经口气管插管患者口腔黏膜压力性损伤预防及管理知信行问卷的编制及信效度检验

doi:10.3761/j.issn.2096-7446.2025.04.002

摘要/Abstract

摘要：

目的编制ICU护士对经口气管插管（orotracheal intubation，OTI）患者口腔黏膜压力性损伤（oral mucosal pressure injury，OMPI）预防及管理知信行问卷并检验其信效度。方法基于知信行理论，通过文献回顾、半结构访谈、2轮德尔菲专家函询、预调查，形成问卷初稿。2024年1月-2月，便利选取441名ICU护士进行调查，利用调查数据进行项目分析、信效度检验。结果最终形成包含3个维度、36个条目的问卷。探索性因子分析4个公因子累计方差贡献率为81.330%，验证性因子分析显示，卡方自由度比为2.557，近似误差均方根为0.084，均方根残差为0.040，增值拟合指数为0.912，比较拟合指数为0.912，非规范拟合指数为0.903，模型拟合良好。问卷平均内容效度为0.993，各条目内容效度为0.875~1.000。问卷总体的Cronbach’s α系数、分半信度、重测信度分别为0.965、0.730、0.981。结论该研究编制的问卷信效度良好，可用于调查ICU护士对OTI患者OMPI预防及管理的知识、态度、行为现状。

关键词: 重症监护病房, 气管插管, 口腔黏膜, 压力性损伤, 护理, 问卷, 信度, 效度

Abstract:

Objective To develop and test the Knowledge，Attitude and Practice Questionnaire for ICU Nurses on the Prevention and Management of Oral Mucosal Pressure Injuries（OMPI） in Orotracheal Intubation（OTI） Patients. Methods Based on the theory of knowledge，attitude and practice，the first draft of the questionnaire was developed through a literature review，semi-structured interviews，2 rounds of Delphi expert correspondence，and a pre-survey. 441 ICU nurses were recruited to take the survey from January to February 2024，the items were analyzed and reliability and validity were tested. Results A final questionnaire consisting of 3 dimensions and 36 items was developed. The exploratory factor analysis revealed that the cumulative variance contribution rate of the four common factors was 81.330%. The confirmatory factor analysis demonstrated that the chi-square degrees of freedom ratio（χ²/df） was 2.557，the root mean square error of approximation（RMSEA） was 0.084，the root mean square residual（RMR） was 0.040，the incremental fit index（IFI） was 0.912，the comparative fit index（CFI） was 0.912，and Tucker-Lewis Index（TLI） was 0.903，indicating good model fit. The average content validity index（CVI） of the questionnaire was 0.993，with item-level CVIs ranging from 0.875 to 1.000. The overall Cronbach’s alpha was 0.965，with split-half reliability of 0.730 and test-retest reliability of 0.981. Conclusion The questionnaire developed in this study has good reliability and validity and is suitable for investigating the current status of ICU nurses’ knowledge，attitude and practices regarding the prevention and management of OMPI in OTI patients.

Key words: Intensive Care Unit, Endotracheal Intubation, Oral Mucosal, Pressure Injury, Nursing Care, Questionnaire, Reliability, Validity

任美霞, 赵文芳, 郝彬, 袁丽荣, 孟效红, 李嘉琪, 李育玲. 经口气管插管患者口腔黏膜压力性损伤预防及管理知信行问卷的编制及信效度检验[J]. 中华急危重症护理杂志, 2025, 6(4): 396-402.

REN Meixia, ZHAO Wenfang, HAO Bin, YUAN Lirong, MENG Xiaohong, LI Jiaqi, LI Yuling. Development and validation of the Knowledge，Attitude and Practice Questionnaire on the Prevention and Management of Oral Mucosal Pressure Injuries in Orotracheal Intubation Patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(4): 396-402.

