A cross-sectional survey and influencing factors analysis of knowledge, attitude, and behavior of enteral nutrition implemented by nurses in burn intensive care unit
-
摘要:
目的 调查烧伤重症监护病房（BICU）护士实施肠内营养护理的知信行现状并分析其影响因素。 方法 采用多中心横断面调查研究方法。2022年5月8日，选择陆军军医大学（第三军医大学）第一附属医院、广东省人民医院、广西医科大学第一附属医院、青海大学附属医院、空军军医大学第二附属医院、南通大学附属医院、贵阳钢厂职工医院、昆明医科大学第二附属医院烧伤科的107名符合入选标准的BICU护士作为调查对象。采用自制严重烧伤患者肠内营养护理知信行调查问卷调查护士的性别、年龄、工作年限、职称、职务、最高学历、是否接受肠内营养知识系统培训，以及肠内营养知识、态度、行为维度的各因子得分及总得分。将护士按照一般资料分类，统计其肠内营养知识、态度、行为的总得分。对数据进行独立样本 t检验、单因素方差分析、Mann-Whitney U 检验、Kruskal-Wallis H 检验。根据单因素分析结果，再结合临床经验和意义，进行广义线性模型分析，筛选BICU护士肠内营养知识、态度、行为总得分的独立影响因素。 结果 接受本次调查的护士共107名，收回有效问卷107份，有效回收率为100%。BICU护士肠内营养知信行问卷中，知识、态度、行为总得分分别为（44±13）、（87±15）、（70±19）分。本次调查的BICU护士大多数为女性，年龄为22~48（31±6）岁，工作年限为1~5、6~10、≥11年的人数分布较平均，大多数护士职称为护师、职务为责任护士、最高学历为本科，有44名护士接受过肠内营养知识系统培训。不同年龄、工作年限、职称、职务、最高学历、是否接受肠内营养知识系统培训的BICU护士肠内营养知识总得分比较，差异均有统计学意义（ H值分别为27.36、15.27、10.19， Z值分别为-3.33、-2.59、-6.46， P<0.05）；不同性别、年龄、工作年限、职称、职务、最高学历、是否接受肠内营养知识系统培训的BICU护士肠内营养态度、行为总得分比较，差异均无统计学意义（ P>0.05）。年龄（26~30、31~35、≥36岁）、最高学历（本科）、接受肠内营养知识系统培训均是BICU护士肠内营养知识总得分的独立影响因素（95%置信区间分别为0.12~0.36、0~0.30、0.03~0.31、0.01~0.32、0.19~0.40，标准化回归系数分别为0.24、0.15、0.17、0.17、0.29， P<0.05），而不同特征下均无BICU护士肠内营养态度、行为总得分的独立影响因素（ P>0.05）。 结论 BICU护士实施肠内营养的认知水平偏低，观念须及时更新，行为也有待进一步规范。年龄（26~30、31~35、≥36岁）、最高学历（本科）、接受肠内营养知识系统培训均是BICU护士肠内营养知识的独立影响因素。 Abstract:Objective To investigate the status of knowledge, attitude, and behavior of enteral nutrition implemented by nurses in burn intensive care unit (BICU) and analyze its influencing factors. Methods A multi-center cross-sectional survey research method was used. On May 8 th, 2022, 107 BICU nurses who met the inclusion criteria were selected from the burn departments of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Guangdong Provincial People's Hospital, the First Affiliated Hospital of Guangxi Medical University, the Affiliated Hospital of Qinghai University, the Second Affiliated Hospital of Air Force Medical University, the Affiliated Hospital of Nantong University, Guiyang Steel Factory Staff Hospital, and the Second Affiliated Hospital of Kunming Medical University. The self-made nurses' enteral nutrition nursing knowledge-attitude-behavior questionnaire for severely burned patients was used to investigate the nurses' gender, age, working years, professional title, position, highest educational background, and whether they received systematic training in knowledge of enteral nutrition, the scores of each factor, and the total scores of knowledge, attitude, and behavior dimensions of enteral nutrition in nurses. The nurses were classified according to the general data, and the total scores of their knowledge, attitude, and behavior of enteral nutrition were calculated. Data were statistically analyzed with independent sample t test, one-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis H test. According to the results of univariate analysis and combined with clinical experience and significance, the generalized linear model