Henry S B
Department of Physiological Nursing, University of California, San Francisco 94143-0604.
Heart Lung. 1991 Sep;20(5 Pt 1):478-85.
This study is an examination of the effect of patient acuity on the clinical decision making of critical care nurses (N = 68) completing two computerized clinical simulations. Ventricular tachycardia represented the high-acuity situation and atrial flutter the lower-acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure or die), and amount of data collected. Analyses of variance were conducted to examine proficiency score and the amount of data collected. Fisher's exact test and the McNemar test of homogeneity of proportions were used to examine patient outcome. In the atrial flutter simulation, proficiency scores were higher (p = 0.000), more dysrhythmias were cured (p less than 0.005), and more data were collected (p = 0.040). Experienced and inexperienced nurses did not differ on proficiency score; however, inexperienced nurses collected more data (p = 0.048) and cured fewer atrial flutter simulations (p = 0.040). Nurses certified in advanced cardiac life support had higher proficiency scores (p = 0.033) and collected fewer data (p = 0.048).
本研究旨在考察患者病情严重程度对68名完成两次计算机化临床模拟的重症监护护士临床决策的影响。室性心动过速代表高病情严重程度情况，心房扑动代表低病情严重程度情况。临床决策通过熟练度评分、患者结局（治愈或死亡）以及收集的数据量来衡量。进行方差分析以考察熟练度评分和收集的数据量。使用费舍尔精确检验和比例齐性的麦克尼马尔检验来考察患者结局。在心房扑动模拟中，熟练度评分更高（p = 0.000），更多的心律失常得到治愈（p < 0.005），并且收集了更多的数据（p = 0.040）。经验丰富和缺乏经验的护士在熟练度评分上没有差异；然而，缺乏经验的护士收集了更多的数据（p = 0.048），并且治愈的心房扑动模拟更少（p = 0.040）。获得高级心脏生命支持认证的护士有更高的熟练度评分（p = 0.033）并且收集的数据更少（p = 0.048）。
