实施一项关于耐甲氧西林金黄色葡萄球菌预防的患者教育干预措施及其对脊髓损伤和疾病退伍军人知识与行为的影响：一项试点随机对照试验。
Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: a pilot randomized controlled trial.
作者信息
Evans Charlesnika T, Hill Jennifer N, Guihan Marylou, Chin Amy, Goldstein Barry, Richardson Michael S A, Anderson Vicki, Risa Kathleen, Kellie Susan, Cameron Kenzie A
出版信息
J Spinal Cord Med. 2014 Mar;37(2):152-61. doi: 10.1179/2045772313Y.0000000153. Epub 2013 Oct 24.
OBJECTIVES
To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).
DESIGN
Blinded, block-randomized controlled pilot trial.
SETTING
Two Department of Veterans Affairs (VA) SCI Centers.
PARTICIPANTS
Veterans were recruited March-September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.
INTERVENTION
Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.
OUTCOME MEASURES
Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.
RESULTS
Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25-3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI -0.08-2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.
CONCLUSIONS
A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants' knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.
目的
评估由护士实施的关于耐甲氧西林金黄色葡萄球菌（MRSA）预防的患者教育干预措施对脊髓损伤和疾病（SCI/D）退伍军人的知识和行为的可行性及效果。
设计
双盲、区组随机对照试验。
地点
两个退伍军人事务部（VA）脊髓损伤中心。
参与者
2010年3月至9月，通过医疗服务提供者从住院、门诊和寄宿护理机构转介招募退伍军人。
干预措施
30名参与者被随机分配到由护士实施的干预组，31名被分配到常规护理组。干预措施包括一本宣传册和协助护士开展教育的工具。
结果指标
干预前后对与MRSA及预防策略相关的知识和行为进行测量，并对与实施相关的可行性指标进行测量。
结果
参与者主要为男性（95.1%），白人（63.9%），四肢瘫痪（63.9%），平均年龄和受伤时长分别为64.3岁和20.5年。干预组的平均知识得分在测试前和测试后显著提高（平均变化得分 = 1.70，95%置信区间，CI 0.25 - 3.15），而常规护理组的得分没有显著变化（平均变化得分 = 1.45，95%CI -0.08 - 2.98）。然而，干预组和常规护理组之间的平均知识变化没有显著差异（P = 0.81）。各治疗组的总体行为得分没有显著差异；然而，干预组更有可能报告有洗手的意愿（90.0%对64.5%，P = 0.03）以及向医护人员询问MRSA状况（46.7%对16.1%，P = 0.01）。护士教育工作者报告称，干预措施的质量很高，可以在临床护理中实施。
结论
有针对性的教育策略在SCI/D临床实践中实施是可行的，可能会提高一些参与者对MRSA的认识，并增加改善手部卫生以及就其MRSA状况与医护人员沟通的意愿。
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