护士对院内卒中识别和救治流程的知晓率及教学需求调查分析

doi:10.3969/j.issn.1673-5765.2022.07.007

摘要/Abstract

摘要：

目的调查护士对院内卒中识别和救治的知晓率和教学需求，为针对性地制订培训内容和计划提供借鉴，以提高培训质量。

方法 2022年4月，采用自制电子调查问卷对西藏自治区人民医院在职护士进行调查。问卷内容包括人口学信息、卒中快速识别知晓率、院内卒中绿色通道知晓率和培训课程需求。比较不同年龄、学历、职务、职称、工作年限及所在科室等组别的护士对院内卒中快速识别及绿色通道知晓率的差异。

结果共发放问卷315份，回收有效问卷270份（85.7%）。卒中快速识别方面：202名（74.8%）护士认为卒中快速识别极为重要，89名（33.0%）护士知晓平衡、眼、面、上肢、语言和时间（balance-eyes-face-arms-speech-time，BEFAST）卒中识别量表，177名（65.6%）护士知晓卒中静脉溶栓治疗，54名（20.0%）护士知晓静脉溶栓最佳时间窗为4.5 h以内。院内卒中绿色通道方面：91名（33.7%）护士报告其所在科室发生过院内卒中，63名（23.3%）护士参与过院内卒中救治。分组比较发现，不同科室的护士对BEFAST卒中识别量表（P<0.001）、卒中静脉溶栓的知晓率（P=0.040），以及报告其所在科室发生过院内卒中者比例（P<0.001）、参与过院内卒中救治者比例（P<0.001）比较，差异均有统计学意义。

结论护士对院内卒中快速识别和绿色通道流程存在认知不足，未来需加强对所有护士，尤其是院内卒中高发科室和非神经科相关科室护士的多种形式的定期培训，以提高院内卒中早期识别率和救治质量。

关键词: 院内卒中; 护士; 培训

Abstract:

Objective To investigate the awareness rate of in-hospital stroke recognition and treatment among nurses, and provide reference for improving the quality of education training.

Methods In April 2022, the clinical nurses in Tibet Autonomous Region People’s Hospital were surveyed using self-made electronic questionnaire. The contents of the questionnaire included demographic information (gender, age, education background, professional title, position, working years and department), awareness rate of stroke rapid recognition, in-hospital stroke fast tract and training needs. The differences in the awareness rate of stroke rapid recognition, in-hospital stroke fast tract were compared among the nurses of different age, education degree, position, professional title, working years and departments.

Results A total of 270 valid questionnaires (85.7%) were collected from 315 nurses. In terms of early stroke identification, 202 nurses (74.8%) considered that stroke rapid recognition was very important, but only 89 nurses (33.0%) knew the BEFAST stroke identification scale, 177 nurses (65.6%) knew stroke intravenous thrombolysis, and only 54 nurses (20.0%) knew the 4.5-hour time window of intravenous thrombolysis. In terms of in-hospital stroke fast tract: 91 nurses (33.7%) reported in-hospital stroke in their department, while only 63 nurses (23.3%) had participated in in-hospital stroke rescue. There were statistical differences in the awareness rates of BEFAST rapid recognition scale (P<0.001) and intravenous thrombolysis (P=0.040), the incidence of in-hospital stroke in their departments (P<0.001) and proportion of participating in acute stroke rescue (P<0.001) among nurses in different departments.

Conclusions It was insufficient for the nurses to identify in-hospital stroke and know in-hospital stroke fast tract. In the future, various forms of regular training should be strengthened for all nurses, especially nurses in departments with high incidence of in-hospital stroke and non-neurology departments.

Key words: In-hospital stroke; Nurse; Training

周立新, 侯秀凤, 陈英, 嘎多, 赵玉华, 次央, 倪俊, 彭斌. 护士对院内卒中识别和救治流程的知晓率及教学需求调查分析[J]. 中国卒中杂志, 2022, 17(07): 714-719.

