老年卒中后失语患者的评估和康复护理审查指标的制定及影响因素分析  

The assessment and formulation of rehabilitation nursing review indicators for aphasia in elderly stroke patients and analysis of influencing factors

作　　者：邢晓慧 王明明[1] 王保荣 姚昱名 王金萍[1] 刘宁利 XING Xiaohui;WANG Mingming;WANG Baorong;YAO Yuming;WANG Jinping;LIU Ningli(Department of Nursing,Affiliated People's Hospital of Jiangsu University,Zhenjiang 212002,China;Department of Nursing,the Third People's Hospital of Danyang,Zhenjiang 212300,China)

机构地区：[1]江苏大学附属人民医院护理部,江苏镇江212002 [2]丹阳市第三人民医院护理部,江苏镇江212300

出　　处：《现代医学》2024年第12期1962-1969,共8页Modern Medical Journal

基　　金：复旦大学循证护理中心证据转化与临床应用项目(Fudanbn202137);镇江市第一人民医院科研项目(YH2023001)。

摘　　要：目的:全面了解老年卒中后失语(PSA)患者的评估和康复护理相关证据的应用现状,分析实践中障碍因素及促进因素,为制订审查指标和行动策略提供理论依据。方法:以知识转化模式为理论指导,确定临床护理问题,组建团队,通过系统检索评价文献后汇总最佳证据,根据最佳证据确定质量审查指标和审查方法,从组织管理水平、证据因素、证据应用过程、医务人员以及患者的个体因素等方面开展影响因素的分析。结果:本研究最终纳入25条最佳证据,制订了12条审查指标。老年PSA患者的评估和康复护理的证据中障碍因素在组织管理水平层面为多学科团队合作和管理者组织引导的缺乏;在证据因素层面为筛查评估工具、相关流程和健康教育资料的缺乏;在证据应用过程层面则包括医务人员培训不够、重视度不足和工作负担过重;在医务人员及患者个体因素层面为医务人员知识缺乏、积极性不高和患者/家属配合能力有限。主要促进因素在组织管理水平层面为医院领导支持和管理者组织领导力强;在证据因素层面为团队人员的的循证护理专业和科研能力强;在证据应用过程层面为医护团队合作密切、HIS系统功能强大、相关政策支持和用人机制灵活等;在医务人员及患者个体因素层面为培训形式多样、健康教育渠道广泛等。结论:老年PSA患者评估和康复护理的证据与临床护理实践尚存在较大差距,我们应充分利用促进因素,努力克服障碍因素,实施持续改进,促进证据向临床的有效转化。Objective:To comprehensively understand the current status of evidence application related to rehabilitation care for elderly post-stroke aphasia patients and analyze the barriers and facilitators in practice,providing theoretical basis for developing review indicators and action strategies.Methods:Using the knowledge translation model as a theoretical guide,we identified clinical care problems,formed a team,summarized the best evidence after a systematic search and evaluation of the literature,identified quality review indicators and review methods based on the best evidence,and carried out an analysis of the influencing factors in terms of organizational management level,evidence factors,the process of applying the evidence,and medical staff as well as individual factors of the patients.Results:This study ultimately included 25 best evidence and developed 12 review indicators.The barriers at the organizational management level in the evidence-based assessment and rehabilitation nursing care for elderly post-stroke aphasia patients are the lack of multidisciplinary team cooperation and managerial guidance;at the level of evidence factors,including the lack of screening and assessment tools,relevant processes,and health education materials;at the level of evidence application process,including insufficient training of medical staff,low priority,and excessive workload;at the level of medical staff and individual patient factors,including the lack of knowledge of medical staff,low motivation,and limited ability of patients/family members to cooperate.The main facilitating factors at the organizational management level are the support of hospital leadership and strong organizational leadership;at the level of evidence factors,including the professional and research capabilities of the team members in evidence-based nursing cares;at the levels of evidence application process,including close cooperation between medical and nursing teams,powerful HIS system functions,relevant policy support and flexible personnel mecha

关 键 词：卒中后失语 失语评估 失语护理 循证实践 康复护理 

分 类 号：R473.74[医药卫生—护理学]