以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (21): 51-55.doi: 10.16460/j.issn1008-9969.2020.21.051

• 调查研究 • 上一篇    下一篇

儿科ICU护士肠内营养相关决策行为的现况调查

胡家杰1, 李梅2a, 温尊甲2b, 严萍2c, 曹金金2d, 徐邦红2e, 徐京2e, 任蕾2a   

  1. 1.南京医科大学第四临床医学院,江苏 南京 210008;
    2.南京医科大学附属儿童医院 a.护理部;b.外科重症监护室;c.新生儿外科;d.消化内科;e.心脏重症监护室,江苏 南京 210008
  • 收稿日期:2020-02-23 出版日期:2020-11-10 发布日期:2020-12-15
  • 通讯作者: 李梅（1969-）,女,江苏南京人,本科学历,主任护师,硕士研究生导师。E-mail：limeilimei6868@126.com
  • 作者简介:胡家杰（1996-）,女,湖南常德人,本科学历,硕士研究生在读,护士。

Enteral Nutrition-related Decision-making Behavior of Pediatric ICU Nurses

HU Jia-jie1, LI Mei2a, WEN Zun-jia2b, YAN Ping2c, CAO Jin-jin2d, XU Bang-hong2e, XU Jing2e, REN Lei2a   

  1. 1. The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing 210008,China;
    2a.Dept. of Nursing Administration; 2b.Surgical Intensive Care Unit; 2c.Dept. of Neonatal Surgery; 2d.Dept. of Gastroenterology; 2e.Cardiac Care Unit, Children's hospital of Nanjing Medical University, Nanjing 210008, China
  • Received:2020-02-23 Online:2020-11-10 Published:2020-12-15

PDF (PC)

365

赞

摘要： 目的 调查儿科ICU护士肠内营养相关决策行为的现状,为推进儿科ICU肠内营养管理的发展提供参考。方法 采用便利抽样法,于2020年1月抽取南京市儿童医院NICU、PICU、CCU、SICU的护士作为研究对象,采用“儿科ICU护士肠内营养相关决策行为问卷”对其进行调查。结果 共发放177份问卷,有效回收142份。仅有57.0%的护士熟知本科室的肠内营养护理流程;胃管留置长度和位置核实方法方面,高达54.2%~94.4%的护士依旧采用传统方法;喂养不耐受监测方面,91.5%的护士每次喂养前都评估胃残留量,当问及如何处理胃残留时,高达60.6%的护士将胃残留全部丢弃;本调查还发现仅有7.0%的护士总是主动采取非药物方式预防或减少喂养不耐受的发生与发展。结论 儿科ICU护士肠内营养的实施与护理措施大多沿用传统方法,欠缺对新方法的学习与探索。建议加强儿科ICU肠内营养相关指南和新理念的培训,制定科学严谨的肠内营养实施与操作流程,规范护理行为,加强营养专科护理人才的培养,营造良好的工作氛围以提高儿科ICU护士工作主动性,从而优化危重患儿肠内营养的管理。

关键词: 儿科, ICU, 护士, 肠内营养, 现况调查

Abstract: Objective To investigate the status quo of enteral nutrition-related behaviors in pediatric ICU nurses, and to provide reference for the development of enteral nutrition management. Methods With convenient sampling, nurses from NICU, PICU, CCU and SICU were selected and surveyed by a self-designed questionnaire on enteral nutrition-related decision-making behavior of pediatric ICU nurses in January 2020. Results We obtained 142 out of 177 questionnaires and only 57.0% of the nurses were familiar with the nursing process of enteral nutrition in the department. In terms of measuring the length and verifying the position of gastric tube, 54.2%~94.4% of the nurses still adopted traditional method and 91.5% of the nurses assessed gastric residual volume before each feeding. When asked how to deal with gastric residual volume, 60.6% of the nurses discarded all of them. Our investigation also found that only 7.0% of the nurses always took the initiative to prevent or reduce the occurrence and development of feeding intolerance. Conclusion Generally, traditional approaches to enteral nutrition were adopted in pediatric ICU, and there are insufficient learning and exploration about new methods. More training of guidelines and new concepts, scientific enteral nutrition implementation procedures, standardized nursing behaviors, cultivation of nutrition specialist nurses, and good work atmosphere are beneficial to improving the initiative of nurses, thus to optimize the management of enteral nutrition in critically ill children.

