化疗失眠患者评估和护理的最佳证据应用

The best evidence for evaluation and nursing of patients with chemotherapy and insomnia

目的评估目前与化疗患者失眠的评估和护理相关的循证证据,将与化疗患者失眠的评估和护理的相关最佳证据应用到护理实践中,通过质量审查促进临床护理质量的改进。方法2016年6-9月,在我院化疗科完成了2轮质量审查。查询到了澳大利亚乔安娜·布里格斯研究中心(Joanna Briggs Institute,JBI)在线临床治疗及护理证据网络(COnNECT+)数据库及美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)中有关化疗患者失眠的最佳证据推荐,根据证据制定了5条审查标准,进行了证据应用前的基线审查,分析了证据应用存在的障碍、可获得的资源及解决办法,制定了相应的循证实践方案,将现有的最佳证据整合到护理实践中,再实施了干预后的审查。结果在基线审查中,5条审查标准的依从性为0~28.57%,将最佳证据引入到护理实践后,第2轮审查中,5条审查标准的依从性达到了69.56%~100%;护士和患者的知识得到了提升;患者的失眠率下降。结论本次最佳证据应用改进了化疗患者失眠的评估和护理的护理实践,提高了护理质量。

Objective To evaluate current practice and develop strategies in chemotherapy patients with insomnia and promote continuous improvement in assessment and management of chemotherapy patients with insomnia among cancer patients.Methods Evidence regarding assessment and nursing of chemotherapy patients with insomnia was obtained from JBI COnNECT＋ and National comprehensive cancer network.Then audit criteria were identified.The project was conducted in a chemotherapy ward of a large cancer hospital in China,from June 2016 to September2016.Five audit criteria were established according to the best available evidence on the assessment and management of chemotherapy patients with insomnia.The program was divided into three phases.Results The compliance rates in the five criteria ranged from 0~28.57% at baseline.After implementation of the project,significant improvement was achieved and the compliance rates in the five criteria achieved 69.56%~100%.Moreover,nurses＇ knowledge,patients＇ knowledge had been strengthened.Conclusion This project is successful in improving clinical changes in assessment and management of chemotherapy patients with insomnia and improves the quality of nursing.