肾脏部分切除术后短期留置导尿管患者导尿管拔除策略的循证实践

Evidence based practice of catheter removal in patients with short-term indwelling catheter after partial nephrectomy

目的 评估目前肾脏部分切除术后短期留置导尿管患者导尿管拔除策略的循证依据,将最佳证据应用于实践,通过质量审查促进临床护理质量的改进.方法 2016年7-12月在2个病区完成2轮质量审查.应用最佳证据制订5条审查标准,进行肾脏部分切除术后短期留置导尿管患者导尿管拔除策略的基线审查,制订相应的循证实践方案,并将现有的最佳证据整合到护理实践中,再实施干预后的审查.结果 在基线审查中,5条审查标准的依从性为0,将最佳证据引入护理实践,第2轮审查中,5条审查标准的依从性均达到100%;泌尿外科护士对导尿管拔除时机循证得分从（73.00±9.35）分,上升到（94.81±3.38）分,差异有统计学意义（t=12.72,P〈0.01）.导尿管留置时间从（5.69±0.79）d,缩短至（4.24±0.82）d,差异有统计学意义（t=5.47,P〈0.01）.结论 本次循证护理实践项目改进了肾脏部分切除术后短期留置导尿管患者导尿管拔除策略的护理实践,但仍需加强医护合作,以促进护理质量的持续改进.

Objective To evaluate evidence-based practice of catheter removal strategy in patients with short-term indwelling catheter after partial nephrectomy. Try to apply the best evidence into practice, and further to improvethe quality of clinical nursing through quality review. Methods Two rounds of quality review were carried out in the 2 wards from July to December in 2016. Using the 5 review criteria of best evidence, we reviewed baseline of catheter removal strategies for patients with short-term indwelling catheter after partial nephrectomy and developed appropriate evidence-based practice. Further, the best evidence was integrated into clinical nursing practice, and the prognosis was reviewed after then. Results In the baseline review, the compliance of the 5 review criteria was 0. However, after introducing the best evidence into nursing practice,the compliance was up to 100%. The mastering of evaluation knowledge of catheter removal of nurses increased from 73.00 ± 9.35 to 94.81 ± 3.38 with significant difference （t=12.72, P〈0.01）. The indwelling time of catheter shorted from （5.69±0.79） d to（4.24±0.82） d. The difference was significant （t=5.47, P〈0.01）. Conclusions Evidence-based nursing practice improvesthe strategies of short-term catheter removal after partialnephrectomy, while closer cooperation between nurses and doctors are still needed to promote the continuous improvement of nursing quality.