基于最佳证据的预防关节置换术后深静脉血栓护理工作内容的田野研究  

A field research based on the best evidence of nursing care for the prevention of deep vein thrombosis after joint replacement

作　　者：王钰 徐园[2] 马玉芬 王晓杰 杨旭 曹晶[1] 姜英[2] 王京京 尚高鹏 朱丽筠 鲁乔丹 吴欣娟[1] WANG Yu;XU Yuan;MA Yufen;WANG Xiaojie;YANG Xu;CAO Jing;JIANG Ying;WANG Jingjing;SHANG Gaopeng;ZHU Liyun;LU Qiaodan;WU Xinjuan

机构地区：[1]中国医学科学院北京协和医院护理部,北京市100730 [2]中国医学科学院北京协和医院骨科,北京市100730 [3]中国医学科学院北京协和医院工会,北京市100730 [4]中国医学科学院北京协和医院乳腺外科,北京市100730

出　　处：《中华护理杂志》2021年第4期521-526,共6页Chinese Journal of Nursing

基　　金：北京协和医院院内护理科研课题(XHHLKY201717)。

摘　　要：目的了解髋关节、膝关节置换术后预防患者深静脉血栓护理的工作内容,明确目前护理实践现况与最佳证据之间的差距。方法2019年6月—10月,采用田野研究方法对北京市某三级甲等医院关节外科病房的护理工作进行为期5个月的参与式观察。对田野笔记采用质性研究三级编码的方法进行分析。结果通过参与预防391例髋关节、膝关节置换术后患者深静脉血栓的护理,了解了目前护理的工作内容,析出了宣教指导类、执行措施类、效果评价类和电子记录类4类工作内容主题,与最佳证据相契合。但实施效果与最佳证据存在部分差距,开展健康教育、促进早期活动等方面,护理特色职能仍有巨大发挥空间。结论开展循证护理研究,构建科学、规范和具有临床可行性的标准化预防护理方案和流程,实现最佳证据在临床中完全落实,是该田野地继续深入做好预防髋关节、膝关节置换术后患者深静脉血栓护理的努力方向。Objective To understand the work content of deep vein thrombosis(DVT)preventive care after hip and knee replacement,and to clarify the gap between the current practice and the best evidence.Methods From June to October 2019,we used the field research methods to conduct a 5-month participatory observation about the nursing work in the joint surgery ward in a level A tertiary hospital in Beijing.We used the three-level coding method of qualitative research to conduct field notes analysis.Results Through the care experience of participating in 391 cases of preventing DVT after hip and knee replacement,this study clarified the work content of preventive care,and extracted 4 work content themes,namely Education,Enforcement,Evaluation and E-recording,which fit with the best evidence.However,there is a partial gap between the implementation effect and the best evidence,and it still needs further development in enhancing health education and early activities promotion.Conclusion Through the field research,we have learned about the nursing work content in preventing DVT after hip and knee replacement,and the gap between the present situation and the best evidence and the possible reasons.Carrying out evidence-based nursing research and constructing scientific,normative and clinically feasible standardized preventive nursing plans are the best ways to prevent DVT after hip and knee replacement.

关 键 词：关节成形术 髋关节 膝关节 深静脉血栓 矫形外科护理 田野研究 

分 类 号：R473.6[医药卫生—护理学]