update[J]. Infect Cont Hosp Ep, 2022, 43(6): 687-713. doi: 10.1017/ice.2022.88
[4]	SIDDIQUEA B N, SHETTY A, BHATTACHARYA O, et al. Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis[J]. BMJ open, 2021, 11(9): e051447. DOI: 10.1136/bmjopen-2021-051447.
[5]	SUN J, HE W T, WANG L, et al. COVID-19: epidemiology, evolution, and cross-disciplinary perspectives[J]. Trends Mol Med, 2020, 26(5): 483-495. doi: 10.1016/j.molmed.2020.02.008
[6]	WICKY P H, NIEDERMANN M S, TIMSIT J F. Ventilator-associated pneumonia in the era of COVID-19 pandemic: how common and what is the impact?[J]. Crit Care, 2021, 25(1): 1-3. doi: 10.1186/s13054-020-03448-7
[7]	ROUYER M, STRAZZULLA A, YOUBONG T, et al. Ventilator-associated pneumonia in COVID-19 patients: a retrospective cohort study[J]. Antibiotics, 2021, 10(8): 988. doi: 10.3390/antibiotics10080988
[8]	KLOK F A, KRUIP M, VAN DER MEER N J M, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19[J]. Thromb Res, 2020, 191: 145-147. doi: 10.1016/j.thromres.2020.04.013
[9]	AL-MUGHEED K, BANI-ISSA W, RABABA M, et al. Knowledge, practice, compliance, and barriers toward ventilator-associated pneumonia among critical care nurses in eastern mediterranean region: a systematic review[C]//Healthcare. MDPI, 2022, 10(10): 1852.
[10]	ZHANG X, DU W, LIU F. Effect of all-in-one nursing model on ICU ventilator-associated pneumonia[J]. Am J Transl Res, 2021, 13(5): 5080.
[11]	AL-SAYAGHI K M. Critical care nurses' compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey[J]. J Taibah Univ Med Sc, 2021, 16(2): 274-282.
[12]	DING X, MA X, GAO S, et al. Effect of ICU quality control indicators on VAP incidence rate and mortality: a retrospective study of 1 267 hospitals in China[J]. Crit Care, 2022, 26(1): 1-11. doi: 10.1186/s13054-021-03885-y
[13]	BATRA P, SONI K D, MATHUR P. Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials[J]. J Intensive Care, 2020, 8(1): 1-14. doi: 10.1186/s40560-019-0415-z
[14]	魏超, 郑喜胜. 益生菌强化治疗联合抗生素预防脓毒症患者并发呼吸机相关性肺炎的效果[J]. 临床医学工程, 2022, 29(7): 923-924. doi: 10.3969/j.issn.1674-4659.2022.07.0923 WEI C, ZHENG X S. Effect of probiotic intensive therapy combined with antibiotics in the prevention of ventilator-associated pneumonia in patients with sepsis[J]. Clinical Medicine & Engineering, 2022, 29(7): 923-924. doi: 10.3969/j.issn.1674-4659.2022.07.0923
[15]	BEN L H, M' RAD A, NAAS T, et al. Antimicrobial susceptibility among pathogens Isolated in early-versus late-onset ventilator-associated pneumonia[J]. Infect Dis Rep, 2021, 13(2): 401-410. doi: 10.3390/idr13020038
[16]	常利霞, 朱利玮, 张淑瑜. ICU患者呼吸机相关肺炎耐药菌感染发生的影响因素及护理对策[J]. 中国药物滥用防治杂志, 2022, 28(8): 1156-1159. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLF202208039.htm CHANG L X, ZHU L W, ZHANG S Y. Influencing factors and nursing countermeasures of ventilator-associated pneumonia drug-resistant bacteria infection in ICU patients[J]. Chinese Journal of Drug Abuse Prevention and Treatment, 2022, 28(8): 1156-1159. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLF202208039.htm
[17]	SHAWAHNA R. Knowledge, attitude, and use of protective measures against COVID-19 among nurses: a questionnaire-based multicenter cross-sectional study[J]. BMC Nurs, 2021, 20: 1-13. doi: 10.1186/s12912-020-00515-w
[18]	HU L, SAE-SIA W, KITRUNGROTE L. Intensive care nurses' knowledge, attitude, and practice of pressure injury prevention in China: a cross-sectional study[J]. Risk Manag Healthc P, 2021, 14: 4257-4267.
[19]	柯紫薇, 项俊之, 管祥云, 等. ICU医护人员过度氧疗知信行现状及影响因素[J]. 护理研究, 2020, 34(11): 1888-1892. doi: 10.12102/j.issn.1009-6493.2020.11.004 KE Z W, XIANG J Z, GUAN X Y, et al. Statue quo and influencing factors of knowledge, attitude and practice of excessive oxygen therapy among medical staff in ICU[J]. Nursing Research, 2020, 34(11): 1888-1892. doi: 10.12102/j.issn.1009-6493.2020.11.004
[20]	许建秋, 陈晓蕾, 占雷, 等. 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[J]. 中华全科医学, 2021, 19(3): 494-497. doi: 10.16766/j.cnki.issn.1674-4152.001844 XU J Q, CHEN X L, ZHAN L, et al. The construction and reliability and validity analysis of the questionnaire on knowledge-belief-behavior of eCASH concept for ICU nurses[J]. Chinese Journal of General Practice, 2021, 19(3): 494-497. doi: 10.16766/j.cnki.issn.1674-4152.001844