手术患者压力性损伤预防管理循证护理实践方案的构建

宋辉; 王悦; 郑晨

doi:10.16766/j.cnki.issn.1674-4152.003439

手术患者压力性损伤预防管理循证护理实践方案的构建

doi: 10.16766/j.cnki.issn.1674-4152.003439

天津医科大学肿瘤医院国家恶性肿瘤临床医学研究中心天津市恶性肿瘤临床医学研究中心天津市"肿瘤防治"重点实验室, 天津 300060

基金项目:

天津市教育科研计划项目 2020KJ146

天津市医学重点学科第2轮建设项目 TJYXZDXK-011A

详细信息

通讯作者:
王悦，E-mail: 89745562@qq.com

中图分类号: R47 R472.3
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- 文章访问数: 89
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-08
- 网络出版日期: 2024-05-27

Construction of evidence-based nursing practice protocol for the preventive management of pressure injuries in surgical patients

Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Cancer Clinical Medical Research Center, Tianjin Key Laboratory of "Cancer Prevention and Treatment", Tianjin 300060, China

摘要

摘要: 目的基于循证构建手术患者压力性损伤预防管理的方案，为手术室临床护理与管理的同质化、规范化发展提供参考。方法成立研究小组，以循证护理为理论指导，检索国内外近5年与手术患者术中压力性损伤有关文献，采用AGREEⅡ、AMSTAR2(2014版)、JBI证据分级标准进行质量评价及证据分级，提取证据并拟定术中获得性压力性损伤防护策略初稿，采用德尔菲法对20名专家进行2轮函询，对策略条目进行修改，确定方案终稿。结果检索筛选出10篇文献，其中临床指南2篇、临床决策2篇、专家共识1篇、证据总结5篇；提取28条最佳证据，初步形成手术患者压力性损伤预防和管理的最佳证据，包含教育培训、风险评估、术前预防、术中预防、术后评价、质量改进的链式整体管理策略。2轮专家会议专家参与率均为100%，所有专家均对方案具体内容发表了相关意见和建议，2轮专家函询积极系数均为100%，专家权威系数0.92，各条目重要性分别为0.392和0.420(P＜0.01)，可操作性Kendall's W系数为0.322和0.366(P＜0.01)。最终构建的预防管理方案包括质量管理、术前管理、术间管理、术后管理4个一级条目，11个二级条目，25个三级条目。结论基于循证护理理论构建的手术患者压力性损伤预防管理方案科学、可靠，具有较强的临床应用价值，可为手术室压力性损伤同质化预防管理奠定基础。
- 压力性损伤 /
- 循证护理 /
- 预防管理 /
- 方案
Abstract: Objective To construct a scheme for the prevention and management of stress injury in surgical patients based on evidence, to provide a reference for the homogenization and standardized development of clinical nursing and management in the operating room. Methods A research group was set up to search the literature related to intraoperative stress injury in the past 5 years under the theoretical guidance of evidence-based nursing. AGREE Ⅱ, AMSTAR2 (version 2014), and JBI evidence classification criteria were used to evaluate the quality and classification of evidence. The evidence was extracted and the first draft of a protective strategy against intraoperative stress injury was drawn up. Twenty experts were consulted by the Delphi method for 2 rounds, and the strategy items were modified. Finalize the final draft of the plan. Results Ten articles were searched and screened, including 2 clinical guidelines, 2 clinical decisions, 1 expert consensus, and 5 evidence summaries and 28 pieces of best evidence were extracted to form the best evidence for the prevention and management of stress injury in surgical patients. including education and training, risk assessment, preoperative prevention, intraoperative prevention, postoperative evaluation, quality improvement chain overall management strategy. The participation rate of experts in the two rounds of expert meetings was 100%, and all experts expressed relevant opinions and suggestions on the specific contents of the plan. The positive coefficient of the two rounds of expert letters was 100%, the expert authority coefficient was 0.92, the importance of each item were 0.392 and 0.420 respectively (P<0.01), and the maneuverability Kendall's W coefficient were 0.322 and 0.366 (P<0.01). Finally, the prevention management program includes 4 first-level items, 11 second-level items, and 25 third-level items, including quality management, preoperative management, inter-operative management, and postoperative management. Conclusion The prevention and management plan for stress injury of surgical patients based on evidence-based nursing theory is scientific and reliable, has strong clinical application value and can lay a foundation for homogeneous prevention and management of stress injury in the operating room.
- Pressure injury /
- Evidence-based nursing /
- Prevention and management /
- Plan

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表 1 手术患者压力性损伤预防策略

Table 1. Strategies for preventing stress injuries in surgical patients

三级条目	重要性(x±s, 分)	变异系数	可操作性(x±s, 分)	变异系数
1.防护策略的制定与质控	5.00±0.00	0.00	4.85±0.37	0.08
2.动态监测并纳入质控管理	4.55±0.51	0.11	4.85±0.37	0.08
3.定期开展相关培训	4.55±0.51	0.11	4.95±0.22	0.05
4.持续质量改进	4.75±0.44	0.09	4.25±0.55	0.13
5.推动临床实践转化	4.70±0.47	0.10	4.25±0.55	0.13
6.应用适宜的风险评估工具	4.40±0.50	0.11	5.00±0.00	0.00
7.制定预防干预计划	4.40±0.50	0.11	4.30±0.57	0.13
8.鼓励患者及家属参与	4.25±0.44	0.10	4.15±0.59	0.14
9.维持适宜的温度和湿度	5.00±0.00	0.00	4.95±0.22	0.05
10.床单位平整，皮肤干燥	5.00±0.00	0.00	5.00±0.00	0.00
11.减少暴露，加温措施	5.00±0.00	0.00	4.60±0.50	0.11
12.合理约束，妥善固定	5.00±0.00	0.00	4.90±0.31	0.06
13.选择适宜的体位摆放设施	5.00±0.00	0.00	4.90±0.31	0.06
14.评估支撑面的合理性	5.00±0.00	0.00	4.70±0.47	0.10
15.采用适宜的支撑工具	5.00±0.00	0.00	5.00±0.00	0.00
16.医护协作规范化安置体位	5.00±0.00	0.00	4.90±0.31	0.06
17.受压部位皮肤再调整	5.00±0.00	0.00	4.30±0.57	0.13
18.选择适宜的预防性敷料	5.00±0.00	0.00	4.45±0.69	0.15
19.加强巡视，定时减压	5.00±0.00	0.00	4.50±0.61	0.13
20.再次评估，调整措施	4.50±0.51	0.11	4.80±0.41	0.09
21.术后及时调整患者体位	4.30±0.47	0.11	4.90±0.31	0.06
22.检查受压情况并记录	4.45±0.51	0.11	5.00±0.00	0.00
23.及时处理及上报	4.45±0.51	0.11	4.95±0.22	0.05
24.术后准确、全面交接	4.65±0.49	0.11	4.45±0.51	0.11
25.动态、持续追踪72 h	4.30±0.47	0.11	4.85±0.37	0.08

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