Sowan Azizeh K, Vera Ana G, Fonseca Elma I, Reed Charles C, Tarriela Albert F, Berndt Andrea E
School of Nursing, University of Texas Health, San Antonio, 7703 Floyd Curl Dr. - MC 7975, TX 78229, USA.
University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA.
Open Med Inform J. 2017 Apr 14;11:1-11. doi: 10.2174/1874431101711010001. eCollection 2017.
Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses' perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose.
This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors' features. Thirty nurses from 4 adult ICUs were invited to respond to the survey.
Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales' scores and demographic characteristics ( > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users' needs.
This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.
关于护士警报管理能力的研究较少，且往往集中在有限的技能方面。为响应国家患者安全目标中关于临床警报系统安全的第二阶段要求，本研究评估了护士在重症监护病房（ICU）使用生理监测仪方面的感知能力，并为此开发并验证了一种工具。
这项描述性研究在美国西南部一个州的一家磁铁医院进行。创建了一份《飞利浦生理监测仪使用护士能力调查问卷》，并由13名ICU专家护士进行了验证。该调查包括5个分量表，共59个评分项目和两个开放式问题。前4个分量表上的项目反映了护士使用生理监测仪执行的最常见任务。第五个分量表（高级功能）上的项目反映了很少使用的技能，纳入这些项目是为了了解利用高级生理监测仪功能的范围。邀请了来自4个成人ICU的30名护士参与该调查。
30名护士（100%）回复了调查。大多数护士来自神经科（47%）和外科创伤科（37%）ICU。数据支持了该调查的高可靠性和结构效度。至少有1名护士（3%）至8名护士（27%）表示对调查中的每个项目缺乏信心。在前四个分量表上，3%至40%的护士表示他们从未听说过或使用过监测仪上的27种功能。各分量表得分与人口统计学特征之间未发现相关性（P＞0.05）。护士们要求提供关于操作中央站监测仪和排除警报故障的培训，以及利用科室特定的超级用户根据用户需求定制培训。
这是第一项创建并测试生理监测仪使用能力清单的研究。严格、定期且个性化的培训对于安全、恰当地使用生理监测仪以及减少警报疲劳至关重要。培训应全面，涵盖所有必要技能，且不应假定护士具备基本技能的熟练程度。应特别关注处理技术警报。增加超级用户数量是进行个性化和科室特定培训的推荐策略。对于配备复杂信息技术的医疗设备，如生理监测仪进行可用性测试，以实现对监测仪的有效、高效和安全操作，是很有必要的。
