Lin Sin-Ying, Hwang Shin-Tsyr, Lai Chien-Heng, Wei Tsung-Rung, Tang Yung-Yu, Lin Sih-Chi, Chuang Pao-Yu
BSN, RN, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
MSN, RN, Supervisor, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2023 Jun;70(3):66-74. doi: 10.6224/JN.202306_70(3).09.
BACKGROUND & PROBLEMS: Extracorporeal membrane oxygenation (ECMO) is an intervention that replaces cardiopulmonary function temporarily to reduce injury to vital organs. As important members of the ECMO medical team, intensive care unit nurses must be well trained and alert to possible critical events. Failure to troubleshoot and manage ECMO promptly and correctly significantly increases the risk of mortality. A previous ECMO critical event in our unit resulted in lingering concerns and stress among nurses related to implementing this intervention. A survey conducted among our medical intensive care unit (MICU) nurses identified an implementation accuracy level for ECMO critical event management of only 59.1%. This poor result was attributed to a lack of technical assessment standards, in-service training, clinical experience, and instruction materials and the failure to offer online courses.
This study was designed to increase the accuracy of ECMO critical event management implementation among intensive care unit nurses to >86%.
We conducted a problem-based training project to improve ECMO critical event management that: introduced a technical assessment sheet and technical simulation exercise, organized in-service training, implemented irregular simulation exercises, and produced multiple different instructional materials.
The accuracy of ECMO critical event management implementation among the intensive care unit nurses increased from 59.1% pretest to 95.9% posttest.
This project improved the ECMO care ability of MICU nurses in our hospital significantly, resulting in increased ECMO critical event management implementation accuracy, better patient care, higher nursing staff confidence, and lower perceived stress among nursing staff.
体外膜肺氧合（ECMO）是一种暂时替代心肺功能以减少对重要器官损伤的干预措施。作为ECMO医疗团队的重要成员，重症监护病房护士必须接受良好培训，并对可能的危急事件保持警觉。未能及时、正确地排除ECMO故障并进行管理会显著增加死亡风险。我们科室之前发生的一起ECMO危急事件导致护士在实施这项干预措施时一直存在担忧和压力。在我们的医学重症监护病房（MICU）护士中进行的一项调查发现，ECMO危急事件管理的实施准确率仅为59.1%。这一糟糕结果归因于缺乏技术评估标准、在职培训、临床经验、指导材料以及未提供在线课程。
本研究旨在将重症监护病房护士对ECMO危急事件管理实施的准确率提高到86%以上。
我们开展了一个基于问题的培训项目来改进ECMO危急事件管理，该项目：引入了技术评估表和技术模拟练习，组织了在职培训，开展了不定期模拟练习，并制作了多种不同的指导材料。
重症监护病房护士对ECMO危急事件管理实施的准确率从前测的59.1%提高到了后测的95.9%。
该项目显著提高了我院MICU护士的ECMO护理能力，提高了ECMO危急事件管理实施的准确率，改善了患者护理，增强了护理人员的信心，并降低了护理人员的感知压力。
