Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia.
Faculty of Education, Centre of Education Leadership and Policy, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
Front Public Health. 2021 Nov 12;9:726647. doi: 10.3389/fpubh.2021.726647. eCollection 2021.
Cardiothoracic intensive care unit (CICU) nurses have shared the role and responsibility for ventilator-weaning to expedite decision-making in patient care. However, the actions taken are based on individual's unstructured training experience as there is no clinical practice guideline (CPG) for nurses in Malaysia. Hence, this study aims to design a CPG for the process of weaning from mechanical ventilation (MV) for a structured nursing training in a CICU at the National Heart Institute (, IJN) Malaysia. The Fuzzy Delphi Method (FDM) was employed to seek consensus among a panel of 30 experts in cardiac clinical practice on the guidelines. First, five experts were interviewed and their responses were transcribed and analyzed to develop the items for a FDM questionnaire. The questionnaire, comprising of 73 items, was distributed to the panel and their responses were analyzed for consensus on the design of the CPG. The findings suggested that the requirements expected for the nurses include: (a) the ability to interpret arterial blood gases, (b) knowledge and skills on the basics of mechanical ventilation, and (c) having a minimum 1-year working experience in the ICU. On the other hand, the CPG should mainly focus on developing an ability to identify criteria of patient eligible for weaning from MV. The learning content should focus on: (a) developing the understanding and reasoning for weaning and extubating and (b) technique/algorithm for extubating and weaning. Also, the experts agreed that the log book/competency book should be used for evaluation of the program. The CPG for structured nursing training at IJN in the context of the study is important for developing the professionalism of CICU nurses in IJN and could be used for training nurses in other CICUs, so that decision for ventilator-weaning from postcardiac surgery could be expedited.
心胸重症监护病房（CICU）护士共同承担呼吸机脱机的角色和责任，以加快患者护理的决策过程。然而，由于马来西亚没有针对护士的临床实践指南（CPG），因此所采取的措施是基于个人非结构化的培训经验。因此，本研究旨在为马来西亚国家心脏研究所（IJN）的 CICU 制定一项用于机械通气（MV）脱机过程的 CPG，为护士提供结构化的培训。采用模糊德尔菲法（FDM）在心脏临床实践方面的 30 名专家小组中寻求共识，以制定指南。首先，对 5 名专家进行了访谈，将他们的答复转录并进行分析，以制定 FDM 问卷的项目。该问卷共包含 73 个项目，分发给专家组，分析他们对 CPG 设计的共识。结果表明，对护士的要求包括：（a）能够解释动脉血气，（b）掌握机械通气基础知识和技能，（c）在 ICU 工作至少 1 年。另一方面，CPG 应主要侧重于培养识别符合 MV 脱机条件的患者的能力。学习内容应侧重于：（a）培养脱机和拔管的理解和推理，（b）拔管和脱机的技术/算法。此外，专家们还一致认为，应使用日志本/能力手册来评估该计划。在研究背景下，IJN 用于结构化护理培训的 CPG 对于提高 IJN CICU 护士的专业水平非常重要，也可用于培训其他 CICU 的护士，以便加快心脏手术后呼吸机脱机的决策。
