内镜下黏膜病变治疗术后出血预防管理审查指标的制定及障碍因素分析  

Development of review indicators for prevention of bleeding after endoscopic mucosal lesion treatment:analysis of barriers to prevention management

作　　者：仲蕾媛 庄若[2] 朱丽群[2] 陈萍[3] 包磊 李卉[3] 厉丽 张文华[1] 张炜[1] Zhong Leiyuan;Zhuang Ruo;Zhu Liqun;Chen Ping;Bao Lei;Li Hui;Li Li;Zhang Wenhua;Zhang Wei(Department of Gastroenterology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院消化科,江苏镇江212001 [2]江苏大学附属医院护理部,江苏镇江212001 [3]江苏大学附属医院胃镜中心,江苏镇江212001 [4]江苏大学附属医院手术室,江苏镇江212001

出　　处：《护理学杂志》2023年第15期107-113,共7页Journal of Nursing Science

基　　金：江苏省老年健康科研项目(LKM2022031);江苏大学临床医学专项基金项目(JDLCHL202207)。

摘　　要：目的制定内镜下黏膜病变治疗术后出血预防管理的审查指标并开展临床现状审查。方法以渥太华研究应用模式为理论框架,确定临床护理问题、组建循证护理团队、系统检索文献、评价及汇总证据,制定审查指标及审查方法,依据审查结果,从基于证据的变革、潜在采纳者和实践环境3个方面分析证据引入临床的障碍及促进因素,制定行动对策。结果共纳入26条最佳证据,制定30条审查指标;14条审查指标依从率>60%,16条<60%,其中14条依从率为0。主要障碍因素为证据内容复杂且未转化为护士可及形式,医护人员循证知识欠缺,多形式宣教材料规范流程缺失,未形成多学科合作机制等;主要促进因素为循证项目管理体系完善,管理层变革意愿强,实践者善于创新等。结论预防内镜下黏膜病变治疗术后出血的证据与临床实践存在较大差距,应充分利用促进因素克服障碍,实施改进,促进证据的有效应用。Objective To develop review indicators for prevention of bleeding after endoscopic mucosal lesion treatment,and to conduct a clinical on-the-site review.Methods Using the Ottawa Model of Research Use(OMRU)as a theoretical framework,we identified clinical care problems,formed an evidence-based care team,systematically searched the literature,appraised the quality of included literature,and summarized the evidence.Then we developed review indicators and review methods.After conduct a clinical on-the-site review,we analyzed barriers and facilitators to the introduction of evidence into clinical setting from 3 perspectives based on the review results:evidence-based transformation,potential adopters,and practice environment.At last,we developed countermeasures for further action.Results A total of 26 pieces of best evidence were included,and 30 review indicators were deve-loped;14 review indicators had an adherence rate>60%,16 review indicators had an adherence rate<60%(among them,14 indicators had an adherence rate of 0).The main barriers were the complexity of the evidence content and the lack of evidence translation into an accessible form for nurses,the lack of evidence-based knowledge of health care workers,the lack of evidence stan-dardized process flows in multi-form health education materials,and the lack of multidisciplinary cooperation mechanisms.The main facilitators were the improvement of evidence-based project management system,the strong willingness to change at the ma-nagerial level,and health care workers′willingness to innovate.Conclusion There is a large gap between the evidence for the ma-nagement of bleeding after endoscopic mucosallesion treatment,and clinical practice.Health care workers are recommended to fully utilize the facilitators,overcome the barriers,and implement improvement schemes,in a bid to promote the effective application of the evidence.

关 键 词：黏膜病变 消化内镜手术 术后出血 审查指标 障碍因素 促进因素 循证护理 

分 类 号：R473.5[医药卫生—护理学]