目的:本临床实践指南旨在提供并推荐评估进食和吞咽过程中的误吸和咽部残留的方法,以及选择和实施成人护理的方法,以通过早期和适当的治疗预防吸入性肺炎。口咽吞咽困难。
方法:2018年4月,日本护理科学研究院成立了护理发展/标准化委员会监督委员会,以制定用于护理的饮食和吞咽过程中的误吸和咽部残留评估的临床实践指南。本临床实践指南是根据《2017年指南制定手册》制定的,目的是为护士提供一条具体的途径,以根据研究证据和多方面因素,包括利弊和患者价值的平衡,确定选择口咽吞咽困难管理的政策。
结果:根据与物理评估有关的10个临床问题,重复唾液吞咽试验,改良水吞咽试验,食物测试,宫颈听诊,使用超声波诊断设备进行观察,还有一个内窥镜,提出了10项建议。八项建议已被评估为建议评估等级,开发和评估(等级)2C,另外两个被评估为无等级。
结论:第一个可靠的临床实践指南是由学术护理组织制定的,该组织专注于护理评估,并结合了最新发现。
OBJECTIVE: This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia.
METHODS: In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients\' values.
RESULTS: Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE.
CONCLUSIONS: The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.