Construction Of The Risk Assessment Scale For Unplanned Endotracheal Extubation Of Adult Based On Evidence

Research objectives:According to the evidence-based results,we analyzed the risk factors of unplanned tracheal extubation,Followed the scientific and systematic scale construction,a quantitative risk assessment scale for unplanned tracheal extubation in adult patients has been developed,We provided scientific means and tools for clinical nurses to assess the risk of tracheal extubation objectively and comprehensively,It was suggested that the medical staff should pay attention to make individualized nursing plan for the high-risk extubation patients,and take targeted preventive measures to effectively prevent unplanned extubation of tracheal intubation.The research could guide the establishment of nursing operation criterion and standard in clinical tracheal intubation,improve the quality of nursing safety management and the effective utilization rate of medical nursing resources,and create a good medical environment.Methods:1.Guided by the evidence-based theory of Hobkins in the United States,a rigorous retrieval strategy was developed for the topic of unplanned tracheal extubation,and the evidence of risk factors was extracted from the retrieved literatures,and the quality and grade of evidence were evaluated,categorized the content and initially constructed the item pool of the scale.2.Based on the pool of items,the focus group selected the items for clinical applicability and importance,consulted the relevant literature,classified the items scientifically, constructed the content frame of the scale and developed the expert consulting table,and selected the consulting experts,through 3 rounds of expert consultation,the content system of the scale was finally determined.3.Based on the result of expert evaluation,the weight of the items in the scale was determined by analytic hierarchy process(AHP),The scale was assigned after panel discussions to ensure the scientificity and rationality of the scale assignment process,and finally a test version of the scale was formed.4.The risk of adult patients with endotracheal intubation was assessed using the beta scale.The sample size was determined by the scale items,The internal consistency reliability,content validity,construct validity and surface validity of the scale were tested by statistical analysis.Results:1.A total of 359 literatures were searched and screened.After full-text reading and re-screening.14 literatures were finally included,one was grade I(7.14%),one was grade I A(7.14%),one was grade I C(7.14%),one was grade II B(7.14%),two was grade II D(14.29%),one was grade III A(7.14%)and five was grade III B(35.71%).The contents of the evidence of risk factors in the literature were sorted and summarized,and 5 items of the first-class items and 19 items of the second-class items were drawn up by the focus group discussion.2.The positive coefficient of three rounds of experts is 88.24%,100.00%,100.00%,the authoritative coefficient of experts is 0.91,the coordination coefficient of experts on the importance of items is 0.484,the coordination coefficient of the rationality of classification of items is 0.329,and the coordination coefficient of assignment of items is 0.759,P< 0.05.3.The risk assessment scale for unplanned tracheal extubation in adults was composed of9 items,including age,sex,decubitus position,muscle strength,pain level,consciousness,sedation level,intubation mode and indwelling time.The total score was 64.4.The Cronbach’α coefficient of the scale was 0.841.5.Results:(1)content validity: I CVI was 0.8 ～ 1.0,S-CVI was 0.96,and I CVI was 0.8 ～1.0,S-CVI was 0.94,which all met the criteria of the item classification.(2)construct validity: the results of confirmatory factor analysis showed that the standardized load coefficient of all items in the scale was greater than 0.4,and the test P was < 0.05.At the same time,CFI and TFI were 0.983 and 0.922.SRMR was 0.03,and RMSEA was0.074,which all met the standards 3 surface validity: the Spearman correlation coefficient between the scores of each item and the total score was greater than 0.60,and the correlation coefficient P was < 0.05.Conclusions:1.Based on the method of evidence-based analysis and Delphi expert consultation,this study constructed a reasonable and comprehensive risk assessment scale for unplanned extubation of adult tracheal intubation.It provided a scientific and effective strategy tool for improving the clinical nursing quality of patients with tracheal intubation.2.In this study,9 risk factors of unplanned extubation in adult patients with tracheal intubation were identified by using analytic hierarchy process(AHP),and the risk factors were ranked according to weight,It provided scientific reference and reference for the follow-up theoretical and practical research.3.In this study,risk assessment scale was used to assess adult patients with tracheal intubation,and the data were collected to test the reliability of the scale.Content validity,construct validity and surface validity were used to test the validity of the scale.The results showed that the scale had good reliability and validity.