糖尿病足部溃疡循证实践指南临床应用现状及其影响因素  

Status quo and influencing factors of clinical application of evidence⁃based practice guidelines for diabetic foot ulcers

作　　者：高宁[1] 田润溪[1] 张丹静[2] 郭海玲[1] 郝玉芳[3] GAO Ning;TIAN Runxi;ZHANG Danjing;GUO Hailing;HAO Yufang(Beijing University of Chinese Medicine,Dongzhimen Hospital,Beijing 100700 China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京医院 [3]北京中医药大学护理学院

出　　处：《护理研究》2022年第15期2633-2637,共5页Chinese Nursing Research

基　　金：北京中医药科技发展资金项目,编号:JJ2016⁃51。

摘　　要：目的:调查糖尿病足部溃疡循证实践指南临床应用现状,并分析其影响因素,为指南的应用提供参考依据。方法:文献回顾2012年1月1日—2017年1月1日发布或更新的临床实践指南,整合出15条糖尿病足部溃疡预防相关的推荐意见,基于Graham知识应用模式(KTA)理论模型,制定糖尿病足部溃疡临床实践指南推荐意见临床实践现状调查问卷,并对北京市16所医院204名临床护士进行问卷调查。结果:临床护士15条推荐意见临床进行实践平均百分比为83.1%,实践频率最高的是避免外伤指导,最低的是对高风险糖尿病足病人的鞋袜指导。影响推荐意见临床实践最主要的证据因素是可实现性,个人因素是理论/技能,资源因素是人力资源,组织因素是职能范围。结论:糖尿病足部溃疡循证实践指南应用广泛,但应用频率和程度参差不齐,在证据因素、个人因素、资源因素、组织因素等方面存在阻碍因素,需制定针对性的临床实践方案,促进临床实践指南的应用。Objective:To investigate the status quo of clinical application of evidence⁃based practice guidelines for diabetic foot ulcers,and to analyze its influencing factors,in order to provide reference for the application of the guidelines.Methods:15 recommendations related to the prevention of diabetic foot ulcers were consolidated by literature review of clinical practice guidelines issued or updated from January 1,2012 to January 1,2017.Based on the Graham knowledge to action model(KTA)theoretical model,a questionnaire on the clinical practice status of the clinical practice guidelines for diabetic foot ulcers was developed.A questionnaire survey was conducted among 204 clinical nurses in 16 hospitals in Beijing city.Results:The average percentage of clinical practice of the 15 recommended opinions by clinical nurses was 83.1%.The highest practice frequency was the guidance of avoiding trauma,and the lowest practice frequency was the guidance of foot wear and socks for high⁃risk diabetes patients.The most important evidence factors affecting clinical practice of recommendations were realizability in evidence factors,theory/skill in personal factors,human resource in resource factors,and function in organizational factors.Conclusions:Application of evidence⁃based practice guidelines for diabetic foot ulcers was widespread.But the frequency and extent of application of the guidelines varied widely.There were still some obstacles in evidence factors,personal factors,resource factors,and organizational factors.Targeted clinical practice protocols needed to be developed to facilitate the application of clinical practice guidelines.

关 键 词：糖尿病 足部溃疡 指南 应用 循证护理 

分 类 号：R473.5[医药卫生—护理学]