基于 ISBAR理论的 ICU护理交班指标构建及其智能化系统实现 [中文引用][英文引用]

目的  依据 ISBAR 理论，即身份确认（Identify）、现状（Situation）、背景（Background）、评估（Assessment）、建议（Recommendation）标准化沟通理论，建立重症监护室（intensive care unit，ICU）护理交班的指标并开发相关的智能护理交班系统（以下简称智能 ICU-ISBAR 护理交班系统），以提升护理交班规范性、交班效率和质量，为 ICU 护理交班提供标准化工具。方法  通过文献回顾梳理 ISBAR 理论的核心要素及 ICU 护理交班的关键内容，初步拟定 ICU 护理交班指标初稿；采用德尔菲专家函询（20 名）筛选并确认指标体系的核心维度和具体指标，并转化为智能 ICU-ISBAR 护理交班系统，进行应用效果评价。结果  第一、二轮函询问卷的有效回收率均为 100.00%，专家权威系数为 0.83，Kendall 协调系数 W 分别为 0.127、0.166，指标重要性赋值分别为 4.25~4.95 分、3.90~5.00 分，变异系数分别为 0.05~0.19、0~0.22，最终构建的智能 ICU-ISBAR 护理交班系统包括 6个一级指标和 60 个二级指标。临床应用效果显示，该系统的数据上传成功率达到 96.67%，平均响应时间为 1.80s；交班记录平均时间为（1.97±0.58）min/ 例；护士对交班质量满意度平均（4.47±0.25）分；对系统使用感受平均（4.75±0.08）分，12 名护士认为该交班系统的实用性、便捷性、智能性较高。结论  基于 ISBAR 理论构建的 ICU 护理交班指标客观、科学且严谨，具备结构性、标准性及专科特异性，由此开发的智能 ICU-ISBAR 护理交班系统能规范交班流程、减少信息遗漏、提高交班效率和质量，可能作为 ICU 护理的标准化交班工具。

Objective To establish an ICU nursing shift handover index based on the standardised communication framework of ISBAR（Identity，Situation，Background，Assessment，and Recommendation）and create an intelligent nursing shift handover system （hereinafter referred as“Smart ICU-ISBAR Nursing Shift Handover System”），thereby improving the standardisation，efficiency and quality of ICU nursing shift handovers with a standardised tool for planning ICU nursing shift handovers. Methods Literature was searched to identify the core elements of ISBAR and the key contents of ICU nursing shift handovers，then a preliminary draft of ICU nursing shift handover index was proposed. Delphi expert-consensus technique（20 experts）was used to screen and finalise the core dimensions and specific indicators of the index system，which were then integrated into the Smart ICU-ISBAR Nursing Handover System. Finally，the clinical effectiveness of the system was evaluated. Results Both Delphi rounds achieved 100.00% response rate. The expert authority coefficient was 0.83. The Kendall’s W values of 2 rounds were 0.127 and 0.166（all P<0.001）respectively. The index importance scores ranged from 4.25-4.95 and 3.90-5.00，with coefficients of variation of 0.05-0.19 and 0.00-0.22，respectively. The final version of Smart ICU-ISBAR nursing shift handover system comprised 6 primary indicators and 60 secondary indicators. Over the clinical trials，the system achieved a 96.67% success rate in data-upload with an average response time of 1.80 sec.，the mean documentation time of shift handover at（1.97±0.58）min per patient，12 nurses’satisfaction with the shift handover quality of（4.47±0.25）and the rating of the system’s usability of（4.75±0.08）. The system was highly practical，convenient and intelligent. Conclusion The ICU nursing shift handover index system developed on the basis of ISBAR theory features a structural integrity，standardisation and ICU-specific characteristics and it is objective，scientific and rigorous. The Smart ICU-ISBAR Nursing Shift Handover System standardises the shift handover process，reduces information omissions，and improves efficiency and quality of nursing shift handover process. It serves as a standardised shift handover tool for ICU nursing shifts.