ZHOU Lixin, HOU Xiufeng, CHEN Ying, GA Duo, ZHAO Yuhua, CI Yang, NI Jun, PENG Bin. Survey on Awareness Rate of In-hospital Stroke Recognition and Treatment among Nurses[J]. Chinese Journal of Stroke, 2022, 17(07): 714-719.

参考文献

[1] KIMURA K，MINEMATSU K，YAMAGUCHI T. Characteristics of in-hospital onset ischemic stroke[J]. Eur Neurol，2006，55（3）：155-159.

[2] DULLI D，SAMANIEGO E A. Inpatient and community ischemic strokes in a university hospital[J]. Neuroepidemiology，2007，28（2）：86-92.

[3] AKBIK F，XU H，XIAN Y，et al. Trends in reperfusion therapy for in-hospital ischemic stroke in the endovascular therapy era[J]. JAMA Neurol，2020，77（12）：1486-1495.

[4] CUMBLER E，WALD H，BHATT D L，et al. Quality of care and outcomes for in-hospital ischemic stroke：findings from the national get with the guidelines-stroke[J]. Stroke，2014，45（1）：231-238.

[5] SALTMAN A P，SILVER F L，FANG J，et al. Care and outcomes of patients with in-hospital stroke[J]. JAMA Neurol，2015，72（7）：749-755.

[6] ALBERTS M J，BRASS L M，PERRY A，et al. Evaluation times for patients with in-hospital strokes[J]. Stroke，1993，24（12）：1817-1822.

[7] VERA R，LAGO A，FUENTES B，et al. In-hospital stroke：a multi-centre prospective registry[J]. Eur J Neurol，2011，18（1）：170-176.

[8] NOUH A，AMIN-HANJANI S，FURIE K L，et al. Identifying best practices to improve evaluation and management of in-hospital stroke：a scientific statement from the American Heart Association[J/OL]. Stroke，2022，53（4）：e165-e175[2022-05-16]. https://doi.org/10.1161/STR.0000000000000402.

[9] DROEGEMUELLER C J，KASHYAP B，HUNA WAGNER R L，et al. A successful quality improvement project for detection and management of acute stroke in hospitalized patients[J]. J Neurosci Nurs，2020，52（4）：186-191.

[10] KAWANO H，EBISAWA S，AYANO M，et al. Improving acute in-hospital stroke care by reorganization of an in-hospital stroke code protocol[J/OL]. J Stroke Cerebrovasc Dis，2021，30（1）：105433[2022-05-16]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105433.

[11] CUMBLER E，SIMPSON J. Code stroke：multicenter experience with in-hospital stroke alerts[J]. J Hosp Med，2015，10（3）：179-183.

[12] YOO J，SONG D，BAEK J H，et al. Comprehensive code stroke program to reduce reperfusion delay for in-hospital stroke patients[J]. Int J Stroke，2016，11（6）：656-662.

[13] MANAWADU D，CHOYI J，KALRA L. The impact of early specialist management on outcomes of patients with in-hospital stroke[J/OL]. PLoS One，2014，9（8）：e104758[2022-05-16]. https://doi.org/10.1371/journal.pone.0104758.

[14] EL AMMAR F，ARDELT A，DEL BRUTTO V J，et al. BE-FAST：a sensitive screening tool to identify in-hospital acute ischemic stroke[J/OL]. J Stroke Cerebrovasc Dis，2020，29（7）：104821[2022-05-16]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104821.

[15] CUMBLER E，ANDERSON T，NEUMANN R，et al. Stroke alert program improves recognition and evaluation time of in-hospital ischemic stroke[J]. J Stroke Cerebrovasc Dis，2010，19（6）：494-496.

[16] FAROOQ M U，REEVES M J，GARGANO J，et al. In-hospital stroke in a statewide stroke registry[J]. Cerebrovasc Dis，2008，25（1/2）：12-20.

[17] 郑静维，彭斌. 综合医院院内新发卒中的临床特征——附116例资料分析[J]. 中华脑血管病杂志（电子版），2020，14（4）：209-216.

[18] CLARE C S. Role of the nurse in acute stroke care[J]. Nurs Stand，2020，35（4）：68-75.