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[JAMA发表论文]: 包括模拟的多模态计划对ICU护士工作压力的影响
2018年11月29日 时讯速递, 进展交流 暂无评论

Original Investigation

Caring for the Critically Ill Patient

November 20, 2018

Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial

Radia El Khamali, Atika Mouaci, Sabine Valera, et al

JAMA. 2018;320(19):1988-1997. doi:10.1001/jama.2018.14284

Abstract

Importance 背景

Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.

在ICU工作的护士暴露在多种职业应激因素下,能够增加应激反应、长期缺勤及员工流动。

Objective 目的

To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.

评价包括模拟的计划减少ICU护士工作相关应激及工作相关结局的作用。

Design, Setting, and Participants 设计,场景及研究人群

Multicenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.

2016年2月8日至2017年4月29日间,在法国8个成人ICU进行的多中心随机临床试验。共纳入198名ICU护士,随访一年只知2018年4月30日结束。

Interventions 干预措施

The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices.

至少有6个月ICU工作经验的护士随机分为干预组(n = 101)和对照组(n = 97)。随机分至干预组的护士接受5天的课程,包括护理理论概述,模拟场景下的角色扮演(基于技术熟练度,临床方法,决策,团队协作能力,任务优先度等),以及随后的态度报告及行为讨论。

Main Outcomes and Measures 主要预后指标

The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.

主要预后终点为采用工作内容量表综合心理需求评分> 21分(评分范围9[最佳]至36[最差])及决策纬度评分< 72分(评分范围24[最差]至96[最佳])评价的工作压力发生率,在6个月时进行评估。共有7项次要指标包括缺勤及人员流失。

Results 结果

Among 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04).

共有198名ICU护士接受随机分组(95人年龄 ≤ 30 岁 [48%] 且 115 名女性 [58%]),182人 (92%) 完成主要预后终点评估。在入选198名研究对象后,根据计划进行的中期分析显示干预措施具有显著效果,因而终止试验。干预组6个月时工作压力发生率显著低于对照组(分别为13% vs 67%;组间差异,54% [95% CI,40%-64%];P < .001)。在6个月随访期间干预组缺勤率为1%,对照组为8%(组间差异,7% [95% CI,1%-15%];P = .03)。6个月随访期间,干预组4名护士 (4%) 离开ICU,对照组12 名护士 (12%) 离开(组间差异,8% [95% CI, 0%-17%];P = .04)。

Conclusions and Relevance 结论与意义

Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.

对于ICU护士,接受包括教育、角色扮演及总结报告的干预措施能够减少6个月时的工作压力。需要进一步研究了解具体何种措施造成上述结果,并评估这些干预措施的成本效益。

Trial Registration 试验注册

ClinicalTrials.gov Identifier: NCT02672072

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