《促进以患者为中心的学习》指南的临床实践适用性评价与阻碍因素分析

Evaluation of clinical practice applicability and analysis of barriers on the guideline for Facilitating Client Centered Learning

目的对《促进以患者为中心的学习》指南进行临床实践适用性评价与阻碍因素分析。方法于2021年9—10月选取11名专家,采用专家会议法,对指南推荐意见进行临床实践适用性评价;于2022年3—5月选取中日友好医院10个试点病房的140名护士,采用自制的《促进以患者为中心的学习》指南临床实践阻碍因素分析问卷进行调查,并基于Apriori算法对阻碍因素进行关联规则挖掘。结果专家意见显示,15条指南推荐意见均有临床意义,均同意在临床开展;在开展现状方面,≥6名专家表示条目2、6、7在临床开展非常好;≥6名专家表示条目3、4、10待改进;≥6名专家表示条目11、12、14未在临床中开展。在阻碍因素的调查中,共发放140份问卷,问卷有效回收率为92.86%(130/140);25.38%(33/130)的护士认为4个因素均无阻碍;阻碍因素间的关联规则分析,经专业筛选,汇总出4条关联规则。结论《促进以患者为中心的学习》指南推荐意见均可应用于临床中,但在临床实践与指南理论间仍存在差距,其在临床应用中可能存在的最大阻碍是人力不足和缺乏相关护理文件。

ObjectiveTo conduct clinical practice applicability evaluation and barrier analysis on the guideline for Facilitating Client Centered Learning.MethodsFrom September to October 2021,11 experts were selected to use the expert meeting method to evaluate the clinical applicability of the recommended guidelines.From March to May 2022,140 nurses from 10 pilot wards of the China-Japan Friendship Hospital were selected to conduct a survey using the self-designed Facilitating Client Centered Learning Guideline Clinical Practice Barrier Questionnaire.The barrier association rules were mined based on the Apriori algorithm.ResultsExpert opinions showed that all 15 recommendations had clinical significance and all agreed to be implemented in clinical practice.In terms of current development status,≥6 experts expressed that the item 2,6,and 7 were very well implemented in clinical practice,and≥6 experts expressed that the item 3,4,and 10 needed improvement,and≥6 experts stated that the item 11,12,and 14 were not carried out in clinical practice.In the investigation of barriers,a total of 140 questionnaires were distributed,and the effective response rate of the questionnaire was 92.86%(130/140).25.38%(33/130)of nurses believed that all four factors were unobstructed.After professional screening,four association rules between barriers were summarized.ConclusionsThe recommendations of the Facilitating Client Centered Learning guideline can be applied in clinical practice,but there is still a gap between clinical practice and guideline theory.The biggest barriers that may exist in clinical applications are insufficient labor and a lack of relevant nursing documents.