Zhongguo cuzhong zazhi (Sep 2023)
标准化培训流程对护士评定格拉斯哥昏迷评分可靠性的影响 The Effect of Standardized Training on the Reliability of Glasgow Coma Score Evaluation by Nurses
Abstract
目的 评价标准化培训流程对护士进行GCS评分可靠性的影响。 方法 基于目前GCS评估方法，采用文字讲解、测验和临床实践培训一体化的标准化培训流程，进行针对护士的评分规范培训。前瞻性、连续纳入收治于首都医科大学附属北京天坛医院神经重症医学科的危重神经系统疾病患者。选取20名低年资（工作2年以内）护士，在进行标准化GCS评分培训前和培训后分别对100例神经重症患者进行GCS评分。采用组内相关系数比较接受标准化培训流程前后，护士对GCS评分评价的一致性。此外，以做培训的神经重症专科医师的GCS评分为金标准，评估培训前后护士评估量表的效度。 结果 标准化培训流程使低年资护士间评估GCS评分的信度，即GCS总分评价的组内相关系数从0.862升至0.956，语言反应评价的组内相关系数从0.874升至0.953，运动反应评价的组内相关系数从0.689升至0.922，睁眼反应评价的组内相关系数从0.486升至0.665。以神经重症专科医师评定的GCS评分为金标准，低年资护士评定GCS总分的效标效度从0.856升至0.942。 结论 标准化培训流程可提高低年资护士评估GCS的信度和效度。 Abstract: Objective To evaluate the effect of standardized training on the reliability of Glasgow coma score (GCS) evaluation by nurses. Methods The current internationally recognized GCS scoring standardized training including text explanation, test and clinical practice training, were conducted for nurses. The consecutive patients with severe neurological diseases who were admitted to Neurointensive care unit, Department of neurology, Beijing Tiantan Hospital, Capital Medical University were prospectively included. Twenty nurses with low seniority (less than 2 years of service) were selected to conduct GCS scores for 100 patients with severe neurological conditions before and after standardized GCS scoring training. The intraclass correlation coefficient (ICC) was used to compare the consistency of GCS scores evaluation before and after the standardized training. In addition, the GCS scores evaluation by neurointensive care specialists who conducted training were used as the gold standard to evaluate the validity of the nurses’ scale assessment before and after the training. Results The standardized training improved the reliability of the GCS evaluation among the low seniority nurses, the ICC of GCS total score increased from 0.862 to 0.956, that of verbal response assessment increased from 0.874 to 0.953, that of motor response assessment increased from 0.689 to 0.922, and that of eye movement assessment increased from 0.486 to 0.665. After the training, the validity of the nurses in assessing GCS increased from 0.85 6 to 0.942. Conclusions Standardized training can improve the reliability and validity of the GCS scale among the low seniority nurses.
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