提高慢性心力衰竭病人自我管理能力的循证实践

Evidence⁃based practice to improve self⁃management ability in patients with chronic heart failure

目的:将慢性心力衰竭病人自我管理的最佳证据应用于临床实践并评价效果。方法:遵循复旦大学开发的持续质量改进模式进行证据获取,通过对证据应用前慢性心力衰竭病人自我管理情况进行审查,分析障碍因素,构建并采取行动策略,评价证据应用后心脏内科病房慢性心力衰竭病人的再入院率、自我管理能力、生活质量以及护士对自我管理相关知识知晓情况。结果:证据应用后病人出院3个月再入院率由29.3%降低至9.5%(P<0.05);病人自我管理能力、生活质量和护士对自我管理相关知识知晓情况均显著提高(P<0.05)。结论:基于证据的循证实践能够提高病人自我管理能力,降低再入院率,提升护理质量,并改善病人结局。

Objective:To apply the best evidence of self⁃management for patients with chronic heart failure to clinical practice and evaluate the effect.Methods:According to the continuous quality improvement model developed by Fudan University to obtain evidence,review before and after the application,analyze obstacle factors,build and take action strategies,and evaluate the effect after evidence application.From January to March 2021,17 nurses and 41 patients with chronic heart failure in cardiology ward were reviewed at baseline.From April to May 2021,17 nurses(the same as before)and 42 patients with chronic heart failure in the cardiology ward were re⁃reviewed.Results:After applying of the evidence,the compliance of each examination index was improved(P<0.05);the 3⁃month re⁃entry rate decreased from 29.3%to 9.5%(P<0.05);patients′self⁃management ability,quality of life and nurses′and patients′awareness of self⁃management related knowledge were significantly improved(P<0.05).Conclusions:Evidence based on practice can improve patients′self⁃management ability,reduce readmission rate,improve nursing quality and improve patient outcomes.