Key words: pediatric, ICU, nurse, enteral nutrition, status survey

中图分类号: 

  • R473.72
[1] Grippa RB, Silva PS, Barbosa E, et al.Nutritional Status As a Predictor of Duration of Mechanical Ventilation in Critically Ill Children[J]. Nutrition, 2017,33:91-95.DOI:10.1016/j.nut.2016.05.002.
[2] Costa CAD, Garcia PCR, Cabral DD, et al.Reducing Malnutrition in Critically Ill Pediatric Patients[J]. Revista Brasileira de Terapia Intensiva, 2018, 30(2):160-165. DOI:10.5935/0103-507X.20180034.
[3] 于康,孙文彦. 护理人员在营养风险筛查中的作用[J]. 中国护理管理, 2020,20(3):324-327.DOI:10.3969/j.issn.1672-1756.2020.03.003.
[4] 詹昱新,杨中善,李素云,等. 基于循证构建住院患者肠内营养护理质量评价指标体系[J]. 护理学报, 2019,26(10):26-31.DOI:10.16460/j.issn1008-9969.2019.10.026.
[5] Mehta NM, Skillman HE, Irving SY, et al.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J]. JPEN,2017,41(5):706-742.DOI:10.1097/PCC.0000000000001134.
[6] Dutta S, Singh B, Chessell L, et al.Guidelines for Feeding Very Low Birth Weight Infants[J]. Nutrients, 2015, 7(1): 423-442.DOI:10.3390/nu7010423.
[7] 丁国芳. 极低出生体重儿尽早达到足量肠内营养喂养策略——《极低出生体重儿喂养指南》解读[J]. 中国实用儿科杂志, 2016,31(2):85-89.
[8] 李菁菁,王莹. 危重症儿童营养筛查及营养评定的研究进展[J]. 中华临床营养杂志, 2014,22(2):106-111.DOI:10.3760/cma.j.issn.1674-635X.2014.02.008.
[9] Santos SC, Woith W, Freitas MI, et al.Methods to Determine the Internal Length of Nasogastric Feeding Tubes: An Integrative Review[J]. Int J Nurs Stud, 2016, 61:95-103.DOI:10.1016/j.ijnurstu.2016.06.004.
[10] Irving SY, Rempel G, Lyman B, et al.Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations from the NOVEL Project[J]. Nutr Clin Pract, 2018,33(6):921-927.DOI:10.1002/ncp.10189.
[11] Mordiffi SZ, Goh ML, Phua J, et al.Confirming Nasogastric Tube Placement: Is the Colorimeter as Sensitive and Specific as X-Ray? A Diagnostic Accuracy Study[J]. Int J Nurs Stud, 2016, 61:248-257.DOI:10.1016/j.ijnurstu.2016.06.011.
[12] Atalay YO, Polat AV, Ozkan EO, et al.Bedside Ultrasonography for the Confirmation of Gastric Tube Placement in the Neonate[J]. Saudi J Anaesth, 2019,13(1):23-27.DOI:10.4103/sja.SJA_413_18.
[13] Parker LA, Weaver M, Murgas Torrazza RJ, et al.Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants[J]. JAMA Pediatrics, 2019,173(6):534.DOI:10.1001/jamapediatrics.2019.0800.
[14] 吕天婵,张玉侠. 早产儿胃潴留管理相关研究进展[J]. 中国护理管理, 2015,15(12):1525-1528.DOI:10.3969/j.issn.1672-1756.2015.12.030.
[15] Baldassarre ME, Di Mauro A, Montagna O, et al.Faster Gastric Emptying is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial[J]. Nutrients, 2019,11(7):1670.DOI:10.3390/nu11071670.
[16] Parker LA, Weaver M, Murgas Torrazza RJ, et al.Effect of Aspiration and Evaluation of Gastric Residuals on Intestinal Inflammation, Bleeding, and Gastrointestinal Peptide Level[J]. The Journal of Pediatrics, 2019. DOI:10.1016/j.jpeds.2019.10.036.
[17] Emami ZA, Sharafkhani M, Armat MR.Gastric Residual Volume[J]. Critical Care Nursing Quarterly, 2016,39(4):387-388.DOI:10.1097/CNQ.0000000000000132.
