一项旨在协助护士与无语言能力患者沟通的干预措施前后，机械通气患者的护理质量和资源利用情况。

Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication.

作者信息

Happ Mary Beth, Sereika Susan M, Houze Martin P, Seaman Jennifer B, Tate Judith A, Nilsen Marci L, van Panhuis Jennifer, Scuilli Andrea, Baumann Brooke M, George Elisabeth, Angus Derek C, Barnato Amber E

机构信息

The Ohio State University College of Nursing, Columbus, OH, USA; The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.

Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.

出版信息

Heart Lung. 2015 Sep-Oct;44(5):408-415.e2. doi: 10.1016/j.hrtlng.2015.07.001.

DOI:10.1016/j.hrtlng.2015.07.001

PMID:26354859

Abstract

OBJECTIVES

Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS).

BACKGROUND

SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown.

METHODS

Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction.

MAIN RESULTS

323/383 (84%) nurses completed training; their communication knowledge (p < .001) and satisfaction and comfort (p < .001) increased. ICU days with physical restraint use (p = .44), heavy sedation (p = .73), pain score documentation (p = .97), presence of ICU-acquired pressure ulcers (p = .78), coma-free days (p = .76), ventilator-free days (p = .83), ICU length of stay (p = .77), hospital length of stay (p = .22), and median costs (p = .07) did not change.

CONCLUSIONS

SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use.

摘要

目的

实施并测试全科室患者-护士辅助沟通策略（SPEACS）。

背景

SPEACS改善了护士与患者的沟通效果；但其对患者护理质量和资源利用的影响尚不清楚。

方法

2009年至2011年，在2家教学医院的6个重症监护病房（ICU）对1440名通气≥2天且至少清醒一个班次的成年患者进行前瞻性、随机阶梯楔形实用试验，并采用盲法回顾性病历摘要。

主要结果

323/383（84%）名护士完成了培训；他们的沟通知识（p <.001）以及满意度和舒适度（p <.001）均有所提高。使用身体约束的ICU天数（p =.44）、深度镇静天数（p =.73）、疼痛评分记录（p =.97）、发生ICU获得性压疮的情况（p =.78）、无昏迷天数（p =.76）、无呼吸机天数（p =.83）、ICU住院时间（p =.77）、医院住院时间（p =.22）和中位数费用（p =.07）均未改变。