Adaptation And Implementation Of Nursing Clinical Guidelines For The Medical Graduated Compression Stockings In Chronic Venous Diseases

Background:Chronic Venous Disease(CVD),whose prevalence and progression of the disease accelerated with age is possibly affecting a quarter of the world's population.Medical graduated compression stockings,MGCS is the most commonly used pressure device for conservative treatment and postoperative care of CVD.The nursing practice of MGCS on CVD is part of the specialized nursing work in vascular surgery.However,through clinical investigation and literature review,it is found that the clinical practice of MGCS is a weak link in nursing work.Due to the lack of clinical technical specifications,the standardization of nursing behavior is insufficient yet.“The 14 th Five-year Plan for Health Standardization” by National Health Commission proposed to strengthen the standardization construction of medical and health institutions,improve the standardization level of medical and health services,and promote the highquality development of nursing with standardized methods.In order to solve the lack of perfect clinical nursing standards of MGCS on CVD and promote the standardization of clinical nursing of MGCS.It is urgent to formulate and implement the clinical nursing practice guidelines for the application of MGCS on CVD in accordance with the clinical environment in China,so as to further promote the high-quality development of nursing work.Objective:To formulate Nursing Clinical Guidelines for the Medical Graduated Compression Stockings in Chronic Venous Diseases(NCG-MGCS),carry out transformation and implementation in clinical practice,monitor the implementation process,evaluate the effect,so as to standardize the clinical nursing technology of MGCS,to promote the standardization and homogeneity of MGCS clinical nursing,continuously and deeply provide high-quality care for patients,and help development of high-quality nursing.Methods:This study is mainly based on the guidance adaptation and implementation plan framework(CAN-IMPLEMENT)and carry out guidelines adaptation and research.Stage 1: Literature review and prevalence survey.By Literature analysis and questionnaire survey,make investigation on the status of MGCS clinical nursing practice on CVD and the level of MGCS clinical practice knowledge of medical staff in China,so as to analyze the existing problems and influencing factors of MGCS nursing practice in China.Stage 2: Guidelines adaptation.By Searching and screening CPGS related to MGCS application on CVD from related guideline websites,professional academic organization websites and medical databases,making decision after comprehensive evaluation,to complete and evaluate the draft of NCG-MGCS after selecting,integrating,adapting and summarizing the recommendations included in the guideline by content analysis method.Stage 3: To Construct guidelines for clinical transformation strategies and plan.Choose varicose vein of lower limb as representative of CVD,and NGG-MGCs were introduced into the clinical nursing of patients with lower extremity varicose veins.The Theoretical Domains Framework(TDF)was used as the guiding theory to formulate the interview outline.Through semi-structured interviews with stakeholders,factors that may hinder and promote the implementation of NCG-MGCS were comprehensively identified.Mapping the obstacle factor to the Behaviour Change Wheel(BCW),formulate NCG-MGCS implementation strategy and “Standardized nursing program of MGCS on postoperative patients with CVD”(Abbreviation: The program).Stage 4: Process evaluation of adaptation guidelines and clinical transformation program implementation.The Program was applied to clinical practice,and the implementation of the program was monitored by the changes of MGCS nursing knowledge level of nurses before and after the training and their compliance with the program.Using the Sustainability Assessment System of National Health Service(NHS)to conduct a questionnaire survey,through the qualitative study to comprehend the feelings of nurses participating in this study and the proposal of sustainable application.Stage 5: Effect evaluation of adaptation guidelines and clinical transformation program implementation.Non-randomized and non-synchronous Comparison was used to evaluate the effect of NCG-MGCs and clinical transformation program by comparing the MGCS nursing knowledge level and postoperative outcomes of patients between two groups with patients receiving traditional care and Patients receiving the "program" nursing measuresResults:1.Results of present study.Feedback was collected from 150 vascular surgical staff,including 105(70.00%)nurses and 45(30.00%)doctors.The average score of MGCS clinical practice knowledge was(64.43±15.58).62% of the medical staff had established MGCS nursing routine or nursing standard,and 21.33% had received MGCS operation training.2.Results of guidelines adaptation.Finally,5 evidence-based guidelines were included as source guidelines.The standardized score range of source guidelines in all AGREE ? fields was 33.33%?89.58%,and the overall score range was 5?6 points,which were all recommended.Adapted guidelines,NCG-MGCS,includes 33 recommendations from five aspects,including indications,contraindications,prescription guidance,side effects and risk assessment,and health education.AGREE II was rated above 50% in all areas,100% was recommended,and most of the FAME structures were approved above 80%.3.Results of clinical transformation program.According to the TDF framework,10 obstacles and 5 facilitation factors were identified in 7 theoretical domains including knowledge,skills,social occupational role identity,ability belief,outcome belief,environment and resources,and social influence.After mapping to BCW,26 guideline implementation strategies and “Standardized nursing program of MGCS on postoperative patients with CVD” were developed.4.Results of Process evaluation of the program application.The theoretical and technical scores of 19 medical staff before training were 67.68±9.80 and 69.68±7.45,and the after training scores were(92.21±4.47)and(93.68±3.33).The after training scores were higher than training before,and the difference was statistically significant(P<0.05).The compliance rate of each project of the program was above 90%.The average score of the NHS sustainability factors questionnaire was(84.45±23.16)points,with all dimensions greater than 55 points.5.Results of effect evaluation of the program application.(1)At discharge,the score of MGCS nursing knowledge in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).(2)In terms of patient compliance,the proportion of patients in the observation group who wore socks for 4-6 months after discharge(40%)was higher than that in the control group(12%).The proportion of patients in the control group who wore socks for less than 8 hours a day was 48%,higher than that in the observation group(29.33%).And the difference was statistically significant(P<0.05).(3)In terms of MGCS complications,the scores of patients in the observation group were all lower than those in the control group in terms of leg tightening sensation,leg swelling,feeling ponderous and total score of complications.And the difference was also statistically significant(P<0.05).(4)At the third month after discharge,the CIVIQ-20 scores of patients in the observation group were higher than those in the control group in pain dimension,physical dimension,social dimension and total score,but the differences were only statistically significant in pain dimension and physical dimension(P<0.05).At the 6th month after discharge,CIVIQ-20 scores in all dimensions and total scores of patients in the observation group were higher than those in the control group,but the difference was only statistically significant in the pain dimension(P<0.05).Conclusion:1.At present,the clinical nursing technical specifications for the application of MGCS on CVD in China need to be further completed.It is urgent to construct the NCG-MGCS to promote the standardization of MGCS clinical practice.2.Formulated NCG-MGCS guidelines is scientific,rigorous,feasible and practical.It can be used as an evidence tool to standardize MGCS clinical nursing technology.3.It is an important guarantee to promote the clinical application of the guidelines by comprehensively evaluating the promoting factors and obstacles to the implementation of the guidelines by TDF and BCW,and constructing the clinical transformation program of NCG-MGCs that promotes the implementation of the guidelines.4.The "program" is carried on perfectly.Nursing staff not only gain knowledge in the practice but also feel the promotion of professional value.Patients with CVD received quality care and improved prognosis and quality of life.