目的:运用知识到行动框架(KTA)探讨无创正压通气(NPPV)患者鼻、面部压力损伤的预防和护理的循证实践。探索其有效性。
方法:使用循证护理方法,成立了一个循证实践小组来制定一个临床问题,对国内外数据库中的文献进行了相关证据研究,证据被引入临床场景,制定了基于证据的实践计划,通过对医疗保健专业人员和NPPV患者进行基线审查,构建了应用最佳证据的策略,分析障碍和促进因素,并在组织层面改变临床实践,从业者级别,和患者水平。目的抽样法选取山东第一医科大学附属山东省立医院心脏外科重症监护病房(CSICU)的医护人员,以及2023年10月1日至11月15日(基于证据前的实践)和11月16日至12月31日(基于证据后的实践)收治的NPPV患者,作为研究对象。通过问卷调查分析,NPPV患者鼻腔和面部压力损伤的发生率,医务人员评审指标执行率,知识的分数,医务人员的信念和行为,并比较循证实践前后患者的依从性和舒适度。
结果:共包括52名医务人员,年龄(28.54±6.50)岁,具有3.00(1.00,12.75)年的工作经验;2名博士学位持有人(3.85%),4个硕士学位持有者(7.69%),学士学位46人(88.46%);高级职称2人(3.85%),中级职称17人(32.69%),和33个初级职称(63.46%)。收集循证护理实践前后50份患者问卷;循证护理实践前后的性别差异,年龄,体重,呼吸机使用的持续时间,24小时出血和总出血无统计学意义,具有可比性。与基于前证据的实践相比,在开展了相应的循证护理实践后,NPPV患者的鼻和面部压力损伤发生率从16.00%(8/50)下降到4.00%(2/50,P<0.05),医务人员复查指标总执行率由79.73%提高到94.08%(P<0.01),和知识的总分,信念和行为显著改善(141.96±13.88vs.114.65±19.72,P<0.05),患者的依从性和舒适度明显提高(依从性评分:4.60±0.99vs.5.82±1.42,舒适度评分:4.10±1.63vs.6.92±2.33,均P<0.05)。
结论:应用循证护理方法获取NPPV患者预防鼻面部压力损伤的相关证据,可用于指导临床实践,显着降低此类患者的鼻和面部压力损伤的发生率,提高审查指标和知识的执行率,信念,并对医务人员进行评分,提高NPPV患者的依从性和舒适度。
OBJECTIVE: To investigate the evidence-based practice of prevention and care of nasal and facial pressure injuries in patients with non-invasive positive pressure ventilation (NPPV) using the knowledge to action framework (KTA), and to explore its effectiveness.
METHODS: Using an evidence-based nursing approach, an evidence-based practice group was established to formulate a clinical problem, the literature from domestic and international databases were researched for relevant evidence, the evidence was introduced into clinical scenarios, an evidence-based practice plan was developed, and a strategy for applying the best evidence was constructed by conducting a baseline review of healthcare professionals and patients with NPPV, analyzing barriers and promoting factors, and making changes in clinical practice at the organizational level, the practitioner level, and the patient level. Purposive sampling method was used to select the healthcare staff of the cardiac surgical intensive care unit (CSICU) of the Shandong Provincial Hospital Affiliated to Shandong First Medical University, as well as the patients with NPPV admitted from October 1 to November 15, 2023 (pre-evidence-based practice) and November 16 to December 31 (post-evidence-based practice), as the subjects of the study. Through questionnaire analysis, the incidence of nasal and facial pressure injury of NPPV patients, the implementation rate of review indicators of medical staff, the score of the knowledge, belief and conduct of medical staff, and the compliance and comfort of patients before and after evidence-based practice were compared.
RESULTS: A total of 52 medical staff were included, aged (28.54±6.50) years old, with 3.00 (1.00, 12.75) years of working experience; 2 doctoral degree holders (3.85%), 4 master degree holders (7.69%), 46 bachelor degree holders (88.46%); 2 with senior title (3.85%), 17 with intermediate title (32.69%), and 33 junior titles (63.46%). Fifty patient questionnaires were collected before and after evidence-based nursing practice; the differences between before and after evidence-based practice in terms of gender, age, body weight, duration of ventilator usage, 24-hour bleeding and total bleeding were not statistically significant and were comparable. Compared with the pre-evidence-based practice, after carrying out the corresponding evidence-based nursing practice, the incidence of nasal and facial pressure injuries of NPPV patients decreased from 16.00% (8/50) to 4.00% (2/50, P < 0.05), the total implementation rate of review indicators of medical staff increased from 79.73% to 94.08% (P < 0.01), and the total scores of knowledge, belief and conduct were significantly improved (141.96±13.88 vs. 114.65±19.72, P < 0.05), and compliance and comfort of patients were significantly improved (compliance score: 4.60±0.99 vs. 5.82±1.42, comfort score: 4.10±1.63 vs. 6.92±2.33, both P < 0.05).
CONCLUSIONS: The application of an evidence-based nursing approach to obtain evidence related to the prevention of nasal and facial pressure injuries in patients with NPPV can be used to guide clinical practice, significantly reducing the incidence of nasal and facial pressure injuries in such patients, improving the implementation rate of review indicators and the knowledge, belief, and conduct scores of medical staff, and enhancing compliance and comfort of NPPV patients.