妇科短期留置导尿管清洁的最佳证据应用  

Application of best evidence for clean nursing on patients with short-term indwelling urinary catheter in gynecology

作　　者：李玲玲[1] 彭飞[1] 李金晓 宋娟 乔安花[1] 陆敏敏[2] Li Lingling;Peng Fei;Li Jinxiao;Song Juan;Qiao Anhua;Lu Minmin(Department of Obstetrics and Gynecology,Shanghai Changzheng Hospital,Shanghai 200003;School of nursing,Fudan University,Shanghai 200032)

机构地区：[1]上海长征医院妇产科,上海200003 [2]复旦大学护理学院,上海200032

出　　处：《护士进修杂志》2018年第19期1759-1764,共6页Journal of Nurses Training

基　　金：复旦大学护理科研基金项目(编号:Fudanebn201711)

摘　　要：目的将短期留置尿管清洁的最佳证据应用于妇科临床实践中,优化妇科短期留置尿管的护理规范,提高患者舒适度,提高护理质量。方法遵循澳大利亚乔安娜·布里格斯研究中心(JBI)循证护理中心的临床证据实践应用系统的标准程序,包括证据应用前基线审查、实践变革和证据应用后的再审查,获取JBI在线临床治疗及护理证据网络(COn NECT+)数据库中留置尿管清洁的相关证据并制定相应审查标准。采用现场观察法和患者访谈收集数据。2017年7月24日-9月18日,完成了对上海长征医院妇产科17名护士和48例患者共116次接收尿管清洁操作的基线审查。分析每条证据应用存在的障碍因素、可获得的资源及解决办法。实践变革后,2017年10月8日-11月30日共纳入17名护士和62例患者,接受尿管清洁操作196次。以护士执行每条审查标准的依从性、患者的舒适度、留置尿管感染率、护士进行留置尿管清洁的操作时间来评价证据应用前后的有效性。结果证据应用后,使用温开水冲洗并擦拭清洁尿道口、整个外阴部及尿管的执行率由0上升到100%,洗手的依从率由76%上升到100%,护士循证行为依从性显著提高。证据应用前后,所有患者均未发生留置尿管感染。患者舒适度与护士工作量在证据应用前后差异有统计学意义(P<0. 05)。结论短期留置尿管清洁的最佳证据的临床应用,改变了临床护理人员根深蒂固地使用消毒剂进行尿管清洁的思维习惯,将温开水冲洗用于留置尿管清洁护理,未发生留置尿管感染,且提高了患者舒适度、护士工作效率及临床护理质量。Objective To apply the best evidence of clean nursing with short term indwelling urinary catheters to clinical practice in gynecology, optimize the nursing norms for short term indwelling urinary catheters, and to im prove patient＇s level of comfort and nursing quality. Methods Through the standard procedure supported by the JBIPACES programs, including pre-application baseline review, practice change, and reexamination after evidence ap plication, Evidence regarding short term indwelling catheter cleaning was obtained from the JBI COnNECT＋ and then review criteria were identified. Data were collected by using field observation and interviews. From July 24 to September 18, 2017, 116 nurses and 48 patients in the department of obstetrics and gynecology of Shanghai Chang Zheng hospital were received a baseline review of urinary catheters cleaning. The existing obstacle factors were ana lyzed in each evidence apply,available resources and solutions were drew up. After practical changing, From Octo bet 8 to November 30, 2017, 17 nurses and 62 patients whose urethral catheter was cleaned 196 times were enrolled in the hospital. Nurses＇ compliance with each criterion, patient＇s level of comfort, urinary tract infection rate and the operation time of indwelling urinary catheter cleaning were used to evaluate the effectiveness of evidence implementa tion. Results After the evidence was applied, the use of warm water to rinse and clean the urethral meatus, the entire genital area, and the urinary catheter increased from 0 to 100%. The compliance rate of handwashing increased from 76 % to 100% , and the compliance of nurses with evidence based behavior increased significantly. There was no in dwelling catheter infection occurred in all patients before and after the evidence was applied. There was a significant statistically difference in patient comfort and nurse workload before and after the application of evidence （P〈0.05）.Conclusion The clinical application of the best evidence for the short term retention

关 键 词：留置尿管 妇科 循证护理 最佳证据 清洁 感染 

分 类 号：R473.71[医药卫生—护理学]