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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (6): 463-468.DOI: 10.3969/j.issn.1673-5501.2022.06.011

• 论著 • 上一篇    下一篇

儿科护士预防和处理静脉外渗/渗出知信行问卷调查

王雨晴1,10,叶茹明2,10,方继红3,白鸽4,杨丽5,余艮珍6,朱伟萍7,杨立利8,谢鑑辉9,王颖雯1,王慧美1,顾莺1
  

  1. 1 复旦大学附属儿科医院 上海，201102；2 福建省厦门市儿童医院（复旦大学附属儿科医院厦门分院） 厦门，361006；3 安徽省儿童医院（复旦大学附属儿科医院安徽分院） 合肥，230022；4 辽宁省大连市妇女儿童医疗集团 大连，116399；5 广西医科大学第一附属医院 南宁，530021；6 华中科技大学同济医学院附属同济医院儿科 武汉，430030；7 江苏省启东市妇幼保健院 启东，226299；8 四川省成都市妇女儿童中心医院 成都，610073；9 湖南省儿童医院 长沙，410007；10 共同第一作者
  • 收稿日期:2022-11-09 修回日期:2022-08-30 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 王慧美;顾莺

Questionnaire survey on knowledge, attitude and behavior of pediatric nurses on prevention and treatment of intravenous infusion extravasation

WANG Yuqing1,10, YE Ruming2,10, FANG Jihong3, BAI Ge4, YANG Li5, YU Genzhen6, ZHU Weiping7, YANG Lili8, XIE Jianhui9, WANG Yingwen1, WANG Huimei1, GU Ying1   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102,China; 2 Xiamen Children's Hospital, Xiamen 361006, China; 3 Anhui Provincial Children's Hospital, Hefei 230022, China; 4 Dalian Women and Children Medical Group, Dalian 116399, China; 5 The First Affiliated Hospital of Guangxi Medical University, Nanjing 530021, China; 6 Tongji Hospital Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China; 7 Qidong Maternal and Child Health Hospital, Qidong 226299, China; 8 Chengdu Women and Children's Central Hospital, Chengdu 610073, China; 9 Hunan Children's Hospital, Changsha 410007, China;10 Co-first author
  • Received:2022-11-09 Revised:2022-08-30 Online:2022-12-25 Published:2022-12-25
  • Contact: WANG Huimei;GU Ying

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摘要： 背景 本文为“医院整体植入基于《儿童静脉输液治疗临床循证指南》的儿科静脉输液管理方案对静脉输液治疗结局影响的多中心自身前后对照试验”的背景调查。 目的 调查儿科护士静脉输液外渗/渗出相关知识、态度和行为的现状。 设计 问卷调查。 方法 以知信行理论为基础拟定了初始问卷（3个维度23个条目），通过条目分析，知识、态度与行为维度分别保留6、4和6个条目。态度和行为维度条目的内容效度为0.82~1.00，问卷水平的内容效度为0.92。态度和行为维度结构效度KMO检验系数为0.807，Bartlett检验P＜0.01，所有条目均只在一个主因子上的载荷＞0.5，态度和行为维度的Cronbach's α系数分别为0.752和0.818。选择与复旦大学附属儿科医院护理部有密切学术交流的9家医院的儿科病房工作近1年、临床工作时间＞40周、且独立或在指导下执行静脉输液的护士，采用问卷星发放和收集问卷。 主要结局指标 知识、态度和行为问卷得分。 结果 发放3 395问卷，回收2 568份，有效问卷2 210份。大学附属儿童医院、大学附属综合医院儿科、省级儿童医院、市级儿童医院和市级妇幼保健院分别占21.8%、15.9%、34.9%、11.1%和29.8%；工作≤5年、~10年、~15年和＞15年分别占35.3%、25.6%、25.6%和13.5%；职称初级、中级和高级分别占66.1%、31.6%和2.4%；责任护士、专科及带教护士和护士长分别占81.0%、14.7%和4.3%；未参加培训、仅参加科室培训、同时参加科室和医院培训、同时参加科室、医院及更高级别培训分别占2.8%、41.0%、46.7%和9.4%；仅接触外周静脉留置针、同时接触外周静脉留置针及中长导管、同时接触外周静脉和中心静脉导管装置分别占22.6%、14.9%和62.4%；仅置入外周静脉留置针、同时置入外周静脉留置针及中长导管、同时置入外周静脉和中心静脉导管装置分别为82.9%、11.1%和5.9%。知识维度总得分（1298±6.95）分，好、中、差分别占8.6%、5.5%和75.9%。态度和行为维度总得分分别为（17.23±2.58）和（23.45±4.14）。知识维度与态度维度（r=0.066）和行为维度(r=0.100)相关性检验差异有统计学意义 (P=0.002)。多元线性回归分析结果显示，医院类别、培训级别数、接触的静脉装置种类数是知识和行为维度得分的影响因素；培训级别数为态度得分的影响因素。 结论 儿科护士静脉输液外渗/渗出的知识、态度和行为未呈现知信行统一和依序而为的趋势。

