护士胰岛素注射知信行临床实践与指南差距的调查研究

doi:10.3761/j.issn.0254-1769.2023.10.004

摘要/Abstract

摘要：

目的调查并分析护士胰岛素注射知信行临床实践与指南的差距，为进一步构建中国临床护士的胰岛素注射知信行干预方案提供依据。方法采用分层随机抽样法抽取医院，采用便利抽样法抽取护士，于2019年7月28日—8月30日采用一般资料调查表、护士胰岛素注射知信行问卷对上海市3所一级医院、7所二级医院和11所三级医院的5 550名护士进行调查。采用SPSS 26.0对知信行影响因素进行独立样本t检验、方差分析，并对知信行进行相关性分析，采用Mplus 8.3对知信行影响因素进行路径分析。结果护士胰岛素注射知信行标准分得分分别为（68.17±15.76）、（87.22±13.34）、（93.74±7.97）分。护士胰岛素注射知识与信念、知识与行为、信念与行为得分呈正相关（r=0.321、0.298、0.561，均P<0.001），性别、职称是护士胰岛素注射知识的主要影响因素；知识、医院级别、科室床位数、职称、科室、最近1次从事胰岛素注射工作的时间是护士胰岛素注射信念的主要影响因素；医院级别、学历、胰岛素注射知识、胰岛素注射信念是护士胰岛素注射行为的主要影响因素；护士胰岛素注射信念在知识和行为间起部分中介作用，总效应值为0.299，间接效应为0.163，中介效应占总效应值的54.5%。结论护士胰岛素注射知信行的临床实践与指南仍存在较大差距。护理管理者应加强对护士胰岛素注射知信行的评估，同时针对护士胰岛素注射知信行特征及影响因素采取干预措施，以提高其知信行水平。

关键词: 糖尿病, 胰岛素注射, 知信行, 影响因素分析, 路径分析, 护理

Abstract:

Objective To investigate and analyze the gap between the current clinical practice and guidelines of insulin injection knowledge，attitude and practice，and to provide a basis for further construction of an intervention program for insulin injection knowledge，attitude and practice that conform to the actual situation in China. Methods The stratified random convenience sampling method was used to investigate 5550 nurses from 3 primary，7 secondary and 11 tertiary hospitals from July 28 to August 30，2019，using the general information questionnaire and the questionnaire of nurses’ knowledge，attitude and practice on insulin injection.SPSS26.0 was used for independent sample T test，variance analysis and correlation analysis on the influencing factors of knowledge，attitude and practice，and Mplus8.3 was used to analyze the path of influencing factors of knowledge，attitude and practice. Results The scores of nurse knowledge, attitude and practice on insulin injection were 68.17±15.76，87.22±13.34 and 93.74±7.97，respectively. There was a positive correlation between nurses’ insulin injection knowledge and attitude，knowledge and practice，attitude and practice scores（r=0.321，0.298，0.561，P<0.001）. Gender and professional title were the main influencing factors of nurses’ insulin injection knowledge scores. Knowledge，hospital level，number of beds，professional title，department，and the last time you engaged in insulin injection were the main influencing factors of nurses’ attitude score of insulin injection. Hospital level，education，knowledge and belief were the main influencing factors of nurses’ insulin injection practice score. Attitude played a partially mediating role in knowledge and nurses’ insulin injection practice. The total effect value was 0.299；the indirect effect was 0.163；the intermediary effect accounted for 54.5% of the total effect value. Conclusion There is still a big gap between clinical practice and guidelines of nurse knowledge，attitude and practice on insulin injection. Nursing managers should strengthen the evaluation of hospital nurses’ knowledge，attitude and practice of insulin injection，and take intervention measures according to the characteristics and influencing factors of nurses’ knowledge，attitude and practice of insulin injection to improve their knowledge，attitude and practice.

Key words: Diabetes Mellitus, Insulin injection, Knowledge, Attitude and Practice, Root Cause Analysis, Path Analysis, Nursing Care

崔培荣, 周莹霞, 张明霞, 赵芳, 袁丽, 肖凌凤, 邢秋玲, 王群, 莫永珍. 护士胰岛素注射知信行临床实践与指南差距的调查研究[J]. 中华护理杂志, 2023, 58(10): 1178-1184.

