Youngquist Scott T, Henderson Deborah P, Gausche-Hill Marianne, Goodrich Suzanne M, Poore Pamela D, Lewis Roger J
Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA, USA.
Acad Emerg Med. 2008 Dec;15(12):1295-303. doi: 10.1111/j.1553-2712.2008.00262.x. Epub 2008 Oct 25.
The objectives were to determine the effect of pediatric airway management training on paramedic self-efficacy and skill performance and to determine which of several retraining methods is superior.
A total of 2,520 paramedics were trained to proficiency in pediatric bag-mask ventilation (BMV) and endotracheal intubation (ETI) on mannequins. Subjects were a convenience sample of 245 (10% of original cohort) presenting for voluntary retraining. A total of 212 of 245 (87%) completed skills testing. Self-efficacy was measured prior to and following initial training and retraining events. Paramedics were assigned to control (no retraining), videotape presentation, self-directed learning, or instructor-facilitated lecture and demonstration retraining. Following retraining, BMV and ETI skills were tested.
Paramedics from low-call-volume areas reported lower baseline self-efficacy and derived larger increases with training, but also experienced the most decline between training events. Pass rates for BMV and ETI were 66% (139/211) and 42% (88/212), respectively. However, overall cohort self-efficacy was maintained over the study period. In ordinal regression modeling, only the lecture and demonstration method was superior to control, with an odds ratio (OR) of achieving higher scores of 2.5 (95% confidence interval [CI] = 1.2 to 5.2) for BMV and 5.2 (95% CI = 2.4 to 11.2) for ETI. Poor performance with ETI but not BMV was associated with time elapsed since training (p = 0.01). Self-efficacy ratings were not predictive of skill performance.
Training provides increases in self-efficacy, particularly among paramedics from low-call-volume areas. A gap exists between self-efficacy and skill performance, in that self-efficacy may be maintained even when skill performance declines. Pediatric airway skills decay quickly, ETI skills drop off more significantly than BMV skills, and a lecture and demonstration format seems superior to other retraining methods investigated.
本研究旨在确定儿科气道管理培训对护理人员自我效能感和技能表现的影响，并确定几种再培训方法中哪种更具优势。
共有2520名护理人员在人体模型上接受培训，直至熟练掌握儿科面罩通气（BMV）和气管插管（ETI）技能。研究对象为245名（占原队列的10%）自愿参加再培训的便利样本。245名中有212名（87%）完成了技能测试。在初始培训和再培训前后分别测量自我效能感。护理人员被分配到对照组（无再培训）、录像演示组、自主学习组或由教员指导的讲座和演示再培训组。再培训后，对BMV和ETI技能进行测试。
来自低出诊量地区的护理人员报告的基线自我效能感较低，培训后提高幅度较大，但在培训期间下降幅度也最大。BMV和ETI的通过率分别为66%（139/211）和42%（88/212）。然而，在研究期间，整个队列的自我效能感得以维持。在有序回归模型中，只有讲座和演示方法优于对照组，BMV获得更高分数的优势比（OR）为2.5（95%置信区间[CI]=1.2至5.2），ETI为5.2（95%CI=2.4至11.2）。ETI表现不佳但BMV表现良好与培训后的时间间隔有关（p=0.01）。自我效能感评分不能预测技能表现。
培训可提高自我效能感，尤其是在低出诊量地区的护理人员中。自我效能感和技能表现之间存在差距，即即使技能表现下降，自我效能感仍可能维持。儿科气道技能衰退迅速，ETI技能比BMV技能下降得更显著，讲座和演示形式似乎优于所研究的其他再培训方法。
