以质量求发展，以服务铸品牌

护理学报 ›› 2018, Vol. 25 ›› Issue (19): 34-39.doi: 10.16460/j.issn1008-9969.2018.19.034

• 循证护理 • 上一篇    下一篇

ICU成人失禁相关性皮炎预防及管理的循证护理实践

黄海燕1a, 米元元1a, 喻姣花1b, 周英凤2, 王玉梅1a, 吴为1a   

  1. 1.华中科技大学同济医学院附属协和医院 a.重症医学科;b.护理部,湖北 武汉 430022;
    2.复旦大学护理学院,上海 200032
  • 收稿日期:2018-06-21 出版日期:2018-10-10 发布日期:2020-07-06
  • 通讯作者: 周英凤（1973-）,女,山东寿光人,博士,副教授,E-mail：zyingfeng@fudan.edu.cn
  • 作者简介:黄海燕（1974-）,女,湖北武汉人,本科学历,主管护师,护士长。

Evidence-based Practice of Prevention and Management of Incontinence-associated Dermatitis in ICU Adult Patients

HUANG Hai-yan1a, MI Yuan-yuan1a, YU Jiao-hua1b, ZHOU Ying-feng2, WANG Yu-mei1a, WU Wei1a   

  1. 1a. ICU; 1b. Dept. of Nursing Administration, Wuhan Union Hospital, Tongji Medical College, Affiliated to Huazhong University of Science and Technology, Wuhan 430022, China;
    2. School of Nursing, Fudan University, Shanghai 200032, China
  • Received:2018-06-21 Online:2018-10-10 Published:2020-07-06

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摘要： 目的 将ICU成人失禁相关性皮炎预防和管理的最佳证据应用于临床实践,提高ICU护士对失禁相关性皮炎预防和管理的能力和依从性,从而降低ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率。方法 根据前期研究获得的最佳证据制定ICU成人失禁相关性皮炎预防及管理的审查指标,指导并规范ICU护士的临床实践;开展多渠道培训结合模式,对ICU护士进行ICU成人失禁相关性皮炎预防及管理最佳证据的培训,比较最佳证据应用前后ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率及质量审查结果,培训前后ICU护士对成人失禁相关性皮炎的认知水平。结果 最佳证据应用后,ICU成人失禁相关性皮炎发生率从12%下降至3%;导尿管相关泌尿道感染发生率从4%下降至0%;失禁性皮炎证据的执行率和ICU护士对失禁相关性皮炎的认知水平显著提高,差异具有统计学意义（P<0.05）。结论 将基于循证的最佳证据应用于临床实践,可促进ICU患者失禁相关性皮炎的预防及管理工作,降低成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率,提高临床护理质量。

关键词: 失禁相关性皮炎, 循证护理, 重症监护, 护理管理

Abstract: Objective To improve ICU nurses’ ability and compliance of prevention and management of incontinence-associated dermatitis (IAD) by using the best evidence for the prevention and management of IAD in ICU adult patients, so as to reduce the incidence of ICU adult IAD and catheter-related urinary tract infection. Methods We developed the criteria according to the best evidences from the previous study to guide and standardize the clinical practice; and carried out multi-channel training of the prevention and management of IAD in ICU adult patients for ICU nurses. The incidence of ICU adult IAD and catheter-related urinary tract infection before and after the application of the best evidences was compared, and the cognition and implementation of the best evidences of ICU nurses before and after the training were also compared. Results After the application of the best evidences, the prevalence of IAD decreased from 12% to 3%; that of catheter-related urinary tract infection from 4% to 0%. The implementation rate of the IAD evidences was improved obviously; ICU nurses’ cognition on IAD was improved from a moderate to a high level and the difference was statistically significant (P<0.05). Conclusion With evidence-based best evidences in clinical practice, the prevention and management of IAD in ICU patients is promoted, and the incidence of adult IAD and catheter-related urinary tract infection is decreased, thus the quality of clinical nursing is improved.

Key words: incontinence-associated dermatitis, evidence-based nursing, intensive care, nursing management

中图分类号: 

