摘要
目的评价《婴儿先天性心脏病肠内营养循证护理实践指南》(以下简称《指南》)应用对改善目标人群婴儿先天性心脏病(CHD)营养状况的效果,探索证据在传播、实施、整合到临床实践过程中有效的实施策略。方法通过实施性研究设计,以健康服务领域研究成果应用的行动促进框架(i-PARIHS)为理论模型,选择2019年1—6月和2019年9月至2020年2月复旦大学附属儿科医院心脏重症监护室收治的接受心脏手术治疗的婴儿CHD为研究对象。以2019年1—6月为实施前阶段,2019年9月至2020年2月为实施后阶段。针对医护人员的实施策略为传播策略、实施过程策略、整合策略、能力建设策略;针对患儿实施策略将《指南》中26条最佳实践推荐意见转化为可操作的护理流程及肠内营养方案,在入院至手术前、术后心脏监护期间、术后病房恢复期、出院前期4个阶段进行实施。采用实施结果变量测评表评价实施策略的有效性;采用住院期间患儿体质量丢失、上臂围、出院前血清白蛋白、前白蛋白等指标评价干预对改善患儿营养状况的有效性。结果实施结果变量中8个方面得分均在总分的75%以上。实施后患儿出院前血清前白蛋白为(166.53±42.57)g/L,高于实施前的(148.41±30.66)g/L,差异有统计学意义(t=-3.21,P<0.01);实施后患儿住院期间体质量丢失-0.10(0.31,0.40)kg,低于实施前患儿住院期间体质量丢失的0.00(-0.15,0.41)kg,差异有统计学意义(Z=-2.90,P<0.01)。结论基于《指南》证据的婴儿CHD肠内营养方案在传播、实施、整合到临床的过程中所采取实施策略可获得有效的实施结果,可显著改善婴儿CHD的营养水平。
Objective To evaluate the effectiveness of Evidence-based Nursing Practice Guideline for Enteral Nutrition of Infants with Congenital Heart Disease application on improving the nutritional status of infants with congenital heart disease(CHD)in the target population,and to explore the effective strategies of evidence implementation in the process of dissemination,implementation and integration into clinical practice.Methods This was an implementation study.Promoting Action on Research Implementation in Health Services Integrated Framework(i-PARIHS)was used as a theoretical model.Infants with CHD who received cardiac surgery from the heart ICU of Children′s Hospital of Fudan University from January 2019 to February 2020 were selected as the study subjects.January to June 2019 and September to February 2020 were the pre and post implementation phase respectively.For medical staff,communication strategy,implementation process strategy,integration strategy and capacity-building strategy were used to advance the implementation process.According to the implementation strategy of children,the 26 best practice recommendations in the guide were translated into operable nursing processes and enteral nutrition programs,which were implemented in four stages:admission to the hospital,pre operation,post operation cardiac care room,post operation ward recovery,and pre discharge.Implementation Results Variable Assessment Form was used to evaluate effectiveness of the implementation strategies;hospitalization weight and upper arm circumference,serum albumin and pre-albumin before discharge were used to evaluate effectiveness of the interventions.Results Scores of eight aspects of Implementation Results Variable Assessment reached more than 75%of the total score.Pre-albumin of post-implementation was(166.53±42.57)g/L,which was statistically significantly higher than(148.41±30.66)g/L before discharge(t=-3.21,P<0.01);the weight loss of pre-implementation was 0.00(0.41)kg,while the weight change of post-implementation was-0.10(0.4
作者
傅唯佳
顾莺
张立华
王慧美
杨玉霞
Fu Weijia;Gu Ying;Zhang Lihua;Wang Huimei;Yang Yuxia(Department of Nursing,Children′s Hospital of Fudan University,Shanghai 201102,China;Nursing College of Fudan University,Shanghai 200032,China;Department of Cardiac Surgery,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Intensive Care Unit,Children′s Hospital of Fudan University,Shanghai 201102,China)
出处
《中国实用护理杂志》
2022年第36期2811-2818,共8页
Chinese Journal of Practical Nursing
基金
复旦大学-复星护理科研基金(FNF202001)。
