Construction And Application Of Cluster Nursing Strategy To Reduce Aspiration Rate Of Patients With Tube Feeding In ICU

Objective:To construct a cluster nursing strategy to reduce the incidence of aspiration in patients with ICU tube feeding,and verify its intervention effect,so as to provide standardized nursing strategy for clinical staff to reduce the incidence of aspiration in patients with ICU tube feeding and the resulting hospital-acquired pneumonia,so as to improve the prognosis of severe patients.Methods:1.Construction of cluster nursing strategy to reduce aspiration incidence of patients with tube feeding in ICU.Based on literature study and Delphi method,this study constructed a cluster nursing strategy to reduce the incidence of aspiration in patients with tube feeding in ICU.Firstly,a research team was set up to formulate retrieval strategies according to the principles of PICO,and the literature related to aspiration of ICU tube feeding patients was retrieved,and the quality of the retrieved literature was evaluated,nursing items of measures to reduce the incidence of aspiration were extracted,and a correspondence questionnaire was developed.Then,experts from third-grade grade A hospitals who have been working in ICU clinical,education or management for 10 years or more and have intermediate or above titles were selected for Delphi consultation,which mainly included risk assessment,tube feeding nursing,position management,intra-abdominal pressure monitoring,artificial airway management,gastric residual monitoring,oral hygiene,sedation and analgesic management,and drug intervention.According to the consultation results,Construct the Checklist of Cluster nursing Strategies to Reduce aspiration Incidence.2.Clinical application of the bunched nursing strategy to observe the effect.Using historical control study method,94 patients in cardiac ICU,extracerebral ICU and comprehensive ICU(two wards)in a third class Ahospital were selected as the study subjects,and 47 patients admitted from July 2022 to August 2022 were set as the control group,receiving routine care of ICU tube feeding.A total of 47 patients admitted from September2022 to October 2022 were selected as the experimental group.The experimental group was based on routine nursing,and the measures in the examination list were implemented in each shift according to the"Examination List of cluster nursing Strategies for Reducing aspiration Incidence".The incidence of aspiration,hospital-acquired pneumonia,gastric retention,aspiration risk score,ICU stay time and hospitalization cost were observed in 2 groups within7 days of tube feeding.If the data conform to the normal distribution and the variance is homogeneous,the two independent samples T-test is used for comparison.If it does not conform to normal distribution,then non-parametric test is performed.X~2test was used for counting data,and rank sum test was used for rank data.The repeated measurements were analyzed using generalized estimation equations.Alpha=0.05.Results:1.The effective recoveries of the three rounds of expert correspondence questionnaire were 100%,86.96%and 78.26%,respectively;The authority coefficients of the experts were0.89,0.84,0.84,respectively.After three rounds of expert correspondence consultation,the importance coefficient of variation was 0.000～0.603,and the operability coefficient of variation was 0.042～0.310.The Kendall harmony coefficient of each item was all<0.05,and the difference was statistically significant.Finally,a cluster nursing strategy covering 8primary items,16 secondary items and 28 tertiary items was constructed to reduce the incidence of aspiration in ICU tube feeding patients.2.Compared with the control group,The incidence of aspiration(21.3%vs 57.4%,X~2=12.881,P<0.001),nosocomial pneumonia(10.6%vs 27.7%,X~2=4.398,P<0.05)and gastric retention(4.3%vs 17.0%,X~2=4.029,P<0.05)were lower,and the differences were statistically significant.The aspiration risk score of the experimental group was lower than that of the control group(19.29±0.773 vs 21.39±0.604,X~2=4.606,P<0.05)within 7 days of tube feeding,and the difference was statistically significant,and with the increase of intervention time,the aspiration risk score of the patients decreased overall.The difference was statistically significant(P<0.05).There were no significant differences in the average hospitalization cost and length of stay between the two groups(P>0.05).Conclusion:1.Guided by the concept of evidence-based nursing,this study uses literature research method and Delphi method in combination with the actual clinical situation in China to construct a localized cluster nursing strategy to reduce the incidence of aspiration of ICU tube feeding patients,which is scientific and feasible.2.Reduce the incidence of aspiration in ICU tube feeding patients.Clinical trials have proved that the bunched nursing strategy can effectively reduce the incidence of aspiration,hospital-acquired pneumonia,gastric retention and aspiration risk score in ICU tube feeding patients,which can provide standardized nursing strategy for aspiration prevention for clinical medical staff and can be applied in clinic.