| ObjectiveThrough qualitative and quantitative research methods,we understand the current situation and clinical needs of post-stroke fatigue nursing interventions in China,and search major domestic and foreign guide websites and databases,select guides and literature that compliance with inclusion criteria,and extract the best evidence.The first draft of the plan is formed on the basis of current investigation and evidence summary,and the items are adjusted and revised through expert meetings to construct an evidence-based,suitable for local,and implementable non-pharmaceutical nursing plan for post-stroke fatigue.Methods(1)Status survey and demand collection1.Qualitative interviews:(1)Develop an outline for the interview through literature review and group discussions.Purpose sampling method selects nurses in stroke-related departments of7 hospitals in Guangdong Province to conduct semi-structured interviews to understand nurses’ perceptions of post-stroke fatigue,clinical interventions and needs.(2)Develop an outline for the interview through literature review and group discussions.Purpose sampling method selects stroke patients and caregivers from a hospital in Guangzhou to conduct semi-structured interviews to understand the true psychological experience and needs of patients and caregivers for post-stroke fatigue.2.Questionnaire survey:Based on the literature review and qualitative interview results,the questionnaire was compiled based on general information,the clinical status of post-stroke fatigue,the status of nursing intervention,and the necessity of nurses to evaluate intervention measures.Convenience sampling method is used to conduct a questionnaire survey of nurses in stroke-related departments across the country,mainly understand the current status of post-stroke fatigue nursing intervention and nurses’ recognition of intervention measures,and provide clues for constructing intervention plan.(2)Summary of clinical evidenceSearch for guidelines and literature related to post-stroke fatigue intervention and management in major guide websites and databases at home and abroad.Use tools to evaluate the quality of the included guidelines and literature,analyze the content of the final included guidelines and literature,sort and refine according to themes and content to form a summary of evidence,and provide a basis for constructing intervention plan.(3)Form an intervention planOn the basis of qualitative interviews,questionnaire surveys and evidence summary,the first draft of the plan was formed.Establish an expert group and hold expert meetings to discuss the content of the plan.After adjustment and modification,a post-stroke fatigue non-pharmaceutical nursing intervention plan is finally formed.Results(1)Status survey and demand collection1.Qualitative study:Results of qualitative interviews with nurses:(1)The nurses have insufficient awareness of post-stroke fatigue;(2)Fatigue has adverse effects on the patient’s physiology,psychology,etc;(3)Patients and their family members do not seek medical help well;(4)Doctors,nurses,and rehabilitation therapists intervene in fatigue within a limited cognitive range;(5)We must pay attention to post-stroke fatigue and actively play the role of nurses;(6)Improving related systems and management is an urgent need for nurses.Results of qualitative interviews with patients and caregivers:(1)Fatigue has diverse manifestations;(2)Patients and caregivers are deeply troubled by fatigue;(3)Patients and caregivers have insufficient awareness of fatigue;(4)Patients and caregivers try to adopt coping methods;(5)Patients and caregivers receive insufficient medical help;(6)Strengthening fatigue education and psychological counseling are the ardent needs of patients and caregivers.2.Questionnaire survey:(1)The occurrence of post-stroke fatigue: 93.9% of the interviewees encountered patients who did not cooperate with treatment and rehabilitation due to fatigue.(2)Responses of different groups of people to fatigue:71.1% of the family members would not cooperate in treatment and rehabilitation due to the fatigue of the patient,resulting in complaints and harshness,72.0% of the respondents had complaints and misunderstandings about the patient.(3)Nurses’ perception of fatigue: 39.2% of the respondents have heard the definition and concept of fatigue,and only 9.1% have participated in relevant training.(4)Current status of fatigue nursing intervention by nurses themselves and their departments: 71.4% of the interviewees thought that fatigue intervention was needed,and 74.8% of those who intervened by themselves or their colleagues were mainly psychological counseling;the implementation rate of 39 interventions in the department is 13.7% ～76.6%,there are 7 items between 60% and 80%,and 32 items below 60%.The implementation rate from high to low is: diet intervention,continuous stimulation,sleep intervention,etc.(5)Nurses’ evaluation of the necessity of intervention measures: the respondents’ approval rate for 39 measures is 78.1%～96.7%,with 38 items above 80%,and only 1item below 80%.The recognition rate from high to low is: assess psychology,adjustment of exercise intensity and amount,sleep intervention,etc.(6)Analysis of the implementation of department intervention measures and nurses’ evaluation of the necessity of measures: The department’s implementation of various measures is lower than the needs of nurses.In addition to assessing psychological conditions and formulating fatigue management strategies,the implementation of other 37 interventions differs from the needs of nurses statistically significant(P < 0.05).(2)Summary of clinical evidenceA total of 380 articles were retrieved,and 4 were included in the guideline after screening,1 was a consensus,6 were systematic reviews.Excluding the 2 low-quality systematic reviews,the included 9 documents have analyzed 3 aspects and 35 recommendations related to post-stroke fatigue intervention and management,and extracted 18 pieces of evidence,which are classified into four major contents:personnel qualification,evaluation,intervention and follow-up according to the theme.(3)Form an intervention planSummarize 21 experience and practice and 42 needs of different groups of people,plus 18 evidence summaries,organize and form the first draft of the plan.Adjusted and revised with reference to expert opinions,forming 31 items,including non-pharmaceutical nursing intervention plan for post-stroke fatigue in four aspects:system and management construction,evaluation,intervention and follow-up.ConclusionFrom the perspectives of nurses,patients and caregivers,this study has learned through qualitative and quantitative research methods that the current status of post-stroke fatigue nursing intervention in my country is not optimistic.The nurses lack relevant knowledge,and the intervention is mainly psychological counseling,and it is difficult to meet the needs of patients and caregivers.Therefore,it is necessary to formulate a post-stroke fatigue nursing intervention plan for clinical practice.Combine the empirical practices,clinical needs,and recommended measures summarized by the evidence from the current situation investigation,and then subject to expert comment to form an evidence-based,local-suitable,and implementable non-pharmaceutical nursing intervention plan for post-stroke fatigue,Not only can guide nursing clinical work,but also can make up for the current vacancy in this aspect in our country,realizing the process from scratch.In the future,scholars can also improve this plan on the basis of more clinical evidence,enrich and mature this plan. |
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