影响重症护理护士采用美国危重症护理协会（AACN）关于确认饲管放置的实践警示的因素。

Factors influencing critical care nurses' adoption of the AACN practice alert on verification of feeding tube placement.

作者信息

Bourgault Annette M, Heath Janie, Hooper Vallire, Sole Mary Lou, Waller Jennifer L, Nesmith Elizabeth G

机构信息

Annette M. Bourgault is an assistant professor at Georgia Regents University, College of Nursing in Augusta, Georgia. Janie Heath is associate dean for academic programs and Thomas A. Saunders III Endowed Professor of Nursing at University of Virginia, School of Nursing in Charlottesville. Vallire Hooper is manager of nursing research at Mission Hospital Health System in Asheville, North Carolina. Mary Lou Sole is the Orlando Health Distinguished Professor at the University of Central Florida, College of Nursing, Orlando. Jennifer L. Waller is an associate professor in the Department of Biostatistics and Epidemiology and Elizabeth G. NeSmith is an associate professor in the College of Nursing at Georgia Regents University.

出版信息

Am J Crit Care. 2014 Mar;23(2):134-44. doi: 10.4037/ajcc2014558.

DOI:10.4037/ajcc2014558

PMID:24585162

Abstract

BACKGROUND

Clinical practice guidelines are intended to bridge the research-practice gap, yet little is known about how critical care nurses adopt guidelines. Feeding tube verification practices remain variable and have led to patient harm and death.

OBJECTIVES

To examine factors influencing critical care nurses' adoption of the American Association of Critical-Care Nurses (AACN) practice alert on verification of feeding tube placement and its 4 recommended clinical practices.

METHODS

Critical care nurses were invited to participate in a national, online questionnaire, guided by Rogers' diffusion of innovation framework. Descriptive statistics and logistic regression were used for data analysis. Alpha level was set at 0.05.

RESULTS

Fifty-five percent of the 370 participating nurses were aware of the practice alert, and 45% had adopted it in practice. Only 29% of the adopters had also implemented all 4 clinical practices. Significant predictors of adoption included BSN or higher nursing education and guideline characteristics of observability and trialability. Predictors of implementation of the clinical practices included staff nurse/charge nurse role, academic medical center, research/web-based information sources, and perception of a policy. Policy was the only significant predictor of implementation of all 4 practices. Adoption of the practice alert was also a predictor for 2 of 4 clinical practices.

CONCLUSIONS

Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.

摘要

背景

临床实践指南旨在弥合研究与实践之间的差距，但对于重症护理护士如何采用指南却知之甚少。饲管验证操作仍然存在差异，并已导致患者受到伤害甚至死亡。

目的

探讨影响重症护理护士采用美国重症护理护士协会（AACN）关于饲管放置验证的实践警示及其4项推荐临床操作的因素。

方法

在罗杰斯创新扩散框架的指导下，邀请重症护理护士参与一项全国性在线问卷调查。采用描述性统计和逻辑回归进行数据分析。设定α水平为0.05。

结果

370名参与调查的护士中，55%知晓该实践警示，45%在实践中采用了它。在采用者中，只有29%也实施了所有4项临床操作。采用的显著预测因素包括护理学学士或更高的护理教育程度以及可观察性和可试验性的指南特征。临床操作实施的预测因素包括 staff nurse/charge nurse 角色、学术医疗中心、研究/基于网络的信息来源以及对政策的认知。政策是所有4项操作实施的唯一显著预测因素。采用实践警示也是4项临床操作中2项的预测因素。