Takahashi Tomohiko, Oyama Yusuke, Sakuramoto Hideaki, Tamoto Mitsuhiro, Sato Tomoo, Nanjo Yuko, Hosoi Sayaka, Unoki Takeshi
Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
SAGE Open Nurs. 2024 Apr 7;10:23779608241245209. doi: 10.1177/23779608241245209. eCollection 2024 Jan-Dec.
Critically ill patients experience various stressful symptoms of discomfort, including dyspnea, pain, and sleep disruption. Notably, ventilated patients have difficulty self-reporting discomfort symptoms. Nurses need to assess discomfort symptoms to alleviate them, but limited research exists on discomfort symptom assessment and management in critically ill patients.
To identify the practices, attitudes, and barriers among nurses related to the assessment of discomfort symptoms in mechanically ventilated patients.
Using a cross-sectional, descriptive study design, a web-based survey was conducted between May and June 2022 with critical care nurses sampled through Japanese academic societies and social networking services. The survey contained questions relative to the above-stated objective. Descriptive statistical analysis was performed without sample size calculation because of the descriptive and exploratory nature of this study.
There were 267 respondents to the questionnaire. The discomfort symptoms that nurses perceived as important to assess were pain (median 100 [interquartile range, IQR 90-100]), insomnia (99 [80-100]), and dyspnea (96.5 [75-100]). Most participants (89.8%) routinely assessed pain in mechanically ventilated patients using a scale; however, other discomfort symptoms were assessed by less than 40% (dyspnea [28.4%], fatigue [8.1%], thirst [13.1%], insomnia [37.3%], and anxiety [13.6%]). Two major barriers to assessing discomfort symptoms were lack of assessment culture within the intensive care unit and lack of knowledge of the relevant evaluation scales.
Nurses were aware of the importance of using scales to assess the discomfort symptoms experienced by mechanically ventilated patients. However, except for pain, most nurses did not routinely use scales to assess discomfort symptoms. Barriers to routine discomfort symptom assessment included the lack of an assessment culture and the lack of knowledge of the assessment scales. Clinicians should be educated regarding the existence of validated rating scales and develop additional rating scales utilizable for minor discomforts in mechanically ventilated patients.
重症患者会经历各种令人不适的应激症状，包括呼吸困难、疼痛和睡眠中断。值得注意的是，使用呼吸机的患者难以自我报告不适症状。护士需要评估不适症状以缓解这些症状，但关于重症患者不适症状评估和管理的研究有限。
确定护士在评估机械通气患者不适症状方面的做法、态度和障碍。
采用横断面描述性研究设计，于2022年5月至6月通过日本学术团体和社交网络服务对重症护理护士进行了一项基于网络的调查。该调查包含与上述目的相关的问题。由于本研究具有描述性和探索性，因此未进行样本量计算就进行了描述性统计分析。
问卷共有267名受访者。护士认为重要的需要评估的不适症状有疼痛（中位数为100[四分位间距，IQR 90 - 100]）、失眠（99[80 - 100]）和呼吸困难（96.5[75 - 100]）。大多数参与者（89.8%）会使用量表对机械通气患者的疼痛进行常规评估；然而，其他不适症状的评估比例不到40%（呼吸困难[28.4%]、疲劳[8.1%]、口渴[13.1%]、失眠[37.3%]和焦虑[13.6%]）。评估不适症状的两个主要障碍是重症监护病房内缺乏评估文化以及对相关评估量表缺乏了解。
护士意识到使用量表评估机械通气患者所经历的不适症状的重要性。然而，除疼痛外，大多数护士并未常规使用量表评估不适症状。常规不适症状评估的障碍包括缺乏评估文化和对评估量表缺乏了解。临床医生应接受关于有效评分量表存在情况的教育，并开发适用于机械通气患者轻微不适的额外评分量表。
