起搏器术后早期康复运动最佳证据应用的审查指标制定及障碍因素分析  

Establishment of review indicators and obstacle factor analysis for early cardic rehabilitation after pacemaker implantation

作　　者：叶灵晓 陈芳芳 胡雁[2] 郑亚华[1] 毛丽娜 楼钶楠[1] 刘梅 胡康丽 汪莉莉 YE Lingxiao;CHEN Fangfang;HU Yan;ZHENG Yahua;MAO Li'na;LOU Ke'nan;LIU Mei;HU Kangli;WANG Lili(Lihuili Hospital,Ningbo Medical Center,Ningbo 315800,Zhejiang,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]宁波市医疗中心李惠利医院,浙江宁波315800 [2]复旦大学护理学院,上海200032

出　　处：《护士进修杂志》2022年第13期1176-1181,共6页Journal of Nurses Training

基　　金：复旦循证护理中心证据转化与临床应用项目(编号:Fudanebn202129)。

摘　　要：目的全面评估起搏器术后早期康复运动证据临床应用的现状,分析其障碍因素,为证据的临床转化提供参考。方法以JBI循证卫生保健模式为理论框架,确定临床护理问题,进行文献检索、评价并汇总证据,制定审查指标及审查方法;根据基线审查结果进行障碍因素分析,制定对策。结果本研究共纳入18条最佳证据,制定15条审查指标,其中仅3条指标依从率为100%;采用i-PARIHS概念框架对审查结果进行分析后得出主要障碍因素:起搏器术后早期康复制度及流程缺乏、医护人员对于循证知识及起搏器术后早期康复知识培训不足、缺乏相应的激励机制、变革造成工作量增加但人员配备不足。主要促进因素:国家政策及医院政策支持,领导者们变革理念强、患者及家属对医护人员信任度较高、团队协作能力好及护理人员的基础知识扎实、学习能力强等。实施相应对策后,15条审查指标中13条依从率为100%。结论起搏器术后早期康复运动证据与临床实践尚存在较大差距,科学、全面评估实践中的障碍与促进因素,并给予相应的对策,可以有效促进证据在临床中的应用。Objective To comprehensively evaluate the clinical status of early cardic rehabilitation after pacemaker implantation,and to analyze the obstacle factors,and provide reference for clinical transformation of evidence.Methods With JBI evidence-based health care model as the theoretical framework,clinical nursing problems were identified;literature retrieval,evaluation,and evidence were collected;review indicators and review methods were developed.According to the results of baseline review,the obstacle factors were analyzed,and methods and countermeasures were developed.Result In this study,18 pieces of best evidence were included and 15 clinical review indicators were formulated,of which there were only 3 indicators with the compliance rate of 100%.After analyzing the review results with i-PARIHS conceptual framework,it was concluded that the main obstacles factors were the lack of early cardic rehabilitation process management after pacemaker implantation;insufficient training of medical staff on evidence-based knowledge and early postoperative pacemaker rehabilitation knowledge;lack of corresponding incentive mechanism,resulting in increased workload but insufficient personnel staffing.The main contributing factors were the national and hospital policies support,leaders'strong reform ideas,high trust of patients and their families in medical staff,good teamwork ability,solid basic knowledge and strong learning ability of nursing staff,etc.After the implementation of corresponding countermeasures,the compliance rates of 13 out of 15 indicators were 100%.Conclusion There is still a big gap between the evidence of early cardic rehabilitation after pacemaker implantation and clinical practice.The obstacles and contributing factors in practice are scientifically and comprehensively evaluated,and corresponding countermeasures are properly proposed,which can effectively promote the application of evidence in clinical practice.

关 键 词：起搏器 心脏康复 审查指标 障碍因素 证据转化 循证护理 

分 类 号：R473.54[医药卫生—护理学] R654.2[医药卫生—临床医学]