Study On Barriers To The Implementation Of Preventive Measures For ICU-acquired Weakness From The Perspective Of Nursing

Objective: The purposes of this study was to develop a questionnaire on the barriers to the implementation of preventive measures for ICU-acquired weakness.The questionnaire was used to investigated ICU nurses in a hospital in Nanjing,in order to explore the barriers to the implementation of preventive measures for ICU-acquired weakness,and to provide scientific basis for clinical managers to take targeted measures to eliminate the obstacles and promote the implementation of prevention measures for ICU-acquired weakness.Methods: 1.On the basis of literature review and semi-structured interviews,item pool of hindering the prevention of acquired weakness was formed.Delphi inquiry form was formed under the discussion of the research group,and experts were invited to conduct correspondence on all levels of items in the questionnaire.The research group revised,deleted or added the items at all levels according to the mean values,coefficient of variation,content validity index and specific opinions from experts.After two rounds of consultation,experts reached a consensus,and initially constructed the questionnaire on barriers to the implementation of preventive measures for acquired weakness in ICU2.A preliminary questionnaire was used to investigate ICU nurses,and the results were analyzed to test the reliability and validity of the questionnaire.Exploratory factor analysis was used for validity analysis and Cronbach’s α coefficient was used for reliability analysis.3.The nurses in the ICU,CCU and NICU of the hospital in Nanjing were surveyed using a self-administered questionnaire to obtain data.Measurement data were described by mean and standard deviation using SPSS version 19.0.Enumeration data were summarized as frequency and percentage.T-test was used for comparison between two groups,and analysis of variance was used for comparison among multiple groups.Results: 1.The results of expert inquiries showed that the active coefficients of experts in two rounds of Delphi inquiries were 100%,the degree of authority(Cr)was 0.865 and 0.88,and the Kendall’s concordance coefficients were 0.175 and 0.148,respectively,and passed the significance test(P < 0.05).After deletion,modification and addition,4 first-level items,8 second-level items and 25 third-level items were finally determined,and the Questionnaire on Barriers to Implementation of Preventive Measures for Acquired Weakness in ICU was preliminarily formed.2.The test of the questionnaire showed KMO was 0.890 and Bartlett’s spherical test was significant(P < 0.05).Five factors were extracted though exploratory factor analysis,and the variance contribution ratio of the five factors after rotation were 38.653%,11.691%,9.040%,6.054%,4.703%,respectively,with the accumulated variance contribution rate of 70.142%.In addition,the corresponding factor load coefficient of third-level items were from 0.558 to 0.925.The reliability test results showed that the Cronbach’s alpha coefficient of the questionnaire was 0.928,and the Cronbach’s alpha coefficients of each dimension were from 0.772 to 0.927.3.The survey of ICU nurses showed that there were many barriers to the implementation of preventing ICU-AW.The mean scores of the first-level items were health care provider factors(3.02±0.63),patient factors(3.14±0.72),department management(3.57±0.74)and management tools(3.33±0.78).The average scores of secondary items was from 2.58 to 3.71,among which the human resources(3.71±0.86)scored the highest and the attention level(2.58±0.79)the lowest.The main barriers of the third-level items were insufficient human resources of nurses(90.2%),intolerance of patients(89.5%),lack of understanding of concepts(87.5%),fear of pain(86.9%)and lack of professional training(86.3%).ICU nurses with different characteristics scored differently in terms of prevention belief,attention level,cooperation compliance and prevention process(P < 0.05).Conclusion: The questionnaire constructed in this study has high reliability and validity and can be widely used.The survey of ICU nurses using this questionnaire show that there are many obstacles to the prevention of ICU-AW from the perspective of nursing,including lack of relevant knowledge,insufficient human resources,poor patient cooperation compliance and lack of preventive strategies and processes.There are differences in the comparison of some barriers among nurses with different characteristics.Hospital leaders and clinical practitioners should pay more attention to the prevention of ICUAW.The barriers of preventing ICU-AW can be inhibited or eliminated through comprehensive measures such as strengthening the training of medical personnel,staffing optimization,formulating and strictly implementing prevention strategies,and strengthening health education to the patients and their families,so as to promote the recovery of critically ill patients.