泌尿外科患者短期留置导尿管的循证护理研究  

Evidence-based nursing practice of short-term urinary catheterization in department of urology

作　　者：于书慧[1] 王为 车新艳 黄燕波[1] 李晶[2] 丁炎明[2] 刘霞[2] Yu Shuhui;Wang Wei;Che Xinyan;Huang Yanbo;Li Jing;Ding Yanming;Liu Xia(Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院泌尿外科,北京100034 [2]北京大学第一医院护理部,北京100034

出　　处：《护理学杂志》2020年第17期93-97,共5页Journal of Nursing Science

基　　金：北京大学第一医院院级科研种子基金项目(2018SF113)。

摘　　要：目的基于最佳临床实践指南制订短期留置导尿管的泌尿外科患者的导尿管护理方案,并验证其安全性和有效性。方法针对留置导尿管护理的相关主题进行文献检索和质量评价,总结生成14条审查指标;通过基线调查及障碍因素分析,针对性制定干预措施,进行证据应用。结果证据应用后,肾癌术后患者留置导尿管时间及住院时间显著缩短(均P<0.01);肾结石/输尿管结石术后患者住院时间显著缩短(P<0.05);患者导尿管相关性尿路感染率、跌倒发生率及导尿管重置率均为0;护士在导尿管固定、接触不同患者更换手套、尿标本正确留取、集尿袋正确放置和及时倾倒、导尿管清洁及尽早拔除的依从性显著提高(均P<0.01);护士导尿管护理知识水平显著提高(P<0.01)。同时,本研究将更新导尿管护理常规。结论基于最佳证据制定的短期留置导尿管护理方案,可缩短患者留置导尿管时间及住院时间,提高护士执行依从性,规范护士行为。Objective To develop a care protocol for patients with short-term indwelling urinary catheter in department of urology based on the best clinical practice guidelines and to validate its safety and effectiveness.Methods Literature regarding urinary catheter care were retrieved and evaluated,then 14 audit criteria were formulated.Through baseline survey and analysis of barriers,targeted intervention measures were implemented.Results After implementation of the evidence,the length of indwelling urinary cat-heter and hospital stay in patients with renal cell carcinoma were significantly shortened(P<0.01 for both).The length of hospital stay in patients with renal/ureteral calculi was also significantly shortened(P<0.05).The incidence rates of catheter-related urinary tract infection,falls and re-catheterization were 0.Nurses′compliance with catheter securement,glove change before providing care for different patients,correct collection of urine specimen,placement of urine drainage bag at right position and pouring out in time,catheter cleansing and early removal were significantly improved(P<0.01 for all).Nurses′knowledge of urinary catheter care was also significantly increased(P<0.01).Meanwhile,urinary catheter care protocol would be revised and updated.Conclusion Implementation of evidence-based care protocol for short-term urinary catheterization could shorten the length of indwelling urinary catheter and hospitalization,enhance nurses′compliance,and standardize nurses′behavior.

关 键 词：泌尿外科 留置导尿管 临床实践指南 循证实践 效果 

分 类 号：R471[医药卫生—护理学] R473.6[医药卫生—临床医学]