摘要
目的审查卒中相关性肺炎(SAP)护理预防证据的应用现状,综合分析障碍因素和促进因素,为SAP预防提供参考。方法研究小组基于循证医学方法,提取SAP护理预防最佳证据并确定审查指标,对某市3家三甲医院神经内科病区66名护士及2021年10月-2022年1月128例卒中住院患者进行审查,并采用i-PARIHS循证框架对障碍因素和促进因素进行分析。结果共纳入20篇文献,提取28条证据,确定18项审查指标。有2项指标审查符合率为100%,8项指标审查符合率<60%(其中1项符合率为0%)。障碍因素主要为证据与环境冲突、证据条目转化不清晰、缺乏证据测量标准、护士及患者知识欠缺、护士工作量大且缺乏循证思维、缺乏多学科协作及专门预防团队等;促进因素主要为具备具体标准及流程、医院及管理者支持、科室排班合理且学习资源丰富、设立卒中小组等。结论SAP护理预防证据与临床护理实践存在一定差距,应充分发挥促进因素的作用,并积极克服障碍因素带来的不良影响,不断优化SAP护理预防流程并持续改进,以促进证据临床转化。
Objective To review the application status of nursing prevention evidence of Stroke-Associated Pneumonia(SAP),comprehensively analyze the obstacle factors and stimulative factors,and provide reference for the prevention of SAP.Methods Based on the evidence-based medicine method,the research team extracted the best evidence of SAP nursing prevention and determined the review indicators.66 nurses and 128 inpatients with stroke from the neurology ward of 3 tertiary hospitals in a city from October 2021 to January 2022 were reviewed,and the i-PARIHS evidence-based framework was used to analyze the obstacle factors and stimulative factors.Results A total of 20 literatures were included,28 pieces of evidence were extracted,and 18 review indicators were determined.The conformity rate of 2 indexes was 100%,and the conformity rate of 8 indexes was less than 60%(among which 1 item was 0%).The main obstacle factors were conflict between evidence and environment,unclear transformation of evidence items,lack of evidence measurement standards,lack of knowledge of nurses and patients,heavy workload of nurses and lack of evidence-based thinking,lack of multidisciplinary collaboration and special prevention teams,etc.The main stimulative factors were specific standards and procedures,hospital and manager support,reasonable department scheduling and rich learning resources,and the establishment of a stroke group.Conclusion There was a gap between evidence for nursing prevention of SAP and clinical nursing practice.We should give full play to the role of stimulative factors and actively overcome the influence of obstacle factors,and continuously optimize the nursing prevention process and carry out continuous quality improvement to promote the clinical application of best evidence.
作者
郭清源
刘高
杨慕维
王蕾
白娅萍
蔡恩丽
GUO Qingyuan;LIU Gao;YANG Muwei(School of Nursing,Yunnan University of Traditional Chinese Medicine,Kunming,Yunnan,650500,China;不详)
出处
《中国卫生质量管理》
2023年第1期49-55,共7页
Chinese Health Quality Management
基金
云南省科技厅中医药基础研究联合专项面上项目(编号:202101AZ070001-221)
云南中医药大学2022年度教育科学研究重大课题(编号:ZD220101)。
关键词
卒中相关性肺炎
循证护理
证据审查
障碍因素
促进因素
i-PARIHS框架
护理质量
Stroke-Associated Pneumonia
Evidence-Based Nursing
Evidence Review
Obstacle Factors
Stimulative Factors
i-PARIHS Framework
Nursing Quality
作者简介
通信作者:蔡恩丽,云南中医药大学护理学院硕士生导师,E-mail:13708482037@139.com。