analysis was carried out to screen the independent influencing factors of the total scores of knowledge, attitude, and behavior of enteral nutrition in BICU nurses. Results A total of 107 nurses were surveyed, and 107 valid questionnaires were collected, with an effective recovery rate of 100%. In the BICU nurses' enteral nutrition knowledge-attitude-behavior questionnaire, the total scores of knowledge, attitude, and behavior were 44±13, 87±15, and 70±19, respectively. Most of the BICU nurses in this survey were female, aged 22-48 (31±6) years, and the number of nurses worked for 1-5, 6-10, and ≥11 years was evenly distributed. The majority of the professional titles of nurses were nurses, positions were responsible nurses, and the highest educational background was undergraduate. Forty-four nurses received systematic training in knowledge of enteral nutrition. There were statistically significant differences in the total scores of knowledge of enteral nutrition among BICU nurses with different ages, working years, professional titles, positions, highest educational background, and whether they received systematic training in knowledge of enteral nutrition (with Hvalues of 27.36, 15.27, and 10.19, respectively, Z values of -3.33, -2.59, and -6.46, respectively, P<0.05). There were no statistically significant differences in the total scores of attitude and behavior of enteral nutrition among BICU nurses with different gender, ages, working years, professional titles, positions, highest educational background, and whether they received systematic training in knowledge of enteral nutrition ( P>0.05). Age (26-30, 31-35, and ≥36 years old), highest educational background (undergraduate), and the systematic training received in enteral nutrition knowledge were the independent influencing factors for the total score of knowledge of enteral nutrition in BICU nurses (with 95% confidence intervals of 0.12-0.36, 0-0.30, 0.03-0.31, 0.01-0.32, and 0.19-0.40, respectively, standardized regression coefficients of 0.24, 0.15, 0.17, 0.17, and 0.29, respectively, P<0.05). There were no independent influencing factors for the total scores of enteral nutrition attitude and behavior of BICU nurses in different characteristics ( P>0.05). Conclusions The BICU nurses have low cognitive level in the implementation of enteral nutrition, their concept needs to be updated in time, and their behavior needs to be further standardized. Age (26-30, 31-35, and ≥36 years old), highest educational background (undergraduate), and the systematic training received in enteral nutrition knowledge were the independent influencing factors for the knowledge of enteral nutrition in BICU nurses. -
Key words:
- Burns /
- Enteral nutrition /
- Nursing care /
- Knowledge /
- Attitude /
- Behavior /
- Cross-sectional studies /
- Root cause analysis
-
参考文献
