缺血性脑卒中患者鼻肠管肠内盲插置管综合护理方案的构建

doi:10.3761/j.issn.0254-1769.2022.06.009

摘要/Abstract

摘要：

目的为缺血性脑卒中患者鼻肠管肠内盲插置管构建一个科学规范、可供推广的综合护理方案。方法结合文献回顾,通过半结构式访谈法、观察法和德尔菲专家咨询法,构建缺血性脑卒中患者鼻肠管肠内盲插置管综合护理方案。2020年8月—9月,开展半结构式访谈,并观察相关案例。2020年9月—12月邀请临床护理和医学、重症医学等相关领域专家进行德尔菲专家咨询。结果共访谈20名医护人员,观察案例7例,整理文字资料10万余字,录制视频325 min。分析半结构式访谈和观察资料,共得到5个核心范畴、18个分支范畴。德尔菲法共纳入15名专家,开展了2轮咨询,问卷有效回收率均为100%;咨询专家权威系数分别为0.787和0.795;肯德尔和谐系数分别为0.112和0.367（P<0.01）。第2轮咨询中,各条目变异系数为0~0.12,满分率为20%~100%。最终形成的综合护理方案包括角色功能、服务流程、核心操作规范、应急预案和实施路径5个一级维度、15个二级维度、43个要素。结论构建的缺血性脑卒中患者鼻肠管肠内盲插置管综合护理方案具有较高的科学性、针对性和可操作性,可以为缺血性脑卒中患者鼻肠管肠内盲插置管技术的推广和应用提供参考。

关键词: 缺血性脑卒中, 鼻肠管, 盲插置管, 护理方案, 德尔菲法

Abstract:

Objective The study aimed to construct a multidisciplinary,scientific,and standard comprehensive nursing scheme of intestinal blind intubation for patients with ischemic stroke.Methods Literature review,semi-structured interview,observational survey,and Delphi technique were used to construct the scheme. Semi-structured interview and observational survey were used from August to September 2020. 15 experts from clinical nursing,clinical medicine,and intensive medicine were consulted in 2 rounds of Delphi experts consultation from September to December 2020.Results After interviewing 20 experts and observing 7 cases,more than 100,000 words of textual materials and 325 minutes of videos were formed. After the analysis of materials,5 core categories and 18 categories were sorted out. 2 rounds of Delphi experts consultation were carried out,and the effective recovery rate of the questionnaire was 100%. The Delphi expert authority coefficients were 0.787 and 0.795,and the coordination coefficients were 0.112 and 0.367（P<0.01）. The coefficient of variation of each item in the second round was 0~0.12,and the full score frequency was 20%~100%. Finally,the comprehensive nursing scheme was constructed,which included 5 first-level indicators （roles and functions,standard service,core operation specification,emergency plan,and mode implementation path）,15 second-level indicators,and 43 third-level indicators.Conclusion The comprehensive nursing scheme for ischemic stroke patients was scientific,specific,and practical,which could provide references for the promotion and application of the technique of intestinal blind intubation.

Key words: Ischemic Stroke, Nasojejunal Feeding Tube, Blind Intubation, Nursing Scheme, Delphi Technique

孙璨, 胡玥, 单萍, 管颖, 孙纯. 缺血性脑卒中患者鼻肠管肠内盲插置管综合护理方案的构建[J]. 中华护理杂志, 2022, 57(6): 703-710.

SUN Can, HU Yue, SHAN Ping, GUAN Ying, SUN Chun. Construction of comprehensive nursing scheme of intestinal blind intubation for ischemic stroke patients[J]. Chinese Journal of Nursing, 2022, 57(6): 703-710.

图/表 3

表1 主轴编码结果

Table 1 The results of the main categories

表2 专家一般资料（n=15）

Table 2 General information of the experts（n=15）

表3 缺血性脑卒中患者鼻肠管肠内盲插置管综合护理方案构成要素重要性评分（第2轮）

Table 3 The scores of elements from the comprehensive nursing scheme of intestinal blind intubation for ischemic stroke patients（the second round）

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