急诊科护士启动不复苏知信行现状及影响因素研究

doi:10.3761/j.issn.2096-7446.2023.09.002

摘要/Abstract

摘要： 目的调查我国急诊科护士启动不复苏（do-not-resuscitate,DNR）知识、态度、行为现状并分析其影响因素。方法通过多阶段抽样,随机抽取全国18个省、自治区、直辖市36所三级甲等医院的急诊科护士进行问卷调查。问卷包括调查对象一般资料和急诊医护人员启动不复苏知信行量表两部分构成。结果共回收有效问卷701份。知识、态度、行为维度的得分分别为（42.68±6.23）分、（44.13±6.62）分、（37.45±7.31）分,总分为（124.26±17.58）分。相关性分析结果表明,急诊科护士启动不复苏知识、态度和行为之间均存在两两相关（P<0.05）。多元线性回归分析结果显示,急诊工作年限是知识的影响因素;民族、急诊工作年限、聘用形式以及既往是否有不复苏沟通经历是态度的影响因素;民族、既往是否有不复苏沟通经历以及科室是否有不复苏相关制度是行为的影响因素。结论急诊科护士启动不复苏知识水平良好,态度和行为水平处于中等。护理管理者和教育者应建立和完善系统的不复苏教育和培训体系,从而提高急诊科护士不复苏临床沟通实践能力。

关键词: 急诊室, 医院, 护士, 不复苏, 健康知识, 态度, 实践, 现状调查

Abstract: Objective To investigate knowledge,attitude,and practice （KAP）status of initiating do-not-resuscitate （DNR）among nurses in Chinese emergency department（ED）,and analyze the related influencing factors. Methods A questionnaire survey was conducted by multi-stage sampling of ED nurses in 36 tertiary Garde A hospitals in 18 provinces（municipalities and autonomous regions）across China. The questionnaire consisted of two parts：general information of the respondents and the Knowledge-Attitude-Practice Scale of Initiating DNR among emergency medical staff. Results A total of 701 valid questionnaires were returned. The scores of knowledge,attitude and practice dimensions were （42.68±6.23）,（44.13±6.62）and （37.45±7.31）,respectively,with a total score of （124.26±17.58）. The results of correlation analysis showed that there was a two-by-two correlation between knowledge,attitude and practice of DNR initiation among ED nurses（P<0.05）. The results of multiple linear regression analysis showed that the years of working in ED was an influencing factor of knowledge;ethnicity,years of working in ED,employment type and previous experience of DNR communication were influencing factors of attitude;ethnicity,previous experience of DNR communication and the presence of DNR-related system in the department were influencing factors of practice. Conclusion ED nurses have a good level of initiating DNR knowledge and a moderate level of attitude and practice. Nursing managers and educators should establish and improve a systematic DNR education and training system so as to improve the DNR clinical communication practice of ED nurses.

Key words: Emergency Service, Hospital, Nurse, Do-Not-Resuscitate, Health Knowledge, Attitude, Practice, Cross-Sectional Studies

任英, 丁传琦, 王钰炜, 王飒, 张玉萍, 金静芬. 急诊科护士启动不复苏知信行现状及影响因素研究[J]. 中华急危重症护理杂志, 2023, 4(9): 779-784.

REN Ying, DING Chuanqi, WANG Yuwei, WANG Sa, ZHANG Yuping, JIN Jingfen. Study on the status and influencing factors of knowledge,attitude and practice of initiating do-not-resuscitate among nurses in emergency department[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(9): 779-784.

