前列腺癌根治术后尿失禁管理最佳证据应用的审查指标及障碍因素分析  

Analysis of review indicators and barriers to the application of best evidence for urinary incontinence management after radical prostatectomy for prostate cancer

作　　者：汤琪 陈永侠[2] 郭琼[2] 张红琴 朱宁宁[3] 刘春芳[2] TANG Qi;CHEN Yongxia;GUO Qiong;ZHANG Hongqin;ZHU Ningning;LIU Chunfang(School of Nursing,Bengbu Medical College/First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China;The First Affi liated Hospital of Bengbu Medical College,Bengbu 233000,China;Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院护理学院/蚌埠医学院第一附属医院,安徽省蚌埠市233000 [2]蚌埠医学院第一附属医院,安徽省蚌埠市233000 [3]蚌埠医学院,安徽省蚌埠市233000

出　　处：《护理实践与研究》2024年第3期429-435,共7页Nursing Practice and Research

基　　金：安徽高校研究生科学研究项目(编号:YJS20210544);中华医学会杂志社护理研究课题(编号:CMAPH-NRI2022038)。

摘　　要：目的通过系统的文献检索,提取与整合目前前列腺癌根治术后尿失禁管理最佳证据,依据最佳证据制定相应的审查指标,并依照临床审查结果分析证据应用的障碍和促进因素,构建相应的变革策略,为证据的临床转化提供参考依据。方法系统检索国内外关于前列腺癌根治术后尿失禁管理的相关证据,形成前列腺癌根治术后尿失禁管理的最佳证据总结,基于证据的FAME属性,结合试点病区具体临床情景,依据i-PARIHS框架,从变革内容、变革接受者和组织环境三方面明确最佳证据应用的障碍与促进因素,制定相应的行动策略。结果共总结16条证据,制定24条审查指标,障碍因素主要包括证据本土转化难度较大、证据应用增加工作量、部分证据内容不清晰、护士及患者知识欠缺、护士缺乏对基于证据的循证实践重要性的认识、缺乏多学科协作模式建立及规范化的流程等。促进因素包括本研究医学院校,有丰富的数据库资源,同时作为复旦大学循证护理证据应用基地,循证资源丰富。患者及家属对术后恢复的知识需求量大。科室氛围良好、管理者重视,且科室护理团队年轻化,科研能力扎实,同时有较为完善的辅助工具。结论前列腺癌根治术后尿失禁管理的临床实践与最佳实践存在一定差距,临床护理工作者应在分析证据转化障碍因素及促进因素基础上,实施相应的变革措施,以期最大程度的克服障碍因素,扩大促进因素,实现证据的有效转化及应用,为提升前列腺癌根治术后尿失禁患者的管理水平提供参考。Objective To extract and integrate the best evidence on urinary incontinence management after radical prostatectomy for prostate cancer through systematic literature search,develop corresponding review indexes based on the best evidence,analyze barriers and facilitators to the application of the evidence according to the results of the clinical review,and construct corresponding change strategies,in order to provide reference basis for the clinical transformation of the evidence.Methods This research systematically searched the relevant evidence on the management of urinary incontinence after radical prostate cancer at home and abroad,formed a summary of the best evidence on the management of urinary incontinence after radical prostate cancer,based on the FAME attributes of the evidence,combined with the specifi c clinical scenarios of the pilot ward,and based on the i-PARIHS framework,we clarifi ed the barriers and facilitators for the application of the best evidence in terms of the content of the change,the change recipients,and the organizational environment,and formulated the corresponding action strategies.The i-PARIHS framework was used to identify barriers and facilitators to the application of best evidence in terms of the content of change and the organizational environment,and to develop appropriate action strategies.Results A total of 16 pieces of evidence were summarized and 24 review indicators were developed.Barriers mainly included the diffi culty of indigenous translation of evidence,increased workload of evidence application,unclear content of some evidence,lack of knowledge of nurses and patients,lack of awareness of nurses about the importance of evidence-based practice,and lack of multidisciplinary collaborative model establishment and standardized process.Facilitating factors include the medical school of this study,which has abundant database resources,as well as being a base for the application of evidence-based nursing evidence at Fudan University,which is rich in evidencebased resources.

关 键 词：前列腺癌根治术 尿失禁 证据总结 审查指标 障碍因素 

分 类 号：R473.73[医药卫生—护理学]