| Objective:Based upon research into basic situation of ICU patients,this study discusses the incidence rate of medical adhesive related skin injury among ICU patients,common types,predilection sites and so on.Then the study aims to analyze the risk factors,develop the evaluation scale of the medical adhesive related skin injury to adult ICU patients in a scientific way and finally define the diagnostic threshold and classify the danger levels.The study also tests the validity and reliability of the scale in order to help the nursing staff recognize the high-risk patients with medical adhesive related skin injury rapidly and correctly so that they can take proper actions and prevent the possible risks.Methods:1.Through investigative research,this study tries to get to know the incidence of medical adhesive related skin injury and analyze the risk factors.From April 2017 to December,with ICU Patients' Condition Registration Form that was designed by myself,after researching into the general information,basic conditions,skin conditions,the use of viscose and medical adhesive related skin injury of patients in five ICU units of three Grade Three A hospitals in Shanxi Province,I employ the method of cluster sampling to choose 104 patients who have MARSI and can meet the requirements of the research as the case group and choose the same amount of patients who don't have MARSI and are in the same wards during the same time as the control group so that I can easily carry out the single factor analysis and conditional logistic regression to explorethe independent risk factors of MARSI.2.Based upon documents and the results of case control study,I confirmed the item pool of the scale,consulted 28 nursing specialists who had a long career in intensive care or wound care and screened the item pool of the scale according to the results of the consultation.Then the first draft of the Risk evaluation scale of medical adhesive related skin injury for adult ICU patients was formed.3.I made use of the initial scale and patients' materials to screen the items of the scale again,the method of factor analysis to define weights of each item in the scale,the subjects' ROC curve to define the diagnostic threshold of the scale,and the quarterback method to classify the danger levels for the formation of Risk evaluation scale of medical adhesive related skin injury for adult ICU patients and the use of the scale in testing the validity and reliability of the scale application and clinic.Results:1.There are 558 ICU patients involved in this study,and 104 of them have got medical adhesive related skin injury.The rate of incidence is 18.64 percent.The chest,collar bone,neck and the limbs are the common sites of MARSI,and the morbidity of MARSI is probably caused by medical adhesive.According to this study,the adhesive product that is most likely to bring MARSI is general medical cloth tape,then transparent sticker and electrode slice.2.The research results show that the age,anemia,fever,state of consciousness,Apache II score,BMI,serum albumin,humidity of skin,skin hydroncus and Waterlow score are all statistically meaningful to study the differences between the two case groups.The results of the multiple conditional logistic regression analysis show the age,Apache? score,humidity of skin,skin hydroncus entering regression equation is the independent risk factor of MARSI.3.Based upon research into documents and the results of case control study,the initial item pool made up of 26 items was defined after the group discussion.4.The recovery rates of the two rounds of expert consultation are 93.3% and 100 %.The two groups of experts' degrees of authority are both over 0.7.Kendall coefficients of concordance are both statistically meaningful.After consulting the two groups of experts,16 items were screened and Risk evaluation scale of medical adhesive related skin injury for adult ICU patients was formed.5.Through the frequency analysis method and critical ratio analysis method,the items were screened once again.15 of the initial items which are more recognizable were retained and then the basic framework of Risk evaluation scale of medical adhesive related skin injury for adult ICU patients came into being.6.The weight of the item:KMO=0.582,Bartlett spherical test,P<0.01.It shows that the data collected in this study are suitable for the use of factor analysis to determine the weight of the items.The first 6 common factors are extracted with the eigenvalue greater than 1,and the cumulative contribution rate is 60.207%.The values of the normalization of each item are as follows:Age(0.090258),Anemia(0.069942),Allergic constitution(0.056784),Apache?score(0.094111),Consciousness(0.078427),Fever(0.056677),BMI(0.057428),Nutritional intake ability(0.050806),Prealbumin(0.043110),Moist skin(0.092258),Xerosis cutis(0.048475),Skin turgor(0.053849),Skin is thin as paper(0.065816),Long-term use of glucocorticoid(0.073102),Radiotherapy/ chemotherapy(0.068957).The item is assigned according to the normalized weight.7.The diagnostic threshold of the scale:In the study,the area under the ROC curve is0.828,P=0.000<0.01.When the cutoff value was 26.5,the highest Youden index was0.510,and the sensitivity was 74.0%,the specificity was 77.0%,with a strong ability of comprehensive diagnosis.Because the scores of these items in this scale are all integers and the main purpose of this scale is to screen high risk patients,with higher requirements for sensitivity,we take 26 as the best diagnostic threshold for the scale.8.The classification of the scale: 26-30 low-risk;31-41 intermediate risk;over 42high-risk.9.Testing the validity and reliability: the reliability coefficient of the evaluators of the scale is 0.946;the internal consistency Cronbach ? is 0.723.That means thereliability is very good.The item of the scale was determined by the combination of expert consultation and statistical analysis,and the content validity of the scale was guaranteed.Since the factor analysis shows the largest loading coefficients of 93.3% of the items are more than 0.4,the construct validity is good,too.Conclusion:The results of investigation showed that the incidence of MARSI was 18.64%.The age,Apache?score,humidity of skin,skin hydroncus entering regression equation is the independent risk factor of MARSI.According to the principle of scale development,developed by scientific research methods of Risk evaluation scale of medical adhesive related skin injury for adult ICU patients validity,sensitivity and specificity are good,that can help identify patients at high risk for MARSI nurses. |
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