老年肿瘤病人跌倒评估及管理审查指标的制订及障碍因素分析

Establishment of fall assessment and management review index and analysis of obstacle factors in elderly cancer patients

目的:开展老年肿瘤病人跌倒评估及管理的循证护理实践,根据最佳证据制订审查指标并分析障碍、促进因素。方法:以澳大利亚Joanna Briggs Institute(JBI)循证卫生保健模式为理论指导,组建循证护理团队及专家小组,系统检索、评价、汇总证据。结果:共纳入5条最佳证据,制订了8条审查指标,其中指标1、5、6、7、8的依从性分别为38.33%、30.00%、63.33%、3.33%、23.64%,其余审查指标的依从性均为0%。依据基线审查结果,结合循证护理实践准备度评估结果中得分<4分的条目(条目12、18、25、26)进行分析得出,主要的障碍因素为系统内部缺乏激励机制、统一的制度和流程、护士缺乏预防跌倒和循证护理相关知识,主要的促进因素为科室循证组织氛围良好、护士对证据认可度高、科学的循证团队,制定主要的行动策略为制定统一的制度、流程和健康教育单,向护士提供学习预防跌倒和循证护理相关知识的机会,并赋权护士进行项目的质控管理。结论:基于我国循证护理实践中证据应用概念模式的理论框架指导,采用可量化的循证护理实践准备度评估量表进行评估,结合临床专业人员的判断和基线审查结果进行障碍、促进因素分析并制定行动策略,具有科学性、全面性,可促进最佳证据的临床转化。

Objective:To carry out evidence-based nursing practice of assessment and management of falls in elderly cancer patients,and to formulate review indicators according to the best evidence,and analyze obstacles and promoting factors.Methods:Based on the theory of Joanna Briggs Institute(JBI)Evidence-based Health Care model,an evidence-based nursing team and expert group were established to systematically retrieve,evaluate and summarize the evidence.Results:Five best evidences were included in this study,and eight review indicators were formulated,of which the compliance of indicators 1,5,6,7 and 8 were 38.33%,30.00%,63.33%,3.33%and 23.64%respectively,and the compliance of other review indicators was 0.Based on the results of baseline review and the items(items 12,18,25,26)with a score of lower than 4 in the assessment of clinic readiness to evidence-based nursing,the main obstacle factors are the lack of incentive mechanism within the system,unified system and process,and the lack of knowledge about prevention of falls and evidence-based nursing,the main promoting factors are the good atmosphere of evidence-based organization,the high degree of acceptance of evidence by nurses,and the scientific evidence-based team,the main operational strategy are develop a unified system,process and health education sheet,provide nurses with the opportunity to learn about fall prevention and evidence-based nursing,and empower nurses to manage the quality of the program.Conclusion:Based on the theoretical framework of evidence application concept model in evidence-based nursing practice in China,a quantifiable Clinic Readiness to Evidence-based Nursing Assessment Scale was used,combining the judgment of clinical professionals and the results of baseline review to analyze barriers,facilitating factors and formulating action strategies is scientific and comprehensive,which can promote the clinical transformation of the best evidences.