| Objectives:This study is based on the concept of bundles care and evidence-based nursing minds.From the perspective of prevention,by consulting a large number of literature,the purpose is to understand the current situation and related factors of VTE in intensive care patients,and to extract evidence-based issues.The intent is to complete the summary of items through literature search and quality analysis of those documents and perfect the final entry through Delphi expert consultation method.The ultimate goal is to establish a comprehensive strategy of Bundles care for the ICU patients to prevent thrombosis in combination with clinical reality,and strive to provide a scientific and reliable reference for ICU nursing practice.Methods:1.Evidence synthesis:comprehensively reviewing the literature by evidence-based nursing theory,analyzing the high-risk factors of VTE for patients in intensive care units,evidence-based issues were established.Retrieving the literature containing the relevant interventions,initial items of evidence were obtained through further screening analysis and quality assessment of those documents.Level of evidence and corresponding recommendations were given.2.Delphi expert consultation:a total of 2 rounds of expert consultations were conducted by selecting 18 experts in related academic area.The final items were developed based on a summary of expert ratings and opinions.Analyzing those items,weights and combination weights were determined of each level.3.Construction of nursing plan:combined with bundled nursing theory to complete the construction of comprehensive nursing plan.Results:1.Among 1518 literature,strictly following the criteria for document exclusion and inclusion,applying appropriate evaluation tools to complete quality screening and evaluation of those literature,36 literature which met the requirements were finally included.An entry pool of 4 first-level entries,14 second-level entries,and 45 third-level entries was initially formulated,and the evidence levels and recommendations for the entries were formed.2.A total of 2 rounds of expert consultations were conducted.20 copies of the first round of questionnaires were issued,18 of which were effectively recovered,and the questionnaire recovery rate was 90%.Among them,1 1 experts from 18 experts made a total of 43 suggestions,and the proposed ratio was 61.11%.18 copies of the second round of questionnaires were issued,18 of which were effectively recovered,and the questionnaire recovery rate were 100%.Among 18 experts there were 5 experts who put forward a total of 6 suggestions,the proposed ratio was 27.78%.In the first round of consultation,Ca was 0.956,Cs was 0.867,and Cr was 0.912.In the second round,Ca was 0.939,Cs was 0.878,and Cr was 0.909.The coefficient of variation of each item in the first round of the questionnaire were 0%?37.76%,which were 0%?28.94%in the second round.Kendall's coefficient of concordance(W)is 0.124 in the first round and 0.129 in the second round.The significance test of two rounds of letter inquiry showed that there was significant difference between the two rounds of letter inquiry(P<0.001).The finalized care plan included 4 first-level items,14 second-level items,and 40 third-level items The First-level item's weights,second and third-level item's weights and combined weights were given.3.A nursing plan was established that include four nursing bundles of special quality control management,risk assessment,hierarchical prevention,and health education.Conclusions:This study was based on the evidence synthesis completed by evidence-based nursing thinking and improved by Delphi expert consultation method.The final VTE clustered comprehensive nursing program for ICU patients is scientific and reliable.This program can provide scientific theoretical support and practical reference for the prevention of VTE in ICU patients. |
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