(30) [1] GuoFM, ZhouH, WuJ, et al. A prospective observation on nutrition support in adult patients with severe burns[J]. Br J Nutr, 2019,121(9):974-981. DOI: 10.1017/S0007114519000217. [2] Alfonso OrtizL,JiangXR,TurgeonAF,et al.Validation of the modified nutrition risk score (mNUTRIC) in mechanically ventilated, severe burn patients: a prospective multinational cohort study[J]. Burns, 2021,47(8):1739-1747. DOI: 10.1016/j.burns.2021.05.010. [3] MoreiraE, BurghiG, ManzanaresW. Update on metabolism and nutrition therapy in critically ill burn patients[J]. Med Intensiva (Engl Ed), 2018,42(5):306-316. DOI: 10.1016/j.medin.2017.07.007. [4] PhamCH,FangM,VrouweSQ,et al.Evaluating the safety and efficacy of intraoperative enteral nutrition in critically ill burn patients: a systematic review and meta-analysis[J]. J Burn Care Res,2020,41(4):841-848. DOI: 10.1093/jbcr/iraa036. [5] ZhangPJ,ZouBW,LiouYC,et al.The pathogenesis and diagnosis of sepsis post burn injury[J/OL]. Burns Trauma, 2021,9:tkaa047[2022-05-22]. https://pubmed.ncbi.nlm.nih.gov/33654698/.DOI: 10.1093/burnst/tkaa047. [6] 罗月, 黎宁. 严重烧伤患者早期肠内营养治疗的研究进展[J].中华烧伤杂志,2021,37(9):880-884. DOI: 10.3760/cma.j.cn501120-20210621-00223. [7] ChourdakisM,BourasE,ShieldsBA, et al.Nutritional therapy among burn injured patients in the critical care setting: an international multicenter observational study on "best achievable" practices[J]. Clin Nutr,2020,39(12):3813-3820.DOI: 10.1016/j.clnu.2020.04.023. [8] SierpEL,KurmisR,LangeK,et al.Nutrition and gastrointestinal dysmotility in critically ill burn patients: a retrospective observational study[J].JPEN J Parenter Enteral Nutr,2021,45(5):1052-1060. DOI: 10.1002/jpen.1979. [9] 潘艳艳, 徐思达, 范友芬, 等. 特重度烧伤患者早期肠内营养不耐受的危险因素分析[J].中华烧伤杂志,2021,37(9):831-838. DOI: 10.3760/cma.j.cn501120-20210511-00180. [10] 彭曦.烧伤临床营养新视角[J].中华烧伤杂志,2019,35(5):321-325.DOI: 10.3760/cma.j.issn.1009-2587.2019.05.001. [11] SharmaK,MogensenKM,RobinsonMK.Pathophysiology of critical illness and role of nutrition[J]. Nutr Clin Pract,2019,34(1):12-22.DOI: 10.1002/ncp.10232. [12] 孙文彦,李夕雯,李佳倩,等.护理人员肠内营养管路安全管理认知及行为现状的调查[J].中华临床营养杂志,2020,28(2):106-111.DOI: 10.3760/cma.j.cn115822-20200327-00076. [13] 钱艳, 张彩华. 临床护士肠内营养知识、态度及行为现状的调查与分析[J].中华现代护理杂志,2017,23(10):1368-1371. DOI: 10.3760/cma.j.issn.1674-2907.2017.10.008. [14] SingerP, BlaserAR, BergerMM, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019,38(1):48-79. DOI: 10.1016/j.clnu.2018.08.037. [15] McClaveSA,TaylorBE,MartindaleRG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr,2016,40(2):159-211. DOI: 10.1177/0148607115621863. [16] 韩春茂.烧伤管理诊疗常规与技术规范[M].杭州:浙江大学出版社,2014. [17] 中华护理学会 T/CNAS 19─2020 成人肠内营养支持的护理 2021 中华护理学会.T/CNAS 19─2020 成人肠内营养支持的护理[S].2021.
[18] 米元元, 黄海燕, 尚游, 等. 中国危重症患者肠内营养治疗常见并发症预防管理专家共识(2021版)[J].中华危重病急救医学,2021,33(8):903-918. DOI: 10.3760/cma.j.cn121430-20210310-00357. [19] 彭曦. 重症烧伤患者的代谢分期及营养治疗策略[J].中华烧伤杂志,2021,37(9):805-810. DOI: 10.3760/cma.j.cn501120-20210802-00264. [20] 蒋琪霞, 王亚玲, 解怡洁, 等. 成年创伤患者创面以外皮肤清洗现况及影响因素的多中心横断面调查[J].中华烧伤杂志,2021,37(5):429-436. DOI: 10.3760/cma.j.cn501120-20210116-00023. [21] 刘慧松, 刘志梅, 陈鑫, 等. 多模式培训对ICU护士肠内营养知信行的影响[J].护理学杂志,2020,35(7):59-61. DOI: 10.3870/j.issn.1001-4152.2020.07.059. [22] 王汇, 程岚, 周金花, 等. 