摘要
目的 全面、系统地检索国内外关于护士发起的成年机械通气患者程序化撤机的相关研究,明确其在临床应用中的结局指标判定及有效性,并确定其在应用过程中的影响因素.方法 采用Arksey和O'Malley范围综述的方法系统检索中英文数据库,根据纳入及排除标准筛选文献,由2名研究者独立对文献进行筛选、整理和分析.结果 共纳入18篇文献,包括干预性研究7篇、质性研究4篇、横断面研究2篇、工具开发2篇、综述3篇.护士发起的程序化撤机是安全有效的,临床常用结局指标包括机械通气时间、撤机时间、ICU住院天数.护士的专业知识水平、团队合作、护士的个性特征以及医护人员低估患者的临床症状是重要的障碍因素.持续的护理、患者参与、良好的护理文化及护士角色的认识是此项治疗的促进因素.结论 未来研究应规范并细化护士发起程序化撤机的干预措施,开展大样本、高质量的研究,为我国开展护士发起的程序化撤机提供参考.
Abstract
Objective To comprehensively and systematically retrieve domestic and international research on nurse-initiated protocolized weaning in adult mechanically ventilated patients,clarify its outcome indicators and effectiveness in clinical practice,and identify influencing factors in its implementation.Methods Employing the scoping review methodology of Arksey and O'Malley,databases in both English and Chinese were systematically searched.Literature was selected based on inclusion and exclusion criteria,with two researchers independently screening,organizing,and analyzing the articles.Results Eighteen publications were included:seven interventional studies,four qualitative studies,two cross-sectional studies,two on instrument development,and three reviews.Nurse-initiated protocolized weaning was found to be safe and effective,with common clinical outcome indicators including mechanical ventilation duration,weaning time,and ICU length of stay.Significant barriers included the professional knowledge level of nurses,team cooperation,nurses'personal characteristics,and the healthcare providers'underestimation of patients'clinical symptoms.Continuous care,patient involvement,a supportive nursing culture,and recognition of the nurse's role were facilitators of this treatment.Conclusions Future research efforts should standardize and refine the intervention measures of nurse-initiated protocolized weaning and conduct large-sample,high-quality studies to provide references for the implementation of nurse-initiated protocolized weaning in China.
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