Capital Medical University, School of Nursing, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing 100069, China.
Int J Nurs Stud. 2012 May;49(5):570-8. doi: 10.1016/j.ijnurstu.2011.10.004. Epub 2011 Oct 29.
As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature.
The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement.
A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression.
Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses.
Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses' skills.
由于心血管疾病已成为包括中国在内的许多国家的主要死因，护士越来越需要掌握技术进步和管理这一不断增加的医疗保健问题所需的技能。中国护士面临着提供熟练的心电图监测的压力，并且需要具备足够的技能来检测心肌缺血和梗死，因为在这个庞大的患者群体中。这对中国护理行业来说是一个挑战，尤其是在冠心病监护病房工作的护士，因为中国的发展非常迅速，但文献中几乎没有进行或报告过相关研究。
两个主要目的是：探讨影响中国 CCU/ICU 护士使用 ST 段监测和正确电极放置的人口统计学和教育因素；探讨影响监测和导联放置的个体和机构因素。
向 126 家随机选定的三级医院的护士发放了一份自填式问卷，这些医院按中国三个同质地区进行分层。该工具调查了人口统计学、医院信息、心电图设备、当前的实践模式以及对监测和导联放置的看法。对来自 59 家医院的 734 名护士和 59 名护士长的数据进行了 t 检验、方差分析、卡方检验和逻辑回归分析。
43.7%的受访者使用心电图监测来检测心肌缺血，35.1%根据心电图或血管造影结果选择导联。大多数（70%）认为监测急性冠状动脉综合征很重要，而 39.2%的人这样做，15.7%的人能够识别正确的导联位置。逻辑回归显示，ST 段监测的使用与医院床位数量、继续教育以及对其使用和易用性的信念之间存在显著关系。正确的电极放置与来自大学医院的受访者、急性冠状动脉综合征入院人数较多的医院和具有独立思考能力的护士显著相关。
尽管有最佳实践证据，但不到一半的样本使用心电图监测来检测心肌缺血，大多数人无法识别正确的电极放置位置，而 ST 段监测并未常规使用。本文强调了需要在大学和医院加强教育，并讨论了在单位中抑制护士技能发展的常规做法。
