Construction And Pre-experimental Study Of Nursing Program For Patients With Mechanical Ventilation To Prevent ICU Acquired Weakness

Background:ICU acquired weakness is characterized by general limb weakness,with difficulty in disengaging from mechanical ventilation,paralysis or tetraplegia and muscle atrophy as the main symptoms.Studies have shown that the duration of mechanical ventilation is directly proportional to the incidence of ICU-acquired debilitation as one of its risk factors.Existing studies mostly focus on single measures such as exercise training and risk factor prevention as a means of prevention,lacking interventions for swallowing disorders,decreased lung function,and prolonged weakness processes brought about by this factor of mechanical ventilation.Thus,it is necessary to construct a care program for the prevention of ICUacquired weakness in mechanically ventilated patients.Objective:To construct a nursing program for the prevention of ICU acquired weakness in mechanically ventilated patients to provide a theoretical basis for ICU nursing staff.The effectiveness of the program was tested through a pre-experiment in order to improve the quality of life and care of patients through the study program.Methods:1.Semi-structured interview: ICU nurses were interviewed to understand the clinical practice status of ICU acquired weakness nursing in patients with mechanical ventilation,and to provide clinical basis for the construction of the program.2.Literature analysis: The research team searched databases and guideline websites for relevant literature on the prevention of ICU-acquired weakness in patients with mechanical ventilation,then screened,evaluated quality,and recommended and summarized evidence levels.To construct the program for ICU acquired weakness in mechanical ventilation patients initially.3.Expert consultation method: With the program as the main body,the questionnaire was prepared and two rounds of expert letter consultation were conducted to modify and improve the draft of the program.4.Pre-experimental study: Patients with mechanical ventilation in ICU were selected as the study subjects.Conventional nursing measures were applied in control group and constructed program was applied in experimental group.The incidence of ICU acquired frailty,MRC muscle strength score,Barthel index score,and swallowing function were compared between the two groups before and after intervention.Results:1.Semi-structured interviews: three themes were extracted:(1)the differences in cognition of ICU nurses;(2)the limitations of nurses’ participation in the program;(3)the necessity of building nursing programs.2.Literature analysis: A total of 25 literatures were included in the study,which focused on risk factor analysis,early activity,pulmonary rehabilitation,dysphagia and early nutritional support.3.Expert consultation method: There are 15 experts including clinical medicine and clinical nursing management.After statistical analysis,the final nursing program including 8primary entries,22 secondary entries and 34 tertiary entries was established by combining the experts’ revised opinions.4.Pre-experimental study: Through the statistical analysis of 18 cases of ICU patients with mechanical ventilation,the MRC score of 46.67±7.810 in the experimental group was higher than that of 33.89±10.179 in the control group,and the Barthel index score of 57.78±15.434 in the experimental group was better than that of 46.11±11.396 in the control group,and the differences were statistically significant(P< 0.05);the incidence of ICU acquired weakness and swallowing disorder in the experimental group were 44.44% and 33.33% lower than 88.89%and 77.80% in the control group,respectively.Conclusions:In this study,a comprehensive and evidence-based nursing program for the prevention of acquired weakness in mechanically ventilated patients in the ICU was constructed through semi-structured interviews,literature analysis,and expert consultation.This program provides a basis and preliminary guidance for clinical work by increasing the training of motor function and swallowing function in mechanically ventilated patients in ICU to prevent the occurrence of acquired weakness and promote the rehabilitation of patients in ICU.