发热管理在儿科急诊中的最佳证据应用

Application of the best evidence of fever management in pediatric emergencies

目的探讨发热管理在儿科急诊中的最佳证据应用。方法依据JBI临床证据实践应用系统(JBIPACES)的标准程序,基于临床问题,通过JBI在线临床治疗及护理证据网络(CONNECT+)数据库获取儿童发热管理的相关证据并制定相应审查标准,经证据应用前基线审查、实践变革、证据应用后变革效果的再审查,将证据推广到特定的临床环境中去。证据应用前后各有50名发热患儿家属及35名护士纳入研究,采用现场观察法、访谈、查阅相关护理文书收集资料,以护士对于每条标准执行的依从性、家属及护士对基于循证的发热知识的掌握度来评价证据应用前后的有效性。结果证据应用后,5条标准的依从性可达到98%~100%。儿科急诊护士的发热知识问卷均分由67.6分上升到90.3分,发热患儿家属的均分由54.5分上升到83.7分。结论儿童发热管理最佳证据的应用,利于护理人员及患儿家属对发热管理进一步的认识,在规范发热处理流程的同时,提升了护理质量。

Objective To study the application of the best evidence of fever management in pediatric emergencies. Method The study was performed and guided by the standardized procedure which was supported by the JBI-PACES programs（ baseline audit, evidence implementation, and re audit）. Evidence regarding management in children with feverish illness was obtained from the JBI CONNECT＋ and then audit criteria were identified. The study involved 50 parents and 35 nurses, and the data were collected by field observation,interviews,and review of nursing records. Nurses＇ compliance with each criterion and the score of nurses and parents in the questionnaire evidence-based about fever were used to evaluate the effectiveness of evidence implementation. Results After the implementation of evi dence, the compliance of the 5 standards can reach 98%-100%. In addition, the average score of questionnaire in the nurses was improved from 67.6 to 90.3, 54.5 to 83.7 in the parents. Conclusion The implementation of best evidence of management in children with feverish illness help nurses and parents better aware of fever management, standardize the procedure of fever management, and improve the nursing quality.