Construction of comprehensive nursing scheme of intestinal blind intubation for ischemic stroke patients

doi:10.3761/j.issn.0254-1769.2022.06.009

Abstract

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

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

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.

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.

Figures/Tables 3

References 19

[1]	黄茂茂, 胡月, 王彬川, 等. 缺血性脑卒中康复近10年国际文献计量学及可视化分析[J]. 中国组织工程研究, 2021, 25(23):3725-3733.
	Huang MM, Hu Y, Wang BC, et al. Bibliometric and visual analysis of international literature addressing ischemic stroke rehabilitation in recent 10 years[J]. Chin J Tissue Eng Res, 2021, 25(23):3725-3733.
[2]	李燕, 崔妙玲. 脑卒中症状管理研究进展[J]. 护理研究, 2021, 35(4):648-652.
	Li Y, Cui ML. Research progress on stroke symptom management[J]. Chin Nurs Res, 2021, 35(4):648-652.
[3]	孙仁华, 江荣林, 黄曼, 等. 重症患者早期肠内营养临床实践专家共识[J]. 中华危重病急救医学, 2018, 30(8):715-721.
	Sun RH, Jiang RL, Huang M, et al. Consensus of early enteral nutrition clinical practice in critically ill patients[J]. Chin Crit Care Med, 2018, 30(8):715-721.
[4]	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke:2019 update to the 2018 guidelines for the early management of acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(12):e344-e418.
[5]	Blaser AR, Starkopf J, Kirsimägi Ü, et al. Definition,prevalence,and outcome of feeding intolerance in intensive care:a systematic review and meta-analysis[J]. Acta Anaesthesiol Scand, 2014, 58(8):914-922. DOI URL
[6]	王小玲, 蒋雪妹, 戴垚. 鼻肠管的运用及护理研究进展[J]. 中华护理杂志, 2014, 49(12):1506-1510.
	Wang XL, Jiang XM, Dai Y. The application and nursing care of nasoduodenal or nasojejunal tubes:a review[J]. Chin J Nurs, 2014, 49(12):1506-1510.
[7]	李晨露, 程云, 赵丽蓉. 提高重症病人鼻肠管盲插置管成功率的研究进展[J]. 护理研究, 2017, 31(35):4465-4468.
	Li CL, Cheng Y, Zhao LR. Research progress on increasing success rate of blind tube insertion for severe intestinal diseases patients[J]. Nurs Res China, 2017, 31(35):4465-4468.
[8]	雷燕妮, 蔡卫新, 李桂云, 等. 螺旋型鼻肠管在脑损伤患者中的幽门通过率及影响因素[J]. 中国临床营养杂志, 2008, 16(4):223-227.
	Lei YN, Cai WX, Li GY, et al. Rate and influencing factors of postpyloric migration of spiral nasojejunal tubes in brain injured patients[J]. Chin J Clin Nutr, 2008, 16(4):223-227.
[9]	屈京楼, 朱亚鑫, 曲波. 德尔菲法在医学教育研究中的应用[J]. 中华医学教育杂志, 2019, 39(3):227-230.
	Qu JL, Zhu YX, Qu B. The Dephi method and its application in medical education research[J]. Chin J Med Edu, 2019, 39(3):227-230.
[10]	Joubert C, Tiengou LE, Hourmand OI, et al. Feasibility of self-propelling nasojejunal feeding tube in patients with acute pancreatitis[J]. J Parenter Enteral Nutr, 2008, 32(6):622-624. DOI URL
[11]	胡北, 叶珩, 陈纯波, 等. 重症患者螺旋型鼻肠管幽门后置管的影响因素[J]. 中华急诊医学杂志, 2012, 21(12):1363-1366.
	Hu B, Ye H, Chen CB, et al. Factors facilitating the successful post-pyloric placement of spiral naso-jejunum tube in critically ill patients[J]. Chin J Emerg Med, 2012, 21(12):1363-1366.
[12]	Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding:techniques,problems and solutions[J]. World J Gastroenterol, 2014, 20(26):8505-8524. DOI URL
[13]	Deane AM, Fraser RJ, Young RJ, et al. Evaluation of a bedside technique for postpyloric placement of feeding catheters[J]. Crit Care Resusc, 2009, 11(3):180-183. PMID
[14]	韩梅, 薛秀娟, 邓传耀, 等. 集束化护理在脑卒中吞咽功能障碍患者鼻肠管管理中的应用[J]. 中国实用护理杂志, 2018, 34(26):2017-2021.
	Han M, Xue XJ, Deng CY, et al. Care bundles in the management of nasal intestine for the cerebral apoplexy patients with dyspinic dysfunction[J]. Chin J Prac Nurs, 2018, 34(26):2017-2021.
[15]	徐灿, 王文丽, 易容芳, 等. 神经外科重症患者应用间歇推进法盲插螺旋鼻肠管的效果研究[J]. 中华护理杂志, 2015, 50(4):439-441.
	Xu C, Wang WL, Yi RF, et al. Application of intermittent-propelling spiral nasointestinal tube insertion in critically ill neurosurgical patients[J]. Chin J Nurs, 2015, 50(4):439-441.
[16]	郑祥德, 冯清, 周文来, 等. 床旁空肠营养管徒手置入技术在危重症病人营养治疗中的应用研究[J]. 肠外与肠内营养, 2016, 23(1):41-43.
	Zheng XD, Feng Q, Zhou WL, et al. A research on bedside manual placement of jejunal feeding tube for nutritional therapy of critically ill patients[J]. Parenter Enter Nutr, 2016, 23(1):41-43.
[17]	王莹, 黄丽华, 冯志仙, 等. 基于循证和德尔菲法构建导尿管维护策略的研究[J]. 中华护理杂志, 2016, 51(2):155-160.
	Wang Y, Huang LH, Feng ZX, et al. Study on establishing urethral catheter maintenance strategies on the basis of evidence-based practice and Delphi method[J]. Chin J Nurs, 2016, 51(2):155-160.
[18]	廖琦, 桂金艳. Delphi法在护理专业中的应用进展[J]. 护理研究, 2015, 29(3):269-271.
	Liao Q, Gui JY. Application progress on Delphi method in nursing profession[J]. Chin Nurs Res, 2015, 29(3):269-271.
[19]	马珂珂, 郭园丽, 董小方, 等. 河南省护士对脑卒中患者吞咽障碍筛查与评估的现状调查[J]. 中华护理杂志, 2020, 55(8):1196-1200.
	Ma KK, Guo YL, Dong XF, et al. Current status of screening and assessment of patients with dysphagia after stroke by nurses in Henan province[J]. Chin J Nurs, 2020, 55(8):1196-1200.