收稿日期: 2025-03-14
网络出版日期: 2025-06-17
基金资助
河南省医学科技攻关项目(SBGJ202102004)
Establishment of a nutrition support specialty nurse position in the ICU and its impact on nutritional management of critically ill patients
目的 探讨在ICU内设立的营养支持专科护士岗位对重症患者营养管理的效果。 方法 在ICU内设立营养支持专科护士岗位,明确其准入条件、考核与绩效标准,并基于高级实践护士核心能力框架确定其工作实践内容。采用便利抽样法,选取2023年8月—9月接受肠内营养的ICU患者作为对照组,2024年5月—6月接受肠内营养的ICU患者作为试验组,对照组接受由责任护士提供的营养管理,试验组接受由专岗营养支持专科护士、责任护士共同提供的营养管理,比较两组喂养并发症发生率、喂养达标时间、血糖水平及ICU住院时长。 结果 试验组喂养并发症发生率低于对照组( χ2=13.050,P<0.001),喂养达标时间短于对照组(t=2.823,P=0.005),血糖平均值优于对照组(t=2.995,P=0.003);两组血糖变异系数(Z=-1.392,P=0.164)、ICU住院时长(t=0.688,P=0.493)比较,差异无统计学意义。 结论 ICU内营养支持专科护士岗位的设立和实践能够降低重症患者喂养并发症发生率,缩短其喂养达标时间,并改善其血糖管理,但对患者ICU住院时长并无明显影响。未来应进一步优化专岗营养支持专科护士使用管理制度,强化其在重症患者营养支持中的作用,以提升患者整体护理质量和预后水平。
李豪 , 徐榆林 , 林红振 , 任婷 , 李春朋 , 蒋秋焕 , 李黎明 , 卫晓静 , 景孟娟 . ICU内营养支持专科护士岗位设立及其对重症患者营养管理的效果研究[J]. 中华护理教育, 2025 , 22(6) : 712 -717 . DOI: 10.3761/j.issn.1672-9234.2025.06.012
Objective To explore the effects of establishing a nutrition support specialty nurse position in the intensive care unit(ICU) on the nutritional management of critically ill patients. Methods A nutrition support specialty nurse position was established in the ICU,with clear admission criteria,performance,and assessment standards. The work practice content was determined based on the core competence framework for advanced practice nurses. Using convenience sampling,ICU patients who received enteral nutrition from August 2023 to September 2023 were selected as the control group,and those who received enteral nutrition from May 2024 to June 2024 were selected as the experimental group. The control group received nutritional management provided by the responsible nurses,while the experimental group received nutritional management jointly provided by the specialized position nutrition support specialty nurse and the responsible nurses. The incidence of feeding complications,the time to achieve feeding goals,blood glucose levels,and the length of ICU stay were compared between the two groups. Results The incidence of feeding complications in the experimental group was lower than that in the control group( χ2=13.050,P<0.001),and the time to achieve feeding goals was shorter(t=2.823,P=0.005). The blood glucose level in the experimental group was better than that in the control group(t=2.995,P=0.003). There were no statistically significant differences in the coefficient of variation of blood glucose(Z=-1.392,P=0.164) or the length of ICU stay (t=0.688,P=0.493) between the two groups. Conclusion The establishment and practice of a nutrition support specialty nurse position in the ICU can reduce the incidence of feeding complications in critically ill patients,shorten the time to achieve feeding goals,and improve blood glucose management,but it has no significant impact on the length of ICU stay. In the future,the management model for specialty nurses should be further optimized to strengthen their role in nutritional support for critically ill patients,thereby improving the overall quality of care and prognosis for patients.
| [1] | Mogensen KM, Robinson MK, Casey JD, et al. Nutritional status and mortality in the critically ill[J]. Crit Care Med, 2015, 43(12):2605-2615. |
| [2] | Powers J, Samaan K. Malnutrition in the ICU patient popula-tion[J]. Crit Care Nurs Clin North Am, 2014, 26(2):227-242. |
| [3] | 浙江省医学会重症医学分会. 中国重症患者肠外营养治疗临床实践专家共识(2024)[J]. 中华危重病急救医学, 2024(7):673-680. |
| [4] | 袁丽, 张海玲, 乔晓斐, 等. 以营养专科护士为主导的营养管理模式的研究进展[J]. 护士进修杂志, 2022, 37(20):1853-1856. |
| [5] | 田君叶, 苏莉, 张嘉晖, 等. 我国专科护士培训20年的发展与思考[J]. 中华护理教育, 2024, 21(7):773-779. |
| [6] | 丁炎明, 吴欣娟, 田君叶, 等. 我国31个省份三级医院专科护士培养及管理的现状调查[J]. 中华护理杂志, 2021, 56(9):1357-1362. |
| [7] | 杨洋, 赵泽华, 黄迎春, 等. 我国临床营养支持专科护士培训及执业现状的调查研究[J]. 肠外与肠内营养, 2024, 31(4):245-251. |
| [8] | 李志菊, 张海玲, 武义华, 等. 安徽省157所医院1 846名专科护士使用现状及影响因素分析[J]. 安徽医学, 2023, 44(10):1240-1245. |
| [9] | 李继平. 护理管理学[M]. 3版. 北京: 人民卫生出版社,2012:107. |
| [10] | 黄师菊, 钟美浓, 蔡有弟, 等. 临床营养专科护士核心能力评价指标的构建[J]. 中华护理杂志, 2020, 55(11):1665-1672. |
| [11] | 龚仁蓉, 刘雨薇, 何凌霄, 等. 高级实践护士核心能力框架构建[J]. 中国护理管理, 2023, 23(5):654-659. |
| [12] | 米元元, 黄海燕, 尚游, 等. 中国危重症患者肠内营养治疗常见并发症预防管理专家共识(2021版)[J]. 中华危重病急救医学, 2021(8):903-918. |
| [13] | 陈小颉, 段霞, 陶丽. 危重症患者肠内营养喂养不耐受影响因素的Meta分析[J]. 中国循证医学杂志, 2023, 23(11):1299-1304. |
| [14] | 卜黎静, 程飞儿, 张爱琴, 等. 危重症患者肠内营养喂养不耐受风险预测模型的构建及验证[J]. 中华护理杂志, 2024, 59(15):1877-1883. |
| [15] | 杨小娟, 王静, 李蓉, 等. 危重症患者早期肠内营养喂养不足发生率及影响因素的Meta分析[J]. 护士进修杂志, 2025, 40(5):516-522. |
| [16] | 刘欢, 杜爱平, 张耀丹, 等. 重症患者气道操作相关肠内营养喂养中断的研究进展[J]. 中华护理杂志, 2024, 59(12):1525-1530. |
| [17] | Queiroz AB. Critically ill patients(Adults):glycemic control[EB/OL].[2025-02-28]. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI1754. |
| [18] | Jing M, Yan F, Li H, et al. Glycemic control in critically ill patients:a best practice implementation project. JBI Evid Implement[EB/OL].(2025-03-20). https://journals.lww.com/ijebh/fulltext/9900/glycemic_control_in_critically_ill_patients__a.170.aspx. |
/
| 〈 |
|
〉 |