摘要
目的:开展急性脑卒中患者吞咽障碍识别的循证护理实践。方法:依据乔安娜·布里格斯研究所(JBI)循证护理中心的基于证据的持续质量改进模式图,包括证据获取、现状审查、证据引入及效果评价4个方面。获取急性脑卒中患者吞咽障碍识别最佳证据并制定相应审查标准。采用现场观察法、问卷调查法、查阅护理记录进行资料收集。证据应用前后各有80例患者及18名护士纳入。分析每条证据应用存在的障碍及可解决方案。比较证据应用前后,各审查指标依从性、吞咽障碍筛查率、筛查准确率、筛查记录率及护士知识知晓情况。结果:证据应用前审查指标依从性为0~33.3%,应用后审查指标依从性达到95.0%~100.0%,差异有统计学意义(均P<0.05)。护士对吞咽障碍识别知识问卷得分由40~80(60.56±10.69)分上升到60~100(82.78±10.18)分,差异有统计学意义(t值为-6.39,P<0.05)。吞咽障碍筛查率由7.5%上升至95.0%,差异有统计学意义(χ^2值为119.10,P<0.05),筛查准确率100%,筛查记录率97.4%。应用后24例吞咽障碍风险患者仅4例发生肺部感染。结论:将吞咽障碍识别最佳证据应用于临床,可提高脑卒中患者吞咽障碍筛查情况,规范护士行为,改善吞咽障碍护理实践。
Objective To study the application of the best evidence of dysphagia recognition in acute stroke patients.Methods The study was performed guided by JBI evidence-based continuous quality improvement pattern,including evidence acquisition,baseline audit,evidence implementation and re-audit.Data were collected by using field observation,questionnaire survey and review of nursing records.80 patients and 18 nurses were recruited in the study.Barriers to evidence implementation and available solutions were analyzed.Before and after the application of evidence,the compliance of audit criterion,screening rate of swallowing disorder,screening accuracy,screening record rate and knowledge of nurses were compared.Results Before and after the implementation of evidence,the compliance of all audit criterion was 0-33.3%and 95.0%-100.0%,and had a significant difference(P<0.05).The dysphagia recognition knowledge score was improved from 40-80(60.56±10.69)to 60-100(82.78±10.18)and had a significant difference(t value was-6.39,P<0.05).The screening rate for dysphagia increased from 7.5%to 95.0%,with statistically significant difference(χ^2 value was 119.10,P<0.05).The screening accuracy was 100%,and the screening record rate was 97.4%,only 4 of the 24 patients at risk of dysphagia developed pulmonary infection.Conclusion The application of the best evidence of dysphagia recognition in acute stroke patients can improve the nurses′ability of dysphagia screening and improve nursing practice in dysphagia management.
作者
侯晓红
陈霞
崔新
高雁飞
李革芹
孙芳芳
杜艳
冯梅
杨丽娟
Hou Xiaohong;Chen Xia;Cui Xin;Gao Yanfei;Li Geqin;Sun Fangfang;Du Yan;Feng Mei;Yang Lijuan(Intensive Care Unit,Shandong Provincial Hospital,Jinan 250000,China;Department of Neurology,Shandong Provincial Hospital,Jinan 250000,China;Department of Nursing,Shandong Provincial Hospital,Jinan 250000,China)
出处
《中国实用护理杂志》
2020年第16期1245-1251,共7页
Chinese Journal of Practical Nursing
关键词
脑卒中
吞咽障碍
识别
循证护理
最佳实践
Stroke
Dysphagia
Recognition
Evidence-based nursing
Best practice
