Development of a questionnaire on adult artificial airway management competence for ICU nurses and tests of its reliability and validity

doi:10.16138/j.1673-6087.2025.06.06

Abstract

Abstract:

Objective To develop a questionnaire on adult artificial airway management competence for intensive care unit (ICU) nurses. Methods A preliminary questionnaire on the competence of ICU nurses in managing adult artificial airways was formulated through literature review, Delphi expert consultation and a pilot survey. Using convenience sampling, 366 ICU nurses from two tertiary grade A hospitals in Shanghai and Harbin were surveyed from April to June 2024. Item analysis, exploratory factor analysis, confirmatory factor analysis and reliability test were conducted. Results The final questionnaire consisted of 32 items across 4 dimensions: artificial airway suctioning, endotracheal tube cuff management, prevention of artificial airway complications and artificial airway extubation care. Exploratory factor analysis extracted four common factors, with item factor loadings ranging from 0.403 to 0.968, and the cumulative variance contribution rate was 68.97%. Confirmatory factor analysis results showed that the model fit indices met acceptable standards, indicating a stable questionnaire structure. The overall content validity index of the questionnaire was 1.00, the total Cronbach's α coefficient was 0.98, the split-half reliability was 0.93, and the test-retest reliability was 0.99. Conclusions The questionnaire on adult artificial airway management competence for ICU nurses demonstrates good reliability and validity, and can be used as a tool to evaluate the corresponding competence of ICU nurses.

Key words: ICU nurse, Artificial airway, Airway management, Questionnaire, Reliability, Validity

CLC Number:

R472.9

CHEN Hui, ZHANG Yin, QIAN Zhuping, YAO Yijin. Development of a questionnaire on adult artificial airway management competence for ICU nurses and tests of its reliability and validity[J]. Journal of Internal Medicine Concepts & Practice, 2026, 20(06): 462-468.

Figures/Tables 2

Table 1

Exploratory factor analysis of questionnaire on adult artificial airway management competence of ICU nurses(n=309)

