| Background:The key role of nursing care in the field of preventing deep vein thrombosis(DVT)has been affirmed.In 2018,our country's National Health Commission issued the "Consent to develop the project to strengthen the prevention and treatment of pulmonary embolism and venous thromboembolism in hospital",which puts forward clear requirements for further prevention of DVT.At present,in the field of preventing DVT after total hip arthroplasty(THA)and total knee arthroplasty(TKA),guidelines,systematic reviews,and expert consensus to guide nursing practice are emerging one after another,and evidence-based resources are abundant.However,there is no evidence-based nursing practice plan for DVT prevention after THA and TKA.Therefore,it is urgent to apply evidence-based methods to construct the "Evidence-based Nursing Practice Plan for Prevention for DVT Prevention after THA and TKA".In addition,although the clinical nurses are more and more willing to implement evidence-based practice,their ability is relatively low.Therefore,in order to promote the application of evidence-based nursing practice for DVT prevention after THA and TKA,it is very necessary to construct a work model.Objective:(1)To describe and analyze the nursing care for DVT prevention after THA and TKA in China,and to summarize the problems in nursing practice;(2)to construct the"Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA",and to solve the problems of lack of clinical knowledge of nurses and the heterogeneity of preventive behaviors;(3)to introduce the "Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA" into the clinic step by step,and to comprehensively evaluate the effect from the system level,nurse level,and patient level;(4)focusing on refining the core elements of evidence-based nursing practice and forming a conceptual framework,and to construct a work model for evidence-based nursing practice for DVT prevention after THA and TKA,and solve the problems of unclear core elements affecting nursing practice in clinical practice and lack of work model.Methods:This study is guided by the Knowledge to Action framework and is divided into four parts.Part one "Orthopedics" or "Joint Replacement" were used to extract relevant data from a multi-center research project,which including the knowledge,attitude and practice of nurses in DVT prevention after THA and TKA.After understanding the current situation in China,a field investigation was carried out with the joint surgery ward of a third-class hospital in Beijing as a study case.In-depth interview method and participatory observation method were adopted to explore the essence of current nursing practice for DVT prevention after THA and TKA,analyzed and summarized the problems and influencing factors in practice.Part two Literature review,holding stakeholder meetings,conducting conversation and expert meeting were used to construct the"Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA".First,through systematic search,screening,and strict evaluation of the quality of relevant literature,the evidence was extracted one by one,and the evidence summary of DVT prevention after THA and TKA were determine by team consensus.Then the evidence was introduced into the clinical scenario,and taking feasibility,suitability and clinical significance as the criteria,opinions from 16 nursing staff and 6 patients were obtained,and the best evidence suitable for the local clinical scenario was screened.Based on the best evidence,the "Evidence-based Practice Plan for DVT Prevention after THA and TKA"were formulated by the research group,and revised based on expert opinions.Part three Through the establishment of the clinical application team,the pre-clinical application evaluation,the identification of possible obstacles,the formulation and implementation of countermeasures,the "Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA" was gradually introduced clinical.Using the before-and-after control study design and the nested mixed research method,the effect of the plan was comprehensively evaluated from the system level,nurse level and patient level.Part four Through the integrated reflection on the research process and results,the core concepts that affect nurses' DVT prevention behavior and their definition were determined by 14 concept domains of the Theoretical Domain Framework,and the relationship between core concepts was determined by the nested model of Theory of Planned Behavior and Social Cognitive Theory.Results:Part one At present,there were four clinical problems in the nursing practice of DVT Prevention after THA and TKA,including lack of knowledge,heterogeneity of preventive behavior,unclear core elements that affect nursing practice and lack of work model.Part two There are 34 pieces of evidence of DVT prevention after THA and TKA,which involving 6 aspects of risk assessment,nursing prevention,mechanical prevention,pharmacological prevention,health education,and promotion of the clinical application of the guidelines.Based on the opinions of stakeholders,24 best evidence with feasibility,clinical significance and suitable clinical situations were screened out.Based on the best evidence,combined with expert opinions,"Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA" were developed.The plan includes three aspects,risk assessment and other multi-dimensional knowledge training,6 work processes(general process,health education process,use of Graduated Compression Stockings process,use of Intermittent Pressure Compression process,use of drugs process,quality control process)and 3 auxiliary tools(health education manual,health education video,exercise quality evaluation device).Part three The long-term memory effect is not good,the process changes are trivial,the memory is difficult,the patient's enthusiasm for taking the initiative to learn the video is low,the patient's enthusiasm for actively participating in doing exercise is low and the implementation of the exercise quality evaluation device is limited by multiple factors,and the lack of flexible evaluation methods,were the obstacle factors that may be encountered in the introduction of the plan into the clinical process.Through the implementation of training,the production of simplified content cards,the modification of daily work information record forms,the addition of positions and the adjustment of responsibilities and other countermeasures,the plan was successfully introduced into the clinic step by step.The results of the effect analysis showed that at the system level,related processes has been improved,auxiliary tools has been developed,positions has been added,and responsibilities has been adjusted;at the nurse level,the nurses' knowledge of DVT prevention after THA and TKA has been improved(from 73.4%to 100%),and the evidence enforcement rate has been improved(from 0?21%to 72%?100%);at the patient level,the knowledge of DVT prevention after THA and TKA has been improved(from 75.6%to 87.8%),the incidence of DVT during postoperative hospitalization has been reduced(from 9.6%to 6.9%).Part four The 10 core elements in nursing practice for DVT prevention after THA and TKA has been identified,which include knowledge,skills,social and professional role recognition,result belief,reinforcement,intention,goals,environment and resources,social influence,and emotion;the definition of core elements has been adaptively modified based on the definition of the conceptual domain in the theoretical domain framework;a conceptual framework of evidence-based nursing practice for DVT prevention after THA and TKA has been deduced from individual rationality and interpersonal level.Finally,the work model of evidence-based nursing practice for DVT prevention after THA and TKA has been constructed,which including 6 parts,integrating knowledge generation(summarizing evidence),identifying the problem(finding out problems),debugging knowledge(screening evidence and formulate the plan),knowledge application(introduce the plan into the clinic and evaluate the effect),a conceptual framework for evidence-based practice and continuous use of knowledge.Conclusions:(1)At present,there are four clinical problems in the nursing practice of DVT prevention after THA and TKA,including the lack of prevention knowledge,the heterogeneity of prevention behavior,the unclear core elements of prevention evidence-based nursing practice,and the lack of work model.Through futher condensing the evidence-based problems,it is clear that the establishment of the "Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA" and work model of evidence-based nursing practice for DVT prevention after THA and TKA are two effective intervention measures.(2)The "Evidence-based Nursing Practice Plan for DVT Prevention after THA and TKA" constructed in this study is scientific and provides evidence-based decision-making basis for nurses,which can improve the current situation,reduce the incidence of DVT after THA and TKA,reduce the burden,and improve the quality of life of patients.(3)The work model of evidence-based nursing practice for DVT prevention after THA and TKA constructed in this study has a solid theoretical basis and a solid clinical foundation,is suitable for our country's conditions,can be used for understanding the practice behaviors of Chinese nurses in DVT prevention after THA and TKA,and provide methodological guidance for the development of relevant evidence-based nursing practice.(4)The development of this study vividly clarified the research methods of evidence-based nursing through personal statements,which can provide a strong guarantee for the development of scientific and standardized clinical nursing practice. |
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