Study On The Construction Of Training Curriculum Content Of Unplanned Extubation Precaution For Nurse Based On Nursing Risk Management Theory

Objective: To construct a training curriculum content of unplanned extubation precaution for nurse based on the theory of nursing risk management,and guided by the experts,which providing theoretical basis for the training for clinical nurses.Methods:Part One:(1)Overviews of systematic reviews: The databases of CNKI,WANFANG,VIP,Sino Med,Pub Med,Embase,Medline,Cochrane Library were searched for unplanned extubation risk factors.AMSTAR was used to assessed the quality of included studies and GRADE system was used to grade the evidence of outcome indicators.And the items of training curriculum content of unplanned extubation precaution for nurse were formated preliminarily.(2)Retrospective study: to collect the risk factors of unplanned extubation in a level of 3 hospital.Further supplement the items of training curriculum content of unplanned extubation precaution for nurse.(3)Qualitative research: to interview nurses and patients respectively to understand the training needs of nurses about unplanned extubation and the needs of patients during the tube.Further supplement the items of training curriculum content of unplanned extubation precaution for nurse.Part Two:Delphi was used to evaluate each item pool,and finally formed the “Training Curriculum Content of Unplanned Extubation Precaution for nurse based on nursing risk management theory”.The items were described and analyzed by frequency,mean,standard deviation and coefficient of variation,and the enthusiasm,authority and coordination of experts were analyzed.The reliability of training course construction was analyzed by experts' positivity,authority,suggestion concentration and coordination.The enthusiasm of the experts was expressed by the effective recovery rate and the submission of suggestion rate;the authority of the experts was the arithmetic average of the familiarity coefficient and the judgment basis coefficient;the degree of expert opinion concentration was the average plus and minus the standard deviation of the items;The degree of coordination of expert suggestion was expressed by the coefficient of variation of each item and the Kendall's W.Results:Part One:(1)Results of systematic review and re-evaluation: A total of 7 articles were included.AMSTAR evaluation results show that the 7 articles are mainly low-quality and medium-quality,and no high-quality documents.The results of the GRADE systematic show that the quality of evidences for unplanned extubation risk factors is dominated by very low quality,without high-quality evidence support.Risk factors for unplanned extubation include patient-related factors,nurse-related factors,sedation-related factors and restraint.(2)Retrospective analysis results: a total of 91 of unplanned extubation adverse events were collected.Most of the patients' clinical diagnosis is cancer(21.98%).The pipelines involved in 91 unplanned extubations were mainly gastric tubes(21.98%).Risk factors for unplanned extubation include patients(74.73%),accompanying nursing personl(3.30%),medical staff(13.19%),pipeline(16.48%),restraint(15.38%)and human resources(1.10%)aspects.(3)Qualitative research results: a total of 19 nurses and 16 patients were interviewed.The needs of nurses and patients are summarized as: pipeline related knowledge,risk assessment knowledge,risk factor related knowledge,health education and nurse-patient communication skills knowledge,unplanned extubation treatment measures,and restraint related knowledge.Based on the results of overviews of systematic reviews,retrospective analysis and qualitative research,the "Training Curriculum Content of Unplanned Extubation Precaution for Nurse Based on the Theory of Nursing Risk Management Theory" was formated preliminarily,including 4 first-level items,21 second-level items and 82third-level items.Part Two:The positive coefficients of the three rounds of expert were 92.86%,100% and100%;the rate of submission of opinions is 42.31%,19.23% and 0;the authoritative coefficients were 0.87,0.90 and 0.91 respectively,the coordination coefficients of opinions are 0.213,0.267 and 0.344 respectively,and the results of ?2 test showed that there were significant differences(P<0.001).After three rounds of Delphi expert consultation,the training curriculum content was finally formed,including 4first-level items,19 second-level items and 71 third-level items.Conclusion: After three rounds of Delphi expert consultation,the "Training Curriculum Content of Unplanned Extubation Precaution for Nurse Based on the Theory of Nursing Risk Management Theory" was finally constructed.By analyzing the enthusiasm of experts,authority and coordination of experts,the selected letter experts in this study have good enthusiasm,good authorition,good coordination and concentration of opinions among experts,and high credibility of the results,which can be used as the clinical reference basis for nurses to carry out unplanned extubation training.