  • R246.7
[1] Bliss D Z, Savik K, Thorson M A, et al.Incontinence-associated Dermatitis in Critically Ill Adults: Time to Development, Severity, and Risk Factors[J]. J Wound Ostomy Continence Nurs,2011,8(4):433-445. DOI:10.1097/WON.0b013e318220b703.
[2] 张娜,吴娟. 失禁相关性皮炎的护理研究进展[J].中华护理杂志,2012, 47(11):1046-1049.DOI:10.3761/j.issn.0254-1769.2012.11.033.
[3] Boronat-Garrido X, Kottner J, Schmitz G, et al.Incontinence-Associated Dermatitis in Nursing Homes: Prevalence, Severity, and Risk Factors in Residents With Urinary and/or Fecal Incontinence[J]. J Wound Ostomy Continence Nurs, 2016,43(6):630-635.DOI:10.1097/WON.0000000000000282.
[4] Campbell J L, Coyer F M, Osborne S R.Incontinence-associated Dermatitis: A Cross-sectional Prevalence Study in the Australian Acute Care Hospital Setting[J]. Int Wound J,2016,13(3):403-411.DOI:10.1111/iwj.12322.
[5] 贾静,徐晶晶,仇晓溪. 住院患者失禁性皮炎患病率和预防现状的调查研究[J]. 中国护理管理, 2014,14(11):1207-1210.DOI:10.3969/j.issn.1672-1756.2014.11.028.
[6] Driver D S.Perineal Dermatitis in Critical Care Patients[J]. Crit Care Nurse,2007,27(4):42-47.
[7] Junkin J, Selekof J L.Prevalence of Incontinence and Associated Skin Injury in the Acute Care Inpatient[J]. J Wound Ostomy Continence Nurs,2007, 34(3):260-269.DOI:10.1097/01.WON.0000270820.91694.1f.
[8] Peterson K, Bliss D, Nelson C, et al.Practices of Nurses and Nursing Assistants in Preventing Incontinence Dermatitis in Acutely/Critically-ill Patients[J]. Am J Crit Care, 2006,15(3):325.
[9] Doughty D, Junkin J, Kurz P, et al.Incontinence-associated Dermatitis: Consensus Statements, Evidence-based Guidelines for Prevention and Treatment, and Current Challenges[J]. J Wound Ostomy Continence Nurs,2012,39(3):303-317.DOI:10.1097/WON.0b013e3182549118.
[10] Dicenso A, Bayley L, Haynes R B.Accessing Pre-ap-praised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs,2009, 12(4):99.DOI:10.1136/ebn.12.4.99-b.
[11] 谢利民,王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报,2012,10(2):160-165.
[12] 张慧文,顾莺. 先天性心脏病患儿高能量密度配方奶喂养的系统评价[J]. 上海护理,2016,16(2):27-30.
[13] 黄海燕,米元元,喻姣花,等. 危重症住院患者失禁相关性皮炎预防及护理的最佳证据总结[J]. 护理学杂志, 2017,32(21):50-53.DOI:10.3870/J.issn.1001-4152.2017.21.050.
[14] Rainsbury P M G, Fabricius M M, Mclarty M E. Management of Urinary Incontinence inPrimary Care[J]. Innov Ai T: Education and Inspiration for General Practice, 2011, 4(1):23-30.
[15] Fallon A, Westaway J, Moloney C.A Systematic Review of Psychometric Evidence and Expert Opinion Regarding the Assessment of Faecal Incontinence in Older Community-dwelling Adults[J]. JBI Libr Syst Rev,2008,6(11):367-431.DOI:10.1111/j.1744-1609.2008.00088.x.
[16] Bliss D Z, Savik K, Thorson M A, et al.Incontinence-associated Dermatitis in Critically Ill Adults: Time to Development, Severity, and Risk Factors[J]. J Wound Ostomy Continence Nurs, 2011, 38(4):433-445.DOI:10.1097/WON.0b013e318220b703.
[17] Fader M, Cottenden A M, Getliffe K. Absorbent Products for Moderate-heavy Urinary and/or Faecal Incontinence in Women and Men[J]. Cochrane Database Syst Rev,2008(4):CD007408.DOI:10.1002/14651858.CD007408.
[18] Sugama J, Sanada H, Shigeta Y, et al.Efficacy of An Improved Absorbent Pad on Incontinence-associated Dermatitis in Older Women: Cluster Randomized Controlled Trial[J]. BMC Geriatrics,2012,12:22.DOI:10.1186/1471-2318-12-22.
[19] Hodgkinson B, Nay R, Wilson J.A Systematic Review of Topical Skin Care in Aged Care Facilities[J]. J Clin Nurs, 2007,16(1):129-136.DOI:10.1111/j.1365-2702.2006.01723.x.
[20] Palmissano C, Norman R A.Geriatric Dermatology in Chronic Care and Rehabilitation[J]. Dermatol Nurs,2000, 12(2):116-123.
[21] Jones M L. Best Practice Statement(2nd ed): Care of the Older Person’s Skin[J]. Brit J Health Assis, 2013,6(12):593-595.
[22] Bliss D Z, Zehrer C, Savik K, et al.An Economic Evaluation of Four Skin Damage Prevention Regimens in Nursing Home Residents with Incontinence: Economics of Skin Damage Prevention[J]. J Wound Ostomy Continence Nurs, 2007, 34(2):143-152. DOI:10.1097/01.WON.0000264825.03485.40.
[23] Dingwall L,Mclafferty E.Do Nurses Promote Urinary Continence in Hospitalized Older People?: An Exploratory Study[J]. J Clin Nurs,2006, 15(10):1276-1286.DOI:10.1111/j.1365-2702.2006.01381.x.
[24] 蒋琪霞,彭青,周昕,等.伤口护理风险预案的制订及应用效果评价[J]. 中华护理杂志,2012,47(11):968-971.D0I:10.3761/J.issn.0254-1769.2012.11.0.
[25] Spiva L, Hart P L, Patrick S, et al.Effectiveness of an Evidence-based Practice Nurse Mentor Training Program[J]. Worldviews Evid Based Nurs,2017, 14(3):183-191.DOI:10.1111/wvn.12219.
[26] 米元元,沈月,黄海燕,等. ICU患者肠内营养并发腹泻证据汇总[J]. 护理学报,2017,24(21):58-66.DOI:10.16460/j.issn1008-9969.2017.21.058.
[27] 周英凤,胡雁,顾莺,等. 基于证据的持续质量改进模式图的构建[J]. 中国循证医学杂志,2017,17(5):603-606.DOI:10.7507/1672.2531.2016110.
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