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参考文献 23

[1]	Schank JE. The NPUAP meeting-this was No consensus conference[J]. J Am Coll Clin Wound Spec, 2015, 7(1/2/3):19-24.
[2]	Kim CH, Kim MS, Kang MJ, et al. Oral mucosa pressure ulcers in intensive care unit patients:a preliminary observational study of incidence and risk factors[J]. J Tissue Viability, 2019, 28(1):27-34.
[3]	刘迪. EICU经口气管插管患者发生相关性口腔黏膜压力性损伤的现状及影响因素分析[D]. 北京: 北京协和医学院, 2022.
	Liu D. Analysis of the current situation and influencing factors of oral mucosal pressure injury in patients with EICU orotracheal intubation[D]. Beijing: Peking Union Medical College, 2022.
[4]	唐莉, 李敏, 姚倩. 经口气管插管病人口腔黏膜压力性损伤护理的研究进展[J]. 护理研究, 2023, 37(20):3682-3686.
	Tang L, Li M, Yao Q. Research progress in nursing care of oral mucosal pressure injury in patients undergoing oral endotracheal intubation[J]. Chin Nurs Res, 2023, 37(20):3682-3686.
[5]	中华护理学会伤口、造口、失禁护理专业委员会. 器械相关压力性损伤预防指南(2020版)[J]. 中华护理杂志, 2020, 55(supplement):115-121.
	Stoma,Wound,and Incontinence Nursing Committee of Chinese Nursing Association. 2020 Guideline for prevention of device-related pressure injury[J]. Chi J Nurs, 2020, 55(supplement):115-121.
[6]	Hajhosseini B, Longaker MT, Gurtner GC. Pressure injury[J]. Ann Surg, 2020, 271(4):671-679. doi: 10.1097/SLA.0000000000003567 pmid: 31460882
[7]	Vélez-Díaz-Pallarés M, Lozano-Montoya I, Abraha I, et al. Nonpharmacologic interventions to heal pressure ulcers in older patients:an overview of systematic reviews(the SENATOR-ONTOP series)[J]. J Am Med Dir Assoc, 2015, 16(6):448-469. doi: 10.1016/j.jamda.2015.01.083 pmid: 25737261
[8]	张飞, 肖冬梅, 钟先进. PDCA在预防经口气管插管致口唇黏膜压力性损伤中的作用分析[J]. 当代临床医刊, 2021, 34(1):36,38.
	Zhang F, Xiao DM, Zhong XJ. Role of PDCA in preventing stress injury of oral mucosa caused by orotracheal intubation[J]. J Contemp Clin Med, 2021, 34(1):36,38.
[9]	Demarré L, van Lancker A, van Hecke A, et al. The cost of prevention and treatment of pressure ulcers:a systematic review[J]. Int J Nurs Stud, 2015, 52(11):1754-1774.
[10]	Wu X, Liang XY, Li Y, et al. Development and testing of the knowledge-attitudes-practices questionnaire for nurses on the perioperative pulmonary rehabilitation of patients with lung cancer[J]. Asia Pac J Oncol Nurs, 2024, 11(4):100387.
[11]	李峥, 刘宇. 护理学研究方法[M]. 北京: 人民卫生出版社, 2012:93
	Li Z, Liu Y. Nursing research methods[M]. Beijing: People’s Medical Publishing House, 2012:93.
[12]	Li Y, Chen H, Zheng YL, et al. Development and validation of an autonomy questionnaire for Chinese adolescents from the perspective of network culture[J]. Front Psychol, 2022,13:810140.
[13]	林玲, 娄湘红, 袁颖, 等. 创面自体组织移植患者自我管理知信行问卷的编制与信效度检验[J]. 护理学杂志, 2024, 39(3):45-48.
	Lin L, Lou XH, Yuan Y, et al. Development and validation of a knowledge,attitude and practice questionnaire towards self-management among patient receiving autologous skin grafting[J]. J Nurs Sci, 2024, 39(3):45-48.
[14]	Rasouli D, Norouzi A, Ramezani G, et al. A psychometric evaluation of inter-professional education competency tool in nursing and medicine students[J]. BMC Med Educ, 2024, 24(1):110.
[15]	Nie SX, Wang L. Constructing an evaluation index system for clinical nursing practice teaching quality using a Delphi method and analytic hierarchy process-based approach[J]. BMC Med Educ, 2024, 24(1):772. doi: 10.1186/s12909-024-05770-y pmid: 39030603
[16]	Chang AM, Gardner GE, Duffield C, et al. A Delphi study to validate an advanced practice nursing tool[J]. J Adv Nurs, 2010, 66(10):2320-2330. doi: 10.1111/j.1365-2648.2010.05367.x pmid: 20626481
[17]	张园, 赵亚娜, 张晓宇, 等. 血液透析患者饮食知信行问卷的编制及信效度检验[J]. 中华护理教育, 2023, 20(4):409-414.
	Zhang Y, Zhao YN, Zhang XY, et al. Development and validation of Dietary KAP Questionnaire for hemodialysis patients[J]. Chin J Nurs Educ, 2023, 20(4):409-414.
[18]	Martinez-Gonzalez D, Dòria M, Martínez-Alonso M, et al. Adaptation and validation of the diabetic foot ulcer scale-short form in Spanish subjects[J]. J Clin Med, 2020, 9(8):2497.
[19]	Wang H, Dai ZW, Jing S, et al. Psychometric properties of the Short-Form Five Facets of Mindfulness Questionnaire among nursing students in China:a confirmatory factor analysis[J]. Nurs Open, 2024, 11(7):e2246.
[20]	Fitzgerald S, McTier L, Whitehead C, et al. Inter-rater reliability of descriptors for the classification of mucosal pressure injury:a prospective cross-sectional study[J]. Aust Crit Care, 2023, 36(2):179-185.
[21]	Choi BK, Kim MS, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units:a prospective observational study[J]. J Tissue Viability, 2020, 29(4):252-257.
[22]	Zhang YB, He L, Gou L, et al. Knowledge,attitude,and practice of nurses in intensive care unit on preventing medical device-related pressure injury:a cross-sectional study in Western China[J]. Int Wound J, 2021, 18(6):777-786.
[23]	Chen G, Li XQ, Li XZ, et al. Mucosal membrane pressure injury in intensive care units:a scoping review[J]. Intensive Crit Care Nurs, 2024,80:103560.