CUI Peirong, ZHOU Yingxia, ZHANG Mingxia, ZHAO Fang, YUAN Li, XIAO Lingfeng, XING Qiuling, WANG Qun, MO Yongzhen. Investigation and research of the gap between clinical practice and guidelines of nurse knowledge, attitude and practice on insulin injection[J]. Chinese Journal of Nursing, 2023, 58(10): 1178-1184.

图/表 7

表1 调查对象的一般资料(n=5 550)

Table 1 Characteristics of the nurses(n=5 550)

表2 护士胰岛素注射知信行得分（n=5 550）

Table 2 Insulin injection knowledge，attitude，and practice scores amomg nurses（n=5 550）

表3 护士胰岛素注射知信行得分最低/错误率最高的3个条目（n=5 550）

Table 3 The 3 items with the lowest scores of insulin injection knowledge，attitude，and practice amomg nurses（n=5 550）

表4 不同特征的护士胰岛素注射知信行比较（分，$\bar{x}±s$，n=5 500）

Table 4 Comparison of insulin injection knowledge，attitude，and practice amomg nurses with different characteristics（score，$\bar{x}±s$，n=5 500）

图1 护士胰岛素注射知信行影响因素的路径分析图

Figure 1 Path analysis of influencing factors of insulin injection knowledge，attitude，and practice amomg nurses

表5 路径分析模型的拟合指标（n=5 550）

Table 5 Fitting indexs of path analysis model（n=5 550）

表6 护士胰岛素注射知信行影响因素路径分析效应分解（标准化路径系数）（n=5 550）

Table 6 Path analysis effect decomposition of factors influencing insulin injection knowledge，attitude，and practice amomg nurses（standardized path coefficient）（n=5 550）

