糖尿病足评估的循证护理实践研究

Evidence-based nursing practice for diabetic foot assessment

目的根据糖尿病足评估的最佳证据,开展循证实践,并评价其应用效果。方法以知识-行动框架模式为指导,在前期糖尿病足评估的证据总结基础上,对证据在临床的适用性进行评价,筛选适宜在临床实施的证据,制订审查指标;进行基线审查,并分析障碍因素,制订干预措施。比较证据应用前后护士对糖尿病足评估的知识掌握程度、审查指标执行情况及伤口面积变化。结果最佳证据应用后,36个审查指标中24个执行率高于实施前(P<0.05),有3个审查指标执行情况为相关工具实现从无到有的改变,护士对糖尿病足评估知识的掌握程度有所提升,但患者伤口4周和12周的面积在实施前后差异没有统计学意义(P>0.05)。结论基于糖尿病足评估最佳证据的循证实践,可提高护士糖尿病足评估的知识水平及证据的执行率,能够规范糖尿病足评估的护理实践。

Objective To develop evidence-based practice based on the best evidence of diabetic foot assessment and evaluate its effectiveness.Methods Guided by the Knowledge-action model,on the basis of the evidence summary of diabetic foot assessment,the clinical applicability of the evidence was evaluated,the evidence items suitability for clinical implementation were screened,and the review indicators were developed.Baseline reviews were conducted,and obstacle factors were analyzed to develop interventions.Before and after the application of evidence,the nurses'knowledge of diabetic foot assessment,the implementation of review indicators and the change of wound area were compared.Results After the application of the best evidence,the implementation rate of 24 of the 36 review items was higher than before the implementation(P<0.05),and three review items changed from non-existence to existence of relevant tools.Nurses'knowledge of diabetic foot assessment was significantly improved(P<0.05),but the wound area at 4 weeks and 12 weeks did not change significantly(P>0.05).Conclusion Evidence-based practice based on the best evidence of the diabetic foot assessment can improve the knowledge level of diabetic foot assessment and implementation rate of evidence,and can standardize the nursing practice of diabetic foot assessment.