| Objective1.Based on the needs of patients and the relationship between nurses and their patients,the guidelines for humanistic nursing practice for ICU nurses in China were constructed by combining the results of quantitative and qualitative studies and the opinions of experts in the field.2.To conduct a survey of clinical ICU nurses based on the constructed guidelines to understand the current practice of the relevant measures in the guidelines and to analyse the feasibility of the guidelines.Methods(1)Review of ICU-related quantitative researchA preliminary search of domestic and international databases was conducted to filter and refine keywords related to humanities in the literature for further search,establish the theoretical framework for guidelines through research studies in related literature,and construct a preliminary pool of entries by drawing on the experience of existing studies.(2)Meta-integration of qualitative research on ICU patients’ needsUsing the SPIDER model to construct the research questions,we systematically searched for qualitative studies related to ICU patients’ needs in domestic and international databases since the establishment of the database using the key words"patient needs","experience" and "experience".The qualitative studies related to the needs of ICU patients included in the database since its establishment until June 30,2021,and the quality assessment tool of the Oxford Centre for Evidence-Based Medicine was used to evaluate the selected included literature.(3)Delphi expert consultation methodOn the basis of the literature review and Meta-integration of qualitative research,a subject group was set up and the first draft of the guidelines was summarized and compiled after several rounds of meetings and discussions,and on this basis a Delphi expert correspondence questionnaire was formed.Twenty-two experts in the field of critical care and humanities from six provinces and cities were selected to evaluate the importance and rationality of the primary and secondary indicators,and the importance and operability of the tertiary indicators,and after two rounds of consultation,the final draft of the guidelines for humanistic nursing practice for ICU nurses was finally formed.(4)Survey on the current status of practice guidelinesAfter the research and discussion of the group,based on the constructed practice guidelines and the results of the expert consultation and pre-survey,a questionnaire with good reliability and validity on the current situation of humanistic nursing practice in ICU was developed,including a questionnaire on the personal situation of nurses,a questionnaire on the implementation of humanistic nursing in ICU,a questionnaire on the situation of their units and departments,and a questionnaire on the environment and medical atmosphere of the care unit.Among them,the questionnaire on the implementation of humanistic care in ICU has 12 dimensions and 82 entries,using a five-point Likert scale with scores ranging from 82 to 410,with higher scores indicating a higher frequency of that humanistic care measure.A convenience sampling method was used to survey 702 clinical nurses in ICUs in 11 prefecture-level cities in Guangdong Province.Results(1)Results of a review of ICU-related quantitative studiesA snowball search of quantitative studies related to ICU humanities at home and abroad,based on theoretical studies related to humanistic nursing,a guideline framework based on Maslow’s hierarchy of needs theory and Chinese nurses’ ethical guidelines was built,involving ICU environment,sleep,dry mouth and thirst,sedation and analgesia,reduction of restraint,early mobility,communication,end-of-life care,family-centeredness,transfer out transition,etc.were formed.The preliminary pool of 76 items in ten areas was formed.(2)Meta-integration results of qualitative studies on the needs of ICU patientsAfter screening,24 papers were included,mainly phenomenological,including 1 mixed study,with 22 studies involving patients,4 nurses,2 family members,and 1 healthcare team.The content of the included literature was analyzed,and a total of 5 integrated results and 13 themes were analyzed:①humanized symptom management(physical discomfort,daily care,pain management);②management and optimization of the environment(environmental optimization,flexible visitation);③psychological burden and negative emotions(easing negative emotions,communication barriers);④support from healthcare professionals(respect for needs,trust in healthcare professionals,support from healthcare professionals);and ⑤professional planning and guidance(knowledge of illness,desire for recovery,safe transfer).The integration resulted in the addition of 46 entries related to patients’ needs to the item pool.(3)Results of Delphi Expert ConsultationThe recall rates of the two rounds of consultation questionnaires were 100%and 95.45%,respectively,and the authority coefficients of the consultation experts were 0.889,0.892,and Kendall’s coordination coefficients were statistically significant after chi-square test(P<0.01).The mean scores of importance and rationality evaluation of the first and second indicators were 4.613 and 4.658,and the mean scores of importance and operability evaluation of the third level indicators were 4.627 and 4.379.The average coefficient of variation was 0.139 after two rounds of consultation.The experts made 156 and 74 comments in the two rounds of consultation,and the group revised 73 and 29 items respectively,and 5 items still reached the deletion criteria after two rounds of revision.Finally,we constructed a set of ICU humanistic care practice guidelines,which including 6 first level indicators("respect","care","safety","communication","fairness" and "evaluation"),20 secondary indicators and 90 tertiary indicators.(4)Results of the survey on the status of guideline practice1)The environment and medical climate of the unit in which the nurses were working:more than 70%of the nurses’ units had sufficient natural light and personalised adjustment of temperature,humidity and light,29.34%had separate rest areas and toilets for family members,26.21%were equipped with reading lights,books and newspapers or electronic devices for patients’ use,17.52%had a dedicated ICU hospice room,and 52.28%of the units still had Poor medical practice.2)ICU nurses’ guideline practice:the mean score of ICU humanistic care practice frequency questionnaire was 332.30±46.80,and there were 8 dimensions with mean scores above 4 out of 12 dimensions,including environment management,comfort management,restraint management,ICU syndrome prevention,transfer out safety,medical and nursing communication,nurse-patient communication,and nurse-family communication.The dimensions with the highest and lowest practice frequency were restraint management(4.37±0.67)and hospice care(3.65±1.00),respectively.3)Factors influencing humanistic nursing practice among ICU nurses:① Personal factors:among 17 personal-related factors,the frequency of nurses’ humanistic nursing practice was correlated with 8 factors including gender,years of critical care work,title,humanistic-related experience,and nurses’ attitude toward work(P<0.05).②Departmental factors:among the nine department-related factors,eight factors,including whether overtime work was regular,whether the department was an ICU specialist nurse training base or a quality service demonstration department,whether opinions were valued by physicians,and the humanistic practice of the unit,had an effect on the frequency of nurses’ humanistic nursing practice(P<0.05).Conclusion1.The study was based on literature and theoretical studies,discussions among members of the group,and consultations with Delphi experts to develop a systematic,scientific,practical and localised guide to humanistic nursing practice for ICU nurses.2.This guideline integrates the original fragmented care measures into a systematic humanistic nursing practice guideline,which is feasible in clinical practice and serves as a guide for ICU nurses in the process of implementing humanistic nursing. |
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