Huang Miao, Li Dongxue, Zhang Chuanlai, Yang Ruiqi, Bai Xue, Gan Xiuni
Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
School of Nursing, Chongqing Medical University, Chongqing, China.
Nurs Crit Care. 2025 Jul;30(4):e70080. doi: 10.1111/nicc.70080.
Critically ill patients are prone to stress hyperglycaemia, which can negatively impact clinical outcomes at high blood glucose levels. Evidence-based blood glucose management practices to improve patient outcomes should be explored.
This pilot study aimed to implement an evidence-based glycaemic management protocol for critically ill adults and assess its impact on ICU nurses' knowledge, attitudes, behaviours as well as healthcare professionals' adherence and patient outcomes.
This quasi-experimental study included a controlled pre-post pilot study that was conducted from April to June 2023 in a general ICU. An evidence-based glycaemic management protocol was developed for critically ill adults using the Rosswurm and Larrabee model for evidence-based practice change. The study cohort ultimately comprised 48 ICU nurses who completed both pre- and post-implementation surveys and 61 patients (control group, 34; intervention group, 27). ICU nurses' knowledge, attitudes and behaviours; healthcare providers' compliance; and patients' clinical outcomes were measured to assess the effectiveness of the intervention.
After implementing the intervention, ICU nurses' knowledge, attitudes and behaviours toward glycaemic management significantly improved. Among the 38 indicators of healthcare providers' compliance, 12 showed a 0%-100% improvement rate post-implementation and 8 showed a compliance rate increase of 5.9%-66.7%. Statistically significant improvements were found in the duration of hyperglycaemia (t = 2.841, p < 0.05, 95% CI [4.15, 24.46]), time to reach target glucose levels (t = -2.215, p < 0.05, 95% CI [-12.02, -0.61]) and rate of complications (χ = 4.325, p < 0.05) among patients.
The evidence-based glycaemic management protocol for critically ill adults is feasible and effective for clinical use. The Rosswurm and Larrabee model was useful for guiding the implementation of the protocol in mainland China.
This pilot study provides a reference for blood glucose management in critically ill patients. Through structured training and procedural refinements, it facilitated the optimization of clinical workflows for glycaemic control, promoting a paradigm shift from experience-based to evidence-driven nursing practices among ICU nurses.
重症患者易出现应激性高血糖，高血糖水平会对临床结局产生负面影响。应探索基于证据的血糖管理措施以改善患者结局。
本试点研究旨在为成年重症患者实施基于证据的血糖管理方案，并评估其对重症监护病房（ICU）护士的知识、态度、行为以及医护人员的依从性和患者结局的影响。
这项准实验研究包括一项对照前后试点研究，于2023年4月至6月在一家综合ICU进行。使用罗斯沃姆和拉腊比循证实践变革模型，为成年重症患者制定了基于证据的血糖管理方案。研究队列最终包括48名完成实施前后调查的ICU护士和61名患者（对照组34名；干预组27名）。通过测量ICU护士的知识、态度和行为；医护人员的依从性；以及患者的临床结局来评估干预措施的有效性。
实施干预后，ICU护士对血糖管理的知识、态度和行为有显著改善。在医护人员依从性的38项指标中，12项在实施后改善率为0%-100%，8项依从率提高了5.9%-66.7%。患者的高血糖持续时间（t = 2.841，p < 0.05，95%可信区间[4.15, 24.46]）、达到目标血糖水平的时间（t = - 2.215，p < 0.05，95%可信区间[-12.02, -0.61]）和并发症发生率（χ = 4.325，p < 0.05）有统计学意义的改善。
成年重症患者基于证据的血糖管理方案在临床应用中是可行且有效的。罗斯沃姆和拉腊比模型有助于指导该方案在中国大陆的实施。
本试点研究为重症患者的血糖管理提供了参考。通过结构化培训和流程优化，促进了血糖控制临床工作流程的优化，推动ICU护士从经验型护理实践向循证护理实践的模式转变。
