癫痫患儿服药依从性提升的循证护理审查指标制定及障碍因素分析  

Evidence-based nursing audit indicators and analysis of barriers to improve medication compliance in children with cpilepsy

作　　者：王芳萍 叶敬花[1] 田小琴[1] 王兴雅楠 孙琳琳 敖玲 王耀叶 王颖雯 WANG Fangping;YE Jinghua;TIAN Xiaoqin(Shenzhen Children's Hospital,Shenzhen(518038),Guangdong,China)

机构地区：[1]深圳市儿童医院神经内科,广东深圳518038 [2]复旦大学附属儿科医院护理部

出　　处：《癫痫与神经电生理学杂志》2024年第4期204-213,共10页Journal of Epileptology and Electroneurophysiology

基　　金：深圳市“医疗卫生三名工程”项目资助(SZSM202311028)。

摘　　要：目的开展癫痫患儿服药依从性提升的循证护理实践,根据最佳证据制定审查指标,分析障碍因素,为其临床应用提供参考。方法检索癫痫患儿服药依从性提升的最佳证据并制定审查指标,采用便利抽样法,选取2023年11~12月深圳市儿童医院神经内科24名护士、19名医生,63例癫痫患儿作为研究对象在临床开展现状审查,采用“i-PARIHS框架下的证据应用障碍识别评估清单”对审查结果进行障碍因素分析,并制定相应的干预策略。结果本研究共纳入14条最佳证据,制定13个审查指标,其中3条审查指标依从性超过90%,2条审查指标依从性为0%,8条审查指标依从性低于90%。障碍因素分析发现,变革层面存在证据转化不足、缺乏相关制度和流程、无开展同伴支持教育组织政策及闭环沟通不畅等问题;变革接受者层面,护士、癫痫患儿及家属缺乏必要的知识培训,高强度的临床工作压力引发了医疗人员的心理抵触,患儿及家属存在对癫痫疾病的羞耻感;组织环境层面,首次在科室开展循证实践,团队缺乏相关经验。结论癫痫患儿服药依从性的最佳证据与临床实践存在较大的差距,应当融合临床专业的判断力与基线审查结果,深入探究障碍因素,并据此制定具体的行动方案,以促进证据的有效应用。Objective To carry out evidence-based nursing practice for improving medication compliance in children with epilepsy to develop audit indicators based on the best evidence,analyze barrier factors and provide the reference for their clinical application.Methods The best evidence for improving medication compliance in children with epilepsy was retrieved.Review audit indicators were developed.Convenience sampling was used to select 24 nurses,19 doctors,and 63 children with epilepsy from the department of neurology,Shenzhen Children's Hospital from November to December 2023 as the research subjects for clinical status review.The audit results were analyzed by"the obstacle identification and assessment list of evidence application under under i-PARIHS Framework"to obtain the obstacle factors and develop corresponding intervention strategies.Results This study included 14 best evidence items and developed 13 audit indicators,of which,3 audit indicators had a compliance rate of over 90%,2 review indicators with a compliance rate of 0%and 8 audit indicators with compliance rate of less than 90%.Obstacle factor analysis revealed that there were issues with insufficient evidence conversion,lack of relevant systems and processes,absence of peer support education organization policies and poor closed-loop communication at the level of change.At the level of change recipients,the nurses,the children with epilepsy and their families did not have any training for necessary knowledge,and highly intensive clinical work pressure had caused psychological resistance among medical personnel.The children and their parents had a sense of shame towards epilepsy.At the organizational environment level,the evidence-based practice was conducted for the first time in the department,but the team lacked relevant experience.Conclusion There is a significant gap between the best evidence of medication compliance in children with epilepsy and clinical practice.It is necessary to integrate clinical professional judgment and baseline audit result

关 键 词：癫痫 儿童 服药依从性 循证护理 最佳实践 障碍因素分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]