Chen Xiuwen, Zhou Yang, Zhou Xia, Su Pan, Yi Jindong
Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Nurs Crit Care. 2023 Nov;28(6):967-975. doi: 10.1111/nicc.12908. Epub 2023 Apr 5.
An increasing number of studies persistently demonstrate that prone position ventilation can significantly improve the oxygenation index and blood oxygen saturation for most patients (70-80%) with acute respiratory distress syndrome (ARDS). Studies have also shown that the awake prone position was both safe and effective in helping patients with coronavirus disease 2019 (COVID-19) breathe spontaneously. However, the prone position is not widely adopted when treating patients with COVID-19 or ARDS from other causes. Basic knowledge, positive attitudes, and correct practices among the nursing staff are necessary to increase the use of prone positions, reduce the incidence of complications associated with prone positions, and improve the quality and safety of health care.
This study aimed to investigate the knowledge, attitudes, and practice of prone positioning of patients among intensive care unit (ICU) nurses working in COVID-19 units and provide suggestions for improvement.
ICU nurses were recruited from two designated tertiary hospitals for COVID-19 treatment in Shanghai, China, in April 2022, using convenience sampling. A questionnaire survey focusing on the dimensions of knowledge, attitudes, and practice of the prone position with 42 items, was conducted.
A total of 132 ICU nurses participated. The scores on the overall questionnaire and the dimensions of knowledge, attitudes, and practice of prone position were 167.28 (95% CI, 161.70-172.86), 78.35 (95% CI, 76.04-80.66), 32.08 (95% CI, 31.51-32.65), and 56.85 (95% CI, 52.42-61.28) respectively. The overall average score was 79.66% (95% CI, 0.77-0.82). The results of multiple linear regression analysis showed that prior experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position.
The ICU nurses strongly believed in the effectiveness of prone positioning, but their knowledge and practice levels need improvement. The experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Nursing managers should ensure that ICU nurses are well trained in prone positioning and help enhance the knowledge and attitudes toward prone positioning to promote its widespread use.
Clinical guidelines and in-service training modules need to be developed to promote the use of prone positioning and reduce prone position-related complications.
越来越多的研究持续表明，俯卧位通气可显著改善大多数（70%-80%）急性呼吸窘迫综合征（ARDS）患者的氧合指数和血氧饱和度。研究还表明，清醒俯卧位对帮助2019冠状病毒病（COVID-19）患者自主呼吸既安全又有效。然而，在治疗COVID-19患者或其他原因导致的ARDS患者时，俯卧位并未得到广泛应用。护理人员具备基本知识、积极态度和正确操作对于增加俯卧位的使用、降低与俯卧位相关的并发症发生率以及提高医疗质量和安全性至关重要。
本研究旨在调查在COVID-19病房工作的重症监护病房（ICU）护士对患者俯卧位摆放的知识、态度和实践情况，并提出改进建议。
2022年4月，采用便利抽样法，从中国上海两家指定的COVID-19治疗三级医院招募ICU护士。进行了一项关于俯卧位知识、态度和实践维度的问卷调查，共42个项目。
共有132名ICU护士参与。问卷总分以及俯卧位知识、态度和实践维度的得分分别为167.28（95%CI，161.70-172.86）、78.35（95%CI，76.04-80.66）、32.08（95%CI，31.51-32.65）和56.85（95%CI，52.42-61.28）。总体平均得分为79.66%（95%CI，0.77-0.82）。多元线性回归分析结果显示，既往COVID-19患者治疗经验和职称与俯卧位知识、态度和实践水平相关。
ICU护士坚信俯卧位摆放的有效性，但其知识和实践水平有待提高。既往COVID-19患者治疗经验和职称与俯卧位知识、态度和实践水平相关。护理管理者应确保ICU护士接受良好的俯卧位摆放培训，并帮助增强对俯卧位的知识和态度，以促进其广泛应用。
需要制定临床指南和在职培训模块，以促进俯卧位的使用并减少与俯卧位相关的并发症。
