| PurposesThe purpose of this study is to know the current situation of stage ? cardiac rehabilitation of patients after PCI in tertiary hospitals in China,and the status of nursing attitude and behavior of Cardiology nurses.Based on that,the clinical practice guidelines and systematic review of stage ? cardiac rehabilitation nursing at home and abroad were systematically searched to developed the "Practical project of stage ?Cardiac Rehabilitation Nursing for Patients with Acute Myocardial Infarction after PCI".So we can apply the best evidence to the nursing practice and standardize the cardiac rehabilitation nursing of patients after PCI.Methods1.By convenient sampling method,76 managers of tertiary hospitals from 10 provinces and cities in China were investigated with self-designed questionnaire of stage ? cardiac rehabilitation of patients after PCI in tertiary hospitals.245 nurses in the Department of Cardiology in tertiary hospital of Guangdong Province were selected by convenient sampling method.The self-made questionnaire with good reliability and validity was used to investigate the nurses' nursing attitude and behavior of stage ?cardiac rehabilitation.2.Based on the "JBI evidence-based nursing practice model" in Australia,this paper systematically searches all the evidences of stage ? cardiac rehabilitation nursing after PCI in the database of RANO,NICE,Cochrane Library,PubMed and Medlive.cn from the establishment of the database to October 2019.Two researchers independently selected the literature and evaluated the quality of the preliminary literature using literature evaluation tools.At the same time,combing and synthesizing the recommendations in the literature,determining the items that can be carried out in the pilot ward through the expert meeting method,and combining with the clinical situation to clarify the obstacles and promoting factors of evidence transformation,to build the first draft of "Practical project of stage ? Cardiac Rehabilitation Nursing for Patients with Acute Myocardial Infarction after PCI".The corresponding review indicators and review methods were developed according to the best evidence,and the baseline review before evidence application and two rounds of clinical application of evidence were completed from November 2019 to April 2020.Results1.In the validity analysis,KMO value of structural validity is 0.895,Bartlett's spherical test chi square=3690.062,(P<0.001),three common factors with characteristic value greater than 1 are selected,and the cumulative variance contribution rate is 73.057%.The load values of each factor were in the range of 0.589-0.909.In the reliability test,Cronbach'a coefficient of the questionnaire is 0.940,and the retest reliability is 0.816.2.252 questionnaires were issued,245 of which were valid.The effective recovery rate was 97.22%.Single factor analysis of variance showed that:the influencing factors of attitude score were the title,the establishment and the degree of interest of nurses(P<0.05);the influencing factors of behavior score were the gender of nurses,whether they had participated in training and the degree of interest(P<0.05).Multiple stepwise regression analysis showed that the influencing factors of behavior scores were the sex(?=-0.231,P<0.001),age(?=0.162,P<0.001),working years(?=0.202,P<0.001),position(?=-0.239,P<0.001),CR training(?=-0.182,P<0.001)and interest degree(?=-0.157,P<0.001),correlation analysis showed that:There was a positive correlation between the attitude items "stage I cardiac rehabilitation can shorten the length of stay of patients,reduce medical costs"and "it is safe for eligible patients to carry out early cardiac rehabilitation exercise training".The correlation coefficients R and P of the two groups were:r=0.210,P=0.001;r=0.169,P=0.008,respectively.3.Among the 76 tertiary hospitals surveyed,39 hospitals(51.32%)have carried out cardiac rehabilitation projects,38 hospitals(97.44%)have carried out exercise tests,and the type of exercise test is mainly cardiopulmonary exercise test(92.11%).15 hospitals(42.86%)have built cardiac rehabilitation centers/clinics.28 hospitals have formulated the first stage cardiac rehabilitation nursing plan,6 of which are based on the evidence-based method;The follow-up form of cardiac rehabilitation is mainly"telephone/SMS follow-up(88.24%).The content of cardiac rehabilitation with high implementation rate was "patient evaluation(97.22%),hypertension management(86.11%)and medication guidance(86.11%)";the content of cardiac rehabilitation with low implementation rate was "sexual activity guidance(16.67%),occupational regression guidance(30.56%)and sleep management(58.33%).Whether the hospital has formulated the first stage cardiac rehabilitation nursing plan has statistical difference in 8 items of "blood lipid management,weight management,nutrition consultation,quitting smoking,physical activity consultation,sports training,diabetes management,psychological consultation"(P<0.05)?4.Through literature screening and evaluation,9 guidelines and 6 systematic reviews were included.The quality evaluation results of AGREE II guidelines showed that the quality of 5 guidelines were A-level,4 were B-level,and the overall quality of the guidelines was good.The two areas with higher standardized scores were "scope and purpose(95.57±6.65)%and" clarity(93.83±7.05)%respectively ".Three systematic reviews from Cochrane library were evaluated as high quality,and the other three were evaluated as low quality.After combing and synthesizing the literature,the evidence-based group selected 39 recommendations within the scope of nurse's responsibilities,mainly covering three aspects of cardiac rehabilitation organization strategy,nurse training and practice.5.After demonstrating the attribute of FAME of the recommendations,15 pieces of best evidence were finally included into the clinical practice reform.The investigation of clinical applicability showed that the evidence introduced had high appropriateness,feasibility,meaningfulness and effectiveness.Experts believed that the main obstacles to practical change included the lack of relevant training of medical staff,the lack of relevant assessment or record sheet in departments,and the low compliance of patients to participate in heart rehabilitation.6.The relevant action strategies were formulated for the practical barriers.After two rounds of evidence review,the research site developed the relevant assessment sheet or record sheet,and improved the stage I rehabilitation nursing process.The compliance rate of nurses to 14 review indicators was significantly improved,among which the compliance rate of four review indicators was greatly improved,and the compliance rate of other review indicators was 100%.After evidence application,the self-management ability of patients after PCI was significantly improved.Conclusion1.The tertiary hospitals in our country have gradually carried out cardiac rehabilitation,but the current situation of stage I cardiac rehabilitation for patients after PCI is still not very good,which needs to be further improved in implementation content,personnel training,construction of cardiac rehabilitation center and follow-up outside the hospital.2.The stage I cardiac rehabilitation nursing of nurses with different characteristics is at different attitude and behavior levels,which indicates that it is imperative to formulate the relevant training and evaluation mechanism and standardized nursing program.3.After strict literature search and quality evaluation,there is no evidence-based nursing standard for the first stage rehabilitation of nurses after PCI in China.The evidence-based practice plan based on the best evidence and clinical situation has high clinical practical value,which effectively improves the nurses' first stage nursing attitude and behavior,and improves the clinical practice environment. |
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