肠内营养循证护理培训实施效果分析

The effectiveness of the training of evidence-based nursing care in enteral nutrition on the standardization of nursing procedure for acute stroke patients

目的:对25名神经内科监护室护士进行肠内营养循证护理的培训,并对培训前后护士对急性脑卒中患者所实施的护理行为进行对比性研究,以期达到营养支持护理操作的规范化。方法:以2008版《临床诊疗指南肠外肠内营养学分册》及《神经疾病肠内营养支持操作规范共识》的内容确立培训前后的7个维度25项指标,并作问卷调查,同时将培训前后所收集的93例急性脑卒中患者营养护理操作规范性进行比较。结果:问卷调查的7个维度25项指标均有所提高。培训前后患者的营养风险筛查、鼻饲管置入深度、床头抬高≥30°、营养液速度由慢到快、每4小时冲管及检查胃内残留等护理操作差异均有统计学意义(P<0.01),肠内营养液给予的速度应从慢到快差异也有统计学意义(P<0.05)。结论:肠内营养循证护理培训可规范护理行为,提高护理执行力度,明显地减少了患者胃肠道并发症的发生,同时为护理管理者提供了策略。

Objective： To obtain the standardization of nursing procedure in enteral nutrition by comparing the nursing behaviors of 25 nurses before and after the training of evidence-based nursing care in enteral nutrition. Methods： According to ＂Chinese clinical guidelines on parenteral and enteral nutrition＂ and ＂Enteral nutrition support practices consensus for neurological diseases＂,a questionnaire composed of 7 domains including 25 index was developed for evaluating the effectivess of evidence-based nursing care in enteral nutrition training. Nursing behaviors on enteral nutrition care of 25 nurses on 93 cases of acute stroke in neuro-intensive care unit were compared before and after the training. Results： Scores on 25 index in 7 domains increased. Nutrition risk screening, insertion depth of nasogastric tube, bed-head elevation ≥ 30°, feeding speed of enteral nutrient fluid from slow to quick, and washing pipe every 4 hours had statistical significance （P〈0.01）. Conclusion： The training of evidence-based nursing care in enteral nutrition can standardize the nursing care behavior of nurses,improve the quality of nursing care,and decrease gastrointestinal complications.