Abstract: Objective　To verify the application effect and nursing strategy applicability of the collaborative comfort care model based on the IKAP theory and incorporating a modified A-DIVA (adult-difficult intravenous access) scale in the voluntary blood donation. Methods　A total of 1 074 donors who donated whole blood at Guangzhou Blood Center from June to October 2024 were selected by the random sampling method for the randomized controlled trial, and were divided into a control group (534 cases) and an experimental group (540 cases) by the participants were divided  method. In the control group, there were 372 males (69.66%) and 162 females (30.34%), with an age of (31.35±5.16) years. In the experimental group, there were 361 males (66.85%) and 179 females (33.15%), with an age of (31.19±5.33) years. The control group received routine care, while the experimental group implemented hierarchical precision nursing intervention based on the IKAP theory and comfortable nursing mode, with the improved A-DIVA scale as the risk assessment tool for the blood donors. t and χ² tests were used as the statistical methods. Results　The first puncture success rate of the experimental group was higher than that of the control group [96.67% (522/540) vs. 92.32% (493/534); χ²=10.235; P<0.05]. The score of venous puncture pain in the experimental group was lower than that in the control group (0.41±0.07 vs. 0.78±0.14; t=54.869; P<0.05). The incidence rate of DRVR in the the experimental group was lower than that in the control group [2.59% (14/540) vs. 5.99% (32/534);χ²=8.421; P<0.05]. The score of A-DIVA in the experimental group was higher than that in the control group, and the blood collection time and the number of punctures were both shorter (all P<0.05). Conclusion　The collaborative comfort care model based on the IKAP theory and incorporating a modified A-DIVA scale can effectively identify blood donors who are at risk of having difficulties with venous access. It also enhances the success rate of the first venous puncture, alleviates the puncture pain, and reduces the incidence of adverse reactions, primarily DRVR.

Key words: IKAP theory, Collaborative comfort care, Difficult intravenous access, Assessment tools, Voluntary blood donation, Venous puncture, Donation related vasovagal reaction

摘要： 目的　验证基于信息-知识-信念-行为（IKAP）理论协同舒适护理模式结合改良A-DIVA量表在无偿献血采血中的应用效果和护理策略适用性。方法　本研究为前瞻性随机对照研究，采用随机抽样法，选取2024年6至10月在广州血液中心捐献全血的1 074名献血者，按随机抽样法分为对照组（534例）和试验组（540例）。对照组中男372例（69.66%），女162例（30.34%），年龄（31.35±5.16）岁；试验组男361例（66.85%），女179例（33.15%），年龄（31.19±5.33）岁。对照组接受常规护理，试验组基于IKAP理论协同舒适护理模式结合改良A-DIVA量表作为献血者风险评估工具，实施分层级精准护理干预。统计学方法采用t检验、χ²检验。结果　试验组首次穿刺成功率为96.67%（522/540），显著高于对照组的92.32%（493/534）（χ²=10.235，P<0.05）；试验组静脉穿刺疼痛评分为（0.41±0.07）分，低于对照组的（0.78±0.14）分（t=54.869，P<0.05）；试验组 DRVR 发生率为 2.59%（14/540），显著低于对照组的 5.99%（32/534）（χ²=8.421，P<0.05）；试验组A-DIVA评分高于对照组，采血时间、穿刺次数均低于对照组（均P<0.05）。结论　基于IKAP理论协同舒适护理模式结合改良的A-DIVA量表在无偿献血采血中能有效识别存在静脉通路困难风险的献血者，提升首次静脉穿刺成功率，缓解穿刺疼痛，减少发生以DRVR为主的献血不良反应。

关键词: IKAP理论, 舒适护理, 困难静脉通路, 评估工具, 无偿献血, 静脉穿刺, 献血相关血管迷走神经反应