| Objective:To construct an evidence-based nursing protocol for prevention of post-stroke depression(PSD),and explore the effect of the application of the protocol,so as to improve the prognosis of patients with stroke,optimize the nursing management process of PSD prevention,and promote the continuous improvement of nursing quality.Method:Phase one: Based on the theory of "continuous quality improvement model",an evidence-based nursing protocol for prevention of PSD was constructed.1.Cross-sectional survey to identify evidence-based issues.2.Establish a multidisciplinary team.3.Evidence was obtained according to the model of JBI evidence-based health care,and evidence quality was evaluated using the evidence classification and recommendation strength standards of the center for evidence-based medicine of the university of Oxford.4.Organize relevant stakeholders to evaluate and adjust the feasibility and suitability of evidence to determine evidence-based nursing programs.5.For the recommended items in the program,researchers and practitioners shall jointly develop quality review indicators,determine the data collection methods and tools for each review indicator,conduct status review,identify the obstacles in the implementation of the program and the corresponding solutions,and finally establish an evidence-based nursing practice program to prevent PSD.Phase two: Experimental study on the clinical application of evidence-based nursing practice.86 first ischemic stroke patients admitted to the Department of Neurology of atertiary hospital in bengbu city,anhui province,from March 2019 to August 2019 were selected as the research subjects.Patients in the control groupreceived routine stroke care.The patients were randomly divided into two groups by random digital table method,and the patients in the control group were treated with routine stroke care,and the patients in the experimental group were intervened according to the program content.General condition questionnaire,social support rate scale(SSRS)were used to assess the patients at the time of admission.Hamilton Depression Scale(HAMD),mini-mental State Examination(MMSE)and Barthel Index(BI)were used to assess the Depression,cognitive function and self-care ability of the patients at the time of admission,4 weeks and 12 weeks after stroke,respectively.All data are analyzed using SPSS21.0 statistical software to measure resources,The material was described by mean ± standard deviation(x ±s),and the two groups were compared by t test;the counting data were compared by chi-square test,P < 0.05 that the difference was statistically significant.In order to control the quality of the study,10 nurses in the department of neurology were selected by the purpose sampling method,and a questionnaire for knowledge of prevention and management of PSD was prepared by themselves according to the program contents.The compliance of nurses with evidence-based practices before and after the implementation of the program was assessed by reviewing criteria and methods for the best recommendations established in the program.Results:1.Established evidence-based nursing practice plan for prevention of PSD,including team management,screening and evaluation,drug prevention,psychosocial intervention,rehabilitation training and health education,total 19 recommendations in6 categories,14 were strong recommendations and 5 were weak recommendations.2.Knowledge level of nurses on prevention and management of PSD: after the implementation of the program,nurses' knowledge score on prevention and management of PSD was(91.60 ± 5.42),significantly higher than that before theprogram implementation(69.20 ± 8.05),showing a statistical difference(t=-8.791,P<0.05).3.Nurses' compliance with evidence-based practice: at baseline,the implementation rate of nurses on review indicators 1,2,3,4,5,6,7,8,9,13 and 14 was 0%,The implementation rate of review indicator 10 was 70 per cent;The implementation rate of review indicator 11 is 50 per cent;The implementation rate of review indicator 12 is 30 per cent;After training and implementation of the program,the implementation rate of all the 14 review indicators of nurses was higher than that of the baseline review.The implementation rate of the review indicators 1,2,3,4,5,8,9,11,12,13 and 14 was 100%.The implementation rate of review indicators 6 and 7was 80 per cent;The implementation rate of review indicator 10 was 95%,and nurses' compliance with evidence-based practice improved.4.Incidence of PSD: before intervention,the HAMD score of the two groups did not meet the diagnostic criteria for depression(HAMD score ?7 points).At 4weeks after intervention,the incidence of depression in the control group was 45.23%,and that in the intervention group was 27.50% in the intervention group.The difference was statistically significant(c 2 =3.852,P<0.05).At 12 weeks after intervention,the incidence of depression was 45.24% in the control group and 17.50%in the intervention group,which were significantly higher in the control group than in the intervention group.The difference between the two groups was statistically significant(c2=7.896,P<0.05).5.HAMD score:(1)Comparison between groups: by single factor analysis,there was no significant difference in HAMD score between the two groups before intervention(z=-1.268,P=0.205,P>0.05).There were statistically significant differences between the two groups at 4 weeks of intervention(z=-2.193,P<0.05),and statistically significant differences between the two groups at 12 weeks of intervention(z=-2.173,P<0.05).(2)Intra-group comparison: Before intervention,4 weeks and 12 weeks of intervention,there was statistical difference between the control group and the studygroup before and after(P<0.05).6.Barthel index score:(1)Comparison between groups: by non-parametric test,there was no statistical difference between the two groups after 4 weeks of intervention(z=-1.801,P>0.05),and there was statistical difference between the two groups after 12 weeks of intervention(z=-2.001,P<0.05).(2)Intra-group comparison: Before intervention,4 weeks and 12 weeks of intervention,there was statistical difference between the control group and the study group before and after(P<0.05).7.MMSE score:(1)Comparison between groups: by one-way analysis of variance,there was no statistical difference in MMSE score between the two groups before treatment(z=-0.622,P=0.534,P>0.05).At 4 weeks of intervention,there was no statistical difference between the study group and the control group(z=-0.468,P>0.05).At 12 weeks of intervention,the MMSE scores of the two groups were improved,but there was no statistical difference between the two groups(z=-1.347,P>0.05).(2)Intra-group comparison: Before intervention,4 weeks and 12 weeks of intervention,there was statistical difference between the control group and the study group before and after(P<0.05).Conclusion:1.The protocol is based on the best evidence,combined with the clinical practice,the patient's will and preference,and the judgment of professionals,which can provide certain reference for the prevention and management of PSD clinical nursing practice.2.This program can prevent or reduce the occurrence of PSD and improve the daily living ability of patients.3.This study can improve nurses' knowledge of prevention and management of patients' PSD and compliance with evidence-based practice. |
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