护士识别与管理脑卒中患者吞咽障碍的循证护理实践

Evidence-based nursing management of dysphagia in stroke patients

目的将卒中后吞咽障碍护理管理的最佳证据应用于护理实践，提高护士管理卒中后吞咽障碍的依从性和能力。方法运用JBI—PACES工具，确定吞咽障碍管理的最佳证据，制定6条审查标准，对30例脑卒中患者和20名护士进行基线审查及最佳证据实践后的再审查。结果6条审查标准执行依从率从基线审查的046．67％上升到第2轮审查80．00％～100％；吞咽功能入院24h内筛查率从6．67％上升至93．33％。结论基于循证的质量审查可提高护士吞咽障碍筛查与管理能力，改善吞咽障碍护理实践。

Objective To promote best practice in management of dysphagia in stroke patients, and to improve nursest compliance and ability of management of dysphagia. Methods The project used the Joanna Briggs Instituters Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in management of dysphagia in stroke patients. Six audit criteria were developed. A baseline audit was conducted on 30 patients to identify the barriers and to develop strategies. A follow up audit including a sample size of 30 patients was conducted by using same audit criteria. Twenty nursing staff were sur- veyed in both baseline and follow up audits. Results The baseline audit results showed that all audit criteria results were found to be less than 10 ~ （0--6.67 ~）, which indicated poor compliance with the current evidence. Following implementation of the strategies, there was an improvement in all the criteria audited, with criteria 1, 2, 5 and 6 achieving 100% compliance, and criterion 4 （providing education for patients before discharge） showing 80.00% compliance. Swallowing screening within 24 h of admission （criterion 3） compliance was improved from 6.67% to 93.33%. Conclusion Evidence-based audit project can enhance nurses＇ ability of screening and management of dysphagia for stroke patients, so as to improve nursing practice in dysphagia management.