Browning Brittan, Page Kent E, Kuhn Renee L, DiLiberto Mary Ann, Deschenes Jendar, Taillie Eileen, Tomanio Elyse, Holubkov Richard, Dean J Michael, Moler Frank W, Meert Kathleen, Pemberton Victoria L
1Office of the Senior Vice President, University of Utah, Salt Lake City, UT. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Pediatrics, University of Arizona, Tucson, AZ. 5Department of Pediatrics, University of Rochester Medical Center/Golisano Children's Hospital, Rochester, NY. 6Department of Critical Care, Children's National Medical Center, Washington, DC. 7Department of Pediatrics, University of Michigan Ann Arbor, Ann Arbor, MI. 8Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 9The Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD.
Pediatr Crit Care Med. 2016 Mar;17(3):e121-9. doi: 10.1097/PCC.0000000000000609.
To understand factors affecting nurses' attitudes toward the Therapeutic Hypothermia After Pediatric Cardiac Arrest trials and association with approach/consent rates.
Cross-sectional survey of pediatric/cardiac intensive care nurses' perceptions of the trials.
Study was conducted at 16 of 38 self-selected study sites.
Pediatric and cardiac intensive care nurses.
The primary outcome was the proportion of nurses with positive perceptions, as defined by agree or strongly agree with the statement "I am happy to take care of a Therapeutic Hypothermia after Pediatric Cardiac Arrest patient". Associations between perceptions and study approach/consent rates were also explored. Of 2,241 nurses invited, 1,387 (62%) completed the survey and 77% reported positive perceptions of the trials. Nurses, who felt positively about the scientific question, the study team, and training received, were more likely to have positive perceptions of the trials (p < 0.001). Nurses who had previously cared for a research patient had significantly more positive perceptions of Therapeutic Hypothermia After Pediatric Cardiac Arrest compared with those who had not (79% vs 54%; p < 0.001). Of the 754 nurses who cared for a Therapeutic Hypothermia After Pediatric Cardiac Arrest patient, 82% had positive perceptions, despite 86% reporting it required more work. Sixty-nine percent believed that hypothermia reduces brain injury and mortality; sites had lower consent rates when their nurses believed that hypothermia was beneficial. Institution-specific approach rates were positively correlated with nurses' perceptions of institutional support for the trial (r = 0.54; p = 0.04), ICU support (r = 0.61; p = 0.02), and the importance of conducting the trial in children (r = 0.61; p = 0.01).
The majority of nurses had positive perceptions of the Therapeutic Hypothermia After Pediatric Cardiac Arrest trials. Institutional, colleague, and study team support and training were contributing factors. Despite increased work, nurses remained enthusiastic demonstrating that studies with intensive bedside nursing procedures are feasible. Institutions whose nurses believed hypothermia was beneficial had lower consent rates, suggesting that educating nurses on study rationale and equipoise may enhance study participation.
了解影响护士对小儿心脏骤停后治疗性低温试验态度的因素，以及与入组/同意率的关联。
对儿科/心脏重症监护护士对试验的看法进行横断面调查。
在38个自行选择的研究地点中的16个进行研究。
儿科和心脏重症监护护士。
主要结局是持积极看法的护士比例，积极看法定义为同意或强烈同意“我很乐意护理小儿心脏骤停后接受治疗性低温的患者”这一陈述。还探讨了看法与研究入组/同意率之间的关联。在受邀的2241名护士中，1387名（62%）完成了调查，77%报告对试验持积极看法。对科学问题、研究团队和所接受培训持积极态度的护士，更有可能对试验持积极看法（p<0.001）。与未曾护理过研究患者的护士相比，曾护理过研究患者的护士对小儿心脏骤停后治疗性低温的看法明显更积极（79%对54%；p<0.001）。在护理过小儿童心脏骤停后接受治疗性低温患者的754名护士中，82%持积极看法，尽管86%报告这需要更多工作。69%的护士认为低温可降低脑损伤和死亡率；当护士认为低温有益时，各研究地点的同意率较低。机构特定的入组率与护士对机构对试验的支持看法（r=0.54；p=0.04）、重症监护病房（ICU）支持看法（r=0.61；p=0.02）以及在儿童中进行试验的重要性看法（r=0.61；p=0.01）呈正相关。
大多数护士对小儿心脏骤停后治疗性低温试验持积极看法。机构、同事和研究团队的支持及培训是促成因素。尽管工作量增加，但护士仍保持热情，表明伴有密集床边护理程序的研究是可行的。护士认为低温有益的机构同意率较低，这表明对护士进行研究原理和 equipoise教育可能会提高研究参与度。