[18] 米元元,沈月,黄海燕,等. ICU患者肠内营养并发腹泻证据汇总[J]. 护理学报, 2017,24(21):58-66.DOI:10.16460/j.issn1008-9969.2017.21.058.
[19] Uysal N, Mete S.Comparison of Two Different Methods for the Measurement of Gastric Residual Volume[J].Gastroenterology Nursing, 2017, 40(4):300-305.DOI:10.1097/SGA.0000000000000165.
[20] Kar P, Jones KL, Horowitz M, et al.Measurement of Gastric Emptying in the Critically Ill[J]. Clinical Nutrition, 2015, 34(4):557-564.DOI:https://doi.org/10.1016/j.clnu.2014.11.003.
[21] 郑伟,赵琴,徐珊玲,等. 超声监测胃残留量在ICU患者经鼻胃管肠内营养中的应用[J]. 中国实用护理杂志, 2019,35(15):1173-1175. DOI:10.3760/cma.j.issn.1672-7088.2019.15.012.
[22] 卜凡莉,梁枫,王珂,等. 对ICU行肠内营养支持患者胃残留量监测相关系统评价的再评价[J]. 护理学报, 2019,26(5):25-29.DOI:10.16460/j.issn1008-9969.2019.05.025.
[23] Wen Z, Xie A, Peng M, et al.Is Discard Better Than Return Gastric Residual Aspirates: A Systematic Review and Meta-analysis[J]. BMC Gastroenterol, 2019,19(1):113.DOI:10.1186/s12876-019-1028-7.
[24] Eveleens RD, Joosten KFM, De Koning BAE, et al.Definitions, Predictors and Outcomes of Feeding Intolerance in Critically Ill Children: A Systematic Review[J]. Clin Nutr, 2020,39(3):685-693.DOI:10.1016/j.clnu.2019.03.026.
[25] Thomas S, Nesargi S, Roshan P, et al.Gastric Residual Volumes Versus Abdominal Girth Measurement in Assessment of Feed Tolerance in Preterm Neonates[J]. Advances in Neonatal Care, 2018,18(4):E13-E19.DOI:10.1097/ANC.0000000000000532.
[26] Tume LN, Valla FV.A Review of Feeding Intolerance in Critically Ill Children[J]. European Journal of Pediatrics, 2018,177(11):1675-1683.DOI:10.1007/s00431-018-3229-4.
[27] Fanaro S.Feeding Intolerance in the Preterm Infant[J]. Early Human Development,2013,89:S13-S20.DOI:10.1016/j.earlhumdev.2013.07.013.
[1] 田美雨, 王翠玲, 高若男, 田佳, 刘怡. 妇科肿瘤科护士性健康照护培训方案的构建[J]. 护理学报, 2025, 32(4): 18-23.
[2] 彭琦, 吴婉英, 谢玲女. 造口伤口失禁专科护士培训中基于ADDIE模型案例教学的实践及效果评价[J]. 护理学报, 2025, 32(4): 24-27.
[3] 吴超瑜, 刘尚昆. 麻醉恢复室护士危机管理能力的质性研究[J]. 护理学报, 2025, 32(3): 17-21.
[4] 郝瑞霞, 王秀梅, 蔚玲, 郭越, 张学. 磁性医院管理理念对手术室护士出勤主义行为的影响[J]. 护理学报, 2025, 32(3): 27-31.
[5] 焦雪萍, 王志稳, 韩舒羽. ICU老年患者躁动行为的干预研究进展[J]. 护理学报, 2025, 32(3): 38-42.
[6] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[7] 李雪, 廖常菊, 张健, 丁娟, 陈晓丽, 胡玉庭. 三级甲等医院ICU护士睡眠障碍的风险预测模型构建及验证[J]. 护理学报, 2025, 32(2): 63-69.
[8] 李静依, 梁冠冕, 缪群芳, 赵月琰, 王晓宁, 钱萍萍. 临床护士死亡工作自我应对能力潜在剖面及影响因素研究[J]. 护理学报, 2025, 32(1): 13-18.
[9] 刘畅, 张维, 王翠雪, 岳鹏. ICU实施非限制性探视制度的影响因素研究进展[J]. 护理学报, 2025, 32(1): 34-38.
[10] 王子萱, 原振青, 赵一鋆, 王惠平, 洪菲菲, 邹敏. 体面劳动感在三级甲等医院手术室护士反思能力与创新行为的中介效应[J]. 护理学报, 2025, 32(1): 62-67.
[11] 陈杰, 赖静, 王城阅, 徐良英, 晏娟, 罗雪. 基于三维质量结构理论的ICU护理人文关怀质量评价指标体系的构建[J]. 护理学报, 2024, 31(9): 54-59.
[12] 黄佳颖, 张静, 梁丽婵, 孟江南, 叶红雨, 王为杰, 史蕾. 简版儿科症状筛查工具的汉化及在4~7岁癌症患儿中的信效度检验[J]. 护理学报, 2024, 31(8): 55-59.
[13] 徐晓东, 刘顺梅, 赵瑄, 丁秀娜. 显微根尖外科手术护士核心能力评价指标的构建[J]. 护理学报, 2024, 31(8): 69-73.
[14] 马瑞瑞, 范晓莉, 徐姝娟, 张伟, 陈婷, 谈飞飞. 护士参与终末期患者临终决策体验的质性研究[J]. 护理学报, 2024, 31(7): 6-11.
[15] 龙瑶, 卢春凤, 冯志仙. 临床护士对横向领导者特质感知的质性研究[J]. 护理学报, 2024, 31(7): 27-31.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!