Chow Kai Ming, Szeto Cheuk Chun, Law Man Ching, Fun Fung Janny Suk, Kam-Tao Li Philip
Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China.
Clin J Am Soc Nephrol. 2007 Jul;2(4):647-52. doi: 10.2215/CJN.03981206. Epub 2007 Apr 25.
This study examined the clinical impact of peritoneal dialysis (PD) training nurses regarding Gram-positive peritonitis among incident dialysis patients.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This study included 200 consecutive inception PD patients in a single center from September 1999 through April 2003. Effects of PD nurse trainers on the clinical outcomes of Gram-positive peritonitis were evaluated.
A total of 81 patients of 200 incident PD patients (mean age 56.9 yr) developed Gram-positive peritonitis. Mean Gram-positive peritonitis-free time for patients who were trained by nurses with years of experience in the lowest tertile was 58.8 mo, as compared with 47.0 mo in those who were trained by nurses within the intermediate tertile of experience (log-rank test, P = 0.044). After adjustment for diabetes and relevant coexisting medical factors, PD trainers' having > or =3 yr of experience, body mass index, and baseline serum albumin were the only independent risk factors for the time to a first Gram-positive peritonitis. Training nurses with > or =3 yr of experience was associated with more than two-fold increased likelihood of subsequent Gram-positive peritonitis, with an adjusted hazard ratio of 2.24 (95% confidence interval [CI] 1.14 to 4.41; P = 0.020). When the lowest tertile group of trainers was used as the reference group in the Cox proportional hazards regression model, the hazard ratio was 1.94 (95% CI 1.04 to 3.61) for the intermediate tertile and 2.13 (95% CI 1.12 to 4.06) for the highest tertile. Experience of the PD trainers was not predictive of Gram-negative peritonitis.
The finding of negative association between the trainers' length of time in practice and peritonitis incidence reminds us that active continued learning and applying principles of adult learning might be the answers for the nurses to teach the patients.
本研究探讨了腹膜透析（PD）培训护士对新入透析患者革兰氏阳性腹膜炎的临床影响。
设计、地点、参与者及测量方法：本研究纳入了1999年9月至2003年4月在单一中心连续入选的200例初始PD患者。评估了PD护士培训师对革兰氏阳性腹膜炎临床结局的影响。
200例初始PD患者（平均年龄56.9岁）中共有81例发生革兰氏阳性腹膜炎。由经验处于最低三分位数的护士培训的患者，其平均无革兰氏阳性腹膜炎时间为58.8个月，而由经验处于中间三分位数的护士培训的患者为47.0个月（对数秩检验，P = 0.044）。在对糖尿病及相关并存医学因素进行校正后，PD培训师有≥3年经验、体重指数和基线血清白蛋白是首次发生革兰氏阳性腹膜炎时间的仅有的独立危险因素。由经验≥3年的护士培训与随后发生革兰氏阳性腹膜炎的可能性增加两倍以上相关，校正后的风险比为2.24（95%置信区间[CI] 1.14至4.41；P = 0.020）。在Cox比例风险回归模型中，以培训师最低三分位数组作为参照组时，中间三分位数组的风险比为1.94（95% CI 1.04至3.61），最高三分位数组为2.13（95% CI 1.12至4.06）。PD培训师的经验不能预测革兰氏阴性腹膜炎。
培训师从业时间与腹膜炎发生率之间呈负相关这一发现提醒我们，积极持续学习并应用成人学习原则可能是护士教导患者的答案。
