胃肠肿瘤患者围手术期应激性高血糖规范化管理证据应用的障碍因素分析

Obstacle analysis of evidence-based nursing application of standardized management of stress hyperglycemia during perioperative period in gastrointestinal tumor patients

目的开展胃肠肿瘤患者围手术期应激性高血糖规范化管理的循证护理,制订审查指标,分析障碍及促进因素,制订行动策略。方法以Johns Hopkins循证护理实践模式为理论指导,检索、评价、汇总证据,制订临床审查指标及审查方法进行质量审查。2021年11月至2022年4月,对安徽医科大学第一附属医院胃肠外科符合纳入标准的医护人员和患者进行临床审查,计算审查指标依从率。根据审查结果,分析障碍及促进因素。结果本研究纳入26条最佳证据,制订14条审查指标对48名医护人员和45例患者进行临床审查,其中7条指标依从率<60%。主要障碍因素为科室缺乏胃肠肿瘤患者围手术期应激性高血糖规范化管理的相关流程和仪器、医护人员相关知识掌握不足等,主要促进因素为组织支持力度大、医护团队合作氛围好、变革意愿强烈等。结论胃肠肿瘤患者围手术期应激性高血糖管理临床实践与最佳证据间存在较大差距,应针对障碍及促进因素提出行动策略,促进证据转化。

Objective To carry out evidence-based nursing for standardized management of stress hyperglycemia in perioperative period of gastrointestinal tumor patients,and to formulate indicators,analyze obstacles and promoting factors,formulate action strategies.Methods Guided by the Johns Hopkins evidence-based nursing model,evidence were searched,evaluated and summarized.Clinical indicators and review methods were formulated to carry out quality review.From November 2021 to April 2022,the medical staff and patients in the gastrointestinal surgery department of the First Affiliated Hospital of Anhui Medical University who met the inclusion criteria were conducted,and the incidence of compliance rate was calculated.Based on the results of the baseline review,the obstacles and contributing factors were analyzed.Results A total of 26 pieces of best evidence were included and 14 indicators were formulated for 48 medical staff and 45 patients to clinical review,among which the compliance rate of 7 indicators was less than 60%.The main obstacle factors were lack of procedures and instruments for management of perioperative stress hyperglycemia in gastrointestinal tumor patients,lack of knowledge of medical staff,etc.The main promoting factors were organizational support,good atmosphere of medical team cooperation,strong willingness to change,etc.Conclusions There is a big gap between the clinical practice and the best evidence of perioperative stress hyperglycemia management in patients with gastrointestinal tumor.Action strategies should be put forward for obstacles and promoting factors to promote evidence transformation.