Cook Curtiss B, Jameson Kimberly A, Hartsell Zachary C, Boyle Mary E, Leonhardi Brenda J, Farquhar-Snow Marci, Beer Karen A
The Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona (CBC, MEB, BJL, KAB)
The Division of Planning Services, Mayo Clinic, Scottsdale, Arizona (KAJ)
Diabetes Educ. 2008 Jan-Feb;34(1):75-83. doi: 10.1177/0145721707311957.
The purpose of this study is to explore attitudes among inpatient midlevel practitioners about hospital hyperglycemia and to identify perceived barriers to care.
A questionnaire previously applied to resident physicians was administered to midlevel providers (physician assistants and nurse practitioners) to determine their beliefs about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in the hospital. Barriers to care reported in this study were also combined with responses from the prior resident survey.
Most respondents indicated that glucose control was very important in critically ill, noncritically ill, and perioperative patients. However, most felt only somewhat comfortable treating hyperglycemia and hypoglycemia and with using subcutaneous insulin; respondents expressed the least amount of confidence with using insulin infusions and insulin pumps. Respondents were not familiar with existing institutional polices and preprinted order sets relating to glucose management. The most commonly reported barrier to hyperglycemia management in the hospital was lack of familiarity with how to useinsulin, a finding that persisted after analyzing composite resident and midlevel responses.
Most midlevel providers acknowledged the importance of good glucose control in the hospital. Lack of familiarity with how to use insulin in the hospital was the most commonly cited barrier to care. Educational programs should heavily emphasize inpatient treatment strategies.
本研究旨在探讨住院中级医疗人员对医院高血糖的态度，并确定他们所感知到的护理障碍。
向中级医疗人员（医师助理和执业护士）发放一份先前应用于住院医师的问卷，以确定他们对住院患者血糖控制重要性的看法、对理想血糖范围的认知，以及他们在医院尝试管理高血糖时遇到的问题。本研究中报告的护理障碍还与先前住院医师调查的回复相结合。
大多数受访者表示，血糖控制在重症、非重症和围手术期患者中非常重要。然而，大多数人对治疗高血糖和低血糖以及使用皮下胰岛素只是感到有些得心应手；受访者对使用胰岛素输注和胰岛素泵的信心最低。受访者不熟悉与血糖管理相关的现有机构政策和预印医嘱集。在医院中，最常报告的高血糖管理障碍是不熟悉如何使用胰岛素，这一发现经过对住院医师和中级医疗人员的综合回复分析后仍然存在。
大多数中级医疗人员承认在医院进行良好血糖控制的重要性。在医院中，最常被提及的护理障碍是不熟悉如何使用胰岛素。教育项目应大力强调住院治疗策略。
