Study On The Application Of Weaning Evaluation Mode Driven By Medical-nursing Cooperative In Patients With Invasive Mechanical Ventilation Based On Chinese Version

Objects(1)To describe the ICU nurses’ knowledge,attitudes and practices on the weaning indications of patients with invasive mechanical ventilation,and to analyze the factors influencing the implementation of nurse-led programmed weaning in clinical practice.(2)To translate the Modified Burns Wean Assessment Program(m-BWAP)which can be used by ICU nurses into chinese,and test its reliability and validity in patients with invasive mechanical ventilation.Based on the study results,it is concluded that the cut-off value for invasive mechanical ventilation patients’ weaning is suitable for our country,which provides a comprehensive,objective,and strong predictive ability for clinical weaning evaluation tool.(3)Improving the level of knowledge,attitudes and practice of ICU nurses on weaning indications,increasing their participation on the weaning process and applying the Chinese version of m-BWAP scale in clinic.Through the weaning evaluation driven by medical-nursing cooperative with the m-BWAP scale,which can ensure integrity and comprehensiveness of the evaluation on weaning,guarantee the safety and improve the outcome of patients with invasive mechanical ventilation.MethodsThis study is divided into three parts: the first part is the investigation of ICU nurses’ knowledge,attitudes and practices on the weaning indications of patients with invasive mechanical ventilation.The second part is to translate the Burns Wean Assessment Program(mBWAP)and test its reliability and validity.The third part is the application of weaning evaluation driven by medical-nursing cooperative in patients with invasive mechanical ventilation.In the first part,from July 2021 to September 2021,using the convenience sampling method,selecting 416 intensive care unit nurses from 29 hospitals in Shandong,Jiangsu,Hubei and Guizhou provinces were investigated by the questionnaires of general data and ICU nurses’ knowledge,attitudes and practices on the weaning indications of patients with invasive mechanical ventilation.In the second part,contacting the authors of the original scale and the modified scale by email and obtaining the authorization of the two authors.This study will strictly follow the Brislin translation model and translate it into Chinese by using the following methods: sequential translation,back translation,cultural adaptation and adjustment of the research group.After further perfecting the preliminary experiment,the Chinese version of m-BWAP scale was formed.Convenience sampling method was used to select patients who received invasive mechanical ventilation in ICU of two hospitas in Zhenjiang and Qingdao from October 2021 to March 2022 for investigation,and to analyze the reliability and validity of the scale.Cronbach’ s α and interrater reliability were used to evaluate the reliability of the scale;Validity using the evaluation of content validity,structure validity and diagnostic validity;the ROC curve analysis was used to find the appropriate cut-off value for the screening score of patients with invasive mechanical ventilation on weaning.In the third part,strictly according to the inclusion and exclusion criterias,adult patients receiving invasive mechanical ventilation in the ICU in Zhenjiang from April 2022 to January2023 were selected as the study objects.Patients admitted from April 2022 to August 2022 were set as the control group according to the admission order.Patients admitted from September 2022 to January 2023 were selected as the intervention group.In the control group,doctors decided whether patients entered the SBT stage according to clinical experience;in the intervention group,adoptting weaning evaluation mode driven by medical-nursing cooperative with the m-BWAP scale,the department leader established airway management group,according to the preliminary study results,implemented targeted training and examination,to ensure the quality of weaning assessment.The difference between the two groups in time of MV,total mechanical ventilation time,ICU stay time,and re-intubation rate within 48 h were compared.Results(1)The scores of ICU nurses’ knowledge,attitudes and practices on weaning indications were(3.60±1.43),(43.97±5.77)and(43.78±6.91)respectively.Multiple regression analysis showed whether they had received relevant training,whether they had respiratory therapists in the department,and whether they had relevant assessment tools in the department were the influencing factors of practice,which could explain 16.1% of the total variation.(2)Cronbach’s α coefficient of m-BWAP was 0.767,and the consistency kappa value was0.805(P<0.001).The Chinese version of m-BWAP scale includes seven dimensions which were named as pulmonary ventilation mechanics status(3 items),airway purification status(2 items),lung and autonomous breathing capacity status(5 items),circulation status(3 items),hemodynamics and acid-base balance status(3 items),nutrient and electrolyte balance status(2items),and mental activity status(2 items).The cumulative variance contribution rate is 63.130%.The second part of the results showed that When the cut-off value of Chinese version of m-BWAP was 60.5,the maximum area under the ROC curve(AUC)was 0.948,the sensitivity was 0.957,the specificity was 0.917.Compared with the clinical weaning standard,the m-BWAP of PPV and NPV were 92.2% and 94.4% respectively.(3)Compared with the experimental group,the weaning evaluation mode driven by medicalnursing cooperative significantly shortened the mechanical ventilation time before the first SBT(67.97 h VS 108h),and decreased the total mechanical ventilation time(87.87 h VS 134.08h)and ICU stay time(5.77 d VS 7.86d).There was no significant difference between the two groups in the rate of re-intubation after extubation at 48h(8.2% VS 11.5%)(P > 0.05).Conclusions(1)The ICU nurses have insufficient knowledge on weaning indications,their attitudes are positive,their practices need to be strengthened.ICU nurses lack targeted training and the screening weaning scale in clinical practice,and the process of weaning lacks integrity and continuity.Training should be strengthened to improve the level of knowledge,attitudes and practices on weaning indications of ICU nurses,nurses should be encouraged to participate in the process of weaning actively,and the evaluation tools should be standardized to improve the participation of ICU nurses in the weaning process.(2)The Chinese version of m-BWAP has good reliability and validity,its evaluation content is comprehensive and objective,which can be used as a reliable tool to evaluate weaning and extubation outcomes of patients with invasive mechanical ventilation successfully.(3)The application of the weaning evaluation mode driven by medical-nursing cooperative can standardize the weaning process,ensure the comprehensive and continuity of the weaning evaluation,shorten the mechanical ventilation time and ICU stay time,and improve the weaning outcome of patients.