基于临床实践指南的老年功能性便秘护理现况调查研究

Status quo of nursing for elderly functional constipation based on clinical practice guidelines

目的调查老年功能性便秘临床护理现况与实践指南之间的差距,提出相应的行动策略,为指南的临床转化提供参考依据。方法采用便利抽样法,于2019年7—10月选取北京地区部分综合医院、中医医院、中西医结合医院中收治老年功能性便秘患者病房的330名临床护士和护理管理者为研究对象,采用自制的调查问卷进行问卷调查,制订推荐意见达标标准和算法公式,使用Excel软件计算推荐意见的达标率、部分达标率和不达标率。本研究共发放330份问卷,回收问卷330份,回收率为100.0%(330/330)。排除条目缺失值大于10%、所有条目答案一致等无效问卷后,有效问卷317份,有效率为96.1%(317/330)。结果12条指南的推荐意见中,达标率最高的3个条目是如厕模式的健康教育、身体活动的健康教育、满意度和效果评价,不达标率最高的4个条目是组建跨学科团队、综合教育和项目推广、体格检查与用药史的健康评估。是否接受过相关培训的护理人员临床实践现况差异有统计学意义(P<0.01)。结论大多数护士能够为老年功能性便秘患者进行全面的护理,但实践内容与指南的标准差距较大,采取加强护士培训和人才培养以及规范便秘的护理流程等措施,可帮助推进证据的临床转化。

Objective To explore the gap between the clinical nursing status and practice guidelines of elderly functional constipation,propose corresponding action strategies,and provide reference for the clinical transformation of the guidelines.Methods From July to October 2019,totally 330 clinical nurses and nursing managers of elderly patients with functional constipation admitted into the general hospitals,hospitals of traditional Chinese medicine,and hospitals of traditional Chinese medicine and western medicine in Beijing were selected by convenient sampling and investigated with self-made questionnaires.The standard and algorithm of recommendations were formulated,and Excel software was used to calculate the compliance rate,partial compliance rate,and non-compliant rate of recommendations.A total of 330 questionnaires were distributed in this study,and 330 questionnaires were recovered,with a recovery rate of 100.0%(330/330).After excluding invalid questionnaires such as items with missing values greater than 10%and all items having the same answers,there were 317 valid questionnaires,with an effective rate of 96.1%(317/330).Results Among the recommendations of the 12 guidelines,the 3 items with the highest compliance rate were health education related to toileting patterns,health education related to activities and sports,satisfaction and effect evaluation,while the 4 items with the highest non-compliance rates were building interdisciplinary teams,comprehensive education and program promotion,health assessment,and physical examination of medication history.There was a statistically significant difference in the clinical practice status between nurses who had and had not received relevant training(P<0.01).Conclusions Most nurses can provide comprehensive care for elderly patients with functional constipation,but there is a big gap between the practice and the guidelines.Measures such as strengthening nurse training and talent training and standardizing the nursing process of constipation can help promote the clinical translation of evidence.