参考文献 17

[1]	WHO. Diabetes[EB/OL]. (2022-09-16)[2023-01-28]. https://www.who.int/zh/news-room/fact-sheets/detail/diabetes.
[2]	Vilovic M, Kurir TT, Novak A, et al. Hypoglycemia and glucagon utilization in insulin-treated diabetic patients[J]. Exp Clin Endocrinol, 2020, 128(8):493-498. DOI URL
[3]	吕忠美, 杨小华, 席巍, 等. 链式管理在农村空巢老年糖尿病患者胰岛素注射中的应用研究[J]. 中华护理杂志, 2022, 57(23):2904-2911. DOI URL
	Lü ZM, Yang XH, Xi W, et al. Effect of chain management on insulin injection management ability of rural empty nest elderly diabetic patients[J]. Chin J Nurs, 2022, 57(23):2904-2911. DOI URL
[4]	袁丽, 赵芳, 张明霞, 等. 我国临床护士胰岛素注射操作实地评价现状及影响因素[J]. 护理研究, 2022, 36(11):1887-1893.
	Yuan L, Zhao F, Zhang MX, et al. Status quo and influencing factors of on-site evaluation of insulin injection operation for clinical nurses in China[J]. Chin Nurs Res, 2022, 36(11):1887-1893.
[5]	张明霞, 赵芳, 袁丽, 等. 31个省份各级医院胰岛素注射院内管理现状调查与分析[J]. 中华护理杂志, 2022, 57(5):594-601. DOI URL
	Zhang MX, Zhao F, Yuan L, et al. Investigation and analysis of the status of insulin injection management in hospitals at all levels in 31 provinces and autonomous regions[J]. Chin J Nurs, 2022, 57(5):594-601. DOI URL
[6]	刘变云, 王晶玭, 江华, 等. 三级综合医院临床护士胰岛素注射知信行水平现状及行为的影响因素分析[J]. 中华现代护理杂志, 2021, 27(11):1492-1497.
	Liu BY, Wang JP, Jiang H, et al. Status quo of knowledge,belief and practice level of insulin injection and influencing factors of practice of clinical nurses in tertiary general hospitals[J]. Chin J Mod Nurs, 2021, 27(11):1492-1497.
[7]	纪立农, 郭晓惠, 黄金, 等. 中国糖尿病药物注射技术指南(2016年版)[J]. 中华糖尿病杂志, 2017, 9(2):79-105.
	Ji LN, Guo XH, Huang J, et al. China diabetes drug injection technical guidelines(2016 edition)[J]. Chin J Diabetes Mellit, 2017, 9(2):79-105.
[8]	厉姝岑, 傅荣, 张红梅, 等. 非内分泌科护士胰岛素注射知信行现状及结构方程模型分析[J]. 中国医药导报, 2020, 17(26):161-165.
	Li SC, Fu R, Zhang HM, et al. Status quo of knowledge,attitude and behavior of insulin injection among nurses of non-endocrinology department and analysis of structural equation model[J]. China Med Her, 2020, 17(26):161-165.
[9]	Swanson JM, Chenitz C, Zalar M, et al. A critical review of human immunodeficiency virus infection:and acquired immunodeficiency syndrome-related research:the knowledge,attitudes,and practice of nurses[J]. J Prof Nurs, 1990, 6(6):341-355. PMID
[10]	Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire:the development and evaluation of a new method for assessing the cognitive representation of medication[J]. Psychol & Health, 1999, 14(1):1-24.
[11]	张苍, 胡细玲, 郭晓迪, 等. 临床护士胰岛素规范注射知信行现状及影响因素分析[J]. 全科护理, 2021, 19(12):1713-1716.
	Zhang C, Hu XL, Guo XD, et al. Analysis on the status quo and influencing factors of clinical nurses’ knowledge,attitude and practice about standardized insulin injection[J]. Chin Gen Pract Nurs, 2021, 19(12):1713-1716.
[12]	赵芳, 李彩宏, 李阳溪. 我国糖尿病专科护士的现状及发展方向[J]. 中国护理管理, 2021, 21(8):1121-1124.
	Zhao F, Li CH, Li YX. Development of diabetes specialist nurses in China[J]. Chin Nurs Manag, 2021, 21(8):1121-1124.
[13]	Wu XJ, Zhao F, Zhang MX, et al. Insulin injection knowledge,attitudes,and practices of nurses in China:a cross-sectional nationwide study[J]. Diabetes Ther, 2021, 12(9):2451-2469. DOI
[14]	陈敏华, 蓝雪芬, 陈琴芬, 等. 医联体内非糖尿病专科护士胰岛素注射优化培训的实践与评价[J]. 中国护理管理, 2021, 21(11):1666-1670.
	Chen MH, Lan XF, Chen QF, et al. Application and evaluation of optimized insulin injection training program for non-diabetic nurse specialists in a medical alliance[J]. Chin Nurs Manag, 2021, 21(11):1666-1670.
[15]	徐晶晶, 王荣, 黄晓萍, 等. 查检表在非内分泌专科护士胰岛素笔注射培训中的应用[J]. 护理学杂志, 2017, 32(21):64-66.
	Xu JJ, Wang R, Huang XP, et al. Application of checklist in insulin pens’ injection training among non-endocrine specialist nurses[J]. J Nurs Sci, 2017, 32(21):64-66.
[16]	李小云, 梁敉宁, 黄金, 等. 3119名护士新型冠状病毒肺炎相关知识现况调查与分析[J]. 中华护理教育, 2020, 17(4):324-327.
	Li XY, Liang MN, Huang J, et al. A survey of the COVID-19 knowledge in 3 119 nurses[J]. Chin J Nurs Educ, 2020, 17(4):324-327.
[17]	胡文彩, 刘刚, 袁群弟, 等. 创伤周会联合抢救视频回放对急诊护士创伤护理知信行的影响[J]. 护理实践与研究, 2022, 19(1):150-153.
	Hu WC, Liu G, Yuan QD, et al. Effect of trauma weekly meeting combined with rescue video playback on emergency nurses’ knowledge,attitude and practice of trauma care[J]. Nurs Pract Res, 2022, 19(1):150-153.