知、信、行模式在临床护士肠内营养护理培训中的应用[J].解放军医院管理杂志,2021,28(8):797-800. DOI: 10.16770/J.cnki.1008-9985.2021.08.035. [23] 李素云, 柯卉, 张献娜. 护理人员安全实施肠内营养知信行调查[J].护理学杂志,2017,32(18):85-88. DOI: 10.3870/j.issn.1001-4152.2017.18.085. [24] 吕琳, 杨艳林, 王宁, 等. 医疗机构专科护士分级岗位管理指标体系构建[J].中华医院管理杂志,2023,39(1):61-66. DOI: 10.3760/cma.j.cn111325-20220901-00760. [25] MaschJL, BhutianiN, BozemanMC. Feeding during resuscitation after burn injury[J].Nutr Clin Pract,2019,34(5):666-671. DOI: 10.1002/ncp.10400. [26] 王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识[J].中华内科杂志,2016,55(11):900-912. DOI: 10.3760/cma.j.issn.0578-1426.2016.11.020. [27] MyattTC, MedakAJ, LamSHF. Use of point-of-care ultrasound to guide pediatric gastrostomy tube replacement in the emergency department[J].Pediatr Emerg Care,2018,34(2):145-148. DOI: 10.1097/PEC.0000000000001400. [28] 都勇, 夏一兰. 重度烧伤患者肠内营养应用管理的研究进展[J].中华急危重症护理杂志,2022,3(2):163-167. DOI: 10.3761/j.issn.2096-7446.2022.02.013. [29] 许静涌, 杨剑, 康维明, 等. 营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版)[J].中华临床营养杂志,2018,26(3):131-135. DOI: 10.3760/cma.j.issn.1674-635X.2018.03.001. [30] 王小雪, 杨永丽, 马丁, 等. NUTRIC评分和mNUTRIC评分在危重症患者中的研究现状[J].临床急诊杂志,2020,21(10):848-852. DOI: 10.13201/j.issn.1009-5918.2020.10.016. -
表1 107名烧伤重症监护病房护士不同一般资料下肠内营养知识、态度、行为总得分比较
表1. Comparison of total scores of knowledge, attitude, and behavior of enteral nutrition among 107 nurses in burn intensive care unit with different general data
项目与类别 人数 构成比（%） 知识总得分（分， 态度总得分（分， 行为总得分（分， 统计量值1 P 1值 统计量值2 P 2值 统计量值3 P 3值 性别 男 9 8.4 34±10 62±5 55±13 Z=-0.83 0.401 Z=-0.56 0.575 t=-0.81 0.419 女 98 91.6 30±9 60±11 60±16 年龄（岁） 21~25 19 17.8 22±3 60±12 59±14 H=27.36 <0.001 H=4.02 0.259 F= 0.68 0.536 26~30 38 35.5 31±9 60±10 59±16 31~35 30 28.0 35±9 63±5 62±18 ≥36 20 18.7 31±8 61±5 56±14 工作年限（年） 1~5 32 29.9 26±7 59±10 56±16 H=15.27 <0.001 H=0.74 0.688 F=3.96 0.052 6~10 38 35.5 31±10 61±11 63±16 ≥11 37 34.6 34±8 61±10 58±16 职称 护士 26 24.3 27±9 61±11 60±18 H=10.19 0.006 H=0.58 0.745 F=0.90 0.407 护师 47 43.9 30±9 60±9 58±15 主管护师及以上 34 31.8 34±8 61±11 61±19 职务 责任护士 94 87.9 29±9 60±11 61±16 Z=-3.33 0.001 Z=-0.31 0.754 t=0.85 0.394 责任组长及护士长 13 12.1 39±7 64±4 57±14 最高学历 专科 9 8.4 23±3 56±16 56±18 Z=-2.59 0.010 Z=-0.85 0.392 t=-0.57 0.564 本科 98 91.6 31±9 61±10 60±16 是否接受肠内营养知识系统培训 是 44 41.1 38±7 61±14 60±19 Z=-6.46 <0.001 Z=-1.52 0.128 t=0.50 0.611 否 63 58.9 26±7 61±7 59±14 注：统计量值1、 P 1值，统计量值2、 P 2值，统计量值3、 P 3值分别为不同一般资料下护士肠内营养知识、态度、行为总得分比较所得 
下载: 导出CSV
表2 107名烧伤重症监护病房护士肠内营养知识总得分的广义线性模型分析结果
表2. Generalized linear model analysis results of the total scores of knowledge of enteral nutrition of 107 nurses in burn intensive care unit
因素与分类 标准化回归系数 标准误 95%置信区间 Wald值 P值 年龄（岁） 26~30 0.24 0.06 0.12~0.36 14.86 <0.001 31~35 0.15 0.07 0~0.30 3.95 0.047 ≥36 0.17 0.07 0.03~0.31 5.69 0.017 职务责任组长及护士长 0.11 0.06 -0.02~0.24 2.71 0.100 最高学历本科 0.17 0.07 0.01~0.32 4.58 0.032 接受肠内营养知识系统培训 0.29 0.05 0.19~0.40 30.01 <0.001
下载: 导出CSV
-
图(1) / 表(2)
计量
- 文章访问数: 285
- HTML全文浏览量: 79
- PDF下载量: 48
- 被引次数: 0
