吞咽障碍患者服药管理最佳证据的临床审查及分析  

Best evidence audit and analysis to the medication management for patients with dysphagia

作　　者：刘艺 朱丽群[2] 庄若[2] 倪益益 曹松梅[2] 眭升[2] 宦迎春[3] 解红锋[4] Liu Yi;Zhu Liqun;Zhuang Ruo;Ni Yiyi;Cao Songmei;Sui Sheng;Huan Yingchun;Xie Hongfeng(Department of Neurosurgery,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of Nursing,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of Neurology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院神经外科,镇江212001 [2]江苏大学附属医院护理部,镇江212001 [3]江苏大学附属医院神经内科,镇江212001 [4]江苏大学附属医院老年科,镇江212001

出　　处：《中国实用护理杂志》2024年第5期357-364,共8页Chinese Journal of Practical Nursing

基　　金：江苏省老年健康科研项目(LK2021026);复旦大学循证护理中心证据转化与临床应用项目(Fudanebn202141);2022年度镇江市社会发展指导性科技项目(FZ2022085);2022年江苏大学临床医学专项基金项目(JDLCHL202209)。

摘　　要：目的基于吞咽障碍患者服药管理最佳证据进行临床现况审查,系统分析证据转化过程中存在的障碍因素及促进因素,制订变革策略。方法采用循证护理研究方法,以渥太华研究应用模式为指导,基于最佳证据制订审查指标,于2021年7—12月对江苏大学附属医院神经内、外科及老年科的223例患者及75名护士开展临床实践行为的现状审查,基于审查结果,对32名潜在采纳者进行深入访谈,采用内容分析法评估基于证据的变革、潜在采纳者和实践环境三方面证据临床转化的障碍及促进因素,从而制订有效策略。结果循证团队基于遴选的22条最佳证据制订了25条审查指标开展临床审查,显示有16条指标依从率<60%,通过分析与归纳潜在采纳者访谈结果,剖析导致护士依从率低的主要障碍因素:基于证据的变革改变了传统工作模式,证据应用不便捷;潜在采纳者层面护士知信行欠佳、工作负担重、患者及照护者认知度不高;实践环境层面为缺乏证据临床转化的护理规范和流程、多学科协作沟通渠道不通畅等。主要促进因素:有完善的循证护理项目监管机制,循证组有丰富的证据转化经验,管理层变革意愿强,实践者善于创新。结论吞咽障碍患者服药管理的临床实践与最佳证据间尚存在较大差距,应充分利用促进因素克服障碍,实施改进,以促进证据向临床实践有效转化。Objective To review the clinical status based on the best evidence of drug administration in patients with dysphagia,systematically analyze the obstacle factors and promoting factors in the process of evidence transformation,and formulate reform strategies.Methods Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use(OMRU),the review indicators were developed based on the best evidence.The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology,Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review,qualitative interviews were conducted with 32 potential adopters,and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects:evidence-based change,potential adopters and practice environment,so as to develop effective strategies.Results Based on the 22 best evidence selected,the evidence-based team developed 25 review indicators to carry out clinical review,showing that the compliance rate of 16 indicators were less than 60%.By analyzing and summarizing the interview results of potential adopters,the main obstacles leading to the low compliance rate of nurses were analyzed as follows:evidence-based reform changed the traditional work mode,and the application of evidence was not convenient;at the level of potential adopters,nurses had poor knowledge and practice,heavy work burden,and low awareness of patients and caregivers;at the level of practice environment,there was lack of nursing norms and procedures for clinical transformation of evidence,and the channels of multi-disciplinary collaboration and communication were not smooth.The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects,the evidence-based group had rich experience in evidence transformation,the management was willing to change,and the practiti

关 键 词：吞咽障碍 服药管理 护理质量审查 障碍因素 促进因素 证据转化 循证护理 

分 类 号：R473[医药卫生—护理学]