关键词: 静脉外渗, 儿科护士, 知识, 态度, 行为

Abstract: Background This is a preliminary multi-center survey for the study on the impact of a pediatric infusion management program on the outcome of infusion therapy under a self-controlled pre-and post-experiment design. The management program is based on Clinical Practice Guideline on Infusion Therapy in Children. Objective To investigate the current situation of pediatric nurses′ knowledge, attitude and behavior related to infusion extravasation. Design Questionnaire survey. Methods Based on the theory of knowledge, attitude and behavior, an initial questionnaire with 23 items in 3 sections of knowledge, attitude and behavior was drawn up. After the item analysis, there were 6, 4 and 6 items kept for knowledge, attitude and behavior respectively. The content validity of the items in the attitude and behavior sections was 0.82 to 1.00, and the content validity of the questionnaire level was 0.92. KMO test coefficient of structural validity was 0.807 in attitude and behavior. The result of Bartlett test was P＜0.01 and all items are loaded on with only one main factor ＞ 0.5. The Cronbach's α coefficients of attitude and behavior sections are 0.752 and 0.818 respectively. The nurses participating in clinical work for over 40 weeks in the past year and performing infusion independently or under guidance were recruited from the pediatric wards of 9 hospitals with close academic exchanges with the Nursing Department of Children's Hospital of Fudan University to complete an electronic questionnaire through the platform of Wenjuanxing. Main outcome measures Scores of knowledge, attitude, and behavior. Results Among 3,395 sent questionnaires, 2,568 were returned, and 2,210 were valid. Among 2,210 respondents, 21.8%, 15.9%, 34.9%, 11.1% and 29.8% was respectively from the children's hospital affiliated to the university, the pediatric ward of university-affiliated general hospital, the provincial children's hospital, the municipal children's hospital and the municipal maternal and child health hospital. In terms of working experience, those who have worked for ≤5 years, 5 to 10 years, 10 to 15 years and >15 years accounted for 25.6%, 35.3%, 25.6% and 13.5% respectively. For professional titles, 66.1%, 31.6% and 2.4% of them was junior, intermediate and senior titles respectively. Charge nurses, specialists and teaching nurses, and head nurses accounted for 81.0%, 14.7% and 43% respectively. Among the respondents, 2.8% did not participate in infusion training, 41.0% only participated in a training organized by departments, 45.7% participated in both department-level and institute-level training at the same time, and 9.4% participated in the infusion training by departments, institutes and higher-level organizations at the same time. In total, 22.6% of the subjects only had used peripheral intravenous catheters; 14.9% had used both peripheral intravenous catheters and midline catheters at the same time; and 62.4% had used both peripheral venous access devices and central venous access devices at the same time. There was 82.9% only with experience in inserting peripheral intravenous catheters, 11.1% in inserting both peripheral intravenous catheters and midline catheters and 5.9% in inserting both peripheral venous access devices and central venous access devices. The total score of knowledge section was (12.98±6.95) with good, medium and poor grade accounting for 8.6%, 5.5% and 75.9% respectively. The total scores of attitude and behavior were (17.23±2.58) and （23.45±4.14) respectively. There was significant difference in the correlation test between knowledge section and attitude (r=0.066) and behavior section (r=0.100) (P=0.002). Multivariate linear regression analysis showed that hospital type, number of training levels and types of venous access devices used by nurses were the influencing factors of knowledge and behavior scores. The number of training levels is the influencing factor of attitude score of the three factors. Conclusion The knowledge, attitude and behavior of pediatric nurses about infusion extravasation did not show the trend of unity and order.

Key words: Extravasation, Pediatric nurse, Knowledge, Attitude, Behavior