条目	因子
条目	人工气道吸痰	人工气道气囊管理	人工气道并发症预防	人工气道拔管护理
1 mmH₂0=0.0098 mmHg。
A1 我在置入吸痰管过程中不带负压	0.968	−0.057	−0.082	−0.099
A2 吸痰过程中，我会密切观察患者的面色、呼吸、血氧饱和度、心率/律和血压	0.949	−0.077	0.044	−0.050
A3 为患者进行密闭式吸痰后，我会及时使用灭菌注射用水或无菌生理盐水充分地冲洗管路	0.913	−0.032	0.099	−0.153
A4 我每次吸痰时间尽可能短，从置入到退出吸痰管不超过15 s，连续吸痰次数不超过2次	0.796	0.127	−0.124	0.057
A5 我为患者进行开放式气道内吸痰时，严格遵循无菌技术，戴无菌手套	0.780	0.072	−0.32	0.265
A6 我会根据产品说明书定期更换密闭式吸痰管，出现可见污染或套囊破损时立即更换	0.759	−0.074	0.150	−0.002
A7 当置入吸痰管感觉有阻力或刺激患者咳嗽时，我会观察吸痰管置入的深度，先退出吸痰管1～2 cm，排除吸痰管贴气道壁或痰痂堵管等因素后，再轻柔旋转提吸	0.749	0.153	0.121	−0.119
A8 我会根据人工气道型号选择适宜型号的吸痰管，吸痰管外径应不超过人工气道内径的50%	0.634	0.289	0.186	−0.334
A9 在吸痰后，我会评估患者的血氧饱和度、呼吸音和机械通气波形，记录吸引物的颜色、性状和量	0.607	0.277	−0.008	0.092
B1 对于已知或疑似通过飞沫或气溶胶传播的呼吸道传染病患者,如果遇到高气道压力,我认为应该调整气管导管气囊压力比气道峰压高5 cmH₂O	−0.030	0.844	0.141	−0.064
B2 我知道聚氨酯材料的人工气囊可以预防短期气管插管患者的呼吸机相关性肺炎	0.058	0.833	−0.036	0.023
B3 我知道预防呼吸机相关性肺炎首选含有硅胶气囊的新型气管插管	0.049	0.747	0.056	0.029
B4 人工气道气囊漏气时，我会通过对患者、呼吸机参数、人工气道的临床评估以及胸片检查等区分原因	0.010	0.612	−0.076	0.381
B5 当气囊性能完好仍存在漏气时,我会考虑改变人工气道位置、更换其他型号的人工气道、增加气囊压力或降低气道峰压	0.046	0.605	−0.018	0.318
B6 我认为对于气管切开无需机械通气的患者,如果自主气道保护能力好,可将气囊完全放气或更换为无气囊套管，需动态评估患者及气切导管情况	0.011	0.565	0.186	0.124
B7 当患者自主呼吸较弱、气道压较低、吸痰、体位改变后或被转移到不同海拔高度时，我会重新测量气囊压力	0.215	0.403	−0.043	0.388
C1 我会每6～8 h为机械通气患者进行口腔护理，包括擦拭、冲洗、用牙刷刷洗牙齿和舌面等，但氯己定不作为常规口腔护理液	−0.118	0.192	0.927	−0.219
C2 我会每天清洗消毒气管套管至少2次，流动水清洗并使用专用刷子或棉签等清理内套管，确保无肉眼可见附着物，金属内套管采用煮沸消毒或浸泡消毒等	−0.177	0.302	0.878	−0.258
C3 我会每日使用生理盐水清洁气管造瘘口及周围皮肤，使用含碘类或乙醇类皮肤消毒剂进行消毒	−0.034	0.058	0.847	−0.07
C4 我会保持气管切开处皮肤及敷料清洁干燥，每天使用专用无菌纱布或泡沫敷料为患者更换敷料	0.201	−0.145	0.671	0.111
C5 我会应定期评估患者对人工气道的耐受程度，在排除人工气道异常导致的不适后，遵医嘱予以适当的镇静、镇痛治疗和四肢约束	0.111	−0.211	0.633	0.326
C6 我会定期检查和调整气管切开固定带的松紧度，以伸入一手指为宜	0.260	−0.232	0.562	0.219
C7 我会定期观察人工气道患者的口腔、唇部、脸颊及颈后等固定位置的皮肤黏膜情况	0.279	−0.118	0.555	0.189
C8 拔管前，我会准备好监护仪、CO₂监护设备、呼吸机、抢救车等设备，确保处于良好备用状态并随手可得	0.107	0.092	0.533	0.189
C9 对于无禁忌证的机械通气患者，我会摇高床头30°～45°取半卧位，防止胃食管反流,减少胃内容物微误吸	0.296	−0.164	0.503	0.240
C10 我会应定期清除气囊上滞留物,尤其是气囊放气前	0.088	0.163	0.478	0.149
C11 拔管后，我会持续密切监测生命体征、意识状态、咳痰能力，使用CO₂监护设备及早发现气道梗阻	−0.025	0.21	0.441	0.282
D1 我会指导/训练患者拔管时的配合要点和拔管后的注意事项	−0.063	0.111	−0.054	0.900
D2 气管切开患者拔管前，我会为患者进行早期活动、胸部物理治疗及吸气肌训练等以提高拔管成功率	−0.096	0.204	−0.043	0.846
D3 我会配合医师或呼吸治疗师为患者做每日唤醒试验和自主呼吸试验	−0.068	0.263	−0.082	0.767
D4 气切患者在拔管前连续堵管24～48 h期间，我会观察并记录患者的活动、睡眠、进食时的呼吸情况	−0.176	0.221	0.292	0.569
D5 在无禁忌情况下，气管切开患者拔管前，我会给予患者头及躯干抬高30°～60°的半卧位作为预防误吸的基础体位	0.119	0.012	0.296	0.508
特征值	16.501	2.942	1.603	1.025
方差贡献率(%)	51.566	9.193	5.010	3.202
累计方差贡献率(%)	51.566	60.760	65.769	68.972

Table 1

Table 2

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拟合指标	χ²/df	RMSEA	RMR	CFI	IFI	TLI
参考范围	＜5（≤3为佳）	＜0.08	＜0.05	＞0.9	＞0.9	＞0.9
结果	3.392	0.088	0.042	0.870	0.870	0.859