参考文献

[1] 丁传琦,金静芬,王钰炜,等. 急诊科患者不复苏应用现状及决策影响因素[J]. 中国实用护理杂志,2020,36(23):1830-1834.
Ding CQ,Jin JF,Wang YW,et al.Status quo of DNR application and influencing factors of decision-making in emergency department patients[J]. Chin J Pract Nurs,2020,36(23):1830-1834.
[2] Azizi K,Waheed S,Barolia R,et al.Understanding perceptions and factors involved in do not resuscitate(DNR）decision making in the emergency department of a low-resource country:a mixed-methods study protocol[J]. BMJ Open,2020,10(9):e038915.
[3] 蒋堂兴. 院内心脏骤停患者签署不复苏指示相关因素分析[D]. 济南:山东大学,2021.
Jiang TX.Analysis of related factors of signing non-resuscitation instructions for patients with cardiac arrest in hospital[D]. Jinan:Shandong University,2021.
[4] Hildén HM,Louhiala P,Honkasalo ML,et al.Finnish nurses' views on end-of-life discussions and a comparison with physicians' views[J]. Nurs Ethics,2004,11(2):165-178.
[5] Anderson-Shaw L.The unilateral DNR order:one hospital's experience[J]. JONAS Healthc Law Ethics Regul,2003,5(2):42-46.
[6] Richter J,Eisemann MR,Bauer B,et al.Decisions and attitudes of nurses caring for severely ill elderly patients:a culture-comparing study[J]. Pflege,1999,12(4):244-249.
[7] Khalaileh MA.Jordanian critical care nurses' attitudes toward and experiences of do not resuscitate orders[J]. Int J Palliat Nurs,2014,20(8):403-408.
[8] Purvis RJ,Law E,Still JM,et al.Nurses' attitudes toward do-not-resuscitate orders[J]. J Burn Care Rehabil,1998,19(6):538-541.
[9] 丁传琦,金静芬,王钰炜,等. 急诊医护人员启动不复苏知信行量表的编制及信效度检验[J]. 中华急危重症护理杂志,2022,3(5):396-401.
Ding CQ,Jin JF,Wang YW,et al.Development and psychometric testing of Knowledge-Attitude-Practice Scale on Initiating Do-Not-Resuscitate among emergency medical staff[J]. Chin J Emerg Crit Care Nurs,2022,3(5):396-401.
[10] 陶秋云,孙彩霞,张宇,等. 肿瘤患者口服化疗药物安全管理知信行现状调查[J]. 护理学杂志,2020,35(5):27-30.
Tao QY,Sun CX,Zhang Y,et al.Knowledge,belief,and practices of safety management of oral anticancer drugs among cancer patients[J]. J Nurs Sci,2020,35(5):27-30.
[11] Safari Malak-Kolaei F,Sanagoo A,Pahlavanzadeh B,et al. The relationship between death and do not resuscitation attitudes among intensive care nurses[J]. Omega(Westport),2022,85(4):904-914.
[12] 丁传琦,金静芬. 急诊科护士死亡态度对其临终照护态度影响的研究[J]. 中华护理教育,2020,17(3):275-278.
Ding CQ,Jin JF.The influence of death attitude on hospice care attitude among emergency nurses[J]. Chin J Nurs Educ,2020,17(3):275-278.
[13] Flannery L,Ramjan LM,Peters K.End-of-life decisions in the Intensive Care Unit(ICU)-Exploring the experiences of ICU nurses and doctors-A critical literature review[J]. Aust Crit Care,2016,29(2):97-103.
[14] Gül Ş,Bağcivan G Aksu M. Nurses' opinions on do-not-resuscitate orders[J]. Omega,2022,86(1):271-283.
[15] Chang HT,Lin MH,Chen CK,et al.Nurses' experiences and factors related to their attitudes regarding discussions with patients and family members about do-not-resuscitate decisions and life-sustaining treatment withdrawal:a hospital-based cross-sectional study[J]. Int J Environ Res Public Health,2020,17(2):557.
[16] Azmoude E,Farkhondeh F,Ahour M,et al.Knowledge,practice and self-efficacy in evidence-based practice among midwives in east Iran[J]. Sultan Qaboos Univ Med J,2017,17(1):e66-e73.
[17] Fry M,MacGregor C,Hyland S,et al. Emergency nurses' perceptions of the role of confidence,self-efficacy and reflexivity in managing the cognitively impaired older person in pain[J]. J Clin Nurs,2015,24(11/12):1622-1629.