婴儿先天性心脏病肠内营养循证实践方案的实施评价  

Implementation and evaluation of evidence-based enteral nutrition practice program for infants with congenital heart disease

作　　者：杨玉霞 顾莺 张立华 傅唯佳 王慧美 徐昱璐 叶岚 Yang Yuxia;Gu Ying;Zhang Lihua;Fu Weijia;Wang Huimei;Xu Yulu;Ye Lan(Intensive Care Unit,Children′s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院重症监护室,上海201102 [2]复旦大学附属儿科医院护理部,上海201102 [3]复旦大学护理学院 [4]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《护理学杂志》2023年第23期103-108,共6页Journal of Nursing Science

基　　金：2022年度市级医院诊疗技术推广及优化管理项目(原临床科技创新项目)(SHDC22022221);2021年上海市医苑新星青年医学人才培养资助计划(沪卫人事[2022]65号)。

摘　　要：目的 基于RE-AIM框架评价婴儿先天性心脏病肠内营养循证实践方案的实施效果。方法 选取就诊于我院心血管中心的179例住院先天性心脏病婴儿为研究对象,2019年1-6月98例为对照组,由医护人员按常规管理与工作模式开展肠内营养实践;以2019年9月至2020年2月81例为观察组,遵循2013年《WHO实施研究指南》中关于实施策略原则,制定促进干预措施实施策略,分别为传播策略、实施过程策略、整合策略、能力建设策略,并应用于肠内营养管理。基于RE-AIM框架,从可及性、采纳性、实施性评价营养方案的实施过程,从有效性与持续性评价其实施效果。结果 医护人员对营养方案的可及性97.7%、采纳性92.3%、实施性100%;实施前、实施中及实施后医护人员婴儿先天性心脏病肠内营养的知识问卷得分分别为18.20±6.44、29.95±4.18、31.55±3.89,差异有统计学意义(F=265.444,P<0.001)。结论 婴儿先天性心脏病肠内营养循证护理实践方案的实施,可促进医护人员对营养方案的可及性、采纳性及实施性,有效改善医护人员对于营养方案的知识水平与实施行为。Objective To evaluate the effect of implementing an evidence-based enteral nutrition(EN) practice program developed based on the RE-AIM framework for infants with congenital heart disease(CHD).Methods In this study,CHD infants admitted to the cardiovascular center of our hospital were selected as the target subjects.From January to June 2019,98 CHD infants were enrolled in to the control group,and medical staff carried out EN practice for them according to routine management and work mode.From September 2019 to February 2020,81 CHD infants were enrolled in to the intervention group.Then medical staff followed the principles of implementation strategies in the 2013 WHO Implementation Research Guidelines to develop strategies(including communication strategies,implementation process strategies,integration strategies,capacity building strategies) aiming to promote the implementation of interventions,and applied those strategies in infants′ EN management.Based on the RE-AIM framework,the implementation process of the nutrition program was evaluated from accessibility,adoption and implementation aspects,while implementation effect was evaluated from effectiveness and sustainability.Results The accessibility,adoption,and implementation of the nutrition program rated by medical staff were 97.7%,92.3%,and 100%.Knowledge questionnaire scores for infant CHD enteral nutrition among medical staff before,during,and after implementation were(18.20±6.44) points,(29.95±4.18) points,(31.55±3.89) points,respectively,and the difference was statistically significant(F=265.444,P<0.001).Conclusion The implementation strategies adopted during the rollout of the evidence-based EN practice program for CHD infants can promote the accessibility,adoption and implementation of the program by medical staff,and effectively improve their knowledge level and implementation behaviors.

关 键 词：婴儿 先天性心脏病 营养不良 肠内营养 营养治疗 喂养不耐受 RE-AIM框架 循证护理 

分 类 号：R473.72[医药卫生—护理学] R459.3[医药卫生—临床医学]