摘要
目的构建基于指南的预防ICU患者肠内营养并发腹泻的集束化方案,并评价其应用效果。方法获取基于指南的预防ICU患者肠内营养并发腹泻的证据,共纳入5篇指南,汇总出12条最佳证据,构建腹泻管理集束化方案12条。选取2020年6—12月山东第一医科大学附属省立医院(山东省立医院)的175例ICU患者按照常规护理措施给予肠内营养护理,2021年3—10月的186例ICU患者采用基于循证的集束化方案进行护理。比较实施前后患者腹泻发生率、护士对证据的知晓情况及方案实施后护士对各证据的执行情况。结果集束化方案实施后,腹泻发生率由26.29%(46/175)降低为11.83%(22/186),差异有统计学意义(χ^(2)=12.33,P<0.05);护士对基于最佳证据的预防ICU患者肠内营养并发腹泻相关知识得分从52~100(75.79±10.18)分上升至72~100(90.00±6.71)分,差异有统计学意义(t=-8.88,P<0.05)。实施后护士对腹泻识别与评估、相关因素、喂养技术、营养制剂、疾病与药物五方面的知识知晓率分别为94.83%(55/58)、91.38%(53/58)、100.00%(58/58)、93.10%(54/58)、94.83%(55/58),与实施前的68.97%(40/58)、63.79%(37/58)、81.03%(47/58)、62.07%(36/58)、70.69%(41/58)比较差异均有统计学意义(χ^(2)值为8.66~14.33,均P<0.01)。方案实施后护士对证据的执行率均>95.00%。结论ICU患者肠内营养并发腹泻集束化方案应用于临床,可降低ICU患者肠内营养腹泻发生率,规范护士行为,提高护理质量。
Objective To construct the evidence-based care bundles for enteral nutrition-related diarrhea in ICU patients and evaluate its effectiveness.Methods Evidence-based care bundles for enteral nutrition-related diarrhea in ICU patients were constructed according to the best evidence from 5 guidelines.12 best evidences were summarized,and 12 cluster schemes for diarrhea management were constructed.175 patients admitted to ICU of Shandong Provincial Hospital Affiliated to Shandong First Medical University from June to December 2020 were selected as the pre implementation group which was given enteral nutrition nursing according to routine nursing measures,and 186 patients admitted to ICU from March to October 2021 were selected as the post implementation group which received nrusing care with evidence-based cluster schemes.The rate of diarrhea in ICU patients undergoing enteral nutrition support before and after using best evidence was compared,and awareness of best evidence among nurses before and after training,and implementation of various measures by nurses after the plan were also compared.Results After the care bundles were applied,the incidence of diarrhea decreased from 26.29%(46/175)to 11.83%(22/186)with statistically significant difference(χ^(2)=12.33,P<0.05).The diarrhea knowledge score was improved from 52-100(75.79±10.18)points to 72-100(90.00±6.71)points and had a significant difference(t=-8.88,P<0.05).After the care bundles were applied,the rate of ICU nurses′diarrhea identification and evaluation,analysis of influencing factors of enteral nutrition associated diarrhea,nasal feeding,selection of enteral nutrition formula and drug were 94.83%(55/58),91.38%(53/58),100.00(58/58),93.10%(54/58),94.83%(55/58),significantly improved than 68.97%(40/58),63.79%(37/58),81.03%(47/58),62.07%(36/58),70.69%(41/58)before applied(χ^(2) values were 8.66-14.33,all P<0.01).The implementation rate after the plan was more than 95.00%.Conclusions The application of the evidence-based care bundles can effectively reduce t
作者
侯晓红
孙倩
孟珠
李瑶瑶
徐芮
回雪英
王玉萍
Hou Xiaohong;Sun Qian;Meng Zhu;Li Yaoyao;Xu Rui;Hui Xueying;Wang Yuping(Department of ICU,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
出处
《中国实用护理杂志》
2022年第25期1927-1932,共6页
Chinese Journal of Practical Nursing
关键词
肠内营养
重症监护病房
腹泻
集束化护理
循证护理
Enteral nutrition
Intensive care units
Diarrhea
Bundle care
Evidence-based nursing
