评定重症患者合理营养阻碍的修订问卷
为了修订和完善重症成人患者合理肠内营养阻碍评定问卷，加拿大维多利亚女王大学、金斯顿总医院基于以前受访者的反馈对问卷进行了修改。修订后的问卷，其中包括20项潜在阻碍，在北美3家医院进行初步测试，要求护士根据每个项目阻碍重症监护病房（ICU）提供肠内营养的程度对其进行分级。使用5个附加在问卷末尾的开放式问题，对修订问卷的可接受性进行评估。
结果共有81位护士完成了修订阻碍问卷，73位受访者中有72位（99%）认为调查问卷容易理解，64位（88%）认为各项问题明确。总体而言，受访者认为向患者提供肠内营养的潜在阻碍程度“非常小”或“有一点”。3个ICU对8～20项可见统计学显著差异。内在可靠性指标被评定为可以接受。
因此，用于评定肠内营养阻碍的修订问卷似乎可以接受，并且具有临床敏感性，同时全面地列出提供肠内营养所有可能可变的阻碍。该问卷仍需进一步研究，以确定采用此问卷衡量阻碍，能否转化为改善重症患者肠内营养实施。
JPEN J Parenter Enteral Nutr. 2016;40(4):511-8.
Revised Questionnaire to Assess Barriers to Adequate Nutrition in the Critically Ill.
Cahill NE, Jiang X, Heyland DK.
Queen's University, Kingston, ON, Canada; Kingston General Hospital, Kingston, ON, Canada.
BACKGROUND: The objective of this study was to revise and improve a questionnaire to assess barriers to providing adequate enteral nutrition (EN) in critically ill adults.
METHODS: Changes were made to the questionnaire based on feedback from previous respondents. The revised questionnaire, including 20 potential barriers, was pilot tested in 3 hospitals in North America. Nurses were asked to rate each item based on the degree to which it hinders the provision of EN in their intensive care unit (ICU). The acceptability of the revised questionnaire was evaluated using 5 open-ended questions appended at the end of the questionnaire.
RESULTS: A total of 81 nurses completed the revised barriers questionnaire. A total of 72 of 73 (99%) respondents felt that the questionnaire was easy to understand, and 64 of 73 (88%) felt that the individual questions were clear. On average, respondents rated the degree to which potential barriers hindered the delivery of EN to the patient as "very little" or "a little." Statistically significantly differences in mean responses were observed across the 3 ICUs for 8 of the 20 items. The indices of internal reliability were assessed to be acceptable.
CONCLUSIONS: The revised questionnaire to assess barriers to EN seems acceptable and clinically sensible and now appears to comprehensively list all possible modifiable barriers to delivering EN. This questionnaire needs further study to determine whether measuring barriers with this questionnaire can translate into improved EN delivery to critically ill patients.
PMID: 25655619
DOI: 10.1177/0148607115571015
