腹膜透析患儿便秘评估的最佳证据应用

The best evidence application of constipation assessment in children with peritoneal dialysis

目的评估目前与腹膜透析患儿便秘评估相关的偱证证据,将与腹膜透析患儿便秘评估有关的最佳证据应用于临床护理实践,提高腹膜透析患儿及家庭照顾者对便秘评估的依从性。方法我院于2017年7-11月将JBI临床证据实践应用系统和临床转化系统作为审查工具,基于现有的腹膜透析患儿便秘评估的最佳证据,制定6条审查标准。对14名护士、30例患儿及照顾者实施基线审查和证据应用后第2轮审查。通过问卷调查护士、患儿或家庭照顾者对便秘相关知识的了解情况。结果在基线审查中,6条标准执行率较差为0～57%,将最佳证据引入到护理实践后,第2轮审查时,第6条审查标准(患儿或者居家照顾者定期评估和记录患者的排便习惯))执行率达到了90%,其余5条审查标准执行率均为100%;护士对腹透便秘相关知识得分从6.4分提高到9.5分;患儿或照顾者便秘相关知识得分从5.0分提高到8.6分。结论基于循证的质量审查改善了腹膜透析患儿便秘评估的临床护理实践,可提高护士和患儿及照顾者对便秘评估的依从性。

Objective To evaluate the evidence related to the assessment of constipation in children with peritoneal dialysis,and to apply the best evidence related to the evaluation of constipation in children with peritoneal dialysis to clinical nursing practice,so as to improve the compliance of children with peritoneal dialysis and family caregivers with the evaluation of constipation.Methods JBI clinical evidence application system and clinical transformation system were used as review tools.Based on the best evidence available for constipation assessment in children undergoing peritoneal dialysis,six review criteria were established.Questionnaires survey were used to investigate the knowledge of constipation among 14 nurses,30 children and caregivers by baseline and the second round of evidence application.Results Six audit criteria showed poor compliance in baseline audit ranging from 0%to 57%.Following implementation of the strategies,the significant improvements were observed in the follow-up audit with five criteria achieving 100%compliance and criteria six.The child's bowel patterns are routinely assessed showing 90%compliance.Nurses knowledge and skill regarding constipation assessment scored 6.4 in the initial audit and 9.5 in the follow-up audit(P<0.01).Children and caregivers’constipation assessment knowledge and skill was improved from 5.0 to 8.6(P<0.01).Conclusion Evidence-based quality review improves the clinical nursing practice of constipation assessment in peritoneal dialysis children,and improves the compliance of nurses,children and caregivers to constipation assessment.