基于跨专业协作团队发展理论的ICU机械通气患者早期活动团队协作方案的构建  

Development of a team collaborative protocol for early mobilisation of ICU patients with mechanical ventilation:based on the theory of interprofessional collaborative team development

作　　者：王雪琴[1] 吕颖 赵庆华[1] 张川林[1] 米洁[1] Wang Xueqin;LüYing;Zhao Qinghua;Zhang Chuanlin;Mi Jie(Department of Nursing Administration,the First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China;Neurosurgical Intensive Care Unit,Affiliated Hospital of Hebei University,Baoding 071000,Hebei Province,China.)

机构地区：[1]重庆医科大学附属第一医院护理部,重庆400016 [2]河北大学附属医院神经外科监护室,河北保定071000

出　　处：《现代临床护理》2025年第3期39-47,共9页Modern Clinical Nursing

基　　金：重庆市科卫联合项目,项目编号为2020FYYX010;重庆市重点专科建设《临床护理》精品建设项目,项目编号为202336。

摘　　要：目的 构建基于跨专业协作团队发展理论(development of the interprofessional collaborative team,DICT)的重症监护室(intensive care unit,ICU)机械通气患者早期活动团队协作方案,以期为多学科团队实施ICU机械通气患者的早期活动提供规范化指导,提升患者活动效率。方法 2023年9月,通过文献回顾和现况研究,了解机械通气患者早期活动的多学科协作现状及相关影响因素,以DICT为基础,构建ICU机械通气患者早期活动团队协作方案初稿;2023年9月—11月,采用德尔菲专家函询法,经过两轮专家函询,得出ICU机械通气患者早期活动团队协作方案终稿。结果 两轮函询专家人数均为21名,函询问卷有效回收率均为100.00%,专家提出修改意见15条;专家权威系数为0.898,两轮条目变异系数均值分别为(0.14±0.05)和(0.12±0.06);两轮肯德尔协调系数分别为0.198(P<0.001)和0.256(P<0.001)。最终构建ICU机械通气患者早期活动团队协作方案包括一级条目3个(评估探索、协作整合、反馈调整),二级条目13个,三级条目57个。结论 本研究形成基于DICT的ICU机械通气患者早期活动团队协作方案科学可靠,可为多学科协作的ICU机械通气患者实施早期活动提供指导和借鉴。Objective To develop a team collaborative protocol,based on the theory of the development of interprofessional collaborative team development(DICT),for early mobilisation of the patients with mechanical ventilation in the intensive care unit(ICU),hence to provide a standardised guidance on a multidisciplinary team with nurses as coordinators to implement the early mobilisation for ICU patients with mechanical ventilation and to improve the efficiency in patient mobilisation.Methods In September 2023,a preliminary draft of the collaborative team protocol based on ICTD was developed for early mobilisation of ICU patients with mechanical ventilation,based on literature review and current situation analysis.The status and influencing factors of multidisciplinary collaboration in early mobilisation for the patients with mechanical ventilation were identified.DICT framework was employed to develop the initial draft of protocol.From September to November 2023,Delphi expert consultation was employed and two rounds of expert consultation had been conducted before the final version of the protocol was drafted.Results A total of 21 experts participated in both rounds of consultation,with a 100.00%effective response rate of the questionnaires.Fifteen suggestions for modification were advised by the experts.The expert authority coefficient was 0.898,and the average coefficients of variation for the items from the two rounds of consultation were(0.14±0.05)and(0.12±0.06),respectively.The Kendall coordination coefficients for the two rounds were 0.198(P<0.001)and 0.256(P<0.001),respectively.The final protocol included 3 primary items(assessment and exploration,collaboration and integration,feedback and adjustment),13 secondary items and 57 tertiary items.Conclusion The team collaborative protocol for early mobilisation of ICU patients with mechanical ventilation,based on the DICT theory,is scientifically reliable.It provides a guidance and a reference for multidisciplinary teams in implementation of early mobilisation for ICU

关 键 词：跨专业协作团队发展理论 多学科 早期活动 重症监护室 机械通气 德尔菲法 

分 类 号：R473.5[医药卫生—护理学]