糖尿病高危足患者足部护理教育证据应用审查及障碍因素分析

Review of evidence application and obstacle factors of foot nursing education in high-risk diabetic patients

目的了解糖尿病高危足患者足部护理教育证据临床应用现状,分析障碍因素并制订干预策略,为循证证据向临床实践转化提供参考。方法采用便利抽样法,于2019年4—6月选取上海中医药大学附属龙华医院内分泌科12名护士、49例糖尿病高危足患者为研究对象。引入糖尿病高危足患者足部护理教育证据15条,根据证据制订10条审查指标开展临床现状审查,依据审查结果展开障碍因素分析。结果10条审查指标的临床依从率为0~43%,其中糖尿病高危足患者足部护理知识、信念、行为的标准化得分分别为68.32%、61.00%、59.44%,护士足部护理知识、信念、行为的标准化得分分别为75.97%、54.17%、52.78%。障碍因素主要包括缺乏糖尿病高危足足部护理教育循证护理实践方案、未引入糖尿病高危足筛查工具、未开展多学科足部护理教育、健康教育形式单一、护士的足部护理教育知信行水平较低、缺乏培训、护士不重视效果评价等。结论糖尿病高危足患者足部护理教育证据尚未有效转化于临床实践,应根据干预策略构建循证实践方案,缩短临床实践与证据间的差距。

Objective To understand the clinical application status of evidence of foot nursing education in high-risk diabetic patients,analyze the obstacle factors and formulate intervention strategies,so as to provide reference for the transformation of evidence-based evidence into clinical practice.Methods From April to June 2019,a total of 12 nurses and 49 high-risk diabetic foot patients in Department of Endocrinology in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as research objects by the convenient sampling method.A total of 15 pieces of evidence of foot nursing education for high-risk diabetic foot patients were introduced.10 review indicators were formulated to carry out clinical status review according to the evidence and obstacle factor analysis was carried out according to the review results.Results The clinical compliance rate of the 10 review indicators was 0-43%,of which the standardized scores of foot care knowledge,belief and behavior in high-risk diabetic foot patients were 68.32%,61.00%and 59.44%,respectively.The standardized scores of foot nursing knowledge,belief and behavior were 75.97%,54.17%and 52.78%,respectively.The main obstacle factors included lack of evidence-based nursing practice plan for high-risk diabetic nursing education,lack of introduction of high-risk diabetic foot screening tools,lack of multi-disciplinary foot nursing education,single form of health education,low level of knowledge,faith and practice of nurses'foot nursing education,lack of training and lack of attention by nurses to effect evaluation.Conclusions Evidence of foot nursing education in high-risk diabetic foot patients has not been effectively translated into clinical practice.Evidence-based practice programs should be constructed according to intervention strategies to shorten the gap between clinical practice and evidence.