使用实施科学来评估关于镇静目标设定和评估的协议障碍
Youyang Yang1,2,3, Kate Becla4, Heather Kennedy4
1Perioperative & Critical Care-Center for Outcomes Research and Evaluation (PC-CORE), Boston Children's Hospital, Boston, MA.
概括
在儿科重症监护室 (PICU) 设定镇静目标的障碍不仅仅是知识差距. 提供者的信念和态度,而不是缺乏理解,阻碍了有效的镇静管理和指南的实施.
科学领域:
- 关键护理医学 关键护理医学
- 儿科重症监护室的儿童重症监护室
- 护理实践 护理实践
背景情况:
- 镇静评估和目标设定对于ICU解放包至关重要.
- 将这些元素整合到日常实践中具有挑战性.
- 了解障碍对于实施最佳实践至关重要.
研究的目的:
- 确定在儿科重症监护室 (PICU) 设置和管理每日患者镇静目标的障碍.
- 调查提供者声明和描述的镇静目标之间的差异.
- 探索教育干预对镇静目标调整的影响.
主要方法:
- 在40个床位的四级 PICU (2022-2023) 中进行的两阶段解释性混合方法研究.
- 第1阶段涉及与床边护士和处方医生 (n=73) 进行预教育调查.
- 第二阶段包括一个教育活动,随后是重复调查和定性访谈 (n=50).
主要成果:
- 最初的评估显示,提供者的数值和描述性镇静目标之间的相关性很差.
- 一个教育干预改善了目标相关性,但它仍然很差.
- 定性访谈表明,提供者的信念和态度,而不是知识差距,是持续分歧的主要原因.
结论:
- 在PICU中设定有效镇静目标的障碍是多方面的,超出了提供者的知识.
- 个体提供者的信念和态度显著影响镇静管理.
- 解决这些潜在障碍对于成功实施基于证据的镇静指南至关重要.
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