1.1 Research objects
1.1.1 Interviewees
Registered nurses who worked in the intensive care department of a tertiary hospital in Nanchang for ≥ 2 years and volunteered to participate in this interview were selected as the interview subjects, and the interview location was the ICU medical and nursing lounge. A total of 10 subjects were included in this interview, numbered 1–10. Among them, there are 2 males and 8 females; the numbers of junior, intermediate and senior professional titles are 2, 6 and 2 respectively. The working time is between 3 and 22 years, and the age is between 25 and 42 years old. After the interview, the interview data were coded and organized.
1.1.2 Objects of expert correspondence
This letter inquiries select experts who have a bachelor's degree or above, intermediate professional titles or above, and have worked for more than 10 years and voluntarily participate in this letter inquiries. The specific results are shown in Table 1.
Table 1
General information of experts in correspondence
Classification
|
number(n)
|
Classification
|
number(n)
|
Classification
|
number(n)
|
Area
|
|
Job Title
|
|
Age
|
|
Sichuan Province
|
3
|
Intermediate title
|
4
|
30~40
|
5
|
Jiangxi Province
|
6
|
Deputy senior title
|
7
|
41~50
|
7
|
Beijing
|
3
|
High title
|
4
|
>50
|
3
|
Guangdong Province
|
3
|
Professional direction
|
|
Working years
|
|
Education
|
|
Nursing management
|
7
|
10~20
|
4
|
Undergraduate
|
9
|
clinical care
|
6
|
21~30
|
8
|
postgraduate
|
5
|
Critical Care Medicine
|
1
|
>31
|
3
|
doctor
|
1
|
Psychology
|
1
|
—
|
—
|
Note: "—" means no number |
1.1.3 Survey Objects
In June 2022, registered nurses who worked independently in the ICU of a tertiary hospital in Nanchang were randomly selected; the working time in the ICU was ≥ 1 year; they volunteered to participate in this survey. According to the sample size of 5 to 10 times the number of items in the questionnaire[7], since there were 41 initial items in this questionnaire, and considering the 10% sample loss rate, 451 subjects were finally considered for inclusion.
1.2 Research methods
1.2.1 Literature review method
Based on the theory of knowledge, belief, and behavior, we systematically searched domestic and foreign literatures with the definition, incidence, assessment tools, high-risk factors, high-risk groups, intervention measures, and follow-up of post-ICU syndrome as search keywords to build a pool of questionnaire entries.
1.2.2 Semi-structured interview method
By establishing an interview outline, interviews were conducted with the included interviewees. The interview outline is: ① Do you think it is necessary to investigate the current status of ICU nurses' knowledge, belief, and practice of post-ICU syndrome? ②What do you think ICU nurses need to know about post-ICU syndrome? ③What do you think the ICU nurses will think about the department's work on the prevention of post-ICU syndrome? ④In your daily work, what kind of work do you think can effectively prevent post-ICU syndrome? ⑤What is your opinion on the knowledge of post-ICU syndrome?
Through the literature review method and semi-structured interview method, a questionnaire on the status quo of ICU nurses' knowledge, belief, and behavior of post-ICU syndrome was initially formed, including a total of 41 items, including 17, 11, and 13 items in the three dimensions of knowledge, attitude, and behavior.
1.2.3 Delphi expert correspondence method
The content of the letter inquiries includes three parts: the general information of experts, the "Questionnaire on the Status of Knowledge, Belief and Practice of ICU Nurses on Post-ICU Syndrome", the expert's familiarity with the content of the questionnaire (Cs) and the basis for judging the importance of the items (Ca). The inquiry form will be returned within 2 weeks after the letter is issued in the form of mail. Experts evaluate the importance of each item, and explain the items that need to be added, deleted or modified. The importance of each item is in order of very unimportant, unimportant, important, very important, and very important, with a score ranging from 1 to 5. Items with an average score < 3.5 and a coefficient of variation (CV) > 2.5 were deleted[8]. The specific amendments, deletions, and mergers are as follows: "I think it is necessary for ICU nurses to master the use of post-ICU syndrome assessment tools" is changed to "I think it is necessary for ICU nurses to master the assessment methods for post-ICU syndrome"; "In clinical work I will pay attention to the patient's psychological condition" to "I will pay attention to whether the patient has anxiety, depression, delirium and other problems in clinical work"; delete "I think my knowledge of post-ICU syndrome can meet the clinical needs"; Interested in knowledge about post-ICU syndrome", "I think it is necessary for ICU nurses to master knowledge about post-ICU syndrome"; "I would like to receive training on post-ICU syndrome" is merged into "I think it is necessary for ICU nurses to have knowledge about post-ICU syndrome" Knowledge of Post-ICU Syndrome". After 2 weeks, the second round of expert letter consultation will be carried out, and "Whether you will pay attention to the patient's physical activity in clinical work" is revised to "I will pay attention to the patient's muscle strength in clinical work", other items are retained, and the letter Inquiry ends. After two rounds of expert correspondence, the number of modified, deleted and merged entries was 8, 4 and 3 respectively.
1.3 Pre-investigation
Randomly selected 15 ICU nurses from tertiary hospitals in Nanchang City for pre-investigation to evaluate whether the content of the questionnaire is reasonable and the description is easy to understand. The filling time is about 6–9 minutes. According to the results of the survey feedback and amend the two items with ambiguity in description: change "the harm of post-ICU syndrome" to "the harm of post-ICU syndrome to patients"; "I will make reasonable adjustments according to the patient's mental and conscious state. "Use of sedatives" was changed to "I will adjust the use of sedatives reasonably according to the patient's mental and conscious state after communicating with the doctor and following the doctor's advice", without deleting and adding items.
1.4 Formal Investigation
Formal questionnaires were distributed to 451 research subjects through Questionnaire Star, and 428 were recovered, with a recovery rate of 94.90%. Excluding duplicate answers and answering less than 1 minute of questionnaires, a total of 28 questionnaires were obtained, and 400 questionnaires were finally obtained. Items 1–11 of the knowledge dimension of the questionnaire are graded likert 5, ranging from "completely ignorant" to "completely understood", with a score of 1 to 5; items 12–15 are multiple-choice questions, select " 3 points for "correct", 2 points for choosing "unclear", and 1 point for choosing "wrong", with a total score of 15 to 67 points. The attitude dimension ranges from "very unnecessary" to "very necessary", with scores ranging from 1 to 5, with a total score of 7 to 35. The behavior dimension ranges from "almost never" to "always", with a score of 1 to 5 and a total score of 13 to 65. The total score of the questionnaire is 35 to 167. The higher the level of syndrome knowledge, attitude and behavior.
1.5 Statistical methods
Using Excel2016, SPSS25.0, Amos24.0 to conduct data sorting and statistical analysis. General survey data are presented as frequencies and percentages. The results of this letter inquiries were evaluated by experts' enthusiasm, expert authority coefficient (Cr), and Kendall's W coefficient; extreme value method (CR) and Pearson's correlation coefficient were used for item analysis of the questionnaire; content validity was based on item content Validity (I-CVI) and scale content validity (S-CVI) were analyzed, and construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The reliability and test-retest reliability were tested, and P < 0.05 was considered statistically significant[9].